A 56-Year-Old Woman Presenting 19 Years After Pubic Bone Fracture with a Surgical Screw Foreign Body in the Bladder.

BACKGROUND Non-calculus foreign bodies in the bladder are rare and are usually introduced via the urethra. Reports of the migration of metallic foreign bodies from previous surgery are uncommon and mainly associated with surgical screws used for the internal fixation of pubic bone fracture and total hip replacement. This report is of a 56-year-old woman presenting with a surgical screw foreign body in the bladder 19 years after open surgical reduction and internal plate and screw fixation of traumatic fracture of the pubic bone. CASE REPORT A 56-year-old woman visited a urologist because of gross hematuria. She mentioned a mild pelvic pain and multiple lower urinary tract infections over the past 2 years, with no other symptoms. From the previous history, she had undergone an open reduction and internal fixation of the pelvic ring, with surgical plates and screws following pubic bone's fracture, due to an accident 19 years earlier. Cystoscopy identified the presence of a screw head protruding into the bladder wall. The screw was extracted via open surgery, and the patient was discharged 2 days later. CONCLUSIONS While intravesical foreign bodies are rarely seen in Emergency Departments, clinicians should maintain a level of suspicion in certain cases. The purpose of this case report is to present the unlikely and delayed complication of internal pubic bone fixation resulting in the migration of a fixation screw to the bladder. It also highlights the importance of imaging in diagnosis and localization of the foreign body in the bladder.

Combination of Adenomyoepithelioma and Adenoid Cystic Carcinoma of the Breast: A Case Report of an Uncommon Histopathological Entity.

BACKGROUND Adenomyoepithelioma and adenoid cystic carcinoma are uncommon types of breast tumors. Adenoid cystic carcinoma accounts for 0.1% of breast neoplasms and typically presents as a tender breast tumor, mostly in the subareolar area. Adenoid cystic carcinoma usually appears in women in the fifth or sixth decade of life and predominantly presents as a mixed tumor, with cribriform, tubular, and solid growth characteristics. Adenomyoepithelioma of the breast shows epithelial and smooth muscle characteristics. Adenomyoepithelioma rarely goes through malignant transformation and is an uncommon type of benign breast tumor. CASE REPORT Our study reviews the current published literature regarding the combination of these 2 rare neoplasms of the breast and shows a rare case of a 48-year-old woman with a combination of adenoid cystic carcinoma and adenomyoepithelioma. CONCLUSIONS The combination of adenoid cystic carcinoma and adenomyoepithelioma should be part of the differential diagnosis in breast cancer. More research is needed regarding the optimal therapy, which is currently surgical excision.

Incidence of Extrahepatic Portal Vein Anatomic Variations and Their Clinical Implications in Daily Practice.

Anatomical variations of the portal vein are relatively common and can affect the outcomes of hepatic resections, transplantations and interventional radiological procedures. The aim of this study was to review the literature regarding extrahepatic portal vein anomalies. Two main databases were searched for suitable articles, and results concerning more than 3,700 patients were included in the analysis. The most common anatomical variations of the portal vein were trifurcation and having a right posterior portal vein as the first branch of the main portal vein; these anomalies were found in 11.7% and 10.8% of cases, respectively.

A Review of the Use of Virtual Reality for Teaching Radiology in Conjunction With Anatomy.

Incorporation of radiology into anatomy education is a frequently used teaching strategy. Our purpose was to investigate to what extent virtual reality can play a significant role when radiology is taught in conjunction with anatomy. PubMed, SCOPUS, Education Resources Information Center, and Cochrane databases were searched for articles with the aim to evaluate the outcomes of incorporation of radiology in anatomy education, using virtual reality. From each included paper, the following data were extracted: authors, number of participants, type of study (comparative or not), level of outcome according to Kirkpatrick hierarchy, and outcomes of the use of virtual reality when radiology was incorporated in anatomy education. Seven papers were included. From them, three were comparative and evaluated students' academic performance after the educational intervention, while four were non-comparative and evaluated only students' opinions about the intervention. In all studies, the use of virtual reality for the incorporation of radiology into anatomy teaching was positively perceived. Also, the three studies which evaluated academic performance showed that virtual reality was effective in terms of enhancing anatomy knowledge. The implementation of virtual reality for the incorporation of radiology into anatomy education has been accompanied by positive outcomes. These outcomes may encourage educators to teach radiology in conjunction with anatomy using virtual reality.

Osteochondroma of the distal tibia in an 8-year-old child: Do we need to excise a benign tumor?

Osteochondromas are benign tumors that can be responsible for angular deformities, limb-length discrepancy, and impending fractures of the neighboring bones. The risk of future fractures and joint malalignment is an indication for surgical intervention.

The Anatomical Relationship of Inferior Thyroid Artery and Recurrent Laryngeal Nerve: A Review of the Literature and Its Clinical Importance.

BACKGROUND: Thyroidectomy is a quite common daily operation in general surgery. However, the anatomical structures of the region, mainly the relationship of recurrent laryngeal nerve (RLN) and inferior thyroid artery (ITA) makes the procedure challenging. The current review of the literature aims to report the anatomical variations of this relationship. METHODS: The preferred reporting items for systemic reviews and meta-analyses (PRISMA) guidelines were used for the systematic review of the articles found after an extensive research through PubMed, Science Direct, EMBASE and Web of Science. A total of 16 studies were included for the statistical analysis. RESULTS: The results showed that the most common type of RLN was posterior to the ITA. However, according to Higgins I2 statistics the heterogeneity of the studies was quite high. CONCLUSIONS: The relationship between the RLN and the ITA is quite variable. Anatomical knowledge of the region is vital for attempting to eliminate the risk of injuring the nerve during thyroidectomy.

Comparative Anatomical Study Between the Human and Swine Liver and Its Importance in Xenotransplantation.

The liver is a multifunctional organ; due to its functional and structural complexity, there are many factors that may lead it to function inadequately, a state called liver failure. Transplantation is the only appropriate therapy for patients in cases of liver failure. However, there are many limitations to this treatment, and the scientific community has considered methods based on pigs because of their unique structural and cellular compatibility with humans. In this review, we conducted an anatomic comparative study of the liver's parenchyma and vascular network between humans and pigs to extract useful information for xenotransplantation and autologous cell or organ generation in pigs. We reviewed articles from 2007 to 2019 and used the databases of Scopus, PubMed and Google Scholar. We concluded that, despite the difference concerning the shape of the human and pig livers, the number of segments and the bile and vascular system are similar, making the pig liver useful in experimental surgery for xenotransplantation.

Valentino's Syndrome (with Retroperitoneal Ulcer Perforation): A Rare Clinico-Anatomical Entity.

BACKGROUND In the emergency department pain in the right lower quadrant is a frequent finding and is related to a wide variety of diseases, the most common of which is acute appendicitis. An unusual presentation of pain in the right iliac fossa is due to perforation of a duodenal peptic ulcer. The fluid that originates from the perforated ulcer moves through the paracolic sulcus to the right iliac fossa and causes irritation of the peritoneum and even chemical peri-appendicitis, thereby imitating all the usual causes of pain in the right lower quadrant. This condition is known as Valentino's syndrome, named after the Italian actor Rudolph Valentino. CASE REPORT The aim of this case report was to review the current published literature regarding Valentino's syndrome and report on a case involving a 51-year-old male who was admitted to our surgical department with right lower quadrant pain and suspicion of acute appendicitis. An exploratory laparotomy was performed, from which a retroperitoneal perforation of a duodenal ulcer was found; suture closure was then applied. The patient's postoperative course was uncomplicated, and he was discharged 9 days after the operation. CONCLUSIONS Surgeons should be alert for this rare condition imitating acute appendicitis, and the differential diagnosis of right lower quadrant pain should include peptic ulcer perforation.

The Anatomical Characteristics of Corona Mortis: A Systematic Review of the Literature and Its Clinical Importance in Hernia Repair.

BACKGROUND: Inguinal hernia repair is one of the most common daily operations in general surgery. However, the anatomical structures of the region, such as the corona mortis (the crown of death), make this procedure quite challenging. A comprehensive knowledge of its anatomy is essential, since massive hemorrhage may occur if the vessel is injured. The current review of the literature aimed to report the frequency and anatomical variations of vascular corona mortis. METHODS: A substantial study was coordinated through PubMed, Scopus and Google Scholar. The Prisma guidelines were used for the systematic review of the articles found. A total of 13 studies and 1,455 patients were included for the statistical analysis. RESULTS: The results showed that corona mortis was present in about half the hemi-pelvises, and to be more accurate, the prevalence was 46%. Venous corona mortis was more frequent than the arterial type (42% vs. 25%). CONCLUSIONS: Considering the percentages mentioned above, every surgeon who schedules an operation on the retro-pubic area, especially during a hernioplasty procedure, should evaluate the possibility of the presence of corona mortis. Anatomical knowledge of the region is vital for attempting to eliminate the risk of injuring the corona mortis during surgery.

How Exercise Can Influence Oxidative Stress and Glucose Levels after Pancreatic Resection: A Randomised Controlled Trial.

BACKGROUND: One of the most challenging operations is the resection of the pancreas, which is associated with high morbidity. Metabolic control during the perioperative period remains an issue that is sometimes difficult to manage. OBJECTIVES: Exercise has a positive effect on glycaemic control. The objective of this trial was determining whether exercise has any benefit for oxidative stress and glucose levels. METHOD: The study was an open-label, randomised clinical trial. It has been registered in the International Standard Randomised Controlled Trial registry. The patients were selected according to the Consolidated Standard of Reporting Trials criteria. RESULTS: In total, 56 patients were assessed for eligibility. There was no statistical difference between the 2 groups (the exercise and the control one) regarding the disease characteristics, morbidity or influence of exercise on oxidative stress; however, the control of glucose was superior in the exercise group. CONCLUSIONS: Exercise has a positive effect on glycaemic control in patients after pancreatic resection.

Α Rare Morphological Study Concerning the Longest Bone of the Human Anatomy in the Population of the Northern Greece.

BACKGROUND: The femur is one of the most researched bones in the human anatomy and forensic medicine. As the longest bone in the human body, it is well preserved in skeletal remains. The sex estimation of human remains is one of the most important research steps for physical and forensic anthropologists. However, osteometric standards built on unburned human remains and contemporary cremated series are often inadequate for the analysis, frequently resulting in a significant number of misclassifications. METHODS: In our study, we present the anthropometric data from 500 skeletons in Northern Greece, including 232 males and 198 females, as well as 430 of known age. The diameters of the femur were measured as well as the indices of robustness. For the statistical interpretation of the results, we have used the discriminant analysis. RESULTS: From the interpretation of the data, we concluded that all the mean values, diameters and indices of the males were greater compared with those of the females. Also, we concluded that the probability of error is quite high in all cases except the vertical diameter of femur's head, which has an acceptable percentage of error of 14.39% and can be used as a safe criterion for sex identification. CONCLUSION: With the aid of statistics, we came to the conclusion that the vertical diameter of the femur's head is a safe variable for sex estimation in skeletal remains.

Abdominal Cocoon Syndrome: Two Cases of an Anatomical Abnormality.

INTRODUCTION: Idiopathic sclerosing encapsulating peritonitis or abdominal cocoon syndrome (ACS) is a rare anatomical deformity characterized by the partial or complete encasement of the small intestine with fibrotic peritoneum. 193 cases have been described worldwide. The aim of this study is to present two cases of ACS successfully treated at the Surgical Clinic of the Agios Dimitrios General Hospital in Thessaloniki, Greece. PRESENTATION OF CASES: Two men (55 and 54 years old) presented to the emergency department complaining of abdominal pain, distension, constipation, nausea, and vomiting. Neither of these patients had any previous operations. The computed tomography scan of the first patient showed considerable distension of the small bowel, suggestive of internal herniation. The second case showed distention of the jejunum with no obvious cause. Both patients underwent emergency surgery. Intraoperatively, it was found that a fibrous membrane had completely covered the small intestine of the first patient and the jejunum and part of the large intestine of the second patient. Adhesiolysis and partial excision of the membrane were performed in both cases. DISCUSSION: ACS is a rare cause of small bowel obstruction. Although conservative management with immunosuppressants and steroids has been described, surgical treatment is the gold standard. CONCLUSION: Preoperative clinical suspicion of this disease can help determine the diagnosis and protect surgeons from intraoperative "surprises".

The Role of Exercise in the Quality of Life in Patients After Pancreatectomy: A Prospective Randomized Controlled Trial.

BACKGROUND: Pancreatic resection is still a challenging operation characterised by high morbidity. The quality of life in patients after pancreatectomy is a critical outcome. The aim of our trial is to prove whether or not exercise has any benefit to the life of these patients. METHODS: The study was an open-label, randomized clinical trial. The patients were selected according to the Consolidated Standard of Reporting Trials criteria. The study was registered at the International Standard Randomized Controlled Trial registry (ISRCTN) with the study ID ISRCTN1087174. The study was approved by the Bioethics and Deontology Committee, Medical School of Aristotle University, Thessaloniki (ref: 166/29.10.2015). RESULTS: Once the allocation and the follow-up were completed, 21 patients in the exercise group and 22 in the control group were analyzed. There was no statistical difference between the two groups regarding co-morbidities and disease characteristics; however, the quality of life and the total status of health were superior in the exercise group. CONCLUSIONS: Exercise can improve the quality of life in patients after complex operations like pancreatectomy.

Invasive Thyroglossal Duct Cyst Papillary Carcinoma: A Case Report and Review of the Literature.

BACKGROUND Thyroglossal duct cyst is a common congenital anomaly of the thyroid gland, usually found centrally. The presence of malignancy occurring in a thyroglossal duct cyst is a rare condition, accounting only for 1% of all cases of thyroglossal duct cyst. This report is of a rare case of papillary carcinoma arising in a thyroglossal duct cyst and includes a review of the literature. CASE REPORT A 27-year-old female patient was referred to our department with a painless cystic mass in the neck. After initial physical examination and endocrinology investigations, a fine needle aspiration (FNA) of the cyst was performed. Cytology showed a papillary neoplasm. The patient underwent total thyroidectomy and surgical excision of the thyroglossal duct cyst (the Sistrunk's procedure). Histopathology of the surgical excision specimen showed a thyroglossal duct cyst with a maximum diameter of 7.5 cm containing a primary invasive papillary carcinoma, measuring 1.5 cm in diameter that infiltrated into the cyst wall. The remaining thyroid gland was normal. CONCLUSIONS Thyroglossal duct carcinoma, most commonly papillary carcinoma, is a rare condition that should be considered in patients presenting with cystic midline neck masses. Surgery and complete excision is the main treatment and the optimal patient management includes multidisciplinary consultation in order to improve survival. The diagnosis of malignancy is made postoperatively, as in the present case.

The Main Anatomical Variations of the Pancreatic Duct System: Review of the Literature and Its Importance in Surgical Practice.

Anatomical variations or anomalies of the pancreatic ducts are important in the planning and performance of endoscopic retrograde cholangiopancreatography (ERCP) and surgical procedures of the pancreas. Normal pancreatic duct anatomy occurs in approximately 94.3% of cases, and multiple variations have been described for the remaining 5.7%. The purpose of this study was to review the literature on the pancreatic duct anatomy and to underline its importance in daily invasive endoscopic and surgical practice. Two main databases were searched for suitable articles published from 2000 to 2017, and results concerning more than 8,200 patients were included in the review. The most common anatomical variation was that of pancreas divisum, which appeared in approximately 4.5% of cases.

The Main Anatomic Variations of the Hepatic Artery and Their Importance in Surgical Practice: Review of the Literature.

Anatomical variations of the hepatic artery are important in the planning and performance of abdominal surgical procedures. Normal hepatic anatomy occurs in approximately 80% of cases, for the remaining 20% multiple variations have been described. The purpose of this study was to review the existing literature on the hepatic anatomy and to stress out its importance in surgical practice. Two main databases were searched for eligible articles during the period 2000 - 2015, and results concerning more than 19,000 patients were included in the study. The most common variation was the replaced right hepatic artery (type III according to Michels classification) which is the chief source of blood supply to the bile duct.

Solid Serous Adenoma of the Pancreas: A Case Report and Review of the Literature.

Herein, we report a case of a solid-type serous cystadenoma of the pancreas which is the 16th case reported worldwide and the first ever reported in Greece. Magnetic resonance imaging showed a hypervascular mass in the tail of the pancreas of a 72-year-old female who presented with mild abdominal pain. Distal pancreatectomy was performed by laparotomy and histological and immunohistochemical examination revealed a solid-type serous cystadenoma of the pancreas. Preoperative diagnosis of a solid-type serous cystadenoma of the pancreas is difficult, and, due to its benign nature, simple excision of the tumor is the recommended treatment.

Correction: Ioannis Dimitriou et al, Palmaris Longus Muscle's Prevalence in Different Nations and Interesting Anatomical Variations: Review of the Literature.

[This corrects the article DOI: 10.14740/jocmr2243w.].