Three level spinal dysraphism: Multiple composite Type 1 and Type 2 split cord malformat?on

It has reported an uncommon case a 3 year-old girl a composite split cord malformation (SCM) with two different levels of SCM type1 and one level SCM type2, tight filum and sacral dermal sinus. The patient was admitted with a hypertrichosis and hyperpigmented patch. MRI of whole spine and brain was done. SCM type1 at T 7 and L2 levels and SCM typ2 at T11 level were removed then tight filum was cut and dermal sinus was excised at different sites during the same surgery

Three level spinal dysraphism: multiple composite Type 1 and Type 2 split cord malformation

İstanbul Bilim Üniversitesi, Tıp Fakültesi.It has reported an uncommon case a 3 year-old girl a composite split cord malformation (SCM) with two different levels of SCM type1 and one level SCM type2, tight filum and sacral dermal sinus. The patient was admitted with a hypertrichosis and hyperpigmented patch. MRI of whole spine and brain was done. SCM type1 at T 7 and L2 levels and SCM typ2 at T11 level were removed then tight filum was cut and dermal sinus was excised at different sites during the same surgery

Postmenopozal Kadında Az Diferansiye Sertoli-Leydig Hücreli Tümör

Sertoli--Leydig hücreli tümör (SLHT)'lerin %70--75'i 40 yaşın altında, 0/010'dan azı menarştan önce veya postmenopozal dönemde görülmektedir. Bu çalışmada, postmenopozal lekelenme şek-- linde vajinal kanama ile hastanemize başvuran, sağ adneksiyal kitle saptanan 59 yaşındaki kadın olgu sunulmuştur. Olguya batın yıkama sıvısı örneklemesi, total abdominal histerektomi ve bilate-- ral salpingooferektomi yapıldı. İntraoperatif frozen kesitlerin değerlendirilmesinde seks kord stro-- mal tümör düşünüldü. Periton biyopsileri, omentektomi ve pelvik, paraaortik lenf nodu diseksiyonu ile evreleme cerrahisi yapıldı. Solid ve kistik alanlar içeren kitleden hazırlanan kesitlerin histopa-- tolojik incelemesinde; immatür görünümdeki sertoli hücrelerinin tübüller yanı sıra geniş sarko-- matöz dağılım paterni oluşturduğu görüldü. İmmünohistokimyasal çalışmada CD 56 ile kuvvetli, kalretinin, inhibin ile fokal pozitif boyanma görüldü. Histopatolojik ve immünohistokimyasal bul-- gular değerlendirilerek az diferansiye SLHT tanısı verildi. Az diferansiye SLHT nadir görülen, ayı-- rıcı tanısında iğsi hücre komponentli tümörlerin düşünülmesi gereken overin seks kord stromal tümörüdür.70—75% of Sertoli—Leydig cell tumors (SLCT) are diagnosed at before age of 40, and less than 10% takes place before menarche and following menapouse. We report case of right adnexal mass in 59 year—old postmenapousal woman who presented with vaginal bleeding. Sex—cord stro— mal tumor was diagnosed at peroperative frozen section assesment. Staging surgery consisting of peritoneal biopsies, omentectomy and pelvic paraaortic lymph node dissection was performed. ln histopathologic assesment of the slides which were prepared from solid—cyctic areas of the mass, revealed immature sertoli cells forming tubules and wide sarcomatoid differantiation. lmmunhis— tochemically, neoplastic cells stained strongly and diffusely positive with CD 56, focal positive with calretinin and inhibin. Poorly differentiated SLCT was diagnosed with the consideration of both histopathologic and immunhistochemical findings. Poorly differantiated SLCT are unusual sex cord stromal neoplasms of ovary of which differantial diagnosis should include spindle cell neoplasms

CT Fluoroscopy-Guided Percutaneous Gastrostomy in the Palliative Management of Advanced and Relapsed Ovarian Cancer: The Charité Experiences and a Review of the Literature

Peritoneal carcinomatosis-associated malignant bowel obstruction is a common feature that merits more attention in advanced and recurrent ovarian cancer. Decompressive gastrostomy is one of the most preferred methods to palliate distressing symptoms and maintain patients’ quality of life. We retrospectively identified 31 patients with ovarian cancer-associated MBO, who underwent decompressive CT fluoroscopy-guided percutaneous gastrostomy (CT-PG) between September 2015 and April 2023 at our institution. A systematic literature review was conducted for CT-guided gastrostomy in ovarian cancer. Prior to CT-PG, 27 (87%) patients underwent unsuccessful attempts at endoscopic gastrostomy or surgery due to bowel obstruction; a total of 55% had received ≥3 lines of chemotherapy. CT-PG could be successfully inserted in 25 of 31 (81%) patients without grade 4–5 complications. CT-PG insertion was feasible in 76% of patients with previous unsuccessful attempts of endoscopic gastrostomy. A total of 80% of patients with a successful insertion had considerable symptom relief and could tolerate fluid intake. Mean survival after the procedure was 44.4 days. Chemotherapy could be administered in 7 of 25 (28%) patients following the CT-PG insertion. CT-guided percutaneous gastrostomy is a safe procedure that effectively manages intractable symptoms of bowel obstruction in ovarian cancer. This minimally invasive technique should be emphasised as a routine instrument within the palliative management of MBO

Anthropometric differences in the newborns with brachial plexus palsy, clavicle fracture in pregnancies without risk factor

Amaç: Omuz distosisi açısından düşük risk taşıyan olgularda brakiyal pleksus felci, klavikula kırığı ve omuz/humerus kırığı komplikasyonları nı yaşayan yenidoğanların antropometrik verilerinden yararlanarak antenatal değerlendirmeye yönelik öngörü oluşturmak. Yöntem: Distosik doğuma neden olabilecek fetal makrozomi, maternal diyabet, maternal obezite ve gebelikte aşırı kilo alımı, omuz distosisi öyküsü, doğum indüksiyonu, epidural anestezi gibi risk faktörleri dışlandıktan sonra hastane veri tabanından retrospektif olarak çıkarılan doğum komplikasyonu olguları, aynı obstetrik ve demografik özellikleri taşıyan, ancak doğum travması yaşamayan, aynı tartı ve cinsiyette yenidoğan verileri ile birebir eşleştirildi. Bulgular: 185 yenidoğan komplikasyonu gözlendi; bunların 149 tanesi klavikula kırığı, 8 tanesi omuz ve humerus kırığı, 28 tanesi de brakiyal pleksus felci olarak sınıflandırıldı. Doğum komplikasyonu yaşanan olgularda doğumun 2. evresinin anlamlı şekilde daha uzun olduğu görüldü (p=0.01; 22.41±6.98 dakikaya karşılık 24.23±6.43 dakika). Omuz distosisi, komplikasyonların yaşandığı çalışma grubunda daha sık gözlendi (p=0.0001; sıklığı %32.97’ye karşılık %2.7). Antropometrik ölçümler açısından göğüs çevresi / baş çevresi oranları nın ROC çalışması anlamlı saptandı, oranın 0.97’den büyük olması durumunda (AUC=0.903; sensitivite %77.84, spesifisite %89.73, PPD %88.3, NPD %80.2, LR 7.58) omuz distosisi ve komplikasyonları öngörebileceği görüldü. Komplikasyonların 4000 gramın üstündeki olgularda anlamlı olarak artmaya başladığı saptandı (p=0.029). Sonuç: Doğum kanalı içinde omuzlar ve uzantıları travmaya açıktı r. İleri sürdüğümüz hipotezde neonatal antropometrik veriler komplikasyonlar ile anlamlı şekilde korele bulunmuştur. Bir öngörüde bulunmak için, antenatal dönem ve özellikle de eylem sırasında fetal baş ölçümlerinin yanı sıra ayrıca bisakromiyal çap ve göğüs çevresi ölçümleri yardımcı olabilir.Objective: To make predictions for antenatal evaluation by using anthropometric data of the newborns which undergo the complications of brachial plexus palsy, clavicle fracture and shoulder/humerus fracture in cases with low risk in terms of shoulder dystocia. Methods: After the risk factors that may cause deliveries with dystocia such as fetal macrosomia, maternal diabetes, maternal obesity and excessive weight gain during pregnancy, history of shoulder dystocia, labor induction and epidural anesthesia were ruled out, birth complication cases found in the hospital database retrospectively were matched one by one with data of the newborns which had same obstetric and demographic characteristics, same weights and genders but did not undergo labor trauma. Results: A total of 185 newborn complications were observed, and of these complications, 149 were classified as clavicle fracture, 8 as shoulder and humerus fracture, and 28 as brachial plexus palsy. It was seen that the 2nd stage of labor was significantly longer in the cases which underwent birth complication (p=0.01; 22.41±6.98 minutes vs. 24.23±6.43 minutes). Shoulder dystocia was more frequent in the study group which had complications (p=0.0001; 32.97% vs. 2.7%). In terms of anthropometric measurements, the ROC analysis of thorax circumference / head circumference ratio was significant, and it was seen that shoulder dystocia and the complications could be predicted in case that the ratio is higher than 0.97 (AUC=0.903; sensitivity 77.84%, specificity 89.73%, PPV 88.3%, NPV 80.2%, LR 7.58). It was found that the rate of complications increased significantly in cases which were above 4000 g (p=0.029). Conclusion: Shoulders and its extensions are vulnerable to trauma within birth canal. In our hypothesis, neonatal anthropometric data were significantly correlated with the complications. In order to make a prediction, bisacromial diameter and thorax circumference measurements as well as fetal head measurements may be helpful during antenatal period and labor in particular

Neural Tube Defects in Jarcho-Levin Syndrome: Study of Twenty-Eight Cases

WOS: 000355932100001PubMed ID: 25792257Jarcho-Levin syndrome (JLS) is a congenital disorder consisting of various vertebral and costal anomalies. Congenital heart defects, abdominal wall malformations, urogenital and anal abnormalities, multiple skeletal anomalies, upper limb anomalies, spina bifida, and inguinal, umbilical and diaphragmatic hernias can be seen as components of JLS. Spina bifida appears to be a common finding in reported JLS cases. We retrospectively reviewed the medical records, plain Xrays and MRIs of patients with spina bifida between 2010 and 2014 and discussed the results. (C) 2015 S. Karger AG, Base

Safe surgical approach to extrahepatic pseudocyst, a rare shunt complication: 2 case reports

Abstract Background Hepatic pseudocysts are not a common complication and “extrahepatic” pseudocysts are rarer complications but may occur in every ventriculo-peritoneal shunt patient. Case presentation We present two patients with ventriculo peritoneal shunt induced extrahepatic pseudocysts, who underwent shunt surgery for different etiologies. Etiology, treatment strategies and our choice of treatment have been discussed. Conclusions When a ventriculoperitoneal shunt patient is presented with non-specific abdominal symptoms, the possibility of this complication should always be considered. In the treatment of this complication, it is shown that repositioning the catheter is sufficient for cyst regression