Xenophon Sinopidis

Congenital Midline Cervical Cleft: Diagnosis, Pathologic Findings, and Early Stage Treatment

Congenital midline cervical cleft is a very uncommon malformation of the anterior neck, with less than 100 cases reported in medical literature. Herein we present a case of a female neonate with this anomaly. A detailed description of the macroscopic and microscopic characteristics is performed. As it is derived from the natural history of the lesion, prompt clinical diagnosis, and operative treatment during early infancy predispose to a better aesthetic and functional prognosis.

Congenital heart disease in twins: The contribution of type of conception and chorionicity

BACKGROUND Increased incidence of congenital heart disease (CHD) has been reported in the offspring of monochorionic twin gestations. Assisted reproductive technology (ART), which is related to increased rates of twinning, has also been associated with higher risk of birth defects. We studied the incidence of CHD in a cohort of twins to clarify the contribution of type of conception and chorionicity. METHODS Data concerning 874 live-born twins of which at least one was admitted in our Neonatal Unit during 1995-2012 were analysed. Forty-five % (N=197) of the gestations resulted from ART (in vitro fertilisation or intracytoplasmic sperm insertion). RESULTS In the ART group 32/389 (8.2%) had CHD compared to 21/485 (4.3%) infants conceived naturally (OR 1.90, 95%CI 1.08-3.34, p=0.024). Spontaneous-conception gestations had higher incidence of monochorionic placentation (47/245 versus 4/197, p<0.001), and included younger mothers (29.1±5.2 versus 33.9±5.5years, p<0.001) who had higher parity (median 2 [range 1-7] versus 1 Pinborg (2005), Blondel and Kaminski (2002), Knopman et al. (2014), Kyvik and Derom (2006) ; p<0.001). Multivariable logistic regression analysis showed that ART (OR 2.60, 95% CI 1.24-5.45) and monochorionicity (OR 3.49, 95% CI 1.57-7.77) were significant determinants of CHD, independently of maternal age, parity, and the gender of the offspring. CONCLUSIONS We confirmed that monochorionic twins have increased risk of CHD and we documented a higher incidence of CHD in ART twins independently of chorionicity. We suggest improvement of echocardiographic skills of health care professionals involved in prenatal screening and foetal cardiology referral of ART dichorionic twins with suspicious findings at screening, in addition to all monochorionic gestations.

Predictive Risk Factors in Childhood Urinary Tract Infection, Vesicoureteral Reflux, and Renal Scarring Management

Approaches to the management of children with urinary tract infection (UTI), vesicoureteral reflux (VUR), and renal scars have been challenged and have become controversial over the past decade. It is difficult to determine when, how, and which patients will benefit from the diagnosis and management of this condition. Therefore, the issues of diagnostic imaging, observation, follow-up, and intervention tend to be decided more on a case-by-case basis, rather than by using an algorithm. Over the past few years, there have been advances in the identification of risk factors that predispose patients with UTI to present with VUR, to develop recurrent UTIs and renal scars, to have deteriorating renal function, to show VUR improvement and/or spontaneous resolution, and to be candidates for and benefit from early surgical intervention.

Omentum in the Pediatric Umbilical Hernia: Is It a Potential Alarm for the Appearance of Complications?

Umbilical hernia is a common benign condition which resolves spontaneously during the first five years of life. However, in certain cases there are some characteristics which may be indicative of a different prognostic approach, as they increase the possibility of complications. The two cases of umbilical hernia that we describe here were treated operatively and revealed the presence of strangulated and adhered omentum, respectively. Reflecting on the adhesive properties of the omentum, we hypothesized that this may occur more often than it is believed, especially in those cases that are described as recurrent symptomatic herniations. In such cases, there should be increased alert for the possibility of complications during the period of the conservative expectance for resolution.

An Uncommon Case of Pediatric Neurobrucellosis Associated with Intracranial Hypertension

We present the case of a 4-year-old boy who was admitted to hospital with intracranial hypertension, headache, diplopia, papilledema, and a normal brain MRI. Brucella melitensis in the cerebrospinal fluid was confirmed with PCR assay. We believe that neurobrucellosis should be included in the differential diagnosis when headaches persist following brucellosis. In addition, we suggest that when cerebrospinal fluid culture is negative, PCR may prove to be an optimal alternative tool for an immediate and accurate diagnosis.

Internet impact on the insertion of genitourinary tract foreign bodies in childhood.

Foreign body self-insertion into the urethra is an uncommon paraphilia. Variety in object form, motivation, clinical presentation, complications, and treatment options is a rule. In childhood it is very rare, and it is attributed to curiosity or mental disorders so far. However, the internet impact on daily life of all age groups has created a new category of sexual behavior in childhood and adolescence, the “internet induced paraphilia.” Such is the case of an electrical cable inserted in the urethra of a 12-year-old boy reported here, which is representative of this kind of impact.

Congenital Spigelian Hernia Combined with Bilateral Inguinal Hernias

This report aims to point out the uncommon presentation of a Spigelian hernia during infancy, which is considered in general as an adulthood problem. A 32-week-of-gestation male with a birth weight of 1900 g presented with bilateral inguinal hernias. A third hernia was located at the lateral edge of the rectus abdominis muscle above the left inguinal hernia. Ultrasonography revealed preperitoneal fat protruding through a defect of the transversalis fascia (Figure 1a). Due to immaturity-related respiratory distress, surgical correction of the inguinal hernias was performed in the second month. Correction of the third hernia was performed in the fifth month, deciding to avoid the prolongation of anesthesia time and the operative stress and implementing a conservative approach to a situation that has never been confronted before (Figure 1b). A hernial sac containing the small intestine was identified intraoperatively, laterally to the rectus abdominis muscle, below the arcuate line, and protruding through a defect of the transversalis fascia and the transversus abdominis muscle. Preperitoneal fat adhered to the tip of the hernial sac was the first to be recognized (Figure 1c). Dissection, inspection, and ligation of the sac were followed by closure of the fascia and the muscle gap. The diagnosis was a Spigelian hernia. Postoperative follow-up until the age of 18 months was uneventful. Written informed consent was obtained from the patients parents. A Spigelian hernia is defined as a hernia of the Spigelian fascia, the part of the transversus abdominis avponeurosis extending from the semilunar line to the lateral edge of the rectus abdominis (1,2). Pediatric Spigelian hernia of nontraumatic etiology has been described in 71 sporadic cases (age 0-18 years) in the English literature (1). The largest published series included only 8 children (1). Infantile Spigelian hernia is considered as congenital in nature. It is related to an intrinsic structural predisposition of the anterior abdominal wall (3). Some authors have suggested a theory that the perforating vessels may weaken the fascia, enabling the entrance of fat and hernia formation (4). The association of Spigelian hernia with undescended testes created the hypothesis of a distinct clinical syndrome with a common

Lumbo-Costo-Vertebral Syndrome: An Iceberg with Tip of Hernia and Body of Spinal and Neurological Malformations

We read with great interest the contribution of Gupta et al on the lumbo-costo-vertebral syndrome (LCVS).[1] We encountered this rare anomaly in a 39 week-of-gestation female patient, who after an uncomplicated birth underwent investigation because of a left lumbar hernia, and vertebral anomalies. Imaging assay with plain radiography, revealed the presence of tenth and eleventh thoracic hemivertebrae, and intervertebral cleft of the twelfth thoracic vertebra. These anomalies resulted in clockwise thoracic and counterclockwise lumbar scoliosis. Magnetic resonance imaging revealed syringomyelia at the level of the three lower thoracic dysplastic vertebrae, and low termination of the spinal cord at the level of the fourth lumbar vertebra.

Surgical Therapy of Neurobrucellosis

The presentation of the role of surgery in the treatment of neurobrucellosis is the scope of this chapter. As laboratory and imaging diagnostic methods and antibacterial drug regimens continuously evolve, the same occurs to operative equipment and methods. Surgical involvement in life-threatening conditions such as brain and spinal abscess is thoroughly presented. In this chapter, special issues such as cerebrovascular involvement or intraparenchymal lesions are addressed. Intervention in structures with high morbidity like the cervical spine is exposed. Minimal invasive techniques, stenting, grafts, and instrumentation are presented in a friendly way for anyone who is involved in the treatment of neurobrucellosis.