Georgios Paraskevas

Signs and symptoms of temporomandibular joint disorders related to the degree of mouth opening and hearing loss.

BackgroundThe temporomandibular joint is a unique bi-condylar joint involved in mastication and speech. Temporomandibular joint disorders (TMD) have a range of symptoms, including aural symptoms, and are present in approximately 75% of normal populations. The present study examined the relationship between signs and symptoms of TMD and mouth opening, gender, joint and aural symptoms, and hearing loss.MethodsThe study involved 464 healthy Greek university students (156 men and 308 women) with a mean age of 19.6 years. Age, gender and maximum mouth opening was recorded. Mouth opening was measured using Vernier calipers. An anamnestic questionnaire was used to stratify the subjects into four groups based on TMD severity. Aural symptoms and an audiogram were recorded for each subject too. Data were analyzed using multifactor ANOVA, chi-square, t-test, Mann-Whitney and Kruskal-Wallis tests.ResultsThe overall incidence of TMD signs and symptoms was 73.3%. The incidence and severity was greater in females than males (p-value 0.0001 < 0.05). The number of aural symptoms was associated to the TMD severity (p-value 0.0001 < 0.05) as well as maximum mouth opening (p-value 0.004 < 0.05). Audiometry showed that moderate and severe TMD was associated with hearing loss of median and low tones respectively (p-value 0.0001 < 0.05). TMJ pain (p-value 0.0001 < 0.05), TMJ ankylosis (p-value 0.0001 < 0.05), bruxism (p-value 0.0001 < 0.05) and ear itching (p-value 0.0001 < 0.05) were also found to be statistically different between TMD and non-TMD subjects.ConclusionsTMD signs and symptoms were more common and severe in females than males. TMD severity is correlated with the degree of mouth opening and the number of aural symptoms. The absence or presence of mild TMD are associated with normal audiograms while moderate and severe TMD are related to hearing loss in median and low tones respectively. Bruxism, joint ankylosis, joint pain and ear itching were more common in TMD than non-TMD patients.

Left common carotid artery arising from the brachiocephalic trunk: a case report

An abnormal origin of the left common carotid artery from the initial portion of the brachiocephalic trunk was found in the superior mediastinum in a 81-year-old Caucasian male cadaver during dissection practice. We report on the exact morphology of that variant that is appeared in an incidence of 0,2% in the literature. We discuss the relative literature and pay attention on the significance of such a variation for clinicians in its recognition and protection.

Lumbosacral transitional vertebra causing Bertolotti’s syndrome: a case report and review of the literature

IntroductionLumbosacral transitional vertebra is an anatomical variation of the fifth lumbar vertebra in which an enlarged transverse process can form a joint or fusion with the sacrum or ilium. The association of that variant with low back pain and the change in the biomechanical properties of the lumbar spine is called Bertolottis syndrome.Case presentationWe report a case of a 40-year-old male patient with chronic low back pain extending to the left buttock, just above the ipsilateral sacroiliac joint. Radiographic investigation revealed an anomalous enlargement of the left transverse process of the fifth lumbar vertebra forming a pseudarthrosis with the infrajacent ala of the sacrum.ConclusionIn young patients with back pain the possibility of Bertolottis syndrome should always be taken in account.

A case of eosinophilic granuloma of the skull in an adult man: a case report

Eosinophilic granuloma is very rare benign bone tumor which presents in more than 90% in children under the age of ten. There is predominance for males. It is usually found at flat and long bones. The skull and vertebral spine is often affected. We report a case of 57 year-old man who gradually developed local pain at his skull and orbit. A soft, movable, palpable and tender mass was found at the left temporal bone. The pain deteriorated after an accidental injury at skull and remained so. The clinical examination revealed no pathological findings. The patient was a doctor who smoked and consumed alcohol daily. He had a history of cardial infraction and psoriatic arthritis. X-rays and CT revealed a round lytic defect at the skull. Its borders were sharp and its size was 1.6 × 1.8 cm. No periostic reaction or bone formation was noted. Scintigraphy depicted a lytic lesion without radionuclide enhancement. Thus we suspected an eosinophilic granuloma. An attempt to excise the tumor failed as it had already eroded the underlying temporal bone. The external meninga was affected but not the internal one. Histological diagnosis with dominance of Langerhans cells set the diagnosis. A second surgery was done and the eosinophilic granuloma was extracted. After eight months the gap was bridged with plastic heterologous transplant. After the curettage the patient received antibiotics and five cycles of radiotherapy. The aesthetic result was excellent. The patients head has a normal hairy appearance. No tenderness, swelling or recurrence is recorded until now.Eosinophilic granuloma is of unknown aetiology but uncontrolled proliferation of Langerhans cells, previous inflammations or tumors and autoimmune disorders are suspected. Due to the co-existence of psoriatic arthritis and eosinophilic granuloma to our patient we assume that an autoimmune mechanism is probable.

Appendiceal Mucocele. A retrospective Analysis of 19 Cases

BackgroundAppendiceal mucocele is an infrequent well-recognized entity that can present in a variety of clinical syndromes or can be asymptomatic and discovered incidentally.Patients and MethodsNineteen patients with a diagnosis of primary appendiceal mucocele treated in our institution between January 1, 1987 and December 31, 2006 were included in this retrospective analysis.ResultsThe histological examination of the specimens revealed simple and hyperplastic appendiceal mucocele in nine cases (47%), mucinous appendiceal cystadenoma in eight cases (42%), and mucinous appendiceal cystadenocarcinoma in two cases (11%). Thirteen patients (68%) underwent appendectomy, five patients (26%) right colectomy, and two patients (6%) underwent right colectomy for invasive appendiceal cystadenocarcinoma and at the same time right nephrectomy and sigmoidectomy, respectively, for concomitant malignancy.ConclusionMucocele of the appendix may be related to a benign or malignant appendiceal process, leading to individualized diagnosis and treatment.

The accessory deep peroneal nerve: A review of the literature

The accessory deep peroneal nerve (ADPN) is a common variant branch of the superficial peroneal nerve. It unrarely participates in the innervation of the extensor digitorum brevis muscle and interferes with the differential diagnosis of peroneal nerve lesions. Several electrophysiological and anatomical studies have been conducted in order to document the topography, characteristics and prevalence of ADPN, presenting significantly different results. ADPN existence is of great clinical and surgical importance, thus the aim of this study is to select and present all the relevant data available in the literature.

Morphological parameters of the superior articular facets of the atlas and potential clinical significance

BackgroundAlthough remarkable investigations exist in regard to the morphology of the superior articular facets of the atlas in the literature, only a few data exist concerning the correlation of these facets with the age of the specimens.MethodsThe superior articular facets of the atlas were studied in 86 dried vertebrae. Several non-metric parameters were recorded, like presence of notches, grooves, complete or partial dissociation, rough surfaces as well as their morphology.ResultsNo notch was found in 37.2% of the superior articular facets. The incidence of notch is decreased as the age progresses. No transverse groove was found in 24.4% and the presence is increased with the age. The incidence of complete and partial dissociations was also found to be age-related. The incidence of rough surfaces, which corresponds to the site of maximum weight bear, was found to be increased in the old age. We classified the shape of the facets into the following types: oval-shaped, kidney-shaped, S-like, triangle, circular and two portioned.ConclusionsWe assume that the increase of incidence of the dissociation, the rough surfaces, the grooves and the decrease of notches could be possibly the result of a restriction of the atlanto-occipital motion in the old age.

Kaplan anastomosis of the ulnar nerve: a case report

IntroductionThe sensory innervation of the hand is usually unvarying and anomalies in this area are uncommon.Case presentationWe report the case of a rare ulnar nerve branch called a Kaplan anastomosis, which anastomosed the dorsal cutaneous branch with the ulnar nerve prior to its bifurcation into the superficial and deep ramus.ConclusionMany authors have reported unusual ulnar nerve branches and knowledge of these anatomical variations is important for the interpretation of pain and sensory loss in the area sustained during injuries or surgical procedures. Our finding is the fourth case of a Kaplan anastomosis to be described in the literature.

Abnormal origin of internal thoracic artery from the thyrocervical trunk: surgical considerations

An unusual case of left internal thoracic artery (ITA) origin from the thyrocervical trunk (TCT) was detected during routine cadaver dissection. The variability of origin and course of ITA has less or more frequently been documented in the literature. However, the ITA origin from the TCT on the left side has been detected less commonly, making its dissection and preparation during coronary artery bypass grafting surgery more difficult. We discuss the ITA origin and course variability as well as clinical significance of the present variant, reviewing the relative literature. The objective of our study is to exhibit a rare ITA origin in order to provide a more accurate knowledge of such variations.

Intestinal Metastasis of a Primary Lung Carcinoma Presenting as Mechanical Small Bowel Obstruction

Lung cancer is the most common cause of cancer-related death in both men and women, attributing for approximately 30% of all cancer deaths. Lung cancer usually metastasizes to brain, adrenal glands, bones, and liver [1, 2]. Gastrointestinal (GI) metastasis from lung cancer is very uncommon and affects approximately 1.7–14% of patients [1]. The symptoms of gastrointestinal metastatic disease include abdominal pain, bleeding, vomiting, and acute presentation of bowel obstruction or perforation [1, 2]. We present a case of a small intestinal metastasis from a squamous cell lung carcinoma, which presented with acute obstruction.