A 4-year-old girl with hypomelanosis of Ito (HI) was referred to the cardiologist for an absence of pulses in the lower extremities. Medical history included hydrocephalus treated with ventriculoperitoneal shunt and congenital glaucoma. She always remained asymptomatic. Physical examination showed upper-body hypertrophy and a repeatedly measured systolic pressure difference between the upper and lower extremities of 35 mm Hg. Contrastenhanced multidetector computed tomography ( Figure 1) showed aortic hypoplasia immediately distal to the origin of renal arteries. Three-dimensional reconstruction obtained from contrast-enhanced multidetector computed tomography (Figure 2) revealed an abrupt diameter reduction in the aorta below the renal arteries. The aorta was divided into very small vessels to supply the lower extremities, mimicking a "pseudo-cauda equina." Despite these findings, patient has remained asymptomatic during follow-up, without hypertension and with good exercise tolerance.HI is a multisystemic neurocutaneous disease associated with genetic disorders such as mosaicism or transloca- Multiple small vessels arise to irrigate the lower extremities (white arrows), mimicking a pseudo-cauda equina. The asterisk points out the ventriculoperitoneal shunt.
The echographic images of the fetal intestines during the final 20 weeks of pregnancy are described. A comparison with the biparietal and abdominal diameter as well as with the echogenicity of the placenta is made. The sonographic images of the fetal intestines are divided into four grades, the last two appearing in the mature foetus only.
Based on three cases of foetal abnormalities (hydrocephalus, prune-belly syndrome, and unilateral multicystic renal disease) diagnosed and treated by intrauterine sonographic control, the article describes the technique, evolution and outcome of these cases. Two patients (the hydrocephalus and the prune-belly syndrome) died after delivery, whereas the third one lives in normal conditions. The different diagnoses and prognoses of this new surgical procedure are discussed. We think that hydrocephaly and renal obstruction have a very bad prognosis when diagnosis and therapy are not performed an initiated at an early stage. Unilateral disease of Potter-Syndrome is associated with a very good prognosis irrespective of whether therapeutic intervention is effected or not. For this reason, the intervention should be considered according to the compressive action that the cystic renal disease can exercise on the other kidney or lung.
Laparoscopic sleeve gastrectomy has been widely accepted and adopted as a weight loss procedure for obesity. Although technically demanding, it is feasible and can improve patients’ overall health. However, any variation from normal anatomy can be challenging for any surgery, especially bariatric surgery, where a mistake could mean going from a life-saving opportunity to costing the patient’s life. We present the case of an obese patient who sought medical attention and decided on bariatric surgery. During her preoperative evaluation, situs inversus totalis was discovered. After careful planning, the surgical team completed the surgery without complications, and the patient recovered completely.
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