Refractory CSF leakage following untethering surgery performed 10 months after birth for enlarging terminal myelocystocele associated with OEIS complex

Background: Terminal myelocystocele (TMC) is an occult spinal dysraphism characterized by cystic dilatation of the terminal spinal cord in the shape of a trumpet (myelocystocele) filled with cerebrospinal fluid (CSF), which herniates into the extraspinal subcutaneous region. The extraspinal CSF-filled portion of the TMC, consisting of the myelocystocele and the surrounding subarachnoid space, may progressively enlarge, leading to neurological deterioration, and early untethering surgery is recommended. Case Description: We report a case of a patient with TMC associated with OEIS complex consisting of omphalocele (O), exstrophy of the cloaca (E), imperforate anus (I), and spinal deformity (S). The untethering surgery for TMC had to be deferred until 10 months after birth because of the delayed healing of the giant omphalocele and the respiration instability due to hypoplastic thorax and increased intra-abdominal pressure. The TMC, predominantly the surrounding subarachnoid space, enlarged during the waiting period, resulting in the expansion of the caudal part of the dural sac. Although untethering surgery for the TMC was uneventfully performed with conventional duraplasty, postoperative CSF leakage occurred, and it took three surgical interventions to repair it. External CSF drainage, reduction of the size of the caudal part of the dural sac and use of gluteus muscle flaps and collagen matrix worked together for the CSF leakage. Conclusion: Preoperative enlargement of the TMC, together with the surrounding subarachnoid space, can cause the refractory CSF leakage after untethering surgery because the expanded dural sac possibly increases its own tensile strength and impedes healing of the duraplasty. Early untethering surgery is recommended after recovery from the life-threatening conditions associated with OEIS complex.

Compulsory auricular cartilage use: Modified septal extension graft application in revision rhinoplasty

OBJECTIVE: This study aimed to demonstrate how to perform a tongue-in-groove graft with the method we developed using auricular cartilage to provide adequate nasal tip support in 17 revision rhinoplasty cases. METHODS: This retrospective study was conducted on 17 patients (17 females; mean age: 23.9+3.7 years; range, 19 to 30 years) who underwent revision rhinoplasty (RR) operations for a low nasal tip between February 2019 and September 2020. After auricular cartilage was removed with a standard posterior auricular intervention, it was folded in two to increase its resistance and fixed to the caudal part of the nasal septum as a tongue-in-groove graft. RESULTS: Solid nasal tip support and satisfactory nasal tip projection and rotation were achieved in all patients. One (6%) patient developed auricular hematoma as a complication on the third postoperative day, and three (17%) of our patients complained of nasal obstruction in their postoperative follow-up. CONCLUSION: When the use of costal cartilage is limited due to social and cultural reasons in RR cases performed due to a low nasal tip, auricular cartilage can be used as a modified tongue-in-groove graft and provides a satisfactory aesthetic appearance.

A case of tracheal foreign body encountered in a Kangal dog: clinical, radiological, endoscopic findings and treatment

The subject of this study was a dog brought to our clinic with complaints of severe cough, dyspnea and anorexia. During the clinical examination, a hard mass was detected by palpation of the neck area. Vomiting reflex was observed. As a result of radiographic and endoscopic examination, a foreign body was found in the caudal part of the larynx. After the diagnosis was made, the patient was anesthetized and the foreign body was removed with forceps from the oral cavity. During the postoperative period, the patient was administered parenteral antibiotics and intraoral antiseptic for a week. The approach to foreign body cases in the respiratory tract of dogs is discussed.

Ossifying Fibroma in the Nasal Cavity of a 2-Year-Old Horse

A 2-year-old mare of an unknown breed was referred to the clinic due to undetermined breathing difficulties. Physical examination revealed painless swelling rostral to the nasoincisive notch and a large, firm mass protruding from the left nostril. Radiographic examination of the head revealed a mass occupying the left nasal cavity and a displaced and hypoplastic last premolar of the left maxilla. The CT scan showed a well-demarcated heterogeneous mass measuring 22 × 9 × 5 cm (length × height × width) in the left nasal cavity attached to the roots of the displaced tooth and conchae. The surgery was performed on the standing horse. Firstly, due to the oblique position of the displaced tooth, the extraction was performed extra-orally through the trephination and repulsion of the maxillary bone. In the next step, a direct surgical approach was chosen for the caudal part of the mass via the osteotomy of the left nasal bone. The mass was bluntly separated from the conchae and removed through the nostril using Fergusson forceps. The histopathological characteristics of the mass led to the diagnosis of ossifying fibroma. The horse recovered completely in seven months, without recurrence after two years.

Abscess removal in a desert horned viper (Cerastes cerastes)

Venomous snakes are widely kept in captive as collections by private reptile keepers. A 7 years old male desert horned viper (Cerastes cerastes) was presented with a lump on the caudal part of the body. Proper physical restraining method using snake hook and transparent tubes was performed for clinical examination and radiography. Two radiography views revealed radiopaque in both lateral and dorsal recumbence. Differential diagnosis was tumor growth and abscess. Surgical intervention was indicated and performed with the viper induced with injectable anesthesia and maintained with gas anesthesia. Surgical correction with manually removing the abscess was performed. The NSAID, broad spectrum antibiotic, topical antibiotic and fluid therapy were performed post-surgery. Six weeks post-surgery the suture material was removed and wound was dry and healed well.

Sirenomelia with vertebral, anal, cardiac defect, tracheo-esophageal fistula, renal anomalies, limb abnormalities association: a case report

Sirenomelia is a rare congenital malformation, characterised by abnormal development of caudal part of body with variable degree of fusion of lower limbs. VACTERL is an acronym used for a group of sporadic non-random birth defects involving multiple organ systems, namely vertebral (V), anal (A), cardiac (C), tracheoesophageal (TE), renal (R) and limb (L) defects. Combination of both the anomalies is very rarely reported in literature. Survival is extremely rare and early prenatal diagnosis may allow for termination of pregnancy. Here we present a case of sirenomelia phenotype, with a complete spectrum of autopsy findings, suggestive of VACTERL association.

ANOMALOUS PERITONEAL FOLDS OF LIVER WITH INCOMPLETE FISSURE FOR IGAMENTUM TERES - A CASE REPORT

Liver is the largest organ in the human body occupying right hypochondrium, epigastrium and left hypochondrium. The organ develops in the ventral mesogastrium dividing the latter into a cranial part which forms the falciform ligament and lesser omentum and the caudal part which normally degenerates but may persist occasionally in the form of accessory fissures, ligaments and folds. The present case report describes the occurrence of exceptional and multiple abnormal peritoneal ligaments extending between the liver, diaphragm and abdominal wall. In concurrence, an incomplete fissure for ligamentum teres hepatis is reported which resulted in a communication between the left lobe and quadrate lobe of liver. The knowledge of the normal and the variant anatomy of such peritoneal reflections of liver is of colossal significance for surgeons performing the segmental resection of the liver and radiologists interpreting radiological findings related to liver.

Investigation of Transmissible Venereal Tumor in Male Dogs by Cytological Examination

Transmissible Venereal Tumor (TVT) is one of the most uncontrolled spreading tumor via mating between dogs observed in both sexes. The clinical findings are less remarkable and are usually located in the caudal part of the penis and may include preputial discharge, licking of the region, dysuria, phimosis or paraphimosis (occasionally). In this study, the incidence of TVT and the relations of tumor with some factors were investigated in 145 male dogs, in Eskiºehir, Turkey. TVT’s diagnosis was based on location of the tumor mass and mainly exfoliative cytological findings. Smears of caudal part of the penis were painted with Giemsa staining method. The cells in the smears were identified as typical transmissible venereal tumor cells, polymorphnuclear leukocytes (PMN), erythrocyte, parabasal, intermediate, nucleated and anuclear superficial cells. In exfoliative cytological examinations, TVT cells were observed in the smears of 17 dogs (11,72 %), but only four of them (2,76 %) had TVT lesions clinically. Thirteen (8,97 %) of dogs had TVT cells but not having TVT lesions . It was found that the ages, weights and breeds of dogs had no effect on the TVT lesions and TVT cells. TVT positive animals were determined to have more erythrocyte and intermediate density than negatives and no association with other cells were found. PMNs were significantly different and high in the TVT cell positive cases compared to the negatives. In dogs with negative TVT cells, parabasal, intermediate, nuclear/anuclear superficial cells were more than those positives. As a result, the male dogs having no lesions could be infected with TVT. Dogs should be examined not only clinically, but also cytologically, to determine whether TVT cells are present. This method can be an easy way to find and treat TVT lesion-free but infected dogs at an early time.

THE CASE TREATMENT OF CYSTADENOMA OF THE PANCREAS

Summary. Introduction. Cystadenoma of the pancreas is a benign tumor in the form of a cyst of epithelial origin, which in the absence of adequate treatment disrupts the function of the pancreas, due to compression on nearby tissues, and in 3 % of cases regenerates into cystadenocarcinoma. Aim. Present a clinical case of surgical treatment of cystadenoma of the body of the pancreas, while preserving the caudal part of the latter to prevent the possible development of diabetes. Material and methods. Patient M., 72 years old, who was hospitalized in the infectious department of the central district hospital, during ultrasound of the abdominal cavity and peritoneal space revealed a neoplasm of the retroperitoneal space in the body and tail of the pancreas, in connection with which she was transferred to the surgery department. After the appropriate examination, the patient underwent surgery — laparotomy. Removal of a neoplasm of the body of the pancreas. Distal pancreatojejunoanastomosis, entero-enteroanastomosis. Abdominal drainage. Results. The postoperative period was without complications, drainage was removed, sutures were removed for 9-10 days, the wound healed with primary tension. In the section of the drug, there is a capsule with a wall thickness of up to 2.0 mm, which contains mucopurulent masses in the form of flakes. The outer wall of the capsule is covered with joints and vessels, and the inner has a shiny matte surface. The histopathological examination indicates cystadenoma of the pancreas. The choice to form a distal pancreatojejunostomy in contrast to the distal resection of the pancreas was due to the patient’s age and high probability of developing diabetes because it is in the caudal part of the pancreas is the lion’s number of islets of Langerhans. Conclusion. When performing radical surgical interventions on the pancreas in elderly and senile patients, it is necessary to preserve the tissues of the latter, especially the tail, to prevent the development of diabetes.