Spigelian hernia (SH) is a rare ventral interstitial hernia occurring through a defect in the transversus abdominis aponeurosis (Spigelian fascia). Spigelian fascia is found between the lateral border of the rectus abdominis muscle and the semilunar line, which extends from the costal cartilage to the pubic tubercle. In other words, Spigelian line is where the transversus abdominis muscle ends in an aponeurosis characterized by a congenital or acquired defect in the Spigelian aponeurosis. Pediatric cases of SH are either congenital or acquired due to trauma, previous surgery or increased intra-abdominal pressure. SH in combination with ipsilateral cryptorchidism may constitute a new syndrome, as such cases are extremely rare in the literature Th is new syndrome is characterized by the following congenital, ipsilateral disturbances: SH, absence of inguinal canal and gubernaculum and the homolateral testis found within the Spigelian hernia sac (a hernia sac containing undescended testis). Th e aim of this study is to emphasize some typical fi ndings of this specifi c entity, and, hence, the necessity for a thorough investigation of the origin of the SH.
Neonatal sepsis, defi ned as sepsis occurring within the fi rst 28 days of life, is associated with signifi cant morbidity and mortality. It is undeniable that fi nding and appliance of biomarkers in clinical practice is of great importance, aiming at the early recognition of the impending clinical deterioration and the prompt and targeted therapeutic intervention. Aft er systematic and thorough research of the limited relevant literature, we attempt to present a documented point-of-view on the diagnostic value of TREM-1 and its soluble form both in early and late onset neonatal sepsis.
Incidence of colonic atresia in living infants ranges from 1:5,000 to 1:60,000 (average 1:20,000). It constitutes 1.8 to 15% of all cases of atresia of the gastrointestinal tract. In 58.56–75% of all cases is right-sided. We aim, through the presentation of two cases of colonic atresia which we encountered and after systematic research of the current literature, at addressing three major issues: diagnostic approach, operative strategy and management of the prognostic parameters of the colonic atresia. The common parameter in these two cases was the early diagnosis, which played a significant role in the uncomplicated postoperative course. The first case was a type I sigmoid atresia. Contrast’s escape during contrast enema examination due to accidental rupture of the distal part of the colon led to diagnosis. Side-to-side anastomosis, restoration of the rupture and a central loop sigmoidostomy were urgently performed. The second case was a type III atresia at the level of the ascending colon, which was early diagnosed via pregenital ultrasonography, in which colonic dilation was depicted. Restoration of the intestinal continuity early after birth was performed at a time. In conclusion, we believe that early diagnosis, selection of the appropriate operative strategy and prompt recognition of potential post-operative complications, especially rupture of the anastomosis, contribute to the optimization of the prognosis in patients with colonic atresia.
Both sarcoidosis and primary Sjögren syndrome (pSS) are multisystem disorders of unknown etiology, which share certain clinical features, making the diff erential diagnosis a real challenge in clinical practice. Several published case reports and case series have posed the question as to whether there is a real association — mimicry between the two diseases or it is just coincidence. We attempt, aft er systematic and comprehensive research of the relevant published literature, to present all those data, clinical or paraclinical, which could be useful in the diagnostic approach and the distinguishment of the two diseases. It is certain that, besides the classic diagnostic methods, emerging is the role of immunology and genetics on this direction, although not established yet.
Meckel’s diverticulum represents a remnant of the proximal end of the omphalomesenteric duct, which constitutes a connection between the middle intestine and the vitelline vesicle. It is the most common congenital anomaly of the gastrointestinal tract and is found in approximately 0.3–2% of the general population. Complications such as hemorrhage, bowel obstruction, infl ammation, perforation, intussusception, volvulus and malignant transformation develop in only 4–4.8% of all patients, with most cases presenting in childhood, while relative risk decreases during life. The aim of the present study is to present our experience in managing a 15-year old male patient with Meckel’s diverticulum covered perforation. It was a case of disguised perforation of the Meckel’s diverticulum, with development of adhesions to the anterior surface of the right third of the transverse colon, which was successfully treated on the basis of emergency. Diagnosis was made intraoperatively and was documented by histological examination of the excised diverticulum.
Hypertension constitutes one of the most common diseases leading patients to the Outpatient Departments. Idiopathic hypertension is the prevailing type, but on the other hand, the possible presence of clinical entities responsible for the development of secondary hypertension should never be underestimated. We retrospectively studied 447 subjects aged between 20 and 84 years old and diagnosed with hypertension, who were thoroughly evaluated for secondary hypertension. Our analysis demonstrated that 35 out of the 447 subjects were fi nally diagnosed with secondary hypertension, representing a relative frequency of 7.8%. Most common causes of secondary hypertension identifi ed in our study group were: glucocorticoid intake (n = 14), obesity hypoventilation syndrome (n = 6), obstructive sleep apnea (n = 2) and preeclamspia (n = 2). Several other causes are also reported. Our study, conducted in a single center in Northern Greece, confi rms previous reports concerning the prevalence of secondary hypertension among Greek patients, shedding light on potential pathophysiologic mechanisms. In conclusion, a high proportion of hypertensive individuals still feature have an underlying cause, thus, diagnostic work-up should be thorough and exhaustive, in order the correct diagnosis to be made and the targeted treatment to be initiated.