Objective: We aimed to present inferior vena cava (IVC) diameter as a guiding method for detection of relationship between IVC diameter measured noninvasively with the help of ultrasonography (USG) and central venous pressure (CVP) and evaluation of patient's intravascular volume status. Methods: Patients over the age of 18, to whom a central venous catheter was inserted to their subclavian vein or internal jugular vein were included in our study. IVC diameter measurements were recorded in millimeters following measurement by the same clinician with the help of USG both at the end-inspiratory and end-expiratory phase. CVP measurements were viewed on the monitor by means of piezoelectric transducer and recorded in mmHg. SPSS 18.0 package program was used for statistical analysis of data. Results: Forty five patients were included in the study. The patients had the diagnosis of malignancy (35.6%), sepsis (13.3%), pneumonia, asthma, chronic obstructive pulmonary disease (11.1%). 11 patients (24.4%) required mechanical ventilation while 34 (75.6%) patients had spontaneous respiration. In patients with spontaneous respiration, a significant relationship was found between IVC diameters measured by ultrasonography at the end of expiratory and inspiratory phases and measured CVP values at the same phases (for expiratory p = 0.002, for inspiratory p= 0.001). There was no statistically significant association between IVC diameters measured by ultrasonography at the end of expiration and inspiration and measured CVP values at the same phases in mechanically ventilated patients. Conclusions: IVC diameter measured by bedside ultrasonography can be used for determination of the intravascular volume status of the patients with spontaneous respiration.

Introduction:Diabetic foot is a clinical disorder, which is commonly seen in patients with diabetes mellitus. It is also the major cause of below knee amputation in the world. There are many underlying causes such as neuropathic, ischemic, and infectious causes for diabetic foot. Local or systemic complications may develop after snake bite.Case Presentation:We reported a very rare case, involving a 78-year-old male admitted to the Emergency Department, who developed anaphylactic shock and diabetic foot after the snake bite.Conclusions:Reviewing the literature, this is the second reported case of snake bite associated with diabetic foot.

Snakebites are seen in summer season in the southern part of Turkey, including Hatay province. In average of 40 patients with snakebites are admitted to our hospital every year. Viper is the most common venomous snakes in our region. Their hemotoxins and necrotoxins lead to local or systemic tissue damage and is responsible for the mortality and morbidity. In this report, we described a rare pediatric case, a six-year-old boy having been bitten on the left side of his face when he was looking around from their home's balcony. The patient was orotracheally intubated and mechanically ventilated because of airway obstruction due to severe edema. 12 flacon of anti-snake venom, mannitol infusion, fresh frozen plasma, erythrocytes suspension and antibiotherapy were administered to the patient. Seven days after the admission, clinical and laboratory findings were improved and the patient was discharged in a good condition. Snakebites inflicted on face and neck areas may cause rapidly progressive edema in respiratory tract and lead to life-threatening conditions. Therefore early orotracheal intubation is very important to prevent mortality.

Fig. 2 Fluoroscopic images showing a loop of the colonoscope within the left inguinal hernia.

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