No abstract available.
Intracranial Aneurysm*

PURPOSE: A traumatic diaphragmatic rupture (TDR) is a diagnostic challenge and the associated injuries determine the outcome in those diagnosed early. A TDR has long been considered to be a marker of the severity of injury with an average reported Injury Severity Score (ISS) between 31 and 50. This report reviewed the TDR cases in order to emphasize the method and timing of the diagnosis, associated injuries and the outcome. METHODS: A retrospective analysis was performed on 30 patient treated for TDR between August 1998 and september 2002. RESULTS: The mean age of the patients was 33.4 years and the injury predomiantly affected males (male: female=2: 1). Blunt trauma by TA was the most common cause of the TDR (25 patients). The ruptured sites were on the left in 22 cases and on the right in 8 cases. The most common symptom was chest pain (23 cases) followed dyspnea (21 cases). Liver injuries and a pneumo-hemothorax were the most common associated injuries. The mean CRAMS scale was 6.47 and Injury Severity Score (ISS) was 18.93. Eighteen TDR cases were suspected based on the abnormal chest X-ray findings. Nineteen cases underwent surgery within 6 hours after the trauma (early diagnosis). Although many complications occurred in 11 cases, there were no lethal complications. The mean size of the diaphragmatic rupture was 9.77 cm and an intraabdominal organ herniation had not occurred in ruptures smaller than 6 cm. Surgical repair of the diaphragm was performed via a laparotomy in 20 cases and thoracotomy in 7 cases. A left side TDR was preferred to a laparotomy whereas a right sided TDR was preferred to a thoracotomy. Pulmonary complications (atelectasis, pneumonia, pleural effusion) occurred in 14 cases postoperatively. CONCLUSION: The patient's complaints and physical findings were not a reliable indicator of the diagnosis, but usually a manifestation of the associated injuries. A suspicion and routine chest X-ray was the most reliable diagnostic tool, even though the chest X-ray was normal in 12 cases. A high rate of early diagnosis can be achieved using an aggresive investigation protocol, suspicion and a combined radiologic evaluation in multiple trauma patients. Although pulmonary complications occurred in the early diagnosed cases, lethal complications and long term sequela were directly related to the time of diagnosis. The higher ISS had many complications (11 cases) but there were no lethal complications, long term sequela.
Chest Pain ; Diagnosis ; Diaphragm ; Dyspnea ; Early Diagnosis ; Humans ; Injury Severity Score ; Laparotomy ; Liver ; Male ; Multiple Trauma ; Pneumonia ; Retrospective Studies ; Rupture ; Thoracotomy ; Thorax

Although obturator herniae are rare, they are associated with a high mortality, as diagnosis is often delayed and the condition tends to occur in the elderly. The preoperative diagnosis is difficult because of nonspecific symptoms and sign. They often produce a small bowel obstruction. The treatment is always surgical. Several repair techniques have been described: a sac ligation alone, a direct suture repair, and the use of autologous tissue or prosthetic repair. Recently, the placement of permanent mesh prostheses, in a clean contaminated operative field, has been performed due to the minimal wound-related morbidity and patient mortality. Thus, utilization of a permanent mesh in an obturator hernia is a new, simple and effective method for repair. Two cases of a strangulated obturator hernia were experienced in elderly women. The peritoneal cavity was not overly contaminated, with only necrotic foci on the herniated small bowel wall noted. A segmental resection of the small bowel was performed. Consequently, the hernia defect was closed with mesh- plug between the peritoneum and periosteum of the obturator foramen. Here, two cases of obturator herniae treated by use of a mesh-plug are reported, with a brief review of the literature.
Aged ; Diagnosis ; Female ; Hernia ; Hernia, Obturator* ; Humans ; Ligation ; Mortality ; Periosteum ; Peritoneal Cavity ; Peritoneum ; Prostheses and Implants ; Sutures

No abstract available.
Intussusception* ; Peutz-Jeghers Syndrome*

Transfer of large quantities of fetal blood across the placental barrier to the maternal circulation is a rare occurrence which results in severe anemia in the newborn infants. This phenomenon is believed to occur most often during labor and delivery and apparently, is more frequent when abnormal obstetric conditions are present. However, fetal erythrocytes have been identified in the naternal circulation throughout most of pregnancy indicating some degree of constant or intermittent transplacental transfusion. We experienced a case of stillbirth due to large amount of fetomaternal transfusion. Acid elutionl test of maternal blood was positive and direct and indirect Coombs test was negative. Ultrasonographic finding on abdomen and cranium to rule out the internal hemorrhage was normal. We report a case of stillbirth due to fetomaternal transfusion with a brief review of related literatures.
Abdomen ; Anemia ; Coombs Test ; Erythrocytes ; Female ; Fetal Blood ; Fetomaternal Transfusion* ; Hemorrhage ; Humans ; Infant, Newborn ; Pregnancy ; Skull ; Stillbirth*

The cecal perforation is very rare in pediatrics. Our center has experienced a 7-year-old girl with idiopathic perforated cecitis. The surgeon couldn't differentiate perforated cecitis from perforated appendicitis because of anatomical location, incidence and ambiguous radiologic result when this patient was admitted to our clinic due to RLQ pain.
Appendicitis* ; Child ; Female ; Humans ; Incidence ; Pediatrics ; Typhlitis*

An epigastric hernia is a protrusion of the extra-peritoneal fat to the linea alba, between the xiphoid process and the umbilicus. About 3~5% of people develop epigastric hernias. The authors have experienced a case of a 79 year-old woman who had an asymptomatic epigastric hernia, where an abdomen CT is helpful in its diagnosis. The size of the defect was large, and a hernia sac existed. The case of an epigastric hernia, which was treated by a primary repair, is reported, with a brief review of the literature.
Abdomen ; Aged ; Diagnosis ; Female ; Hernia* ; Humans ; Umbilicus

An intussusception was first reported by Barbette in 1674, but an intussusception of the appendix was first reported in London, in 1858. Of all intussusceptions, 5% occur in adults, and of these 90% are as a result of a primary cause. Therefore, treatment is usually based on the primary cause. An intussusception of the appendix can be treated by barium or air reduction, or by an appendectomy, with manual reduction in pediatrics, but these are very uncommon in adult, and can be treated by various methods, according to the underlying cause. A 74 years old woman was preoperatively diagnosed, by radiological examination, to have an intussusception of the appendix. An exploratory laparotomy was performed, and the lesion confirmed as an intussusception caused by an appendix mass, which was cystic and filled with mucin. Therefore, a right hemicolectomy was performed, with the pathological results confirming a mucinous cystadenocarcinoma of the appendix. Here, we report a case of an adult intussusception of the appendix in a 74 years old woman.
Adult ; Aged ; Appendectomy ; Appendix ; Barium ; Cystadenocarcinoma, Mucinous* ; Female ; Humans ; Intussusception* ; Laparotomy ; Mucins* ; Pediatrics

Trauma-related spigelian hernia is a rare event that has been reported only sporadically. Because of its rare nature and nonspecific physical findings, its diagnosis is difficult. This hernia most commonly presents at the level of the semicircular line known as the arcuate line. A 70-year-old man was admitted after overturn of his cultivator. A scratch wound surrounding a cutaneous sign of the cultivator handlebar impact was evident on his right upper abdominal wall. Trauma-related spigelian hernia occurred in the site of the handlebar impact. We report this cases of trauma-related spigelian hernia that was treated by primary repair with a brief review of the literature.
Abdomen* ; Abdominal Wall ; Aged ; Diagnosis ; Hernia* ; Humans ; Wounds and Injuries

It is important to predict the prognosis of patient with cancer. Well known parameters predicting the prognosis are staged and degree of differentiation. Recently, the prognostic and diagnostic significance of silver-stained nucleolar organizer regions(Ag-NORs) and flow cytometric DNA analysis are introduced. This study aims to detect the diagnostic significance of Ag-NORs in breast lesions, and to correlate the number of Ag-NORs and cellular ploidies in breast carcinoma. In addition, the existence of heterogeneity according to the sample in the same patient is studied Sixty six paraffin blocks(two primary lesions and the two metastatic lymph nodes in 13 patients, and one primary lesion and one metastatic lymph node I 10 patients) of breast carcinoma, 30 paraffin blocks of fibroadenoma and 23 paraffin blocks of normal breast are studied. The numbe of Ag-NORs increase from normal breast(mean 1.45) through fibroadenoma(mean 1.60) to carcinoma(mean 2.43). It was significantly different between each lsions(P<0.0005). The number of Ag-NORs increased in the aneuploidy carcinoma than that in the euploidy one(P<0.05). But, there was difference between the number of Ag-NORs and DNA index according to the sample area in the same patient with carcinoma. In conclusion, the number of Ag-NORs is diagnostically significant in breast lesions and is correlated with cellular ploidies in breast carcinoma. In addition, Ag-NORs and cellular ploidies are heterogenous in the same patient.
Neoplasm Metastasis