An unusual inflammatory tumour of the umbilicus.
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Transabdominal sonograms of 68 consecutive pregnant women were reviewed retrospectively. Images of fetal parts obtained through the umbilical window (UW) were compared with those obtained through the paraumbilical window (PUW) as to (1) thickness of tissue to amniotic cavity, (2) clarity of the part imaged, and (3) noise produced. The paraumbilical tissue thickness had a mean of 18 mm; the umbilical tissue thickness, a mean of 11 mm. In patients where the difference in thickness of their paraumbilical tissue and umbilical tissue was only 0 mm to 6 mm (group 1), the UW improved clarity in 10 of 34 (29%), reduced clarity in 3 of 34 (9%), and did not change clarity in 21 of 34 (62%). Improvement of images with use of the UW was not statistically significant. However, in the group of patients with the difference in tissue thickness between the paraumbilical and umbilical areas of > 6 mm (group 2), clarity was improved in 19 of 32 (60%), reduced in 2 of 32 (6%), and was unaltered in 11 of 32 (34%). In this group the image improvement with the UW was statistically significant. Images through the UW had relatively less noise. In group 1, noise was reduced in 12 of 35 (34%). The effect of the UW on noise reduction was more significant in group 2 (tissue thickness difference > 6 mm): 24 of 31 (77%) of cases.
Umbilical metastases from known and unknown primary cancers are rare. The eponym "Sister Mary Joseph's nodule" has been used by generations of physicians. The first reports of this clinical sign were from Walshe in 1846. A review of the literature revealed 265 cases from then until 1989. Only 85 cases of umbilical metastasis from unknown primary tumors were found. This review should help us to focus on the common and uncommon primary sites in the diagnosis of patients with this finding. A single case report and the work-up for the hidden primary tumor are described.
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Two cases of umbilical pilonidal sinus are reported herein. Both patients were young adult males aged 21 and 27 years, respectively. The predisposing factors are briefly discussed, however, the exact etiology of this disease remains unknown. Umbilectomy is the most commonly offered treatment and although it is rare, this entity probably goes undiagnosed in the majority of cases.
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Reconstruction of the navel after tumour excision with subsequent navel resection is of great aesthetic importance for the patient. Methods of navel reconstruction are found in the literature but do not provide an elegant solution to the problem. Our method permits reconstruction of the navel during wound closure, by creation of two opposing trapezoidal skin flaps at the excision margin in the midline of the body; the umbilical fossa is then restored by jointly anchoring these flaps to the linea alba. Reconstruction has been successfully carried out in this way after melanoma excision in 7 patients.
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Two different neonatal umbilical cord treatment regimens were studied prospectively. Although a greater proportion of cords had separated by the seventh day in those babies not treated with topical antiseptics (47% vs. 26%), there was a significant excess (53% vs. 30%) of umbilical colonization by Staphylococcus aureus compared to those neonates whose cords were treated with alcohol wipes and hexachlorophane powder. The main purpose of treating cords is to prevent significant S. aureus colonization, and therefore current proposals to stop antiseptic treatment of umbilical cords should be disregarded.