Chronic appendicitis: the process from pre-diagnosis to pathology.

OBJECTIVE: Chronic appendicitis (CA) is a rare medical condition. CA is characterized by a less severe and almost continuous abdominal pain. It has a clinical picture lasting longer than 1-2 days and extending over weeks, months, even years. The exact etiology of CA is unclear. Certain resources have reported it as the cause of partial obstruction in the lumen of the appendix. PATIENTS AND METHODS: Our study was carried out with the approval of the Clinical Research Ethics Committee. A retrospective analysis was performed between August 2018 and March 2020. RESULTS: It was determined that 207 appendectomies were performed during the retrospective scan period. The data of 182 of these patients could be accessed fully and we could get answers to the criteria we thought. Only 8 of the patients screened were likely to be diagnosed with chronic appendicitis in the preoperative period. CA was found in 1 of the 8 patients (12.5%) who underwent surgery after a preliminary diagnosis of CA. Two patients were reported as malignant (25%), 3 patients (37.5%) as reactive lymphoid hyperplasia, and 1 patient as peri appendicitis (12.5%). Bleeding and congestion were reported in the last patient (12.5%). CONCLUSIONS: The diagnosis of chronic appendicitis is made by pathological examination. It may not always be possible to consider "chronic appendicitis" as a preliminary diagnosis. This should still be kept in mind. In our opinion, it is a bit difficult to make a preliminary diagnosis of chronic appendicitis and make a surgical decision. We believe that controlled and prospective studies can shed more light on chronic appendicitis.

Investigation of the relationship between serum hormones and pilonidal sinus disease: a cross-sectional study.

AIM: The aim of this cross-sectional study was to determine whether pilonidal sinus is influenced by hormones that stimulate body hair growth. Currently, there are insufficient data on the presence of hormonal abnormalities in pilonidal sinus disease. METHOD: Hormone levels (including those of thyroid-stimulating hormone, follicular-stimulating hormone, luteinizing hormone, prolactin, progesterone, oestradiol, testosterone, cortisol and dehydroepiandrosterone) were measured in 39 patients with pilonodal sinus presenting between February 2013 and March 2013. The results were compared with those of 39 volunteers without this disease. RESULTS: There was no statistically significant difference between men with pilonidal sinus disease (P > 0.05). The prolactin levels of women with pilonoidal sinus were significantly higher than those of women in the control group (P < 0.05). CONCLUSION: Raised serum prolactin levels in women may be related to the development of pilonidal sinus disease.

Small bowel obstruction due to anomalous congenital peritoneal bands - case series in adults.

BACKGROUND: Congenital bands cause 3 % of all intestinal obstruction and almost always lead to small bowel obstruction. In adults, obstruction due to bands is even rarer. MATERIALS AND METHODS: A multicenter study in Turkey. From January 2000 to December 2010 inclusive - a period of 10 years - all adult patients admitted to the emergency departments with a clinical diagnosis of acute intestinal obstruction due to congenital peritoneal band were included in the study. Surgery was defined as emergency. Recorded operative findings included the site of obstruction, and the operative procedure to relieve it. In the present study, the findings in adult patients with congenital band reported in the literature together with findings in ten cases operated at four center were retrospectively assessed with respect to their demographic, preoperative, peroperative, and postoperative characteristics. RESULTS: There were 8 males and 2 females aged between 18 and 72 year. There were no history of abdominal or inguinal surgery. Plain abdominal X-rays radiography revealed air- fluid levels in all patients. All the bands were ligated and divided. On histopathological examination, the bands were composed of loose connective tissue containing blood vessels. There were no calcification in the bands. CONCLUSION: an anomalous congenital band could be included in the differential diagnosis of intestinal obstruction. This clinical situation requires early surgical intervention that will be diagnostic and therapeutic (Tab. 1, Fig. 4, Ref. 21).

The long thoracic nerve: Its origin, branches, and relationship to the middle scalene muscle.

Anatomical knowledge regarding the long thoracic nerve (LTN) is important during surgical procedures considering that dysfunction of this nerve results in clinical problems. The purpose of this study was to explore the anatomy of the LTN, its origin, configuration, branching pattern, and relationship to the middle scalene muscle (MSM). The course of the LTN was investigated in 12 embalmed cadavers (21 sides). We defined four different types for this nerve according to the origins of its roots. The most common formation of the LTN was the contribution of three branches that originated from the fifth, sixth, and seventh cervical ventral roots. C5 and C6 components or upper portion of the LTN roots lay primarily between the middle and posterior scalene muscles, sometimes passed through the MSM, and less frequently coursed over the MSM. C7 contributions to the LTN were always located anterior to the MSM. Contributions from C8 were also found over the MSM. The median number of branches arising directly from the cervical roots and branches arising from the main trunk of the nerve were 3 and 7, respectively. Along its course, the median number of branches to the serratus anterior was 10.

Pulmonary artery diameters measured by multidetector-row computed tomography in healthy adults.

BACKGROUND: The range of the diameters of pulmonary arteries (PA) is not fully shown in the current literature. Contrast-enhanced computed tomography (CT) of the thorax might be used for measuring diameters of the PA. PURPOSE: To determine the diameters of PAs in subjects with normal PA pressure by using thoracic CT. MATERIAL AND METHODS: 126 subjects aged between 19 and 46 years, having normal thoracic CTs (5-mm slice thickness) and normal PA pressures ((25 mmHg, determined by echocardiography), were included in the study. The diameters of the main, right, and left PAs were measured by using multidetector CT. RESULTS: The main PA diameters of all the subjects showed a normal distribution, and the mean was 24.0 ± 2.8 mm. The main PA diameters in male and female subjects also showed a normal distribution. The difference between the sexes for the main PA diameters was not significant (P=0.08). There were correlations between main PA diameter and body-mass index (BMI) (R=0.41, P=0.001) and weight (R=0.34, P=0.001). However, there was no significant correlation between main PA diameter and height (R=0.05, P=0.6). CONCLUSION: This study suggests that diameters of the main PA and its main branches show a normal distribution in subjects having normal PA pressures. Based on our findings, the upper limits of the main, right, and left PA diameters are 29.5 mm,19.8 mm, and 22.1 mm, respectively, in healthy adults.

The morphology of the koniocellular axon pathway in the macaque monkey.

The key objective of this study was to determine the distribution and morphology of koniocellular (K) lateral geniculate nucleus (LGN) axons in primary visual cortex (V1) of the macaque monkey. In particular, we were interested in understanding whether subpopulations of K axons exist in this species and, if so, if these subpopulations arise from different K layers of the LGN. Restricted injections of the tracers, biotinilated dextran amine, or Phaseolus vulgaris leucoagglutinin were targeted to specific LGN K layers under electrophysiological guidance and immunocytochemistry was used to visualize labeled axons in cortex that were subsequently reconstructed through serial sections. A total of 36 complete axons and 166 axon segments were reconstructed. Our results identified at least 2 main subpopulations of K axons in macaque V1 based on branching patterns and bouton distribution. Axons that arise primarily from LGN layers K1 and K2 are morphologically simple and tend to branch in cortical layers 1 and 3A. These axons give rise to fewer boutons than seen in axons arising from the dorsal K LGN layers K3-K6. Axons that arise from LGN layers K3-K6 terminate as complex, focused arbors in the cytochrome oxidase (CO) blobs in layer 3Balpha, with only occasional simple projections to the more superficial layers of cortex. Combined with previous observations, our data suggest that there are at least 3 subclasses of K LGN axons in macaque monkey that are similar to K axons identified earlier in both nocturnal simian owl monkeys (Ding and Casagrande 1997) and in prosimian, bush babies (Lachica and Casagrande 1992) suggesting that the LGN K channels that terminate in the CO blobs and in layer 1 are not unique to macaque monkeys but are a common primate feature.

An unusual variation of the superficial ulnar artery.

Anomalous superficial ulnar arteries were found bilaterally during routine dissection of the upper limbs of a 60-year-old male cadaver. In the left arm, the superficial ulnar artery originated from the axillary artery. It crossed the median nerve anteriorly and ran anteromedial to this nerve and the brachial artery. The superficial ulnar artery was also rudimentary and gave rise to only a narrow muscular branch to the biceps brachii. In the hand, it anastomosed with the radial artery, completing the superficial palmar arch. The radial artery was larger than usual and the deep palmar arch was formed only by the radial artery. In the right arm, the superficial ulnar artery originated from the brachial artery at the level of the inter-epicondylar line. Additionally there were "inverse palmaris longus muscles" bilaterally. This was a rare case in which the superficially ulnar artery originated from a different source on each side accompanied by anomalies of the palmar arches on one side.

The neurovascular and muscular anomalies of the gluteal region: an atypical pudendal nerve.

In two cases, one male and one female, muscular anomalies together with neurovascular variations were encountered in the gluteal regions, in each cadaver on the same side. In the male cadaver, there was a double piriformis muscle and high division of the sciatic nerve. In the female cadaver, in addition to these anomalies, the superior and inferior gemelli and obturator internus muscles, and the internal pudendal vessels and pudendal nerve passed behind the sacrotuberous ligament. Although duplication of the piriformis and high division of the sciatic nerve have been reported previously, to the best of our knowledge the other anomalies have not yet been reported. The abnormal relationship of the internal pudendal vessels and the pudendal nerve with the sacrotuberal ligament, as in our case, may cause venous congestion, arterial obstruction, dysfunction of penile erection and perineal neuralgia. These anomalies of the gluteal region are not only of academic interest, but may be of practical importance for surgical intervention in the area.

Variant innervation of the coracobrachialis muscle and unusual course of the musculocutaneous nerve in man.

During the educational gross anatomy dissections of the upper extremities of 60 embalmed cadavers in our laboratory, the coracobrachialis muscle was found to be innervated by a nerve branch arising from the lateral root of the median nerve, but not from the musculocutaneous nerve nor from the lateral cord of the brachial plexus. Also the musculocutaneous nerve was found not to pierce the coracobrachialis muscle and to course downwards medial to it. The combination of two variations was seen in the right arm of a 64-year-old Turkish female cadaver. No other abnormality was observed in the branching pattern of the brachial plexus on both sides.

Accessory insertions of pectoralis major muscle to the brachial fascia: a case report.

Two accessory fibrous bands arising from the posterior aspect near the lateral border of the pectoralis major muscle were found to attach to the brachial fascia at the posterior arm region. Those bands were in intimate contact with the median nerve, brachial veins and its branches. They were thought to be remnants of the distal origin of the pectoralis major muscle. The impact of those fascial bands in the compression syndromes of the upper extremity and in the surgical operations directed to the fossa axillaris were discussed.

Double superior gemellus together with double piriformis and high division of the sciatic nerve.

We report a case with double superior gemellus and double piriformis mm. associated with the sciatic n. dividing high and passing between the two piriformis mm. in the same lower extremity. This abnormality has not previously been described in the literature. As many musculoskeletal structures may be involved in sciatica, the supernumerary superior gemelli and piriformis mm. may exert pressure on the sciatic n. and this should be taken into account by clinicians.

Accessory extensor carpi radialis muscle and interconnecting muscular bundle.

An accessory muscle and a muscular bundle were found and prepared in both forearms of a 55-year-old male cadaver. On the left side, the accessory muscle-originated from the medial aspect of the extensor carpi radialis brevis (ECRB) muscle, coursed downwards, crossed posterior to the tendon of ECRB, passed through the second chamber of the extensor retinaculum and inserted into the base of second metacarpal bone. Additionally, a muscular bundle was observed between the extensor carpi radialis longus (ECRL) and ECRB muscles. On the right side, both ECRL and ECRB had bifid tendons. The long and thin additional tendon of ECRL coursed downwards and joined the accessory tendon of the ECRB before entering the second chamber of the extensor retinaculum and the common tendon inserted into the base of the second metacarpal bone.

A complicated variation of the upper extremity vascularisation.

In the right upper extremity of a cadaver, the radial artery originated from the medial side of the brachial artery at a higher level than usual, which was 16.7 cm below the coracoid process. Then, this artery crossed over the brachial artery, passed to its lateral side and ran to the forearm in front of the aponeurosis of the biceps brachii muscle. The brachial artery ended 1 cm distal to the elbow joint by dividing into the ulnar, anterior interosseous and posterior interosseous arteries. The common interosseous artery was absent. As the radial and ulnar arteries may be used as microvascular donor or recipient vessels, a good knowledge of the arterial vascularisation of the upper extremity is essential in planning surgical and reconstructive procedures in this area. Secondly, the course of the radial artery in our cadaver may be mistaken for a vein and an intravenous injection in such an artery can result in the loss of the hand or forearm.