Amyand’s hernia is defined as when the appendix is trapped within an inguinal hernia. While the incidence of this type of hernia is rare, the appendix may become incarcerated within Amyand’s hernia and lead to further complications such as strangulation and perforation. Incarceration of the appendix most commonly occurs within inguinal and femoral hernias, but may arise to a lesser extent in incisional and umbilical hernias. Incarcerated appendix has been reported in a variety of ventral abdominal and inguinal locations, yet its indistinct clinical presentation represents a diagnostic challenge. This paper reviews the literature on incarceration of the appendix within inguinal hernias and discusses current approaches to diagnosis and treatment of Amyand’s hernia and complications that may arise from incarceration of the appendix within the hernia.

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Using a combined search of the Children’s Hospital (Birmingham, Ala., USA) medical records and the Jefferson County Health Department death records, we reviewed all shunt-related deaths that occurred between January 1990 and July 1996. Of these, we excluded patients who died of nonhydrocephalus-related reasons, such as bronchopulmonary dysplasia, as well as patients who had other serious neurological illnesses such as brain tumor and hydranencephaly. Twenty-eight patients died of shunt-related causes in the 6.5-year period. A survival analysis showed that 96% survived 32 months after first shunting. Of 28 patients, 23 were beyond help prior to medical evaluation. However, at least 10 of these patients had symptoms suggestive of shunt failure at least 24 h and as long as 2 weeks prior to their demise. We conclude that hydrocephalic children still die of shunt failure despite the modern technology of the 1990s. Some of these causes may be avoidable through early detection of symptoms. Guidelines to patients, families, and primary caregivers should be emphasized.

SummaryEntrapment of the ulnar nerve at the elbow is the second most common compression neuropathy in the upper limb. The present study evaluates the anatomy of the cubital tunnel. Eighteen upper limbs were analysed in unembalmed cadavers using ultrasound examination in all cases, dissection in nine cases, and microscopic study in nine cases. In all cases, thickening of the fascia at the level of the tunnel was found at dissection. From the microscopic point of view, the ulnar nerve is a multifascicular trunk (mean area of 6.0 AE 1.5 mm 2 ). The roof of the cubital tunnel showed the presence of superimposed layers, corresponding to fascial, tendineous and muscular layers, giving rise to a tri-laminar structure (mean thickness 523 AE 235 lm). This multilayered tissue was hyperechoic (mean thickness 0.9 AE 0.3 mm) on ultrasound imaging. The roof of the cubital tunnel is elastic, formed by a myofascial trilaminar retinaculum. The pathological fusion of these three layers reduces gliding of the ulnar nerve during movements of the elbow joint. This may play a role in producing the symptoms typical of cubital tunnel syndrome. Independent from the surgical technique, decompression should span the ulnar nerve from the triceps brachii muscle to the flexor carpi ulnaris fascia.

Situs inversus is a rare condition in which the position of the thoracic and the abdominal viscera are exchanged from the left to the right sides. A possible inversion of normal dominant intracranial anatomy, has however, rarely been discussed. We examine here the gross anatomy of an elderly cadaveric female for a possible "situs inversus" of the intracranial contents. This study has found that many structures commonly dominant on one side in the intracranial compartment were reversed in this specimen. These findings support the concept that a reversal of more commonly found intracranial anatomy may occur in situs inversus totalis, and this should alert the clinician performing invasive procedures in this population. These data will also hopefully provide further insight into possible mechanisms that contribute to situs inversus totalis.