ABSTRACT
PURPOSE: To establish the proper approach and management of an urachal anomaly in children. MATERIALS AND METHODS: We retrospectively reviewed the medical records and imaging studies of 33 children (21 boys, 12 girls) treated for an urachal anomaly over a ten-year period. RESULTS: Twenty-four patients were equally diagnosed with either an urachal sinus or urachal cyst; the other nine patients were confirmed to have a patent urachus. Umbilical discharge (14 patients) and umbilical granuloma (9 patients) were the most common presentations. The 12 patients with an urachal sinus underwent ultrasonography (USG) (10; diagnostic), 2 fistulography (all; diagnostic). Those with an urachal cyst underwent either USG (6/12; diagnostic), computed tomography (CT) (3; diagnostic), fistulography (2; diagnostic), or magnetic resonance imaging (MRI) (1; diagnostic). One subject was affected by acute appendicitis, which was confirmed by CT. Of the 9 children with patent urachus, 7 underwent USG (all; diagnostic); exploration without further imaging studies was performed on the remaining 2 subjects. Surgical excision was performed in 30 patients. Omphalomesenteric duct or Meckel's diverticulum were incidental findings, which were simultaneously repaired. Conservative treatment was successful in only 3 patients. CONCLUSIONS: Urachal anomalies in children mainly manifest as umbilical discharges and umbilical granuloma, but may present non-specific symptoms in some cases. USG is a useful method for diagnosis, but other imaging modalities can be useful to establish the differential diagnosis. A limited number of children with urachal anomalies, mainly presenting with an umbilical discharge, can be managed conservatively. However, complete surgical excision of the lesion, with the possible associated anomalies, should be the basic scheme for children with urachal anomalies.
Subject(s)
Child , Humans , Appendicitis , Diagnosis , Diagnosis, Differential , Granuloma , Incidental Findings , Magnetic Resonance Imaging , Meckel Diverticulum , Medical Records , Retrospective Studies , Ultrasonography , Urachal Cyst , Urachus , Vitelline DuctABSTRACT
OBJECTIVE: The authors describe four patients in whom we performed a single stage, pedicle subtraction and extension wedge osteotomy for the correction of sagittal imbalance by creating lumbar lordosis. METHODS: One patient presented with congenital hemivertebra, one with post-laminectomy kyphosis, and two with lumbar degenerative kyphosis. All patients suffered from back pain and were unable to walk due to forward stooping of the trunk. We performed a single stage, pedicle subtraction and extension wedge osteotomy for the correction of sagittal imbalance. RESULTS: The angles of correction were 37, 44, 45, and 49 degrees. No case had any neurologic complication. All patients reported complete relief of back pain and were able to upright standing. CONCLUSION: Single-level wedge osteotomy and reduction provide excellent sagittal correction of rigid kyphotic deformities in the lumbar lesion without neurologic compromise.
Subject(s)
Animals , Humans , Back Pain , Congenital Abnormalities , Kyphosis , Lordosis , Osteotomy , SpineABSTRACT
The purpose of our present study was to asses the effectiveness of middle cerebral artery occlusion in producing acute focal cerebral ischemia in rats by use of Bederson's or Longa's method in which occlusion was performed with or without craniectomy respectively. In twenty-nine Sprague-Dawley rats weighing 250-300 gm, right middle cerebral artery occlusion was achieved by use of either Bederson's method or Long's method. After 4 hours of ischemia, neurological evaluation was performed and then brain water content was determined in the central, intermediate, and outer zones of each cortical mantle. in both groups, a significant neurological deficit caused by focal cerebral ischemia was observed. More severe neurological deficit was achieved by Longa's method than by Bederson's method(p<0.001). In Bederson's method group, significant brain edema was observed only in the ischemic central and intermediate zones. However, in Longa's method group, significant brain edema was observed in all of the three ischemic zones. And more severe brain edema was achieved by Long's method in each of three ischemic zones than by Bederson's method(p<0.001, respectively). Theses results incicate that Longa's method is more effective and persistent method in producing acute focal cerebral ischemia than Bederson's method. Longa's method is considered as one of a good, less invasive, and technically easy method to achieve focal cerebral ischemia in rats.