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A successful umbilical reconstruction is described, using two twisted flaps with one pedicle. This technique is easy and simultaneously revises the scar of the abdominal wall. With this procedure, the umbilicus has a natural appearance with sufficient depression and normal-appearing wrinkles.
INTRODUCTION: Red umbilicus is considered to be an infectious disease typical of neonates. In our experience, umbilical erythema could be due to cow's milk protein intolerance (CMPI). AIMS: To evaluate the frequency and clinical significance of umbilical erythema in a series of consecutive children referred for suspected CMPI. PATIENTS AND METHODS: Seven hundred ninety-six consecutive patients (median age, 18 months) referred for suspected CMPI diagnosis were studied. CMPI diagnosis was based on the disappearance of symptoms on elimination diet and their subsequent reappearance on double-blind placebo-controlled cow's milk challenge. RESULTS: CMPI was diagnosed in 384 patients: 120 with respiratory, 75 dermatologic and 198 gastroenterological symptoms. Although some patients showed more than 1 type of symptom, whether gastroenterological, dermatologic or respiratory, they were classified in 1 category only according to the main reason for referral to the outpatients clinic. Umbilical erythema was observed in 36 patients (median age, 10 months): 16 (8%) with gastroenterological symptoms, 9 (7.5%) with recurrent asthma and 11 (15%) with atopic dermatitis. None of the symptomatic controls without CMPI had umbilical erythema. On elimination diet, the erythema disappeared within the second week. On CMPI challenge, it reappeared within 24 hours. CONCLUSIONS: Umbilical erythema can be a sign of food intolerance and can be a useful diagnostic tool for CMPI.
We report a case of metastatic Crohn's disease of the umbilicus which responded to topical corticosteroid treatment. Crohn's disease is a granulomatous disease of the bowel which may affect other organs. The skin is commonly involved, and the cutaneous manifestations may be non-specific, e.g. pyoderma gangrenosum or erythema nodosum, or specific with epithelioid granulomas and multinucleated giant cells in the skin. Specific skin lesions may be contiguous with the bowel at sites including the perineum, mouth and adjacent to fistulae, or separated from it by normal skin from the bowel, a rare condition which has been termed 'metastatic' Crohn's disease.
A method for simply and accurately locating the umbilicus in abdominoplasty is described. The method uses a shaped wire and ink.
We report the case of a 23-year-old woman with a persistent omphalomesenteric duct. The diagnosis was verified by histology. Further differential diagnoses of bleeding umbilicus are the urachal fistula and endometriosis.
A 19-year-old man with Crohn's disease presented with faecal production of the umbilicus due to an entero-urachal fistula.
Omphalomesenteric duct derivatives cause an assortment of complications, most notably intestinal hemorrhage and obstruction. Intestinal obstruction is the most lethal complication and usually results from a diverticulum with an attachment to the umbilicus. This cause of intestinal obstruction is not generally recognized preoperatively. We report a teenager with episodic abdominal pain, acute small bowel obstruction, and a curious umbilical deformity with an underlying omphalomesenteric duct remnant. We believe that this physical finding suggests the diagnosis in patients with intestinal obstruction who have experienced unexplained episodes of abdominal pain.
Knowledge of the embryonic developments of the umbilicus and its contents assists the physician in correctly assessing the various anomalies found in this area. Although some will require specialized facilities and care, the majority of these anomalies can be corrected by simple operative means.
The diagnostic value of the appearance of the umbilicus in a wide range of conditions is discussed. Umbilical sepsis, tumours, fistulas, developmental anomalies and hernias are described, and the embryology of related structures is outlined.
The histological and ultrastructural features, as well as the immunoreactivity of one case of uncommon primary papillary and psammomatous adenocarcinoma of the umbilicus are studied in the present work. The observations have been undertaken in a nine-year follow-up, and have included the primitive tumour, two local recidives, and inguinal lymphatic metastasis on two occasions. Papillary structures, numerous psammoma bodies, as well as weak and focal positive reactions to CEA and cytokeratin were present in all the tumours. Since these features and their ultrastructural characteristics were identical to primary papillary serous neoplasias of the peritoneum and ovarium, the hypothesis of an origin in coelomic remnants is considered.
A 22-year-old woman presented to our hospital complaining of high fever and a painful fist-sized mass in the lower abdomen. From the results of imaging studies, including abdominal urtrasonography and computerized tomography, the patient was diagnosed as having a urachal abscess. Despite intensive antibiotic therapy, her high fever persisted. Drainage via the umbilicus was then performed with a pigtail catheter being inserted into the abscess through a fistula. Her temperature normalized within a few days and the size of the abscess gradually decreased. Total excision of the urachus and partial cystectomy were carried out 19 days after the drainage. The drainage procedure allowed us to perform surgery with relative case and to reduce the extent of the tissue to be excised.
A 72-year-old woman presented with a progressively enlarging, painful umbilical nodule. A biopsy specimen of the lesion showed focally mucin-producing adenocarcinoma, and the patient was diagnosed to have metastatic carcinoma of umbilicus: Sister Mary Joseph's nodule. Search for the primary tumor revealed adenocarcinoma of the splenic flexure of colon with metastasis to liver, spleen, and periaortic lymph nodes. Sister Mary Joseph's nodule is a well-known entity. It is a rare form of cutaneous umbilical metastases, can present as the first sign of intra-abdominal malignancy, carries very poor prognosis, and generally is inoperable. This report emphasizes the need for careful evaluation of any umbilical lesion and the importance of histologic diagnosis in case of doubt.
Thirteen cases of neonatal tetanus were treated conservatively between 1976 and 1977. A single dose of A.T.S. was infiltrated subcutaneously around the umbilicus and sedation and antibiotics were given as required along with special nursing care. In a previous study (Rathore 1976) large amounts of A.T.S. were given in divided doses by both intravenous and intramuscular routes, the mortality rate was 74 per cent, while in the present series the mortality was reduced to 30.7 per cent.
The pedicled tensor fasciae latae myocutaneous flap is a well-recognised and reliable method of reconstruction of full-thickness defects of the lower abdominal wall and groin. Its superior reach can be extended above the level of the umbilicus by the simple manoeuvre of flexing the hip.
Umbilicus rupestris (pennywort) switches from C3 photosynthesis to an incomplete form of crassulacean acid metabolism (referred to as 'CAM-idling') when exposed to water stress (drought). This switch is accompanied by an increase in the activity of phosphoenolpyruvate carboxylase. This enzyme also shows several changes in properties, including a marked decrease in sensitivity to acid pH, a lower Km for phosphoenolpyruvate, very much decreased sensitivity to the allosteric inhibitor malate, and increased responsiveness to the allosteric effector glucose 6-phosphate. The Mr of the enzyme remains unchanged, at approx. 185 000. These changes in properties of phosphoenolpyruvate carboxylase are discussed in relation to the roles of the enzyme in C3 and in CAM plants.
Phytochemical investigation of the leaves of Umbilicus pendulinus afforded in addition to 2-O-caffeoyl malate, isoquercitrin and Z-venusol, the new isomer E-venusol. Special NMR experiments were carried out to elucidate the configuration of the two latter compounds.
OBJECTIVE: To try to use appendix in situ without any special treatment as a conduit of the continent cutaneous ileocolonic reservoir. METHODS: An isolated ileocolonic segment, about 20 cm of terminal ileum and 20 cm of ascending colon, was detubularized by antimensenteric splitting and a pouch was completed by side-to-side anastomosis of the colon and the ileum loop. Both ureters were implanted into two separate submucosal tunnels of 3 cm long into the colon wall of the pouch. The appendix after tail was amputated was passed through the umbilicus hole with which the base of the cecum was sutured. RESULTS: As a conduit of the pouch, the appendix had a good continent ability when 8 patients were followed up for 10 to 30 months after operation. It was easy and convenient for the patients to make self-catheterization. The mean capacities of the pouch were 500-700 ml and then the pressures were 20-45 cm H2O while it was filled. There were no definite complications such as urine leakage, stoma stenosis, ureter reflux, and hydroureteronephrosis. CONCLUSION: The operation of the ileocolonic pouch with the appendix as a continent umbilical stoma is simple and easy to perform and has such advantages as good continent, convenient self-catheterization and provides a quality life for the patients undergoing total cystectomy.
OBJECTIVE: To elongate the proliferation life-span of human umbilicus vein endothelial cell (HUVEC). METHODS: We synthesized the human telomerase reverse transcriptase mRNA (hTERT mRNA) by in vitro transcription, then transferred the hTERT mRNA into HUVEC in quicent stage by lipofect introduction. RESULTS: Telomerase expressed transiently in HUVEC, and the cell life-span was elongated for 7 population doublings. CONCLUSION: Telomerase can be reconstructed controllably and transiently in HUVEC by hTERT mRNA introduction, this method has the potential to be used to elongate the lifespan of cells cultured in vitro.