Double myelomeningocele: case report

Double myelomeningocele is very rare, with only a few cases are published in the world's literature. The mechanism of this form of neural tube defects constitutes a challenging problem. The authors present an unusual case of a 3 month-old child, with two myelomeningoceles, one at the cervical level and the other at the lumbar level, without hydrocephalus or Chiari malformation.     

双J管在小儿离断性肾盂成形术中的应用

目的：探讨双J管内引流在小儿离断性肾盂成形术中的应用效果。方法：在离断性肾盂成形术中采用放置双J管作内支架和内引流治疗小儿肾盏输尿管连接部（UPJ）梗阻35例40侧，术后留置导尿5－7天，4－6周拔除双J管，结果：术后无切口感染，漏尿管并发症，患肾积水明显好转，吻合口通畅，结论：双J管具有内支架和内引流的双重作用，并发症少，减少了术后再狭窄的机会，缩短了住院时间，使用安全，可靠。     

Double Hamoudi: A case report

INTRODUCTIONSolid pseudopapillary neoplasms are rare pancreatic neoplasms with low malignant potential and favorable prognosis that are typically seen in young women.PRESENTATION OF CASEWe report a case of two large solid pseudopapillary neoplasms in a 23-year old woman who was treated successfully with a total pancreatectomy.CONCLUSIONTo the best of our knowledge, this is the first report of two discrete solid pseudopapillary neoplasms in the same patient.     

Anomalous digital nerve loop: A case report

In this case, a digital nerve loop was observed during the dissection of the digital nerves to the third web space; the common digital artery was passing through this loop. This rare case is presented and its importance is discussed. © 1998 Wiley-Liss, Inc. MICROSURGERY 18:170–171 1998     

Double gall-bladder--two pathologies: a case report

True gall-bladder duplication is a rare biliary anomaly, which is usually discovered as an incidental finding. There are reports of double gall-bladders missed during the first operation. We present the case of a double gall-bladder which, albeit suspected during the operation, was confirmed post-operatively. The patient underwent successful laparoscopic cholecystectomy and the examination of the resected gall-bladder revealed two chambers, only one containing stones. Predisposing factors for the development of gall-stones in one gall-bladder only, as well as surgical options, are briefly discussed.     

Bilateral multiple ureteral diverticula diagnosed after ileal loop procedure: report of a case and review of the literature

We report a case of multiple diverticula of the ureter. The clinical and radiological findings of the previously reported 41 cases, including our own, are analyzed, and the microscopic findings of the condition are reviewed. Multiple diverticula of the ureter or ureteral diverticulosis is most likely an acquired condition with a distinct radiological appearance.     

Double myelomeningocele: case report and review.

The presence of a myelomeningocele at multiple levels along the spinal column is a rare event. There are only a few cases of double myelomeningocele reported in the world's literature. Large myelomeningoceles present surgical closure challenges due to the size and location of these defects. We report the case of a newborn female who had two myelomeningoceles with one at the thoracic level and the other at the lumbar level. Surgical closure must provide durable and stable coverage for the spinal cord. Stable coverage was provided for this patient using bilateral paraspinous myofascial turnover flaps. This unusual case report as well as a review of the literature is presented.     

Suprapubic catheter insertion is an outpatient procedure: cost savings resultant on closing an audit loop

OBJECTIVE

To explore, by an audit, the regional practice of inserting a suprapubic catheter (SPC), and to prospectively determine the proportion of patients that can be successfully managed on an outpatient basis in one department.

METHODS

Both local and regional practice were determined by a retrospective analysis of the hospital database for all cases of SPC insertion between April 2005 and March 2006. In addition, a questionnaire was e‐mailed to each of 11 urology departments. Locally, from August 2006 onwards, all patients scheduled for SPC insertion were referred to a new clinic, where the SPC was inserted using a new SPC kit and the Seldinger technique.

RESULTS

Locally, 66 patients (mean age 70 years, range 26–93) had a SPC inserted between April 2005 and March 2006; 49 had an elective procedure while 17 were emergency admissions. The median (range) hospital stay was 3.5 (1–85) days. Within the region, 480 SPCs were inserted in theatre during the same period, of which 52% (249) were inserted as elective inpatients, 11% (52) were inserted as a day case, and 37% (179) had SPCs as emergency admissions. A nurse‐led outpatient service was available in two hospitals, where 89% of patients seen in the clinic had successful insertion under local anaesthesia, and only 11% were referred for insertion under general anasthesia. Between August 2006 and July 2007, 50 of 54 patients had a SPC inserted successfully in the new SPC clinic. There were no major complications. The cost benefits of adopting an outpatient management strategy were significant, at ≈£GB 100 000/year in our hospital, £790 000/year in the region and £9 500 000/year for the UK.

CONCLUSION

An outpatient procedure for a SPC is safe and feasible in most patients, and its widespread use would produce considerable cost savings.     

Knotting of an epidural catheter: a case report.

Difficulty with removal of an epidural catheter is described due to formation of a knot near the end of the catheter. It is stressed that in the lumbar area an epidural catheter should never be inserted more than 5 cm into the epidural space, as curling with knot formation may occur. Removal may be attempted by pulling on the catheter if testing of a similar catheter indicates that it will withstand the tension. The patient and the spouse should be kept informed and involved in the decision-making for medico-legal reasons.     

Intrahepatic migration of a peritoneal shunt catheter: case report

The intrahepatic migration of a peritoneal shunt tube of a ventriculoperitoneal shunt system (low pressure Pudenz valve and low pressure Pudenz peritoneal catheter) is reported. This is a rare complication of ventriculoperitoneal shunting and was diagnosed by metrizamide shuntography and abdominal computed tomography. To our knowledge, this is the second case complicated with migration of a peritoneal shunt tube into the liver.     

Lunate migration following Darrach's procedure: a case report

We report a case of a 28-year-old female patient who underwent Darrach's procedure to her dominant right wrist affected by rheumatoid disease. She developed severe pain in the wrist 4 weeks postoperatively. Collapse of the scaphoid and proximal migration of the lunate was noted. Total wrist arthrodesis using the Arbeitsgemeinschaft für Osteosynthesefragen wrist arthrodesis plate was performed, which alleviated the pain. Darrach's procedure is described for conditions causing derangement of the distal radio-ulnar joint, the classical inflammatory cause being rheumatoid arthritis. It is however a potentially destabilising procedure. The extreme complication encountered in this case highlights the risk of Darrach's procedure if pre-existing ligamentous instability is present.     

Double duodenal atresia with perforation: a case report

Duodenal atresia is a common cause of neonatal bowel obstruction. Double duodenal atresia has been reported as a rare variation of duodenal atresia. This report discusses the importance of an appreciation of unusual anatomy in neonatal duodenal obstruction and highlights the importance of assessing bowel continuity intraoperatively.