Can it really predict prior to delivery? A new ultrasonographic method for prediction of short and long umbilical cords in full-term pregnancy

Objective: This study aimed to ultrasonographically determine the presence of short and long umbilical cords in full-term, uncomplicated pregnancies before delivery.Methods: A total of 681 pregnant women aged between 18 and 35 years who had a single pregnancy and an intact amniotic membrane, and who were past the 37th week of gestation, were included. Umbilical cord lengths were ultrasonographically evaluated using a new method, and were compared with postnatal umbilical cord length.Results: The mean index values for short, normal, and long umbilical cords were 2.96, 5.36, and 6.98, respectively. The cut-off index value for a short umbilical cord was 3.75 and the sensitivity and specificity were calculated as 67 and 97%, respectively, for a value ≤3, and as 92 and 80%, respectively, for a value ≤4. The cut-off index value was 6.25 for a long umbilical cord and the sensitivity and specificity were calculated as 75 and 78%, respectively, for a value ≥6, and as 85 and 64%, respectively, for a value ≥6.5.Conclusions: Calculation of the umbilical cord length index is a new ultrasonographic method that can be easily used to predict short and long umbilical cords during routine amniotic fluid evaluation in full-term pregnancies.

Rare cause of bilateral groin swelling: Round ligament varicosities

Round ligament varicosity (RLV) is rare and almost all cases are pregnant women. RLV appears as a unilateral or bilateral groin swelling. Pain and tenderness may present. Clinical evaluation is inadequate for exact diagnosis because inguinal hernia has similar findings. Ultrasonography (US) is essential when a groin swelling is detected in a pregnant woman. We present gray scale US and colour Doppler US findings of a 32-week pregnant woman with bilateral RLVs at the inguinal canal, parauterine area and in the myometrium.

The effect of different suture materials on the safety of colon anastomosis in an experimental peritonitis model

BACKGROUND

The aim of this experimental study was to compare the safety of different suture materials in a left colonic anastomosis in the presence of peritonitis.

MATERIALS AND METHODS

Twenty-one male Wistar albino rats were randomly divided into three groups. First, left colonic injuries were created in all groups for the peritonitis model. After 24 hours, coated polyglactin 910 and silk suture were used in Group I rats, polydioxanone and silk suture were used in Group II rats, and coated polyglactin 910 plus antibacterial suture and silk suture were used in Group III rats during colonic anastomosis. Tissue hydroxyproline, anastomotic bursting pressure, and histopathologic findings on the anastomosis line were evaluated on the 10th postoperative day by performing a relaparatomy.

RESULTS

The mean bursting pressure values were 198 ± 11.37, 220 ± 17.7, and 244 ± 9.52 in Groups I, II, and III, respectively (Group I vs. II, p < 0.035; I vs III, p < 0.002; and II vs III, p < 0.021). The mean hydroxyproline levels were 1.21 ± 0.58, 1.47 ± 0.44, and 2.11 ± 0.32 in Groups I, II, and III, respectively (Group I vs II, p < 0.338; I vs III, p < 0.011; and II vs III, p < 0.025). When histopathologic findings of the groups were compared, the healing score of the intestinal tissue was higher in Group III than in Group I (p < 0.015), whereas there were no statistically significant differences among Groups I vs II and II vs III (p < 0.081 and p < 0.095, respectively).

CONCLUSION

Antibacterial suture usage increased anastomosis safety in the presence of peritonitis in resection and primary anastomosis.

Isolated cavernous hemangioma: a rare benign lesion of the stomach

Gastric cavernous hemangioma is a relatively rare benign gastric disease. Here we report the case of a 25-year-old male patient who had been admitted complaining of epigastric pain and hematemesis. Preoperative imaging indicated that the mass lesion palpated in the epigastric region was a probable mesenchymal tumor of gastric origin. Due to the hypervascular nature and submucosal localization of the mass, we did not obtain definitive preoperative diagnosis by endoscopic biopsy. The histologic diagnosis of cavernous hemangioma was confirmed by post-resection histopathologial evaluation of the mass.

Pneumatosis cystoides intestinalis: A single center experience

AIM: To share our experience of the management and outcomes of patients with pneumatosis cystoides intestinalis (PCI).

METHODS: The charts of seven patients who underwent surgery for PCI between 2001 and 2009 were reviewed retrospectively. Clinical features, diagnoses and surgical interventions of patients with PCI are discussed.

RESULTS: Seven patients with PCI (3 males, 4 females; mean age, 50 ± 16.1 years; range, 29-74 years) were analyzed. In three of the patients, abdominal pain was the only complaint, whereas additional vomiting and/or constipation occurred in four. Leukocytosis was detected in four patients, whereas it was within normal limits in three. Subdiaphragmatic free air was observed radiologically in four patients but not in three. Six of the patients underwent an applied laparotomy, whereas one underwent an applied explorative laparoscopy. PCI localized to the small intestine only was detected in four patients, whereas it was localized to the small intestine and the colon in three. Three patients underwent a partial small intestine resection and four did not after PCI was diagnosed. Five patients were diagnosed with secondary PCI and two with primary PCI when the surgical findings and medical history were assessed together. Gastric atony developed in one case only, as a complication during a postoperative follow-up of 5-14 d.

CONCLUSION: Although rare, PCI should be considered in the differential diagnosis of acute abdomen. Diagnostic laparoscopy and preoperative radiological tests, including computed tomography, play an important role in confirming the diagnosis.

The effect of preoperative nutritional supports on patients with gastrointestinal cancer: prospective randomized study

BACKGROUND/AIMS

Malnutrition adversely affects the postoperative outcome of patients with gastrointestinal cancer. Therefore, the malnourished cancer patients are supported by enteral or parenteral nutrition. In this study, we aimed to investigate the effects of preoperative nutritional supports on total antioxidant capacity (TAC) in malnourished patients with gastrointestinal (GI) cancers.

METHODOLOGY

Seventy-five malnourished patients with GI cancers and 25 patients with non-cancer surgical problems were included in the study. The dietary of cancer patients were supported with immune-enhancing enteral solution in group II or standard enteral solution in group III and with parenteral solution in group IV. Plasma TAC levels were measured prior and after nutritional support. Data were expressed as mmol Trolox eq./L.

RESULTS

The mean TAC levels of groups before treatment were 1.10±0.17, 0.92±0.19, 0.89±0.17 and 0.92±0.18, respectively. It was significantly higher in group I than others. The mean TAC levels of supported groups after treatment were 1.11±0.20, 1.08±0.21 and 1.09±0.27, respectively. Although there was a statistically significant increase in TAC after treatment in group II and III, it was not statistically significant in group IV.

CONCLUSIONS

It was concluded that preoperative nutritional support with standard or immune-enhancing enteral solutions significantly increased TAC levels of malnourished patients with GI cancers.

Benign fibrous histiocytoma arising from the right shoulder: Is immunohistochemical staining always required for a definitive diagnosis?

INTRODUCTION

Fibrous histiocytomas are divided into two subgroups: malignant and benign fibrous histiocytomas (BFHs). BFH is one of the most common tumors of the superficial and deep soft tissues; it is commonly found on the skin and presents as a slow-growing solitary nodule made up of a mixture of fibroblastic and histiocytic cells.

PRESENTATION OF CASE

In this study, we present the case of a 45-year-old female who was histopathologically diagnosed with dermatofibrosarcoma protuberans (DFSP) and received radiotherapy, but whose diagnosis was changed to BFH based on subsequent immunohistochemical analyses.

DISCUSSION

BFH is a mesenchymal soft-tissue tumor with fibroblastic and histiocytic differentiation. Differential diagnosis for BFH found in deeper tissues includes other aggressive fibrohistiocytic lesions, such as DFSP and malignant fibrous histiocytoma. Differentiating among these tumors is crucial in selecting the correct surgical strategy and patient management in the postoperative period. In most cases, the pleomorphism and atypical mitotic activity seen histopathologically are sufficient for the differentiation between benign and malignant tumors. Immunohistochemical staining methods should be used in cases that are difficult to diagnose. The treatment of choice for BFH is wide resection of the tumor, which results in an excellent prognosis and low recurrence rate. In agreement with cases reported in the literature, our case confirms that wide excision is adequate to prevent the recurrence of the tumor.

CONCLUSION

Although benign fibrous histiocytomas is rare, it must be considered in the differential diagnosis of tumors arising from the soft-tissue.

Benign fibrous histiocytoma arising from the intercostal space

Benign fibrous histiocytoma is a tumor of unknown etiology that is believed to be of mixed fibroblastic and histiocytic origin. Deep benign fibrous histiocytomas are most commonly found in the lower limbs or the head and neck region; it is relatively rare that they are seen in the intercostal space. Only six case reports of this entity are described in the literature. We report a 20-year-old woman who suffered from a painless swelling in the left chest wall, with a computed tomographic correlation. The lesion was totally excised, and histopathology revealed a benign fibrous histiocytoma. This is the first case of a benign fibrous histiocytoma that arose from the intercostal space reported in the English-language literature. The six cases reported in the medical literature are also discussed.

Is methotrexate an acceptable treatment in the management of idiopathic granulomatous mastitis?

PURPOSE

The treatment of choice for idiopathic granulomatous mastitis (IGM) has not yet been established. There are limited data on the use of methotrexate (MTX) in the treatment of IGM. Herein, we investigated the role of MTX in the treatment of IGM patients.

METHODS

We present four new cases of IGM treated with MTX and a review of the English language literature concerning the use of MTX in the treatment of IGM.

RESULTS

We prospectively investigated the clinicopathological features of four female patients (aged 28-37 years) who were multiparous and had used oral contraceptives. The patients were administered 7.5-15 mg MTX over 2-6 months. No recurrence was detected during the follow-up period of 4-8 months. In five published studies on MTX use in IGM, data were available for 12 patients aged 21-40 years. In nine patients, treatment was changed to MTX because of a lack of response to steroids, recurrence or steroid-induced diabetes mellitus. Steroids were used in combination with MTX as an initial treatment choice in three patients. Satisfactory results were achieved in ten patients treated with MTX, and only two demonstrated recurrence despite the treatment and underwent mastectomy.

CONCLUSION

MTX in the present cases of IGM was effective, prevented complications and limited corticosteroid side effects.

Gossypibomas mimicking a splenic hydatid cyst and ileal tumor : a case report and literature review

BACKGROUND

Gossypiboma is a term used to describe a retained surgical swab in the body after a surgical procedure. Gossypiboma is a rare surgical complication, but can cause significant morbidity and mortality. It may be a diagnostic dilemma with associated medico-legal implications, and is usually discovered during the first few days after surgery; however, it may remain undetected for many years.

METHODS

We present a gossypiboma case immigrating to small intestine, as well as a literature review of studies published in the English language on intraluminal migration of gossypiboma, accessed through PubMed and Google Scholar databases.

RESULTS

Case of a 51-year-old man who was admitted due to vomiting, abdominal distension, and pain. He had a history of abdominal trauma 8 years previously, and surgery had been performed at another hospital. The physical examination revealed muscular guarding and rebound tenderness in the right lower quadrant. A splenic hydatid cyst and ileal calcified mass were suspected based on results of abdominal computed tomography. Therefore, a laparotomy was performed. Segmental ileal resection, end-to-end anastomosis, and splenectomy were performed. The final diagnosis was gossypiboma in both the spleen and ileum. We performed a systemic review of the English-language literature between 2000 and 2010 in PubMed and Google Scholar, and we found 45 cases of transmural migration of surgical sponges following abdominal surgery. Three cases in which the gossypiboma was located in the spleen are also discussed.

CONCLUSION

Gossypiboma should be considered as a differential diagnosis of any postoperative patient who presents with pain, infection, or a palpable mass.

Tubercular tubo-ovarian cystic mass mimicking acute appendicitis: a case report

INTRODUCTION

Female genital tuberculosis is a rare form of extrapulmonary tuberculosis. It is an asymptomatic disease usually diagnosed during the search for causes of infertility. However, it can present with a number of abdominopelvic symptoms. Herein we report a case of tubo-ovarian tuberculosis mimicking acute appendicitis.

CASE PRESENTATION

A 17-year-old single Turkish woman presented to our hospital with complaints of right lower quadrant abdominal pain, nausea, and vomiting. Her physical examination findings, ultrasonogram, and leukocyte count were consistent with acute appendicitis. A cystic mass (15 cm × 6 cm) was detected on the right tubo-ovarian structure by laparotomy. The mass was excised while the tubo-ovarian structures were preserved and the need for an appendectomy was avoided. No microbiological evaluation was performed. The histopathological examination of the cystic mass revealed a granuloma with central caseating necrosis surrounded by epithelioid histiocytes. The patient was treated with anti-tuberculosis therapy for six months. No recurrence was observed during a 10-month follow-up period.

CONCLUSION

Genital tuberculosis should be considered in the differential diagnosis of right lower quadrant pain in women who live in tuberculosis-endemic regions.

Mucoepidermoid carcinoma in a breast affected by burn scars: comprehensive literature review and case report

BACKGROUND

Mucoepidermoid carcinoma (MEC), which is primarily found in the salivary glands, is rarely seen in the breast. These tumors usually develop from squamous and mucus-secreting cells. Histological grading is an important prognostic factor.

CASE REPORT

We present herein a case of a 69-year-old female patient with a painful mass in the left breast. Of importance is that, in addition to MEC, the patient had a wide area of scar tissue secondary to a burn that completely occupied the left bottom quadrant of the abdomen and retracted the left nipple up to the left upper quadrant. Fine needle aspiration biopsy was negative, and a lumpectomy was performed. Because the pathology results were consistent with MEC, modified radical mastectomy with subsequent adjuvant chemotherapy and radiotherapy was performed. The patient remained disease-free for 12 months after the treatment. In addition to a discussion of this case, we performed a review of the clinicopathological characteristics of 30 cases with breast MEC reported in the English language literature between 1979 and 2010.

CONCLUSIONS

MEC of the breast is a rarely seen tumor, and this is the first report of MEC in a breast affected by burn scars.

Ectopic bone formation and extramedullary hematopoiesis in the thyroid gland: report of a case and literature review

This purpose of this article is to document ectopic bone formation (EBF) and extramedullary hematopoiesis (EMH) in thyroidectomy specimens. We present a case of multinodular goiter with EMH and EBF, as well as a literature review of studies published in the English language on EMH and/or bone formation in the thyroid gland, accessed through PubMed and Google Scholar databases. Thirteen published cases of EMH and/or EBF in the thyroid gland were evaluated, and a case of multinodular goiter with histopathologically proven EMH and EBF in a 54-year-old woman is herein presented. In the reviewed literature, 12 patients were women, and 1 was a man (age range, 28-82 years; median, 56.46 +/- 18 years). EMH was histopathologically detected in 8 patients, EMH and EBF were detected in 4 patients, and only bone formation was detected in 1 patient. Although a solitary nodule was detected in 7 patients, multinodular goiter was detected in 6 patients. Fine needle aspiration cytology was used in the preoperative period to arrive at a diagnosis in 6 of the 13 patients, but it was not possible to obtain proper biopsy material in the remaining patients. Although no previously known hematologic disease was detected in 11 patients, 2 were known to have myelofibrosis in the preoperative period. When EMH is pathologically detected in the thyroid, the question of whether there is an underlying hematologic disease in the patient must be investigated. In addition, it must be kept in mind during fine needle aspiration cytology and frozen section examinations that EMH maybe among the differential diagnoses for anaplastic thyroid cancers.

Unusual histopathological findings in appendectomy specimens: A retrospective analysis and literature review

AIM: To document unusual findings in appendectomy specimens.

METHODS: The clinicopathological data of 5262 patients who underwent appendectomies for presumed acute appendicitis from January 2006 to October 2010 were reviewed retrospectively. Appendectomies performed as incidental procedures during some other operation were excluded. We focused on 54 patients who had unusual findings in their appendectomy specimens. We conducted a literature review via the PubMed and Google Scholar databases of English language studies published between 2000 and 2010 on unusual findings in appendectomy specimens.

RESULTS: Unusual findings were determined in 54 (1%) cases by histopathology. Thirty were male and 24 were female with ages ranging from 15 to 84 years (median, 32.2 ± 15.1 years). Final pathology revealed 37 cases of enterobiasis, five cases of carcinoids, four mucinous cystadenomas, two eosinophilic infiltrations, two mucoceles, two tuberculosis, one goblet-cell carcinoid, and one neurogenic hyperplasia. While 52 patients underwent a standard appendectomy, two patients who were diagnosed with tuberculous appendicitis underwent a right hemicolectomy. All tumors were located at the distal part of the appendix with a mean diameter of 6.8 mm (range, 4-10 mm). All patients with tumors were alive and disease-free during a mean follow-up of 17.8 mo. A review of 1366 cases reported in the English literature is also discussed.

CONCLUSION: Although unusual pathological findings are seldom seen during an appendectomy, all appendectomy specimens should be sent for routine histopathological examination.

Prognostic value of preoperative CEA and CA 19-9 levels in patients with colorectal cancer

AIMS

This study evaluated the prognostic value of the preoperative CEA and CA 19-9 levels on the survival time and TNM staging in patients with colorectal cancer.

METHODOLOGY

We retrospectively analyzed 172 patients who underwent potentially curative resection of colorectal cancer (TNM I-III) between 2002 and 2007. Clinical data were obtained from medical charts, including age, gender, tumor location, TNM stage, mortality, follow-up duration, and preoperative CEA and CA 19-9 levels. A CEA > or = 5ng/mL was defined as abnormal (CEA+), while the cutoff for the CA19-9 was set at 37U/mL (CA19-9+). Patients were categorized into Groups I-IV according to the preoperative serum CEA and CA 19-9 levels [CEA/ CA 19-9: (-/-), (+/-), (-/+), and (+/+)].

RESULTS

Follow-up was longest for Group I (p<0.001). Mortality rates were higher in Groups V (p<0.001) and II (p<0.008). On comparing patients according to CEA levels, survival was longer in the CEA-negative group (p=0.0001). On comparison according to CA 19-9 levels, survival was greater in the CA 19-9-negative group (p=0.0001). While CEA (p<0.016) and CA 19-9 (p<0.001) were independent prognostic factors according to the logistic regression analysis, TNM (p=0.002), CEA (p<0.001), and CA 19-9 (p<0.001) were prognostic factors in the ROC curve analysis.

CONCLUSIONS

Colorectal cancer patients with elevated levels of both CEA and CA 19-9 have a significantly poorer prognosis than those with normal levels of these tumor markers.

Phytocontact dermatitis due to Ranunculus arvensis mimicking burn injury: report of three cases and literature review

Ranunculus arvensis (corn buttercup) is a plant species of the genus Ranunculus that is frequently used in the Far East to treat rheumatic diseases and several dermatological disorders. In Turkey, the plant is seen in the eastern and southeastern Anatolian highlands, which are underdeveloped areas of the country. Herein, we report three patients who used Ranunculus arvensis for the treatment of arthralgia and osteoarthritis. A distinctive phytodermatitis developed on the right thumb in one patient (48-year-old male), on the anterior aspect of both knees in another patient (70-year-old female) and all around both knees in a third (59-year-old female). The patients were treated with topical antibiotics and daily wound dressing, and none of them experienced any complications. Ranunculus arvensis was confirmed as the cause of the phytodermatitis in the three cases. Poultices of plants applied to the skin demonstrate beneficial effects on many dermatological and rheumatic diseases; however, they have several adverse effects that should not be ignored. In this study, we also present a review of 25 cases reported in the literature.

The effect of antivascular endothelial growth factor on the development of adhesion formation in laparotomized rats: experimental study

Aims. This study determined the effects of a single dose of bevacizumab, an antiangiogenic recombinant monoclonal antibody that specifically targets vascular endothelial growth factor (VEGF), on adhesion formation in the rat cecal abrasion model. Methodology. Thirty female Wistar albino rats (200-224 g) were divided into three groups. All rats underwent laparotomy at which time cecal wall abrasion and abdominal wall injuries were induced. Group I (control) underwent only the abrasion procedure; Groups II and III received saline or bevacizumab intraperitoneally, respectively, following the abrasion. The rats were killed on postoperative day 7, and the severity of adhesions was evaluated, together with histopathological fibrosis parameters and immunohistochemical staining to identify the VEGF receptor. Results. The mean adhesion severity score in Groups I-III was 2.5 ± 0.52, 2.4 ± 0.69, and 0.7 ± 0.82, respectively; the score in Group III was significantly lower than that in Groups I (P < 0.001) and II (P < 0.001). In the histopathological evaluation, the mean fibrosis score in Group III was significantly lower that the scores in Groups I (P < 0.001) and II (P < 0.001). VEGF staining of the adhesion areas in Group III was significantly lower than that in Groups I (P < 0.001) and II (P < 0.001). Conclusion. Bevacizumab decreases adhesion formation following laparotomy in rats by blocking VEGF receptor occupancy.

Can the classical euchromatic variants of 9q12/qh+ cause recurrent abortions?

Various heteromorphisms of the 9q heterochromatic area have been reported, and the 9q12/qh variant has been postulated to be more prevalent than initially perceived. Of note is that all probands are clinically normal. This paper documents two cases with a G-band within the 9q12h region and recurrent miscarriages. Patient 1 is a 22-year-old woman with a history of 2 miscarriages. Patient 2 is a 19-year-old woman with a history of 3 miscarriages. Chromosome analysis of the patients showed 46,XX,9q12h+. Thus, the existence of a G+ band in 9qh may not be a normal variant in humans. We suggest IVF and preimplantation genetic diagnosis in such patients.