The size of the foramen ovale regarding to the presence and absence of the emissary sphenoidal foramen: is there any relationship between them?

Background: The study investigates the size of the foramen ovale (FO) in relation to the presence and absence of the emissary sphenoidal foramen (ESF). Any possible alteration of the FO size in relation to the ESF (unilateral or bilateral) presence and absence was also examined. Materials and methods: One-hundred and ninety-five (117 male and 78 female) Greek adult dry skulls were investigated. Results: The ESF was present in 40% of the skulls (21.5% bilaterally and 18.5% unilaterally). No statistical significant difference was detected between ESF presence or absence and its unilateral or bilateral occurrence. The ESF existence had no relation to the FO size. Conclusions: The ESF absence or presence has no effect on FO size. The emissary sphenoidal vein is an additional venous pathway connecting cavernous sinus with the pterygoid venous plexus. These findings enhance that the venous plexus of the FO is a constant trait. The meticulous knowledge of the middle cranial fossa anatomy is of paramount importance during transovale procedures, as the outcome of cannulation may be affected by the existence of ESF, the confluence FO-ESF, the existence of osseous spurs and bridging into the FO. (Folia Morphol 2018; 77, 1: 90–98)

Immediate surgery or conservative treatment for complicated acute appendicitis in children? A meta-analysis

Purpose: This study carried out a meta-analysis to compare immediate surgery (IS) with conservative treatment (CT) of complicated acute appendicitis (CAA) in children. Methods: Systematic literature research was performed for relevant studies published from 1969 to date. Trials of IS compared with CT were included. Outcomes of interest were postoperative morbidity and length of hospital stay (LOS). Results: Fifteen trials were studied (1.243 patients). CT achieved better rates of any complication type (odds ratio [OR] 0.22, [95% confidence interval (CI): 0.14, 0.38], p = 0.001) and wound infection (OR: 0.40 [95% CI: 0.17, 0.96], p = 0.041). Neither intraabdominal abscess (OR: 1.03 [95% CI: 0.31, 3.37], p = 0.958) nor postoperative ileus (OR: 0.29 [95% CI: 0.06, 1.44], p = 0.130) was affected by the treatment option. The polled difference in LOS showed a trend for shorter LOS in the IS group (standard mean difference [SMD]: 0.25 [95% CI: 0.07, − 0.43], p = 0.007). Conclusions: IS was associated with shorter LOS, while overall complication rates and wound infection declined significantly with CT. The development of intraabdominal abscess and postoperative ileus was not affected by the treatment of choice. The heterogeneity of most studies depicts the need for randomized controlled trials (RCTs) to discover safe management of CAA in children. Level of evidence: III: Type of study: Meta-analysis. © 2018 Elsevier Inc

Double versus single cervical cerclage for the prevention of preterm births

Objective: To evaluate the effectiveness double cervical cerclage in reducing antenatal complications and improve perinatal outcomes. Methods: We searched Medline, Scopus, Clinicaltrials.org, The Cochrane Central Register of Controlled Trials and Google Scholar search engines. Results: Six studies were included that involved 880 women. Double cerclage was significantly superior to single cerclage in reducing preterm births <34weeks (734 cases, OR 0.59, 95% CI 0.40, 0.86) and preterm births <28weeks (645 cases, OR 0.43, 95% CI 0.26-0.73). It also significantly increased the gestational age (380 cases, MD 2.63, 95% CI 0.87, 4.39). However, as a technique, it failed to improve the rates of preterm births <37weeks (740 cases, OR 0.98, 95% CI 0.72, 1.34) the incidence of chorioamnionitis (740 cases, OR 0.83, 95% CI 0.51, 1.36) and the occurrence of preterm premature rupture of the membranes (796 cases, OR 1.32, 95% CI 0.95, 1.82). Conclusions: It seems that double cerclage effectively increases the gestational age at delivery and decreases the rates of extremely premature births. However, as a procedure, it does not reduce the incidence of antenatal morbidity or the neonatal death rates. Further research is needed in the field as our meta-analysis is limited by the small number of enrolled studies. © 2014 Informa UK Ltd. All rights reserved: reproduction in whole or part not permitted

The size of the foramen ovale regarding to the presence and absence of the emissary sphenoidal foramen: Is there any relationship between them?

Background: The study investigates the size of the foramen ovale (FO) in relation to the presence and absence of the emissary sphenoidal foramen (ESF). Any possible alteration of the FO size in relation to the ESF (unilateral or bilateral) presence and absence was also examined. Materials and methods: One-hundred and ninety-five (117 male and 78 female) Greek adult dry skulls were investigated. Results: The ESF was present in 40% of the skulls (21.5% bilaterally and 18.5% unilaterally). No statistical significant difference was detected between ESF presence or absence and its unilateral or bilateral occurrence. The ESF existence had no relation to the FO size. Conclusions: The ESF absence or presence has no effect on FO size. The emissary sphenoidal vein is an additional venous pathway connecting cavernous sinus with the pterygoid venous plexus. These findings enhance that the venous plexus of the FO is a constant trait. The meticulous knowledge of the middle cranial fossa anatomy is of paramount importance during transovale procedures, as the outcome of cannulation may be affected by the existence of ESF, the confluence FO-ESF, the existence of osseous spurs and bridging into the FO. Copyright © 2018 Via Medica

Prenatal cocaine exposure and its impact on cognitive functions of offspring: A pathophysiological insight

It is estimated that approximately 0.5%-3% of fetuses are prenatally exposed to cocaine (COC). The neurodevelopmental implications of this exposure are numerous and include motor skill impairments, alterations of social function, predisposition to anxiety, and memory function and attention deficits; these implications are commonly observed in experimental studies and ultimately affect both learning and IQ. According to previous studies, the clinical manifestations of prenatal COC exposure seem to persist at least until adolescence. The pathophysiological cellular processes that underlie these impairments include dysfunctional myelination, disrupted dendritic architecture, and synaptic alterations. On a molecular level, various neurotransmitters such as serotonin, dopamine, catecholamines, and γ-Aminobutyric acid seem to participate in this process. Finally, prenatal COC abuse has been also associated with functional changes in the hormones of the hypothalamic-pituitary-Adrenal axis that mediate neuroendocrine responses. The purpose of this review is to summarize the neurodevelopmental consequences of prenatal COC abuse, to describe the pathophysiological pathways that underlie these consequences, and to provide implications for future research in the field. © 2016 by De Gruyter

Teenage pregnancy antenatal and perinatal morbidity: Results from a tertiary centre in Greece

We present the experience of a tertiary referral hospital in Greece, evaluating obstetric and perinatal outcomes among teenage and average maternal age (AMA) women. We retrospectively assessed all singleton pregnancies during a twelve-month period (January-December 2012). A total of 1,704 cases were reviewed and divided into two groups: one of AMA mothers (20-34 years old) (1,460 women) and the other of teenage mothers (12-19 years old) (244 women). We observed significantly higher incidence rates of preterm births (p < 0.001), preterm premature rupture of the membranes (p < 0.001), gestational hypertension (p < 0.001), preeclampsia (p = 0.043) and Apgar scores < 7 at 5 min (p = 0.015) among teenage mothers. Antenatal surveillance was decreased among teenage mothers (p < 0.001), while rates of anaemia were higher (p < 0.001). Teenage pregnancy is accompanied by significant antenatal and perinatal complications that need specific obstetrical attention. Obstetricians should be aware of these complications in order to ameliorate the antenatal outcome of childbearing teenagers. © 2015 © 2015 Taylor & Francis Group, LLC

Retention of cervical cerclage after preterm premature rupture of the membranes: a critical appraisal

Purpose: The present meta-analysis aims to assess the efficacy of cervical cerclage retention after the occurrence of preterm premature rupture of the membranes by analyzing the observed maternal and neonatal perinatal outcomes. Methods: We searched Medline (1966–2014), Scopus (2004–2014), Clinicaltrials.org (1997–2014), Cochrane Central Register of Controlled Trials (CENTRAL) (1999–2014) and Google Scholar (2004–2014) search engines, as well as reference lists from all included studies. The statistical analysis was performed using the RevMan software. Results: Six studies were finally included in the present review, involving 293 parturient. Cerclage retention did not significantly prolong the gestational latency period (MD 2.56 days, 95 % CI − 1.06, 6.71). It did, however, increased the rates of delivery after the first 48 h (OR 6.27, 95 % CI 1.08, 36.24). As a technique, it did not significantly increase the rates of neonatal sepsis (OR 1.42, 95 % CI 0.65, 3.12) or the neonatal death rates (OR 1.09, 95 % CI 0.48, 2.47).Maternal chorioamnionitis was, however, significantly more prevalent among women offered cerclage retention (OR 1.78, 95 % CI 1.02, 3.12), although the same was not observed in the case of postpartum endometritis (REM OR 4.73, 95 % CI 0.74, 30.09). Conclusions: Current evidence is insufficient to support the retention of cervical cerclage after the occurrence of PPROM, therefore, its implementation should be exceptionally instituted in everyday clinical practice, until further evidence becomes available. © 2014, Springer-Verlag Berlin Heidelberg

TNFAIP3 F127C coding variation in Greek primary sjogren's syndrome patients

Tumor necrosis factor, alpha-induced protein 3 (TNFAIP3) gene encodes the A20 protein, an important negative feedback regulator of the nuclear factor kappa-light-chain-enhancer of activated B cell (NF-κB) pathway. A coding TNFAIP3 variant, namely rs2230926, has been previously linked to B cell non-Hodgkin's lymphoma (NHL) development in patients with Sjogren's syndrome (SS) of French and UK origin. Herein, we aimed to determine the prevalence of rs2230926 in a Greek primary SS cohort and explore possible associations with disease characteristics. The rs2230926 gene variant was genotyped in 327 primary Greek SS patients (ninety-one complicated by NHL (SS-lymphoma)) and 448 Greek healthy controls (HC) of similar age and sex distribution. Clinical and laboratory characteristics were also recorded and gene expression of relevant genes of the NF-κB pathway was quantitated by real-time PCR in available whole peripheral blood (PB) from 165 primary SS patients. Increased prevalence of the rs2230926 mutant variant was detected in both SS-lymphoma and SS-nonlymphoma subgroups compared to HC (8.8% vs. 7.6% vs. 3.6%, p values: 0.04 and 0.03, respectively) in association with higher IgM, LDH serum levels, and PB Bcl-XL transcripts but lower leucocyte and neutrophil counts. Of interest, approximately one-fifth of SSlymphoma cases with age at disease onset ≤ 40 years carried the rs2230926 variant (18.2% vs. 3.6%, OR 95% (CI): 6.0 (1.8-19.8), p value: 0.01). We postulate that deregulation of the NF-κB pathway as a result of the TNFAIP3 rs2230926 aberration increases SS and SS lymphoma susceptibility particularly in patients with early disease onset. Copyright © 2018 Adrianos Nezos et al