Cervical Anomalies Research Articles

EVALUATION OF ASSOCIATION OF CLEFT LIP AND CLEFT PALATE WITH CERVICAL VERTEBRAL ANOMALIES: A LATERAL CEPHALOGRAPH STUDY

The precise origin of cervical vertebral anomalies is still unstated, but it has been suggested that the association between abnormal development of cervical vertebrae and the maxilla and the mandible might be caused by a developmental fault of the mesenchyme as these structures might be dependent on the similar para-axial mesoderm. Hence it is appropriate to focus on this area of research and to consider the craniofacial morphology as an important diagnostic tool in Orthodontic treatment planning. The present study was planned to evaluate the association of Cleft lip and Cleft palate with cervical vertebral anomalies.
 The present study was planned in Department of Pediatric and Preventive Dentistry, Buddha Institute of Dental Sciences & Hospital, Patna, Bihar, India. Thirty cases of Cleft Lip and Cleft Palate (CLCP) patients were enrolled in the present study. The age of the patients ranged from 5 years to 15 years. The cleft sample were subdivided into patients with CP only, and unilateral cleft lip and palate (UCLP) and bilateral cleft lip and palate (BCLP). Radiographs were examined on a film viewer by a single examiner. The profile of first four cervical vertebrae and Atlanto Occipital Articulation were structurally traced on an acetate paper with 3H lead pencil under optimum illumination and Cervical Vertebral Anomalies (CVA) were registered and categorized into Posterior Arch Deficiencies - PAD (dehiscence and spina bifid) and fusion.
 The present study concludes the association between cleft lip and palate and Cervical Vertebral Anomalies indicating that CVA may be implicated as the etiology of cleft lip and palate. The present study showed a specific relation between the Cleft Palate and cervical anomalies and the vertebral anomalies following a specific pattern in different types of cleft was found to be PAD which occurred more frequently in UCLP and CP only and fusion occurring significantly more often in BCLP.
 Keywords: Cleft Lip and Cleft Palate; Cervical Vertebral Anomalies; Dehiscence; Fusion; Lateral Cephalograph

Traumatic Atlanto-Axial Rotary Subluxation (AARS) in a 6-Year-Old Child during Recreational Jūdō Practice: A Case Report and Mini-Review of Serious Neck Injuries in Jūdō

Introduction: Traumatic atlanto-axial rotational subluxations (AARS) represent a serious condition that is associated with neurological complications, and should be considered among jūdō sports injuries involving the neck. Case presentation: A 6-year-old Caucasian girl with approximately 1 year of recreational jūdō experience presented with neck and shoulder pain while holding her head in a “Cock-robin” sideways tilted position. During a children’s jūdō class while seated on “all fours” she had been subjected to an improperly executed turnover performed by a boy of similar age, body mass and experience. Because of increasing torticollis symptoms after class she was taken by her parents to a local hospital’s emergency department where X-rays showed a mid-clavicular fracture. It was not until 7 weeks post-accident that a CT scan was ordered and a type-III traumatic acute AARS causing her clinical symptoms was recognized. Differential diagnosis: Congenital cervical spine anomalies, Grisel’s syndrome, Juvenile rheumatoid arthritis, Odontoid fracture without atlanto-axial dislocation. Treatment: A halo crown traction brace connected to a cervical traction pulley with gradual increased weight (+0.5 kg every half day to a maximum of 6.5 kg) was used for reduction over a 17-day period, followed by 6 weeks of ambulant immobilization with a halo vest, and 8 weeks of wearing a stiff neck brace. The girl fully recovered but was advised not to return to practicing contact sports. Uniqueness of the study: AARS has not previously been described in association with jūdō practice in children. Conclusion: Traumatic AARS should be considered as a potential diagnosis in jūdōka, especially those of very young age and of female gender, when presenting with torticollis following mechanical impact or severe pressure on the head if blocked in a tilted position. Prompt diagnosis is crucial, preferably by open-mouth X-rays and CT scan, to ensure proper management and prevent neurological complications.

Congenital Osseous Anomalies of the Cervical Spine: Occurrence, Morphological Characteristics, Embryological Basis and Clinical Significance: A Computed Tomography Based Study.

Study DesignObservational retrospective computed tomography (CT) based study.PurposeTo analyze the congenital anomalies of the cervical spine, their morphological variations and their clinical significance.Overview of LiteratureStudies published to date have focused mainly on upper cervical anomalies; no study has comprehensively reported on anomalies of both the occipitocervical and subaxial cervical spine.MethodsNine hundred and thirty cervical spine CT scans performed in Ganga Hospital, Coimbatore, India between January 2014 and November 2017 were screened by two independent observers to document anomalies of both the upper and lower cervical spine. CT scans conducted for infection, tumor, and/or deformity were excluded. Different morphological variations, embryological basis, and clinical significance of the anomalies were discussed.ResultsOf the 930 CT scans screened, 308 (33.1%) had congenital anomaly. Of these, 184 (59.7%) were males and 124 (40.2.7%) were females, with a mean age of 44.2 years (range, 14–78 years). A total of 377 anomalies were identified, with 69 cases (7.4%) having more than one anomaly. Two hundred and fifty (26.8%) anomalies of the upper cervical region (occiput to C2–C3 disk space) were identified, with the most common upper cervical anomalies being high-riding vertebral artery (108 cases, 11.6%) and ponticulus posticus (PP) (75 cases, 8%). One hundred and twenty seven (13.6%) anomalies of the lower cervical spine (C3–C7) were noted, of which double foramen transversarium was the most common anomaly observed in 46 cases (4.8%).ConclusionsWe found that 33.1% of CT scans had at least one congenital anomaly. Some anomalies, such as abnormal facet complex and arch anomalies, have to be differentiated from fractures in a trauma patient. Other anomalies, like PP, have to be looked for during preoperative planning to avoid complications during surgery. Therefore, knowledge of these anomalies is important as different anomalies have different clinical courses and management.

Prevalence of cervical vertebrae anomalies in patients with cleft lip and palate

Abstract Objective To investigate the prevalence of cervical vertebral anomalies (CVA) in a group of patients presenting with cleft lip and palate (CLP) and to compare with a non-cleft population. Material and methods The sample comprised of 150 lateral cephalograms of non-syndromic patients with CLP and 150 non-cleft age-matched controls. The age range of both groups covered 6 to 20 years. An expert radiologist blinded to the cleft status evaluated the cephalograms for CVA and categorised them into normal, fusion, dehiscence and multiple cervical anomalies. The cleft group was subdivided according to the types of cleft (UCLP/ BCLP/ CPO) and gender (male/female). The CVA prevalence was compared between the cleft and non-cleft patients. Results The prevalence of CVA was 37.7% and 20.7% in cleft and non-cleft patients, respectively. The difference was statistically significant with a p-value <0.01. Of the types of clefts, a left UCLP had the highest prevalence of CVA (47.2%), with fusion (35.8%) most commonly seen. On comparing CLP with CPO, no significant variation was observed between the types of anomalies. Conclusions A high prevalence of CVA was observed in cleft patients compared with non-cleft subjects. The prevalence of CVA was similar between males and females. The practitioner should carefully evaluate the lateral cephalogram of CLP patients for CVA, which otherwise may remain undetected and lead to neurological symptoms later in life.

Double Cervix with Normal Uterus and Vagina - An Unclassified Müllerian Anomaly.

Müllerian anomalies are very common, and a frequent cause of infertility. The most used classification system until now, proposed by the American Society for Reproductive Medicine in 1988, categorizes comprehensively uterine anomalies but fails to classify defects of the cervix or vagina. This is based on a developmental theory that postulates that müllerian duct fusion is unidirectional, beginning caudally and extending cranially, which does not account for isolated cervical or vaginal defects. More recently, the European Society of Human Reproduction and Embryology has developed a consensus, which allows for independent cervical anomalies. We present a case of a 39-year-old woman with secondary infertility, found to have a cervical duplication in an anteroposterior disposition, which puts into question the principles of embryology formerly known, but supports the theory that development happens in a segmentary fashion.

A Stepwise Approach to Laparoscopic Excision of a Noncommunicating Rudimentary Horn

Study ObjectiveTo demonstrate our approach to laparoscopic excision of a noncommunicating rudimentary horn (AmericanSociety for Reproductive Medicine classification II(b), European Society of Human Reproduction and Embryology/European Society of Gynaecological Endoscop classification class U4a). DesignTechnical video (Canadian Task Force classification level III). SettingUniversity Hospital. PatientA 25-year-old women with a left-sided pelvic mass. InterventionLaparoscopic excision of noncommunicating rudimentary horn with hysteroscopy and cystoscopy. Institutional Review Board/Ethics Committee ruled that approval was not required for this study. Measurements and Main ResultsNoncommunicating rudimentary horns are present in 20% to 25% of women with a unicornuate uterus [1]. Noncommunicating rudimentary horns may be associated with dysmenorrhea, pelvic pain, subfertility, and poor obstetric outcomes. Laparoscopic excision of rudimentary horns can be challenging and complex. Factors to consider in relation to the rudimentary horn are attachment to the uterus, presence and course of the ureter, and vascular supply. In this video we demonstrate our approach to laparoscopic excision of a rudimentary horn including preoperative imaging to plan surgical care. A 25-year-old women presented with pelvic pain and underwent a laparotomy for a left-sided pelvic mass. Intraoperatively, a rudimentary horn was suspected, and she was started on a gonadotropin-releasing hormone analogue pending diagnostic imaging and definitive surgery. Computed tomography demonstrated an absent left kidney and ureter. Intraoperatively, we began with a cystoscopy to identify and confirm an efflux from ureteral openings. A real-time hysteroscopy was performed to identify the unicornuate uterus from the rudimentary horn and to exclude vaginal or cervical anomalies. Through hysteroscopic transillumination the plane of dissection was identified between the rudimentary horn and uterus [2,3]. This technique is especially useful when the rudimentary horn is densely fused to the unicornuate uterus. Retroperitoneal dissection was performed ipsilateral to the rudimentary horn. A lateral approach was used to coagulate the uterine artery at its origin. The bladder was reflected from the horn to allow excision. A Thunderbeat device (Olympus Medical Systems, Tokyo, Japan) was used to excise the rudimentary horn, keeping very close to the specimen to ensure no penetration of the unicornuate uterus. Hemostasis was achieved, and no additional sutures were required. The specimen was removed using in-bag morcellation. ConclusionA stepwise hysteroscopic and laparoscopic approach can be used to safely resect a rudimentary horn as demonstrated by this case.

Vertebral Artery Dissection Caused by Neck Tics

AbstractVertebral arterial dissection (VAD) is a rarely observed cause of vertebrobasilar ischemia. It is often reported as individual case reports in children, and the underlying cause is usually congenital anomalies or trauma to the neck. In this case report, we present a pediatric case of VAD whose magnetic resonance (MR) and computed tomography angiographies were normal and could only be diagnosed after a careful reassessment of the initial brain MRIs considering the dynamic nature of the dissection process. Etiological investigations pointed to the patient's neck tics as the origin of the condition, which is a rare and interesting cause different from the previously reported cases in the literature. Due to the ischemic lesions in the brain stem and the cerebellum, low molecular weight heparin treatment was started and the neurological symptoms rapidly receded. Since a severe tic disorder involving the face and neck has been observed as a rare cause of VAD aside from the previously reported causes such as the Bow–Hunter syndrome reported in archers, congenital cervical anomalies, traumatic mechanical accidents, and cervical chiropractical maneuvers, the sharing of this case will contribute to the literature.

Deregulated TNF-Alpha Levels Along with HPV Genotype 16 Infection Are Associated with Pathogenesis of Cervical Neoplasia in Northeast Indian Patients.

Multiple factors are associated with human papillomavirus (HPV) infection related cervical anomalies and its progression to cervical carcinoma (CaCx), but data vary with respect to the underlying HPV genotype and with population being studied. No data are available regarding the role of immunological imbalance in HPV infected CaCx pathogenesis from Northeast India, which has an ethnically distinct population, and was aimed to be addressed through this study. The study included 76 CaCx cases, 25 cervical intraepithelial neoplasia (CIN) cases, and 50 healthy female controls. HPV screening and genotyping were performed by PCR. Differential expression of tumor necrosis factor alpha (TNF-α) was studied at serum level by enzyme-linked immunosorbent assay and tissue level by immunohistochemistry and messenger RNA (mRNA) level by real-time PCR. The data were correlated with interferon gamma (IFN-γ) and NF-κβp65 levels at protein level, as well as HPV16 E6 and E7 expression at transcript level statistically. HPV infection and HPV16 genotype were predominant in the studied cohort. TNF-α was found to be downregulated at both mRNA and protein levels in CaCx cases compared to controls; and the gradient downregulation correlated with progression of the disease from normal→CIN→CaCx. TNF-α expression correlated with insufficient modulation of both IFN-γ and NF-κβp65. The HPV16 E6 and E7 transcripts were found to be sharply upregulated in CaCx cases strongly inversely correlated with the TNF-α expression. Significant role of TNF-α downregulation associated with insufficient IFN-γ and total NF-κβp65 modulation and the resulting significant upregulation of viral transcripts E6 and E7 are key to the HPV16 infection mediated CaCx pathogenesis in northeast Indian patients.

Concordance of the frequency, typing, and results of high risk human papilloma virus in cervical cytology materials with biopsy: Retrospective analysis of 5604 patients

Aim: The aim of the study is to evaluate retrospectively the results of human papilloma virus (HPV) screening test started at our center, to identify the rates of high risk HPV (hrHPV) causing /not causing cellular anomalies and HPV16, 18/45 genotypes, to review the concordance of smear results and biopsy, and to compare our results with the similar studies conducted in different parts of the world and our country. Material and Methods: Five thousand six hundred four cases in Hospital, between 2016 and 2017, with transcription-mediated amplification and hybridization protection method,14 hrHPV types including HPV16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66, 68 were investigated with presence of HPV E6/E7 mRNA. HPV(+) cases were reevaluated with the genotyping study for detection of HPV16, 18/45. Results: When the hrHPV results of 5604 patients were evaluated, 421 cases (7.5%) were hrHPV positive and 5183 cases (92.5%) were hrHPV negative. In the genotyping study of hrHPV positive cases, it was found that HPV16 was present in 97 cases (23%), HPV18/45 was present in 40 cases (9.5%) and other hrHPVs were found in 282 cases (67%). HPV16 and HPV 18/45 coexisted in 2 cases (0.5%). Biopsy results of hrHPV positive cases were 56 cases (32.7%), 40 cases (23.4%) and 5 cases (2.9%) for low grade squamous intraepithelial lesion (LGSIL), high grade squamous intraepithelial lesion (HGSIL) and Squamous Cell Carcinoma (SCC), respectively. Conclusion: In our study, prevalence of hrHPV is 1.2% in cases with normal cytology results and 7.5% in general population. In the majority of studies conducted in our country, HPV positivity is very high because HPV is studied in smear and cervical anomaly cases instead of general population. We believe that this study contributes to determine the frequency and genotype distribution in normal/ abnormal cytology of HPV in our country.

Orthopaedic manifestations within the 22q11.2 Deletion syndrome: A systematic review.

The 22q11.2 Deletion Syndrome (22q11.2DS) is the most common microdeletion syndrome with an estimated prevalence of 1:4,000 live births. 22q11.2DS is known to have wide phenotypic variability, including orthopaedic manifestations. The purpose of this systematic review is to increase the awareness of orthopaedic manifestations associated with 22q11.2DS. This systematic review was performed according to the PRISMA Guidelines. Original epidemiological studies on the prevalence of orthopaedic manifestations within 22q11.2DS were systematically searched for in PubMed and EMBASE. The included articles were scored according to a risk-of-bias tool, a best-evidence synthesis was performed and the prevalence data was extracted. Sixty-nine published manuscripts described 58 orthopaedic manifestations in a total of 6,055 patients. The prevalence of at least one cervical or occipital anomaly is 90.5-100% (strong evidence). Fourteen studies (n = 2,264) revealed moderate evidence for a wide scoliosis prevalence of 0.6-60%. Two studies demonstrated that 5-6.4% of all 22q11.2DS patients required surgical scoliosis correction. Fifteen studies (n = 2,115) reported a 1.1-13.3% prevalence of clubfoot with moderate evidence. Other reported orthopaedic manifestations are patellar dislocation (10-20%), juvenile rheumatic arthritis (3.75%), impaired growth and skeletal anomalies like polydactyly (1.0-3.7%), syndactyly (11-11.8%), butterfly vertebrae (11.1%) and 13 ribs (2-19%). Orthopaedic findings are important manifestations of the 22q11.2DS, both in bringing patients to diagnostic attention and in requiring surveillance and appropriate intervention. Data on these manifestations are scattered and incomprehensive. Routinely screening for cervical anomalies, scoliosis, and upper and lower limb malformations is recommended in this vulnerable group of patients.

The Clinical Utility of Flexion-extension Cervical Spine MRI in 22q11.2 Deletion Syndrome.

Our goal is to correlate the findings on flexion and extension radiographs with dynamic magnetic resonance imaging (MRI), and the clinical history, in a nonrandomly selected cohort of patients with 22q11.2 deletion syndrome (22q). All patients with the 22q who had a dynamic MRI from January 2004 to March 2015 were included. We analyzed multiple radiographic measurements on both the dynamic plain films and the MRIs, and correlated these findings with a review of each patient's medical record. Multiple congenital anomalies were identified as noted in previous studies, and 61% of the patients had a failure of fusion of the anterior (n=2, 9%), posterior (n=2, 9%), or anterior and posterior arches (n=10, 43%). Quantitative measurements were impossible to report with certainty because of the upper cervical anomalies, and no cases of instability were identified using a qualitative assessment. We identified spinal cord encroachment (30%) and impingement (18%); however, none of the patients had any signal change in their spinal cord. None of these findings could be definitively correlated with any clinical symptoms. A single patient was diagnosed with a Chiari I malformation, while another had cerebellar ectopia. Although the upper cervical anomalies are extremely common in 22q, we did not identify cases of instability on dynamic plain radiographs and MRI. Although our findings do not support routine screening with flexion and extension MRI, this study may be required in patients with neurological symptoms and/or findings or abnormalities on dynamic plain radiographs. Level III.

MRI in the evaluation of obstructive reproductive tract anomalies in paediatric patients

To outline the anatomical variations of obstructive reproductive tract anomalies (ORTA) using magnetic resonance imaging (MRI) and its role in preoperative evaluation. MRI and treatment of 21 paediatric patients with ORTA were reviewed and analysed. MRI findings were correlated with ultrasound and surgical findings. Patients presented in two distinct ways: primary amenorrhoea with cyclic pelvic pain, or progressive dysmenorrhoea. MRI showed haematocolpos, haematocervix, haematometra, and/or haematosalpinx; it also provided detailed information regarding uterine morphology, ipsilateral kidney absence, and endometriosis. Diagnosis at MRI of the obstruction sites correlated completely (100%) with the surgical diagnosis. Obstruction occurred at different levels of the genital tract, and surgical treatment was given based on the obstruction sites. One patient underwent excision of the hymen tissue for imperforate hymen. Four cases of lower vaginal atresia were treated with vaginoplasty. Three patients with typical Herlyn-Werner-Wunderlich (HWW) syndrome underwent resection of the vaginal septum, and one patient with concurrent post-partum placenta increta was treated accordingly; one patient with atypical HWW syndrome had the left uterus resected. There were 11 cases of cervical agenesis or cervicovaginal dysgenesis, eight of which were complicated with uterine anomalies, and in all cases the uterus was removed. Among the 10 obstructive cervical anomalies, there were three cases of cervical agenesis and seven cases of cervical dysgenesis, including five obliterated cervical os (cervical obstruction), one cervical fibrous cord, and one cervical fragmentation. ORTA can occur from the hymen to the lower segment of the uterus and requires surgical intervention. The preoperative evaluation is vital to guide proper surgery. MRI, with its imaging advantages, is the imaging technique of choice to assess the obstructed sites and complicated anomalies of ORTA.

Mayer–Rokitansky–Kuster–Hauser syndrome: Syndrome of Mullerian agenesis – A report of two cases

The Mayer–Rokitansky–Kuster–Hauser syndrome (MRKH syndrome), simply called Rokitansky syndrome or vaginal aplasia of the uterus, is a congenital condition that is characterized by the absence of the uterus and vagina, but ovaries are present and the external genitalia are normal. It affects at least 1 out of 4500 women. MRKH may be isolated (Type I), but it is more frequently associated with renal, vertebral, and to a lesser extent, auditory and cardiac defects (MRKH Type II or Mullerian duct aplasia, Renal dysplasia, and Cervical Somite anomalies association - mullerian duct aplasia, renal dysplasia, and cervical somite anomalies). There were very few cases of MRKH syndrome reported in the literature. Here, we report two cases of MRKH syndrome, one in a 20-year-old woman who presented with primary amenorrhea (MRKH Type I) and the other in a 65-year-old woman with primary amenorrhea and associated renal malformations and a rare ovarian sertoliform variant of endometrioid tumor (MRKH Type II).

Intrauterine growth restriction and impaired skeletal growth in mouse fetuses following maternal exposure to aflatoxin B1 during early and late organogenesis

There is a paucity of information on the toxic effects of aflatoxins on reproduction, and any data that are available in the literature are largely from experiments with poorly described methodology, possibly making them unreliable. Consequently, the aim of this study was to evaluate the consequences of aflatoxin B1 (AFB1) administered during the early and late stages of organogenesis on fetal growth and development in the mouse. Groups of mice were administered a single dose of 20mg/kg AFB1 dissolved in dimethyl sulfoxide (DMSO) either intraperitoneally or orally on gestation day (GD) 7 or 13. The control animals received a similar volume of DMSO. Fetuses were collected on GD 18. This treatment was found to be maternally non-toxic; however, AFB1 treatment resulted in a significantly increased incidence of fetuses with intrauterine growth restriction, characterized by a body weight of ≥ 2 standard deviations below the mean of the control animals. A significant number of fetuses of AFB1-treated mice were also found to have developed smaller kidneys. In addition, the AFB1 group fetuses exhibited delayed ossification of the supraoccipital bone, cervical and coccygeal vertebral bodies, and the bones of the forepaws and hindpaws. Another major finding was a significantly increased incidence of cervical ribs and sternal anomalies. Interestingly, the effects of AFB1 were found to be more severely pronounced in the GD-13 treatment group than in the GD-7 treatment group. These results show that the later organogenesis stage of development (GD 13) is more susceptible to the deleterious effects of AFB1 in mouse fetuses.

Hysterosalpingography in The Assessment of Congenital Cervical Anomalies.

Cervical abnormalities may be congenital or acquired. Congenital anomalies of the cervix are rarely isolated, and more commonly accompany other uterine anomalies. Various imaging tools have been used in the assessment of Müllerian duct anomalies (MDAs). Currently, magnetic resonance imaging (MRI) is the modality of choice for definitive diagnosis and classification of these MDAs. Hysterosalpingography is a basic tool for evaluation of infertility and allows us to detect a spectrum of anatomical malformations of the utero-cervix in the setting of MDAs. It provides good outlines of the uterine cavity and fallopian tubes, as well as the cervical canal and isthmus. However, hysterosalpingograms (HSG) cannot be performed in patients with isolated congenital maldevelopment (agenesis/disgenesis) of the cervix. This part of pictorial review illustrates the various radiographic appearances of congenital malformations of the utero-cervix with a brief overview of the embryologic features. Accurate diagnosis of such cases is considered essential for optimal treatment and categorization of each anomaly.

Experience in thyroglossal duct pathology: clinical case series

The thyroglossal duct cyst pathology represents the second cause of bening cervical anomalies in childhood. Diagnosis is mainly clinical. Sistrunk (1920) proposed a surgical technique that is still considered the gold standard for definitive treatment of this condition. A retrospective study was made including patients who underwent surgery for thyroglossal duct cyst pathology in our department between June 2008 and August 2015. In this period, we performed 54 procedures in 45 patients (39 primary cases). Median age was 4.7 years; 14/39 patients (31.1%) had pre-operative infection. All patients were studied with neck ultrasound. A Sistrunk's procedure was performed in all cases. The global recurrence rate was 17.8% (8/45).

Distribution of female genital tract anomalies in two classifications

ObjectiveThis study assessed the distribution of Müllerian duct anomalies in two verified classifications of female genital tract malformations, and the presence of associated renal defects. Study design621 women with confirmed female genital tract anomalies were retrospectively grouped under the European (ESHRE/ESGE) and the American (AFS) classification. The diagnosis of uterine malformation was based on findings in hysterosalpingography, two-dimensional ultrasonography, endoscopies, laparotomy, cesarean section and magnetic resonance imaging in 97.3% of cases. Renal status was determined in 378 patients, including 5 with normal uterus and vagina. ResultsThe European classification covered all 621 women studied. Uterine anomalies without cervical or vaginal anomaly were found in 302 (48.6%) patients. Uterine anomaly was associated with vaginal anomaly in 45.2%, and vaginal anomaly alone was found in 26 (4.2%) cases. Septate uterus was the most common (49.1%) of all genital tract anomalies, followed by bicorporeal uteri (18.2%). The American classification covered 590 (95%) out of the 621 women with genital tract anomalies. The American system did not take into account vaginal anomalies in 170 (34.7%) and cervical anomalies in 174 (35.5%) out of 490 cases with uterine malformations. Renal abnormalities were found in 71 (18.8%) out of 378 women, unilateral renal agenesis being the most common defect (12.2%), also found in 4 women without Müllerian duct anomaly. ConclusionsThe European classification sufficiently covered uterine and vaginal abnormalities. The distribution of the main uterine anomalies was equal in both classifications. The American system missed cervical and vaginal anomalies associated with uterine anomalies. Evaluation of renal system is recommended for all patients with genital tract anomalies.

Diagnosis and treatmen analysis of acute abdomen caused by cervical anomalies

Diagnosis and treatmen analysis of acute abdomen caused by cervical anomalies

Computed Tomographic Evaluation of Degenerative Spine Changes in Patients with Obstructive Sleep Apnea Syndrome: A Case Control Study

Objective: Recently few studies have described presence of cervical spine anomalies in obstructive sleep apnoea syndrome (OSAS) patients. It is also reported that some cases of cervical spine pathologies and osteophytes producing obstructive sleep apnea. We aim to investigate the prevalence of facet joint arthrosis and degenerative disc disease (DDD) in cervical spine using computed tomography (CT) in OSAS patients. Materials and Methods: We studied on thirty patients with OSAS who had cervical spine CT. Facet joints were evaluated in four grades and scored in 1-4 points by using multiplanar CT images. Disc levels was evaluated by using two-point subjective scale for loss of height, posterior osteophytes, endplate sclerosis, and spinal canal stenosis to determinate DDD. Degeneration of anterior atlanto-odontoid joint (AAOJ) were classified into four grades. Tomographic findings were compared with those for thirty control subjects. Results: The mean degeneration scores of C2-T1 facet joints and C2-C5, C7-T1 disc spaces were significantly higher in the cases of OSAS group than the cases of the control group. There were no significant differences in the mean degeneration scores for C5-6 and C6-7 cervical intervertebral disc levels between the groups. Degeneration scores of the facet and disc for whole cervical spine in the cases of the OSAS group was significantly higher than in cases of the control group (P<0.001 and P=0.002). AAOJ degeneration degrees showed differences between the groups. Statistically significant correlations were found between the OSAS degrees and the intervertebral disc degeneration (R=0.338, P=0.007) and facet joint degeneration (R=0.543, P=0.000) for all cervical vertebrae. Conclusions: The cervical spine of the OSAS patients has more severe disc degeneration and facet joint and AAOJ arthrosis, compared to subjects without OSAS. This findings may contribute to clinic evaluation of OSAS patients with servical pain and limited movement.

Retrospective review of 22 surgically treated adults with congenital anomalies of the upper cervical spine: a clinical and radiological review.

The purpose of this study was to clarify the characteristics of adult cases with instability due to upper cervical spine anomalies who needed fusion surgery regarding the clinical and radiological findings. Twenty-two consecutive patients with instability due to upper cervical spine anomaly in adult cases were reviewed. The congenital anomalies included idiopathic atlanto-axial subluxation in nine cases, os odontoideum in seven cases, occipitalization of the atlas in four cases, atlanto-occipital subluxation in one case and AAS with another anomaly in one case. We evaluated the severity of neurological symptoms before surgery and at the last follow-up. We also observed MR images before and 1year after surgery. Before surgery, the 22 patients included seven Ranawat Grade I cases, ten Ranawat Grade II cases, and five Ranawat Grade IIIa cases. Regarding the neurological status after surgery, those included eighteen Ranawat Grade I cases, three Ranawat Grade II cases, and one Ranawat Grade IIIa case. Preoperative T2-weighted MR images demonstrated intramedullary high signal intensity (IHSI) in 12 cases. IHSI group did not include significantly more Ranawat Grade IIIa cases compared to the remaining 10 cases. In postoperative MR images (nine cases), the regression or disappearance of IHSI was demonstrated in only three cases. In adult cases with instability due to upper cervical spine anomalies, we acquired favorable clinical outcomes after surgery. Regarding the neurological severity before surgery, there was no relationship with the IHSI on T2-weighted MR image. Moreover, the regression or disappearance of IHSI after surgery was not frequently demonstrated.