Anterior sacral meningocele simulating ovarian cyst

Anterior sacral meningocele is a rare condition characterized by the herniation of meningeal membranes and cerebrospinal fluid through a defect in the anterior aspect of the sacrum. We report a case of an anterior sacral meningocele that was mimicking an ovarian cyst.     

Arterial features of inner canthus region: confirming the safety for the flap design

The medial canthus represents a fixed-point fulcrum that is necessary for eyelid function. The aim of the study was to investigate the arterial distribution of the inner canthus. The origin, calibration, and branches of the inner canthus arteries and their topographical relations were examined by dissecting 19 cadavers, injecting red latex to their corresponding 38 nasal sections before the dissection. The distance from the dorsal nasal artery to the inner canthus was found to be 7.2 +/- 0.3 mm. In this study, the average diameter of the dorsal nasal artery was 0.74 mm on the right side and 0.88 mm on the left. Concerning the course of dorsal nasal artery on the lateral side of the nose, 4 types were observed. In most of the examples (44.7%), dorsal nasal artery anastomosed with angular artery via thick branch and gave off supplying branches to the medial canthus and to the lateral side of the nose. Dorsal nasal artery is a vessel of satisfactory size and is potentially a good vascular source for a thin free flap. It may be an ideal flap to reconstruct the eyelid defect for texture and color similarity of the inner canthus skin. A better understanding of the inner canthus vascularity should allow modification of reconstructive techniques and reduce postoperative complications.     

Image construction methods for phased array magnetic resonance imaging

PURPOSE: To study image construction in phased array magnetic resonance imaging (MRI) systems from a statistical signal processing point of view. MATERIALS AND METHODS: Three new approaches for image combination with multiple coils are proposed: 1) one based on the singular value decomposition of the measurement matrix, which is asymptotically optimal in the signal-to-noise ratio sense; 2) one based on a maximum-likelihood formulation, incorporating a priori information on the coil sensitivities in a Bayesian manner; and 3) one based on a least-squares formulation, which incorporates a smoothness constraint on the coil sensitivities. RESULTS: Numerical examples using synthetic and real data are presented to illustrate the performance of these new approaches. Results on the synthetic data show improvement in signal-to-error ratio, while results on the real data (a 4.7 T four-coil image of a cat spinal cord) show that the proposed methods can improve the SNR in the final image by up to 3 dB in the regions of interest compared to conventional sum-of-squares processing. CONCLUSION: It is demonstrated that phased array MRI reconstruction performance can be improved by the use of more elaborate statistical signal processing algorithms.     

Laryngocele in association with ankylosing spondylitis

A laryngocele is a cystic dilatation of the laryngeal saccule. The etiology of laryngoceles is unclear, but congenital and acquired factors are considered to play a role in their development. An acquired laryngocele may develop when the laryngeal ventricle becomes functionally obstructed as a result of an increase in intraglottic pressure, such as that caused by excessive coughing, playing a wind instrument, glass blowing or obstruction of appendicular ostium. We present a case of laryngocele in a patient with ankylosing spondylitis. To the authors' knowledge, and from a review of the literature, this combination has not been previously described. The laryngocele was also infected in this case. We believe that development of the laryngocele might be a result of increased intra-abdominal pressure, caused by rheumatoid arthritis, with associated increased intralaryngeal pressure.     

Hydrocele of the canal of Nuck: sonographic and MRI appearances

Hydrocele of the canal of Nuck is a rare disorder in females. A 50-year-old female presented with the complaint of swelling and occasional pain in the right groin. Sonographic examination revealed a proximal dilatation at the inguinal canal with a 3-cm ovoid, septated cystic lesion at the distal end. The mass appeared as a simple cyst on MRI. Valsalva's maneuver during real-time sonography helped differentiate the hydrocele of the canal of Nuck from an inguinal hernia.     

Utility of preoperative exercise therapy in reducing postoperative morbidity after surgery; a clinical overview of current evidence

Introduction: Surgery is a major stressor especially for older patients that are prone for postoperative complications and mortality. Hospitalization due to surgery and illness can be major life events, and the age-related impairments in physiological function and the decreased ability to respond to metabolic and hormonal perturbations in response to surgery often lead to a longer convalescence.

Areas covered: This article gives an overview of the effects of PET in various surgical fields and also what to account for and expect of PET after various types of surgery. A comprehensive literature search was performed in Pubmed, Embase, Medline, Cochrane Library, and PEDro database (from the earliest date of each database to March 2019) using search words ‘Preoperative Exercise Therapy’, ‘Physical Therapy’ and ‘surgery’. Secondly, the literature searches were modified depending on the surgical specialty.

Expert opinion: Evidence is growing that preoperative exercise therapy in various surgical specialties is well tolerated and effective, with by far the most evidence in the cardiac surgical field. Future improvements in standards of care and optimal pre-operative preparation should not only focus on the surgical team and the hospital organization but also on incorporating the active role of the patient.     

Vancomycin-related partial necrosis of congenital hemangioma

The term hemangioma refers to the common tumor of infancy that exhibits rapid postnatal growth and slow regression during childhood. Infantile hemangiomas are benign vascular neoplasms that develop from the dermal capillary network. Vancomycin is a bactericidal antibiotic agent commonly used in the treatment of infections caused by Gram-positive organisms. The most common adverse effect of intravenously administered vancomycin is “red man syndrome” (RMS), which is associated with the rapid infusion of large doses of vancomycin. This reaction is secondary to mast cell degranulation and is characterized by erythema, pruritus, flushing of the upper torso, and, in severe cases, angioedema and (rarely) cardiovascular complications. We present the case of a 3.5-month-old girl who developed partial hemangioma necrosis secondarily to RMS following intravenous administration of vancomycin for the treatment of Gram-positive bacteremia.Level of Evidence: Level V, prognostic / risk study.     

Comparison of ultrasound-, palpation-, and scintigraphy-guided steroid injections in the treatment of plantar fasciitis

Background  The aim of the study was to compare the efficacies of steroid injections guided by scintigraphy, ultrasonography, and palpation in plantar fasciitis. Methods  A total of 35 heels of 27 patients were randomly assigned to three steroid injection groups: palpation-guided (pg), ultrasound-guided (ug), and scintigraphy-guided (sg). Patients were evaluated for pain intensity before the injections and at the last follow-up of 25.3 months with a 100-mm visual analog scale (VAS). Results  There were significant improvements in plantar fascia thickness, fat pad thickness, and VAS. Among the three groups of ug–pg, ug–sg, and pg–sg there were no statistically significant differences after treatment (P = 0.017, MWU = 36.5; P = 0.023, MWU = 29.5; and P = 0.006, MWU = 13, respectively). Conclusions  The ug, pg, and sg injections were effective in the conservative treatment of plantar fasciitis. We are of the opinion that steroid injections should be performed, preferably with palpation or ultrasonographic guidance.