Search

Giant congenital melanocytic nevus (GCMN) is a rare birthmark disorder that reportedly affects 1 in 20,000–500,000 live births. Here, we present a case of GCMN in a 1-day-old newborn that covered the entire abdomen, reaching the thigh and chest, and laterally toward the backward aspect of the trunk to involve the entire back and buttocks. We discuss the diagnostic and treatment approach.

Purpose Perfusion zones of the deep inferior epigastric perforator (DIEP) flap aid surgeons in estimating approximate tissue territory with reliable perfusion. Since the Hartrampf perfusion zone was developed, it has been modified continuously; however controversies remain regarding whether the recent perfusion models can satisfy current anatomical and clinical evidence. We conducted a comprehensive review of previous studies to synthesize relevant knowledge and critically reappraise current perfusion models. Methods All anatomical and clinical studies that investigated perfusion of DIEP flaps were searched, yielding 21 studies suitable for review. A meta-analysis was conducted when sufficient data were provided. Results The perforators had unpredictable subcutaneous courses and were preferentially directed laterally. The medial and lateral perforators showed different characteristics in terms of branching pattern, orientation, and linking vessels between them. Ex-vivo perfusion findings suggested that medial perforators favored Hartrampf zone II rather than zone III and perfused the entire abdomen frequently, whereas the lateral perforators favored zone III and their perfusion territories were limited primarily to the hemi-abdomen. In the meta-analysis based on the clinical perfusion studies, zone III had significantly higher perfusion than zone II (P = 0.04) and these tendencies remained in both medial and lateral perforator-based flaps. Conclusions Considerable discrepancies were found between findings of ex-vivo and clinical perfusion studies. A thorough review of existing knowledge based on the perforasome concept explained these discrepancies satisfactorily and revealed unsolved issues of the current perfusion models. Flap perfusion clearly varies widely individually; however, this review will help with surgical planning and decision making. © 2016 Wiley Periodicals, Inc. Microsurgery, 38:98-108, 2018.

A two-point Dixon technique using a novel phase-correction algorithm and commercially available dual-echo fast gradient-echo pulse sequence is presented. The phase-correction algorithm determines the directional rather than phase distribution of signals due to field inhomogeneities. Specifically, a region-growing scheme uses precalculated spatial gradients of the signal phase to guide the growth sequence, so there is no need to manually select the seeds or use an empirical angular threshold. Further, the determination of the signal direction of a given pixel is based on both the amplitude and phase of the surrounding pixels, the direction of which has already been determined. The advantages of this algorithm include its easy implementation, computational efficiency, and robustness in the presence of pixels with large phase uncertainty. The feasibility and usefulness of the technique are demonstrated in vivo with artifact-free water and fat images of an entire abdomen in a single breath-hold.

CT has become the primary imaging modality for evaluation of possible appendicitis. About 20 % of patients taken to surgery for appendicitis without CT have had a normal appendix removed. CT has demonstrated overall accuracy of between 93 % and 98 %. Alternative diagnoses are seen in 34–80 % of patients without appendicitis but who were suspected of having appendicitis. For evaluation of appendicitis different techniques have been successful, including the use of no contrast, use of oral and intravenous contrast, and use of rectally administered contrast. Scanning of the entire abdomen and pelvis and scanning of an area limited to the right lower quadrant are also options. Ultrasonography has been shown to have a role in pediatric patients. If ultrasonography is positive, CT is not necessary. If ultrasonography is negative, CT should follow.

A case of giant (32 Kg) malignant fibrous histiocytoma (MFH) arising from the uterus and occupying the entire abdomen and the pelvis is reported. The patient had debulking surgery, followed by combination chemotherapy, but died 7 months after diagnosis.

A 10-year-old female presented with a palpable mass occupying the entire abdomen. Computerized tomography scan showed a large expansive lesion measuring 22 cm × 20 cm × 13 cm. The mass was resected and the diagnosis of leiomyoma was made from immunehistochemical findings. Mesenteric leiomyoma is an uncommon tumor among gastrointestinal stromal tumors.

Giant solitary nonparasitic cysts of the liver are rarely encountered in children, and establishing a preoperative diagnosis is usually difficult, especially when the cyst occupies the entire abdomen. We report herein the case of an 8-year-old girl found to have a giant congenital solitary cyst of the liver masquerading as an ovarian cyst.

The presence of a pelvic spleen is an exceedingly rare occurrence. Correct diagnosis, which is essential for appropriate management, can be suggested by sonographic evaluation and confirmed with the use of computed tomography. The case presented here demonstrates the necessity of examination of the entire abdomen by sonography when a pelvic mass of unknown etiology is encountered.

Presentation of Case A forty-two-year-old gravida 2, para 2, was admitted to the hospital because of abdominal pain. Two days previously she experienced the onset of crampy pain over the left iliac crest. It varied in intensity and was accompanied by a sensation that a bowel movement might afford relief. An enema yielded a moderate amount of soft stool but did not relieve the pain. The pain increased in intensity and was present over the entire abdomen, especially the lower portion. On the day before entry there was bilateral shoulder pain, especially with deep respirations or coughing. The patient was . . .

Phenol and trichloroacetic acid (TCA) are used for cosmetic face peeling. Deaths associated with phenol have been ascribed to the cardiotoxicity. Our purpose has been to study and compare the cardiovascular responses to these two agents in a rat model. Fifteen rats underwent abdominal epilation. Two to six days later a surface area comparable to the human face (16 cm2) was delineated on the abdomen. Baker's phenol or 50% TCA was applied to this area. Cardiac rate and rhythm and arterial pressure were monitored. Once stable, the same agent was applied to the entire abdomen for further study. TCA has been shown to be a safer agent than phenol in this rat model. Assuming that this model simulates the human response, monitoring would appear to be indicated during full-face Baker's phenol peeling.