Ioannis Spyridakis

Paratubal cysts in young females as an incidental finding in laparotomies performed for right lower quadrant abdominal pain

Abstract Paratubal cysts represent remnants of the paramesonephric or mesonephric duct, the former being more common. Most of them are asymptomatic, but they may rarely give rise to clinical problems due to enlargement or torsion. In this study, we looked for paratubal cysts or other pathological lesions of the right uterine adnexa in young females operated upon for right lower quadrant (RLQ) abdominal pain. Our material consisted of 338 white female patients aged 4–14 years. Laparotomy revealed only acute appendicitis in 283 cases, while 44 had acute appendicitis plus a coincidental paratubal cyst. Most of these cysts were smaller than 1 cm in diameter. However, 2 additional cases had torsion of a large paratubal cyst, while 5 had a ruptured corpus luteum. We suggest that a thorough search of the right adnexa for the presence of paratubal cysts during laparotomies performed for RLQ pain is a useful procedure. This approach also allows detection of other pathological lesions of the right adnexa that often produce symptoms similar to acute appendicitis.

High origin of a testicular artery: a case report and review of the literature

IntroductionAlthough variations in the origin of the testicular artery are not uncommon, few reports about a high origin from the abdominal aorta exist in the literature. We discuss the case of a high origin of the testicular artery, its embryology, classification systems, and its clinical significance.Case presentationWe report a very rare case of high origin of the left testicular artery in a 68-year-old Caucasian male cadaver. The artery originated from the anterolateral aspect of the abdominal aorta, 2 cm cranially to the ipsilateral renal artery. Approximately 1 cm after its origin, it branched off into the inferior suprarenal artery. During its course, the artery crossed anterior to the left renal artery.ConclusionsA knowledge of the variant origin of the testicular artery is important during renal and testicular surgery. The origin and course must be carefully identified in order to preserve normal blood circulation and prevent testicular atrophy. A reduction in gonadal blood flow may lead to varicocele under circumstances. A knowledge of this variant anatomy may be of interest to radiologists and helpful in avoiding diagnostic errors.

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.

Diagnostic and Surgical Approach of Thyroglossal Duct Cyst in Children: Ten Years Data Review.

INTRODUCTION Thyroglossal duct cysts are the most common congenital midline neck swelling in children. AIM To evaluate the clinical features, treatment, incidence of complications and outcomes in children with congenital midline neck lesions and more specifically with thyroglossal duct cyst, treated in our department the last ten years. It is a retrospective study. MATERIALS AND METHODS The aggregated data revealed 59 patients with congenital midline neck lesions, of which 33 patients were with thyroglossal duct cyst (TDC). The diagnosis of TDC was made by physical examination, ultrasound (US) in all cases, and for complicated cases a magnetic resonance imaging (MRI) was performed. In all cases followed histopathological conformation of thyroglossal duct cyst. RESULTS Fifty nine patients were admitted with midline cystic neck mass and the histopathological evaluation revealed, 33 cases (55.9%) of thyroglossal duct cyst, 14 cases (23.7%) of dermoid cysts, 3 cases (5.1%) of second branchial anomalies, 4 cases (6.7%) of inflammation of unknown cause, 4 cases (6.7%) of lymph nodes and 1 case (1.7%) of capillary skin haemangioma. More specifically, 38 patients were admitted with preoperative diagnosis of thyroglossal duct cyst, but in 5 patients pathological investigation demonstrated the presence of dermoid cyst. The mean age of the 33 patients with TDC at the time of surgery was 6.125 years, ranging between 9 months and 13 years with 10 patients younger than 3 years. Of the 38 patients with initial diagnosis of thyroglossal duct cyst, only four patients (10.5%) had a simple cyst excision and complication rate was 25% (1 case with recurrence). In these patients, the histopathological examination showed that three of them had a dermoid cyst and one had thyroglossal duct cyst. The other 34 patients (89.4%) were treated by Sistrunks procedure, with two cases (5.9%) were proven on histology to be non TDC. In this group the complication rate was 3.03% (1 case with wound infection). CONCLUSION The inappropriate surgical approach due to misdiagnosis or the incomplete surgical procedure remains the impact factor for recurrence. The modification of Sistrunks procedure remains the main surgical technique that can provides good results with low rate of complication (3.03%) and recurrence (0%) as shown of our collecting data.

Uncommon Surgical Causes Of Right Lower Quadrant Pain In Children. Single Center Experience.

Right lower quadrant pain is one of the major reasons of children reference at the emergency department. The most common surgical cause, which needs appropriate management, is acute appendicitis. The purpose of this study is to reveal uncommon surgical causes found during surgery in children who were misdiagnosed as acute appendicitis in our department during the last 10 y. Data of patients who have undergone appendicectomy during a ten year period (since Feb 2004 until Mar 2014) were collected retrospectively. Eight hundred twenty children have undergone appendicectomy in our department. In six children another uncommon cause of the symptoms was revealed during surgery. In one patient the cause was a duplication cyst of the terminal ileum, in two patients an omental torsion, in one patient a meckel diverticulum torsion, in one patient a splenic rupture and in one patient a retroperitoneal tumor. All of the patients were successfully managed during the first operation. The possibility of other uncommon causes of right quadrant abdominal pain should always be kept in mind, especially when there is a negative appendicitis. However, the transaction of further paraclinical examinations - ultrasonography or computed tomography- preoperatively is under discussion. Nevertheless a thoroughly taken case history is undoubtedly always necessary.

MULTIPLE VARIATIONS OF THE SUPERFICIAL JUGULAR VEINS: CASE REPORT AND CLINICAL RELEVANCE

The jugular venous system constitutes the primary venous drainage of the head and neck. It includes a profundus or subfascial venous system, formed by the two internal jugular veins, and a superficial or subcutaneous one, formed by the two anterior and two external jugular veins. We report one case of unilateral anatomical variations of the external and anterior jugular veins. Particularly, on the right side, three external jugular veins co-existed with two anterior jugular veins. Such a combination of venous anomalies is extremely rare. The awareness of the variability of these veins is essential to anesthesiologists and radiologists, since the external jugular vein constitutes a common route for catheterization. Their knowledge is also important to surgeons performing head and neck surgery.

Anatomical variation of co-existence of 4th and 5th short metacarpal bones, sesamoid ossicles and exostoses of ulna and radius in the same hand: a case report

IntroductionThe anatomical variations of bones in the hand are common. The existence of exostosis and shortening of metacarpal bones has been described in the literature as part of the hereditary multiple exostosis syndrome but no case has been reported with the co-existence of sesamoid ossicles in the same patient.Case presentationWe report a case with co-existence of distal ulnar and radial exostoses, 4th and 5th short metacarpals and sesamoid ossicles in the wrist area.ConclusionThis variation may help the interpretation of pain or sensory disorders in the hand and wrist areas.

Recurrent giant cell fibroblastoma: Malignancy predisposition in Kabuki syndrome revisited

Kabuki syndrome is a genetic condition characterized by distinctive facial phenotype, mental retardation, and internal organ malformations. Mutations of the epigenetic genes KMT2D and KDM6A cause dysregulation of certain developmental genes and account for the multiple congenital anomalies of the syndrome. Eight cases of malignancies have been reported in young patients with Kabuki syndrome although a causative association to the syndrome has not been established. We report a case of a 12‐year‐old girl with Kabuki syndrome who developed a tumor on the right side of her neck. A relapsing tumor 19 months after initial excision, proved to be giant cell fibroblastoma. Τhis is the first report of giant cell fibroblastoma ‐a rare tumor of childhood‐ in a patient with Kabuki syndrome.

Aberrant innervation of the sternocleidomastoid muscle by the transverse cervical nerve: a case report.

Two aberrant rami originating from the right transverse cervical nerve and innervated the midportion of the sternocleidomastoid muscle (SM) were detected during routine cadaver dissection. Although SM is commonly innervated by the accessory nerve, as well as by cervical nerves, it is likely to be innervated additionally by other nerves such as hypoglossal nerve, ansa cervicalis, facial or external laryngeal nerve. Some considerations as regards the possible composition of the aberrant rami of the transverse cervical nerve detected in the current study, as well as the relevant literature is discussed.

Carcinoid Tumors of the Appendix – Last Decade Experience

INTRODUCTION Carcinoid of the appendix is a rare clinical entity in childhood and usually has a good clinical outcome. The impact of the operative preparations appendix ranges between 0.1-0.9%. The aim of our study is to report the experiences of our department in the management of appendiceal carcinoid tumors in children. MATERIALS AND METHODS Data of all patients aged 15 y or less who underwent appendectomy at the 2nd Department of Pediatric Surgery of Aristotle University of Thessaloniki between January 2004 and February 2014 were evaluated for the existence of appendiceal carcinoid tumors in pathological specimens. The collected data included: gender, patients age, clinical indications and surgical intervention, tumor localization in the appendix and the diameter of lesion, histological type of the tumor and postoperative care (follow up) of patients. RESULTS Four cases (3 girls, 1 boy) with carcinoid treated at our department during a 10 y period. Median patient age was 10.75 y (9- 12 y). In all cases the diagnosis was after appendectomy on ground of acute appendicitis. A single incident brought findings of gangrenous appendicitis. In three cases the tumors diameter was smaller than 1cm, while the incident with the gangrenous appendicitis was larger than 1cm in diameter. In four cases the tumor was localized at the apex of the appendix without extending to the surrounding tissues. In all patients with carcinoid tumor followed a further testing based on specific monitoring protocol. In no case was residual or metastatic disease identified and no further treatment was required. No relapse was observed during follow-up. CONCLUSION Our study confirms the good prognosis of appendiceal carcinoid.