Handlebar hernias are abdominal wall hernias resulting from direct trauma to the anterior abdominal wall. They usually result at weak anatomic locations of the abdominal wall. Such traumatic hernias are rare, requiring a high index of suspicion for a clinical diagnosis. We report the case of a handlebar hernia resulting from an injury sustained during a vehicular injury, and discuss the management of such injuries.

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IntroductionAcute appendicitis is one of the most common emergencies treated by the general surgeon. Simple appendicitis can progress to perforation, which is associated with a much higher morbidity and mortality, and surgeons have therefore been inclined to operate when the diagnosis is probable rather than wait until it is certain. The aim of this study was to evaluate the sensitivity and specificity of the Alvarado score combined with ultrasounds of the abdomen and pelvis in cases of right iliac fossa pain with suspected acute appendicitis.Methods100 patients admitted to the Department of Surgery at Alexandria Main University Hospital in 2013 complaining of right iliac fossa pain with suspected acute appendicitis were studied prospectively. The demographic information, histopathology, physical examination, laboratory data, Alvarado score, sonography report and histopathological reports of these patients were gathered. The treating surgeon made decisions for surgery or conservative management without any intervention from the research team.ResultsA combination of methods showed that Alvarado alone was 100% sensitive in excluding appendicitis at scores below five and was highly specific at scores above eight (91.9%) with no added value when combining it with ultrasound in those scores. On the other hand, ultrasound was beneficial only in patients with Alvarado scores between five and eight for detecting appendicitis and not excluding it (increasing specificity to 100% and not affecting sensitivity).ConclusionUltrasound is a good adjuvant examination in cases with Alvarado scores between five and eight in order to diagnose appendicitis. Negative ultrasound results do not exclude appendicitis and further assessment by other modalities should be performed.

AIM:To evaluate magnetic resonance imaging (MRI) fea tures of different types of gray matter heterotopia. METHODS:Between June 2005 and December 2009, the medical records and MRI studies of patients with gray matter heterotopia were reviewed. The MRI mor phologic findings of heterotopia were recorded along with the presence and type of associated cranial malfor mations. Available clinical and electrophysiological data were also recorded.RESULTS: 20 patients were included in the study. Their ages ranged from 9 mo to 39 years with a mean age of 15 years. All patients suffered from epileptic seizures. According to the location of heterotopia, patients were classified into three groups: subependymal (12), sub cortical (5) and band (3) heterotopia. CONCLUSION:MRI was useful in diagnosing and differ entiating between various types of gray matter heteroto pia. The severity of clinical manifestations of heterotopia was related to the location and pattern of heterotopia. Determination of heterotopia type and its extent is use ful for management planning and predicting prognosis.

Aim Enhanced lipid peroxidation and elevated interleukin-6 levels are common in type 2 diabetes mellitus patients. Atherosclerotic vascular complications greatly contribute to morbidity and mortality in diabetes. The aim of this study was to assess the relation of lipid peroxidation and interleukin-6 with carotid atherosclerosis in type 2 diabetes mellitus. Methods This cross-sectional study included 90 type 2 diabetes mellitus male patients with age ≥ 40 years and 30 healthy male subjects matched for age. All of them were subjected to measuring of 8-iso prostaglandin F2α as a marker of lipid peroxidation, interleukin-6 and carotid intima media thickness as a marker of carotid atherosclerosis. Results Both 8-iso prostaglandin F2α and interleukin-6 were found to have significant positive correlation with carotid intima media thickness (P < 0.001) and both were found to be significant predictors of the presence of subclinical carotid atherosclerosis in multiple regression analysis. Conclusion Lipid peroxidation and interleukin-6 may play an important role in atherogenesis in type 2 diabetes mellitus and limiting their effects may reduce atherosclerotic vascular complications in type 2 diabetes mellitus.

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Müllerian duct cyst is a congenital anomaly that originates from remnants of the müllerian duct that usually regresses in utero. It is most commonly detected in adult males during the third and fourth decades of life. Müllerian duct cyst is rarely reported in infants less than 1 year of age, in whom diagnosis is difficult because of immaturity of the genital tract. In this case report, we describe the sonographic and CT appearance of a large intrapelvic müllerian duct cyst presenting with acute epididymitis in a 9-month-old infant. The embryological basis, imaging findings and relation to epididymitis are discussed.