Inguino-scrotal hernia of a double district ureter: case report and literature review

Ureteral hernia is uncommon and usually misdiagnosed. From an anatomic point of view, we can distinguish between two uretero-inguinal hernias: intraperitoneal and extraperitoneal. Ureter inguinal hernias are nearly always indirect. This kind of hernia can include the ureter alone or, frequently, other abdominal sliding organs within the hernia sac (bladder, bowel tracts, etc.). Kidneys and urinary tracts present normal anatomic conformation, although renal ptosis may be found. As of July 2004, 139 cases of ureteral hernia had been described in the literature. Here we report a case of inguino-scrotal herniation of double district ureter and review the current literature to analyze the main clinical characteristics of this pathology and to establish pitfalls.     

Soft tissue facial volumes and shape in skeletal Class III patients before and after orthognathic surgery treatment.

BACKGROUND: To obtain the best surgical results in orthognathic surgery, treatment planning and the evaluation of results should be performed on measurable three-dimensional reproductions of the face of the patients, and compared to reference subjects. METHODS: Seven women aged 18-35 years, all with a skeletal Class III and mandibular asymmetry, were assessed both before (on average, 2 months) and after (on average, 10.7 months) surgical intervention (mandibular reduction by sagittal split osteotomy and LeFort I maxillary advancement). The three-dimensional coordinates of 50 soft tissue facial landmarks (face, eyes, nose, mouth and lips, ears) were collected with a noninvasive, electromagnetic digitizer; facial volumes were estimated, and compared to reference values collected in 87 healthy women of the same age and ethnic group. Inter-individual modifications in facial shape were also assessed. RESULTS: Before surgery the patients had smaller faces than the reference women, with larger lower lips and noses. A large within-group variability was found. Surgical treatment significantly reduced total facial volume and mandibular volume, increased total and upper lip volumes (Student's t test, p<0.05), and made all values more homogenous within the group. Shape differences were significantly larger before than after surgery. On average, right side gonion was the landmark that moved the most, closely followed by menton, while the tragi and ala nasi moved the least. The three-dimensional approach used in this study enabled quantitative evaluation of the final soft tissue results of surgery, without submitting the patients to invasive procedures.     

Transnasal sinusectomy with combined microscopic and endoscopic technique

Severe, diffuse polyposis can be adequately treated through a transnasal approach which combines microscopic and endoscopic surgery. The operating microscope is used to perform ethmoidectomy, usually from the front to the back, and to open the sphenoid sinus and the antral window. The telescopes allow the sphenoid and maxillary sinuses to be cleaned under direct view control as well as enabling good drainage to be performed from the frontal sinuses. The results from 22 consecutive patients were good, with a very low rate of minor post-operative complications.     

Significance of PBMC response of rheumatic fever patients and control individuals to immunodominant streptococcal M5 protein epitopes

β-hemolytic streptococcal infection in developing countries still causes thousands of cases of Rheumatic Fever (RF). Molecular mimicry between streptococcal M protein (strep M) and heart components has been proposed as the triggering factor leading to autoimmunity in individuals with genetic susceptibility, which is linked to different HLA-DR alleles in different populations. In our hands, RF was significantly associated to HLA-DR7/53. Previous work in our lab has shown that heart-infiltrating T cells that simultaneously recognize strep M and heart proteins. Further, such T cells predominantly recognized the 81-103 strep M5 epitope. In this work, we analysed the proliferative response of peripheral blood mononuclear cells of 99 RF patients and 40 normal controls. Eighty-nine of the RF patients were HLA-typed. As among heart-infiltrating T cells, the 81-103 strep M5 protein epitope is the most frequently recognized epitope among RF PBMC (35.4%), against a 7.5% frequency of proliferation among normal controls (p=0.0018, chi square). However, the 81-103 epitope was as frequently recognized by HLA-DR7,53 positive as by negative individuals (45.2% vs 54.8%, respectively). Taken together, the results suggest that the 81-103 strep M5 epitope may be the immunodominant epitope, “promiscuously” recognized by T cells in a genetically diverse population. The demonstration that molecular mimicry is targeted to a discrete immunodominant “promiscuous” epitope in strep M5 may allow the development of a safe anti-streptococcal synthetic vaccine devoid of such epitopes.     

3D facial morphometry in Italian patients affected by Aicardi syndrome

Aicardi syndrome (AIC) is a rare congenital neurodevelopmental disorder of unknown etiology, that affects almost exclusively females, originally characterized by corpus callosum agenesis, chorioretinal lacunae, and infantile spasms. The current diagnostic criteria also include qualitative facial features (prominent premaxilla, upturned nasal tip, decreased nasal bridge angle, sparse lateral eyebrows, and microphthalmia) that still need quantification. A three‐dimensional (3D) photogrammetric assessment of 11 Italian females, age 7–32 years, who satisfied AIC criteria, was performed. Linear distances and angles were computed from soft‐tissue facial landmarks coordinates. The z‐score values were calculated using data of 850 healthy reference females matched for age and compared by Mann–Whitney test (p < .01). Patients showed a shorter philtrum and right side orbital height (mean z‐scores: ?1.7, ?0.9), shorter superior, middle, and inferior facial depths (mean z‐scores: ?1.3, ?2.2, ?2.3), and a smaller length of mandibular ramus (mean z‐score: ?2.1); conversely, they showed larger nasal and lower facial widths, and lower facial convexity (mean z‐scores: 1.7, 1.4, 2.4). The inclinations of the orbit versus the true horizontal were increased bilaterally (mean z‐scores: 1.8, 1.1). Some common facial abnormalities were quantified in AIC patients using a noninvasive instrument. They may help clinicians in performing a definite AIC diagnosis in atypical or doubt cases.     

Intracranial capillary hemangiomas: literature review in pediatric and adult population

Neurosurgical Review - Capillary hemangiomas (CHs) of the central nervous system represent a rare diagnosed pathology. CHs are benign vascular tumors whose most common manifestations are dermal and...     

Color-doppler velocimetry of uterine arteries in pregnant and nonpregnant patients during multiovulation induction for IVF

Objectives To evaluate uterine artery resistance during multiovulation induction in relation to the implantation rate in patients attendingin vitro fertilization (IVF) cycles.Patients Multiovulation induction for IVF was monitored by daily determination of the pulsatility index (PI) of the uterine arteries, obtained by a transvaginal probe (6.5 MHz) implemented with color-flow imaging. Doppler data were obtained from 5 days before hCG administration to the day of follicular aspiration. One IVF cycle was monitored in 70 patients. In 17 patients, 41 IVF cycles were monitored until a successful attempt occurred.Results In the 70 patients studied during one IVF attempt, the PI of the uterine arteries significantly varied (P < 0.001) in the different phases of the cycle. In the 24 patients who conceived, a significantly lower PI (P < 0.03) was found throughout the cycle. This result was mainly due to a highly significant difference of PI values observed the day after hCG administration (P < 0.005). In the 17 patients who conceived after 1 to 4 negativein vitro fertilizations, no significant difference in PI was observed in the uterine artery resistance in cycles in which implantation was or was not successful.Conclusions Uterine artery resistance varies significantly during phases of the induction therapy. Uterine artery resistance is lower throughout the course of multiovulation induction in patients with higher pregnancy rates. The PI on the day after hCG administration was the best index of pregnancy rate. Low uterine artery resistance was present even in negative attempts in patients who eventually achieved a successful implantation. PI values 3 can be considered a favorable prognostic factor for future IVF cycles.Presented at the 49th Annual Meeting of the American Fertility Society, Montreal, 1993 and the 50th Annual Meeting of the American Fertility Society, November 5–10, 1994, San Antonio, Texas.     

Managing (In)differently: The management and delivery of Australian nursing care under the economic rationalists

Conclusion Economic (mis)management in Australia has understandably been influenced by the experiences of countries such as the UK and the USA with which Australia has traditionally had a close relationship. However, the uncritical acceptance of economic rationalism is an indication of our nation's seduction by the possibility of a quick fix for a struggling economy. In accepting economic rationalism there has been a dismissal, or at least a failure to take account of, both past Australian experiences and the overseas experience—including the recent experience of a close neighbour, New Zealand, whose health system is under severe strain.The introduction of economic rationalist programmes into the Australian health sector was an attempt to contain expenditure and at the same time reduce dependence on the public system. This has failed to happen on both counts. Its only real achievement has been to produce yet more evidence of the practical inadequacies of economic rationalism in general.