Quantitative analysis of healthy olfactory sulcus depth, olfactory tract length and olfactory bulb volume in the paediatric population: a magnetic resonance study.

BACKGROUND: The aim of this study was to determine the normal reference values for olfactory sulcus depth, olfactory tract length and olfactory bulb volume in the paediatric population with routine magnetic resonance imaging (MRI) and determine the relationship, if any, between these values and patient sex and age. MATERIALS AND METHODS: Ninety patients with a median age of 8 years (age range: 3-17 years), consisting of 45 males and 45 females with normal brain MRI scans were evaluated. The patients were divided into three subgroups based on age range, with n = 30 per subgroup; group 1: young children (3-6 years), group 2: children (7-11 years) and group 3: adolescents (12-17 years). In the cranial MRI examination of all groups, the right, left and total olfactory bulb volume values were measured in mm3, the right and left olfactory tract length values and the right and left olfactory sulcus depth values were calculated manually in mm. Demographic data including sex and age were recorded. RESULTS: There was no significant difference between the age groups in terms of sex. Right-left olfactory sulcus depth; right-left olfactory tract length and right-left total olfactory bulb volume values increased significantly when they are compared in terms of age groups (p < 0.0001, = 0.028; < 0.0001, < 0.0001; < 0.0001, < 0.0001; < 0.0001, respectively). There was no significant difference between right and left olfactory tract length and olfactory bulb volumes in all groups (p = 0.792 and p = 0.478), but the right olfactory sulcus depth was significantly larger than the left (p = 0.003). CONCLUSIONS: Especially as the age progresses, olfactory tract length and olfactory bulb volume dimensions of olfactory nerve and olfactory sulcus depth should be checked during diagnosis of respective illnesses in paediatric population.

Diagnostic value of the choledochal sphericity index in the diagnosis of obstructive cholestasis using magnetic resonance cholangiopancreatography.

BACKGROUND AND STUDY AIMS: Dilatation of common bile duct (CBD) is the first sign in the diagnosis of obstructive jaundice. On magnetic resonance cholangiopancreatography (MRCP), the measurement of the CBD diameter is commonly performed on the widest part of the duct, and the long axis diameter is used in clinical practice. It is aimed to investigate the role of long axis, short axis and sphericity index (SI) of CBD in the diagnosis of obstructive cholestasis. PATIENTS AND METHODS: MRCP images of 68 patients who had a bile duct diameter of ≥6 mm were retrospectively evaluated. The cases with a direct bilirubin value ?0.4 mg/dl were determined to be cholestasis. Using the curved planar images, the long and short axis measurements were obtained from the widest portion of the bile duct in the transverse section and SI were obtained by calculating the ratio of the long axis over short axis. Short axis, long axis and SI was compared between cholestatic and non-cholestatic group. RESULTS: The mean age of the patients was 58.97 ± 17.84. Long axis, short axis, and SI showed statistically significant difference between groups (p=0.034, p=0.001, and p=0.014, respectively). Sensitivity and specificity were 60.7% and 80% for long axis, %53.6 and 82.5% for short axis, 65% and 71.4% for SI, respectively. CONCLUSIONS: In addition to the long axis measurement, evaluation of the short axis measurement and calculation of the SI on MRCP examination will help exclude physiological dilatation in the suspicion of cholestasis.

DIAGNOSTIC VALUE OF DUPLEX DOPPLER ULTRASOUND PARAMETERS IN PAPILLARY THYROID CARCINOMA.

CONTEXT: Papillary thyroid carcinoma (PTC) is the most common type of thyroid cancer due to its high fibrotic content; it can affect the blood flow resistance. OBJECTIVE: To introduce duplex Doppler ultrasonography (DDUS) parameters of papillary thyroid carcinoma (PTC) and their correlation with size. DESIGN: The study was designed as a prospective study. SUBJECTS AND METHODS: Thyroid nodules of the patients who were already scheduled for thyroid surgery either for malignant thyroid nodules or multinodular goiter were evaluated for DDUS parameters. Size, systolic to diastolic flow velocity (S/D) ratio, pulsatility index (PI), and resistive index (RI) of each nodule were recorded. Nodules were diagnosed as PTC or benign nodules based on histopathology. DDUS parameters were compared between PTCs versus benign nodules and micro PTCs (≤ 10 mm) versus large PTCs (> 10 mm). A correlation analysis was performed between the size and DDUS parameters. RESULTS: 140 thyroid nodules (30 PTCs, 110 benign nodules) were obtained. The mean S/D ratio, PI, and RI values were significantly higher in PTC than in benign nodules (p values were 0.0001, 0.0003, and 0.0001 respectively). The optimal cut-off values of S/D (0.732), PI (0.732), and RI (0.738) had accuracy rates of 71%, 69%, and 69%, respectively. There was no statistically significant difference between micro PTC and large PTC with regards to DDUS parameters. The size and DDUS parameters of PTC showed no significant correlation. CONCLUSIONS: PTC has a high resistive flow pattern regardless of its size; however the clinical utility of DDUS to differentiate a PTC from benign nodule is limited.

Lip reconstruction using a functioning serratus anterior free flap: preliminary study.

Reconstructive surgery to the lips requires the replacement of defective tissues with similarly functioning tissues. While non-dynamic free tissue transfers provide adequate lower lip reconstruction, improved benefits may be obtained with innervated free muscle flaps. This study reports the use of innervated serratus anterior muscle free flaps for lip reconstruction in five patients. All patients had squamous cell carcinoma of either the upper or lower lip. After resection of the tumours, the resultant defects comprised two-thirds of the lips. The innervated serratus anterior muscle free flap was transferred to the lip and an end-to-end vascular anastomosis on the facial artery was performed. The marginal mandibular branch of the facial nerve was preferred for nerve coaptation. The inner and outer surfaces of the flaps were grafted with a split-thickness skin graft. Concentric needle electromyography of the orbicularis oris and frontal muscles was performed for all patients in the preoperative, postoperative, and follow-up periods. All patients survived the surgical operation. Three patients achieved perfect oral sphincter function without drooling. Electromyography at 1 year postoperative demonstrated the successful reinnervation of the serratus anterior muscle. This study demonstrates that lip reconstruction using an innervated serratus anterior muscle free flap is a reliable method, providing a functional lower lip.

Bilateral inguinal hernia with an uncommon content : A case report.

Here we present a sixty-two year old man with bilateral swellings palpated in inguinal areas on physical examination. Ultrasonography and abdominal multi-detector computed tomography revealed a bladder herniation through the right inguinal canal and a sigmoid colon herniation through the left inguinal canal. Radiologic imaging methods are important and can guide clinicians for preemptive or emergent surgery. (Acta gastroenterol. belg., 2016, 79, 495-496).

Abdominal cocoon with imaging findings: Importance of radiology.

Abdominal cocoon is a rare disease characterized by a thick fibrous membrane surrounding and compressing the small intestines completely or partially, which results in mechanical small bowel obstruction. The clinical findings of the disease include recurrent ileus and subileus episodes, colicky abdominal pain, weight loss, and abdominal distension. The etiology and pathogenesis of abdominal cocoon is not clearly defined. Detection of the disease is essential for accurate treatment. Imaging modalities come into prominence due to the nonspecific clinical findings of the disease.

Amyand's hernia: 10 years' experience.

BACKGROUND: Amyand's hernia is an atypical groin hernia which contains the vermiform appendix. The aim of this study was to review a single institution's experience in the clinical presentation, management and prognostic factors of this rare hernia. METHODS: The authors reviewed records of all patients undergoing hernia surgery from 1996 to 2006 at their institution, a tertiary care, University-affiliated hospital. RESULTS: Twelve patients (six men) with a median age of 88 years (range 60-97) were included. Six presented with right inguinal hernias and six presented with right femoral hernias. All required emergency surgery: eight for strangulated hernias, two for hernias with lower quadrant peritonism and two for incarcerated hernia. Despite small differences in outcome and length of hospitalisation between Amyand types, appendix inflammation, pre-operative blood examinations and hernia localisation, only right lower quadrant peritonism as a presenting sign (p=0.004) and age greater than 90 years old (p=0.04) were significantly associated with a poor outcome. CONCLUSION: Amyand's hernia is a rare hernia which is seldom diagnosed before operation. It must be considered in the evaluation of a strangulated or incarcerated hernia. Further studies are required to define the optimal surgical strategy, prognostic factors and risks of hernia recurrence.

Risk factors for mortality-morbidity after emergency-urgent colorectal surgery.

BACKGROUND: The aim of this study was to assess the risk factors associated with mortality and morbidity following emergency or urgent colorectal surgery. MATERIALS AND METHODS: All data regarding the 462 patients who underwent emergency colonic resection in our institution between November 2002 and December 2007 were prospectively entered into a computerized database. RESULTS: The median age of patients was 73 (range 17-98) years. The most common indications for surgery were: 171 adenocarcinomas (37%), 129 complicated diverticulitis (28%), and 35 colonic ischemia (7.5%). Overall mortality and morbidity rates were 14% and 36%, respectively. In multivariate analysis, the only parameter significantly associated with postoperative mortality was blood loss >500 cm(3) (odds ratio (OR) = 3.33, 95% confidence interval (CI) 1.63-6.82, p = 0.001). There were three parameters which correlated with postoperative morbidity: ASA score > or =3 (OR = 2.9, 95% CI 1.9-4.5, p < 0.001), colonic ischemia (OR = 3.4, 95% CI 1.4-7.7, p = 0.006), and stoma creation (OR = 2.2, 95% CI 1.4-3.4, p = 0.0003). CONCLUSIONS: The main risk factors for postoperative morbidity and mortality following emergency colorectal surgery are related to: (1) patients' ASA score, (2) colonic ischemia, and (3) perioperative bleeding. These variables should be considered in the elaboration of future scoring systems to predict outcome of emergency colorectal surgery.

Visual clues act as a substitute for haptic feedback in robotic surgery.

OBJECTIVE: The lack of haptic feedback (HF) in robotic surgery is one of the major concerns of novice surgeons to that field. The superior visual appearances acquired during robotic surgery may give clues that make HF less important. METHODS: We surveyed 52 individuals on their perception of HF during robotic surgery. The first group of 34 surgically inexperienced people used the da Vinci robot for their first time (drylab). The second group included 8 laparoscopic surgeons with experience up to a fifth robotic operation. The third group included 10 surgical experts with substantial experience (150-650 robotic cases). Visual analog assessment was made of perception of HF, how much HF was missed, how much the absence of HF impaired the operators' level of comfort. Robotic experts were asked if complications have occurred as a result of a lack of HF. RESULTS: Of the first group, 50% reported the perception of HF, as did 55% of the second group and 100% of the third group (difference between group 1 and group 3: p < 0.05). The first group missed HF for 6.5; the second group for 4.3, and the third group for 4 (difference between groups 1 and 3: p < 0.05). The surgical experts claimed to have missed HF for 7.2 s when they first started robotic surgery (Difference to now: p < 0.05). The lack of HF caused discomfort for the first group of 4; for the second group of 4,4, and for the third group of 2,6. One complication was reported by the robotic experts as resulting from the lack of HF. CONCLUSIONS: The data support the conclusion that even beginners quickly experience the perception of HF when performing robotic surgery. With more experience, perception of HF and the level of comfort with robotic surgery increases significantly. This perception of HF makes "real" HF less important and demonstrates that its importance is overestimated by novices in robotic surgery.

[Hernia surgery: the unavoidable era of laparoscopy]. / Chirurgie herniaire: l'ére incontournable de la laparoscopie.

Optimal treatment of groin hernia is a primary public health concern. The inguinal hernia is associated with dysfunctions of the collagen matrix of genetic or acquired origin. Recurrence rate after hernia surgery without mesh reinforcement is estimated at 10-15%. The use of mesh decreases the risk of recurrence by between 50 and 70%. The open techniques (Lichtenstein and derived) are easy to learn, feasible with local anaesthesia and in outpatient setting but they produce chronic pain and sexual disorders. Laparoscopic surgery produces less acute and chronic pain, allows a faster return to the daily activities and allows better cosmetic results. Well codified and taught, the laparoscopy has an important role to play in hernia surgery today as well as in the future.

Laparoscopic versus open resection for appendix carcinoid.

BACKGROUND: Since an increasing number of appendectomies are performed via laparoscopy, it is crucial to determine the impact of this approach on appendix carcinoid (AC) outcome. The goal of this study was to compare results of laparoscopic (LAP) versus open (OP) appendectomy for AC according to intend to treat approach. METHODS: A retrospective review (1991-2003) identified 39 patients (median age, 36 years; range, 12-83) treated by laparoscopy (LAP) or laparotomy (OP) for AC in a single institution. Follow-up was complete for all patients (median, 67 months; range, 4-132). RESULTS: Most cases had associated acute appendicitis (64%). Median carcinoid size was 1.1 cm (range, 0.3-5) and 0.4 cm (range, 0.2-3) in the LAP and OP groups, respectively. LAP and OP were performed in 21 (54%) and 18 (46%) patients, respectively. Surgical margins were positive in two patients in the LAP group and one patient in the OP group (p = 0.6). Right colectomies were performed for AC >2 cm in five patients after LAP and in four patients after OP (p = 0.9). Actuarial 5-year survival rates were 100 and 94% in the LAP and OP groups, respectively (p = 0.2). Two patients died in the OP group, one due to metastatic carcinoid and the other due to metachronous colorectal cancer. Synchronous or metachronous colorectal carcinomas developed in six patients (15%). CONCLUSION: Laparoscopic appendectomy is a safe procedure for AC, with carcinologic and long-term results similar to those of conventional appendectomy. Thus, pre- or per-operative suspicion of AC is not a contraindication to LAP. Prognosis of AC appears more dependent on carcinoid malignant potential or associated tumors. Risk for developing colorectal adenocarcinoma is high in AC patients and warrants follow-up of all patients with colonoscopic screening.

A trial of a new regimen with clomiphene citrate administration to reduce the antiestrogenic effects on reproductive end organs.

OBJECTIVE: To determine the endocrinological and clinical outcomes of a 3-day clomiphene citrate (CC) regimen and compare it with the classical 5-day clomiphene citrate regimen. STUDY DESIGN: 59 patients, diagnosed with Class II ovulatory deficiency according to the criteria defined by WHO, were randomized into two groups. Patients in Group I received 50mg per day of CC for 3 days starting on the first day of the cycle during 72 cycles. Group II received 50mg per day of CC for 5 days starting on the fifth day during 64 cycles. RESULT(S): The ovulation rate was significantly higher in Group II (78.11%) compared to Group I (63.88%) (P < 0.05). However, the implantation rate was higher in Group I than Group II. CONCLUSION: We observed that starting CC on the first day of the cycle for 3 days would lead to higher implantation rates compared to the classical 5-day CC therapy.

Comparison of ethacridine lactate and prostaglandin E2 in second trimester medical abortion.

BACKGROUND: A comparison of ethacridine lactate and prostaglandin E2 (PGE2) with or without oxytocin infusion in second trimester medical abortion cases. METHODS: A prospective study was performed on 151 women requiring second trimester medical abortions between 1989 and 1995. Patients were randomly assigned to PGE2 group (n = 30), ethacridine lactate group (n = 48), ethacridine lactate combined with oxytocin infusion group (n = 49) and PGE2 combined with oxytocin infusion group (n = 24). Rates of successful abortion (i.e., complete evacuation of fetal and placental tissues from the uterus) within 24 hours for each group were determined and compared by chi2 and the Student t-test. RESULTS: Statistically significant difference concerning successful abortion rates was observed between ethacridine lactate and PGE2 groups, PGE2 and PGE2+oxytocin infusion groups, and ethacridine lactate+oxytocin infusion and PGE2 groups, while there was no significant difference between ethacridine lactate and ethacridine lactate+oxytocin infusion groups, ethacridine lactate and PGE2+oxytocin infusion groups, and PGE2+oxytocin infusion and ethacridine lactate+oxytocin infusion groups. CONCLUSIONS: Extra-amniotic ethacridine lactate instillation alone and intracervical PGE2 gel application are effective and safe methods for second trimester abortion.