Salvage reconstructive surgery in an adult patient with failed previous repair of an extrophy-epispadias complex. An operation with a functional and aesthetic purpose.
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Salvage surgical procedures after failed reconstruction for an extrophy-epispadias complex are extremely challenging. The goals are to restore continence and improve aesthetic appearance in order to provide quality of life and an improved body image to the patient. We describe the surgical steps in an adult patient who presented anal urinary incontinence and a poor body image due to the absence of an umbilicus and the presence of hypertrophic scars. He underwent a modified Mainz II reconstruction of the lower urinary tract at childhood for an extrophy-epispadias complex. Restoration of continence was achieved by the construction of a modified Mainz I pouch with a continent stoma in a neo-umbilicus. Body image improved dramatically by the construction of a neo-umbilicus, a surgical revision of the hypertrophic abdominal scars and an abdominoplasty. It is mandatory that such demanding surgery should only be attempted as a combined multidisciplinary effort with urologists and plastic/reconstructive surgeons. (+info)
Sister Mary Joseph's nodule as the first sign of pregnancy-associated gastric cancer: a case report.
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Sister Mary Joseph's nodule is an inconspicuous and uncommon clinical sign of advanced malignant disease, especially gastric cancer. Pregnancy-associated gastric cancer is an extremely rare condition and can be difficult to diagnose, due to the absence or misinterpretation of symptoms as pregnancy-related. Diagnostic aids, such as a basic chemistry panel and imaging techniques, may not show any abnormalities. We present a case of a 37-year-old pregnant patient whose umbilical nodule was the first presenting physical sign of gastric cancer, which had metastasized throughout the abdominal and pelvic regions. (+info)
Diffuse endometritis in the setting of umbilical endometriosis: a case report.
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BACKGROUND: Umbilical endometriosis is rare and can be a challenging diagnosis in the absence of classic signs and symptoms. CASE: A case of severe, primary, spontaneous umbilical endometriosis with foci of plasma cell endometritis and diffuse stromal lymphovascular presence occurred. CONCLUSION: Despite a lengthy differential, endometriosis must be considered in the evaluation of an umbilical mass. The presence of plasma cell endometritis and stromal lymphovascular elements in the absence of pelvic endometriosis lends evidence to the theory of lymphovascular transport as an etiology of extrapelvic endometriosis. (+info)
Umbilical port-site complications in laparoscopic cholecystectomy: role of topical antibiotic therapy.
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BACKGROUND AND OBJECTIVES: Umbilical port-site infections after video-laparoscopic cholecystectomy (VLC) are frequent complications. The aim of this prospective randomized study was to verify the validity of topical rifamycin for prevention of post-VLC umbilical infections. METHODS: From September 2006 to April 2007, 48 patients with uncomplicated cholelithiasis who underwent VLC were enrolled in the study. Enrolled patients were randomized into 2 groups. The first group of 24 patients was treated with topical rifamycin to the umbilicus. The second group of 24 patients was not treated with rifamycin. RESULTS: Postoperative umbilical pain with a need for analgesics, presence of signs of inflammation of the umbilical wound, dehiscence of the umbilical skin sutures, and the presence of incisional umbilical hernia on the 60th postoperative day were statistically significantly better in the rifamycin group compared with the control group. CONCLUSIONS: Topical administration of rifamycin to the umbilicus in the pre-, intra- and postoperative periods was a rapid, safe, and economic way to reduce infective complications after VLC. (+info)
Maternal and birth attendant hand washing and neonatal mortality in southern Nepal.
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Genetic and environmental growth trait parameter estimates for Brahman and Brahman-derivative cattle.
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Beefmaster, Brahman, Brangus, and Santa Gertrudis field data records were used to determine genetic and environmental parameter estimates using a multiple-trait, pseudo-expectation approach. Adjusted birth weight, 205-d weight, and postweaning gain records were analyzed for each breed. Also, Brangus weaning sheath and navel scores were both analyzed using a single-trait, pseudo-expectation method to determine genetic parameter estimates. Additive birth weight heritability (h2A) estimates ranged from .22 to .37 and maternal birth weight heritability (h2M) estimates ranged from .12 to .55. Estimates for 205-d weight h2A for the four breeds varied from .21 to .25, and 205-d weight h2M estimates ranged from .15 to .21. Postweaning gain h2A estimates ranged from .16 to .56. The genetic correlation between direct and maternal portions of birth weight was negative for all breeds. This was also true for the genetic correlation between direct and maternal portions of 205-d weight, except in Brahman cattle, for which it was .15. The genetic correlation between additive portions of birth weight and 205-d weight was large and positive in all breeds. A moderately positive correlation between 205-d weight and postweaning gain was found for all breeds except Santa Gertrudis, whereas the environmental correlation between these two traits was a small to moderately negative estimate in all breeds. Brangus weaning sheath and navel score heritabilities indicated that genetic change for the size and shape of the sheath and navel area is possible. (+info)
We report a case of umbilical necrosis after a unilateral pedicled transverse rectus abdominis myocutaneous flap in a patient post mastectomy. This uncommon complication of breast reconstruction is highlighted. (+info)