Savas Deftereos

Acute abdomen in children due to extra-abdominal causes.

Background: Acute abdominal pain in children is a common cause for referral to the emergency room and for subsequent hospitalization to pediatric medical or surgical departments. There are rare occasions when the abdominal pain is derived from extra‐abdominal organs or systems. The aim of the present study was to establish the most common extra‐abdominal causes of acute abdominal pain.

Suprapubic catheter knotting: an unusual complication.

We describe a case of true knotting of a suprapubic catheter in a 25-month-old boy who underwent surgery for urethrocutaneous fistula as a complication of a distal penile hypospadias repair. This unusual complication was probably attributable to an excessive length of catheter being inserted into the bladder, thereby allowing it to bend onto itself.

Involution of a Large Parotid Hemangioma with Oral Propranolol: An Illustrative Report and Review of the Literature

Propranolol has emerged as a new treatment option for infantile hemangiomas. We describe a 20-month-old boy with a large right parotid hemangioma diagnosed at the age of 37 days. Starting at the age of 2.5 months, he received oral propranolol for 6.5 months. Although the mass regressed, it recurred when propranolol was discontinued. He was successfully retreated at the age of 11 months with propranolol for another 5.5 months without further recurrences. Treatment was tolerated well. Our paper and a review of the literature demonstrate that propranolol appears to be safe and effective for symptomatic infantile parotid gland hemangiomas.

Bisphosphonate-induced osteonecrosis of the jaw in patients with bone metastatic, hormone-sensitive prostate cancer. Risk factors and prevention strategies.

AIMS AND BACKGROUND Evidence from the literature suggests that osteonecrosis of the jaw is emerging as a serious complication of treatment with bisphosphonates for patients with advanced prostate cancer. METHODS AND STUDY DESIGN This study is a series of 60 patients with osseous metastases from prostate cancer under complete androgen deprivation therapy. All patients also received bisphosphonates intravenously every 3 to 4 weeks. Over a period of 3 and a half years, we recorded the incidence, presenting signs and symptoms of osteonecrosis of the jaw among those patients and the diagnostic workup required. RESULTS Nine of the 60 patients with metastatic prostate cancer were found to be affected with osteonecrosis of the jaw secondary to bisphosphonate administration at the Urology Department at the University Hospital of Alexandroupolis between January 2006 and August 2009. For diagnostic reasons, all 9 patients underwent computed tomography scan and magnetic resonance imaging of the maxillary region, as well as a three-phase whole body bone scan. CONCLUSIONS; There is evidence that administration of bisphosphonates in patients with advanced prostate cancer may increase the risk of osteonecrosis of the jaw. Guidelines regarding the diagnosis and management of those patients are needed.

Seizures as initial manifestation of vitamin D-deficiency rickets in a 5-month-old exclusively breastfed infant.

Despite the fact that sunlight-dependent skin synthesis is the major mechanism for vitamin D synthesis in vivo, vitamin D-deficiency rickets continues to occur in exclusively breastfed infants in Greece. We present such a case in a 5-month-old infant who presented with afebrile seizures and whose mother was underexposed to sunlight due to veiling for religious reasons. Additionally, we briefly but thoroughly review the relevant medical literature. A high index of suspicion is required for nutritional rickets, when seizures occur in exclusively breastfed infants whose mothers have inadequate exposure to sunlight.

Management of abdomen hydatidosis after rupture of a hydatid splenic cyst: a case report

We present a case of multiple hydatidosis in an 8-year-old boy that resulted from a ruptured hydatid cyst of the spleen and spread into the peritoneal cavity. We also present a new approach for managing these difficult and high-risk cases.

Peripheral Nerve Sheath Tumors. Benign or Malignant? The Role of MRI and Ultrasonography in A Case Report

A 31‐year‐old male patient admitted to another hospital for investigation of a localized painful hump in the medial surface of his left leg. The clinical examination revealed a painful palpable lump in the medial surface of left thigh that was initially thought to be a hematoma due to a history of recent trauma. However, an ultrasound was requested to exclude deep venous thrombosis (DVT). The US examination revealed a heterogeneous, fusiform lesion with elongated proximal and distal projections in close proximity to superficial femoral artery and vein and could not definitely exclude the DVT hypothesis. In a second ultrasound examination performed in our department, a neurogenic origin of the lesion was proposed. A consequent MRI examination confirmed the presence of a fusiform tumor in the anatomic path of the saphenous nerve. This was further confirmed intraoperatively, and pathologically was diagnosed as a malignant peripheral nerve sheath tumor (MPNST). In this present study the role of ultrasonography, the correlation between MRI and ultrasonographic findings are discussed and a review of the literature is presented.

Hematogenous infantile infection presenting as osteomyelitis and septic arthritis: a case report

The case of a 6-month old male infant presenting at the emergency department with fever and swelling at the left knee joint is discussed. Laboratory tests showed an inflammatory condition. Left knee plain radiograph demonstrated local soft tissue oedema. Percutaneous needle aspiration of articular fluid showed a positive culture for Staphylococcus aureus. The diagnosis of septic arthritis was confirmed. Because of inadequate response to treatment an MRI study was followed to evaluate possible abscesses. The presence of an abscess in the suprapatellar bursa was confirmed and an additional inflammatory process of the bone marrow was revealed, consistent with osteomyelitis. The pathophysiology, the imaging findings, the patients management and a review of septic arthritis and osteomyelitis coexistence are presented in this paper.

Reversal of Deep Vein Reflux After Successful Stenting in a Patient With Venous Hypertension After Thigh Access Graft Creation

Presented here is a case of reversal of deep vein reflux after successful stenting in a patient with venous hypertension and valve incompetence after thigh angioaccess creation. The patient with exhausted upper-extremity access sites underwent a loop graft in the upper thigh. Six months later, the patient developed leg edema and significant femoral vein reflux on duplex ultrasound. Fistulography revealed an iliac vein stenosis, which was treated successfully with stenting. The edema and reflux on duplex promptly resolved. In similar cases, reflux may be a consequence of functional valve incompetence and can be reverted by timely treating the underlying stenosis.

Hepatobiliary and pancreatic: Duplication of the gallbladder

Congenital anomalies of the gallbladder can be categorized as anomalies of number, anomalies of form and anomalies of position. Anomalies of number include congenital absence of the gallbladder, duplication of the gallbladder and perhaps hypoplasia of the gallbladder. Abnormalities of form include the presence of septa or abnormal folding of the gallbladder that results in a bilobed gallbladder, hourglass deformity or a phrygian cap deformity. This category can also include diverticula of the gallbladder. Anomalies of position include an intrahepatic gallbladder, leftsided gallbladder and a floating gallbladder that is susceptible to torsion. Of the above, the most common are anomalies of form that result in a phrygian cap deformity or a bilobed deformity. In relation to anomalies of number, congenital absence of the gallbladder is rare but duplication of the gallbladder has an estimated prevalence of 1–3 per 10 000 individuals. The patient illustrated below was a 30-year-old white woman who was referred for investigation because of discomfort in the upper abdomen and episodes of pain in the epigastrium and right upper quadrant. On examination, the only abnormality was mild tenderness on palpation over the right upper quadrant. Routine blood tests including liver function tests were within the reference range. An ultrasound study of the upper abdomen revealed two cystic structures in the gallbladder fossa lying side by side (Fig. 1). The structure on the left had the appearance of a normal gallbladder while the structure on the right had minor thickening of the wall and contained echogenic material. Magnetic resonance cholangiopancreatography revealed a true duplication of the gallbladder and showed that the two cystic ducts converged to form a common cystic duct prior to entry into the bile duct (Fig. 2). The presence of duplication of the gallbladder was confirmed at the time of laparoscopic cholecystectomy. Although a common cystic duct was demonstrated in the above patient, the majority of patients have separate cystic ducts that enter the bile duct. There are also reports of duplication where the second gallbladder is in an anomalous position such as within the liver or under the left lobe of the liver. There is no persuasive evidence that duplication of the gallbladder is associated with increased risks for gallbladder stones or gallbladder neoplasia.