Common Anomalies Research Articles

The Healthcare Needs of Children With Down Syndrome in the First Year of Life: An Analysis of the EUROlinkCAT Data Linkage Study.

Globally, Down syndrome is the most common chromosomal anomaly, often co-occurring with cardiac or gastrointestinal anomalies. There is a lack of robust data on specific healthcare needs of children with Down syndrome compared to children with other major congenital anomalies. To quantify the healthcare needs of children with Down syndrome in the first year of life compared to children with major congenital anomalies in a large population-based cohort across Europe. The EUROlinkCAT study was a multicentre data linkage study between congenital anomaly registries in Europe and hospital and mortality databases. Children born between 1st January 1997 and 31st December 2014 were included. Summary statistics were used to compare differences between children (those with Down syndrome compared to all major anomalies) and regions. Random-effects meta-analysis was used to pool results related to survival, need for intensive care and ventilation support. A total of 3554 children were born with Down syndrome out of 89,081 children with major congenital anomalies. The pooled 1-year survival was 95.4%. In every region, > 80% of children with Down syndrome had a hospital admission excluding the birth admission. Hospital length of stay in the first year was higher for children with Down syndrome compared to those with all anomalies (median: 14 versus 7 days). Despite having similar need for ventilation support (9.7% vs. 8.4%), children with Down syndrome had higher rates of intensive care admission than all children with anomalies (24.8% vs. 13.0%). There is a high need for hospital care for children born with Down syndrome in the first year of life. Future work should continue to explore the long-term prognosis for children with Down syndrome to ensure their care needs are met.

Evaluating robustly standardized explainable anomaly detection of implausible variables in cancer data.

Explanations help to understand why anomaly detection algorithms identify data as anomalous. This study evaluates whether robustly standardized explanation scores correctly identify the implausible variables that make cancer data anomalous. The dataset analyzed consists of 18587 truncated real-world cancer registry records containing 8 categorical variables describing patients diagnosed with bladder and lung tumors. We identified 800 anomalous records using an autoencoder's per-record reconstruction error, which is a common neural network-based anomaly detection approach. For each variable of a record, we determined a robust explanation score, which indicates how anomalous the variable is. A variable's robust explanation score is the autoencoder's per-variable reconstruction error measured by cross-entropy and robustly standardized across records; that is, large reconstruction errors have a small effect on standardization. To evaluate the explanation scores, medical coders identified the implausible variables of the anomalous records. We then compare the explanation scores to the medical coders' validation in a classification and ranking setting. As baselines, we identified anomalous variables using the raw autoencoder's per-variable reconstruction error, the non-robustly standardized per-variable reconstruction error, the empirical frequency of implausible variables according to the medical coders' validation, and random selection or ranking of variables. When we sort the variables by their robust explanation scores, on average, the 2.37 highest-ranked variables contain all implausible variables. For the baselines, on average, the 2.84, 2.98, 3.27, and 4.91 highest-ranked variables contain all the variables that made a record implausible. We found that explanations based on robust explanation scores were better than or as good as the baseline explanations examined in the classification and ranking settings. Due to the international standardization of cancer data coding, we expect our results to generalize to other cancer types and registries. As we anticipate different magnitudes of per-variable autoencoder reconstruction errors in data from other medical registries and domains, these may also benefit from robustly standardizing the reconstruction errors per variable. Future work could explore methods to identify subsets of anomalous variables, addressing whether individual variables or their combinations contribute to anomalies. This direction aims to improve the interpretability and utility of anomaly detection systems. Robust explanation scores can improve explanations for identifying implausible variables in cancer data.

Outcomes of pediatrics cardiac patients in the PICU: an analysis of clinical and echocardiographic risk factors

Background: Cardiovascular diseases in pediatric patients present significant challenges in Pediatric Intensive Care Units (PICUs), with adverse outcomes influenced by factors such as ventricular dysfunction, sepsis and delayed intervention. Echocardiography plays a vital role in assessing cardiac function, identifying risk factors and guiding treatment. This study aims to analyze the clinical and echocardiographic profiles of pediatric cardiac patients admitted to the PICU and identify critical mortality risk factors to improve care and outcomes. Methods: A prospective observational study was conducted over 18 months from November 2022 to April 2024 in a tertiary care hospital in Srinagar. The study included 103 pediatric patients aged 1 month to 18 years with congenital or acquired heart diseases. Data collected included demographics, clinical presentations, echocardiographic findings, laboratory results and outcomes. Statistical analysis was performed using SPSS 25, with p<0.05 considered significant. Results: The cohort comprised 48 males (46.6%) and 55 females (53.4%), predominantly aged 1 month to 5 years. Ventricular Septal Defect (VSD) was the most common cardiac anomaly (18%), followed by Tetralogy of Fallot (4.8%). Respiratory distress (65.5%) and bronchopneumonia (30%) were prevalent comorbidities. Significant mortality risk factors included infant age, cyanosis (50% mortality), congestive heart failure (52.3%), deranged kidney function tests, altered pH and prolonged mechanical ventilation. Conclusions: Early diagnosis and timely interventions targeting high-risk groups are critical to improving survival. Identifying key echocardiographic profiles and clinical risk factors provides insights for optimizing PICU care for pediatric cardiac patients.

Epidemiologic trends of cleft lip and/or palate in Switzerland

BackgroundEpidemiologic data on the number of cleft lip and/or palate (orofacial cleft (OFC)) births in Switzerland are currently sparse. However, this knowledge is essential for better understanding the etiologies underlying the various cleft phenotypes and providing expectant parents with the best possible healthcare planning and counseling.MethodsThis is the first descriptive study to report data on the prevalence of the various cleft types, their sex, and regional distributions in Switzerland. Data for the years 1998–2021 were obtained from the Swiss Federal Statistical Office. Due to the notable initial underreporting of cleft cases from 1998 to 2006, this period was omitted from the final analyses.ResultsBetween 2007 and 2021, the prevalence of all Swiss OFC cases per 10,000 live births was 12.5, with a stable trend. Cleft lip was the least common anomaly. Except for cleft palate, which was more common in females, males were generally more affected by OFC than females. There was no discernible regional trend for any of the malformations, even though the prevalence differed throughout the seven Swiss regions.ConclusionsThis study presents the first descriptive epidemiologic profiles for OFCs in Switzerland and emphasizes the importance of nationwide OFC registries with an accurate and reliable reporting system for the benefit of current and future patients with clefts, their parents or caregivers, and society as a whole.

Methodology for Fault Detection Applied in Photovoltaic Plants Based on Inverter Power Curve Analysis

The maintenance of photovoltaic plants is crucial to ensure their proper performance, longevity, and efficiency, while also enhancing the return on investment and contributing to sustainable energy production. In such context, this paper proposes a methodology to characterize the main issues in photovoltaic plants, based on the analysis of the proposed inverter output power curve. Through power curve analysis, the most common anomalies and faults encountered in inverters are identified, providing a valuable tool for the early detection of operational issues. Additionally, power curve analysis allows a comparison between projected and actual values of generated energy, offering an index of system energy losses. Lastly, an economic analysis is presented, ranking inverters based on the magnitude of their energy losses, from highest to lowest. This analysis provides important insights for prioritizing maintenance actions and allocating resources to enhance generation returns.

Ebstein's anomaly in children and young adults: clinical features, arrhythmia, surgical management, and factors affecting arrhythmia and mortality.

Ebstein's anomaly represents 40% of congenital tricuspid valve abnormalities. Studies about paediatric Ebstein's anomaly patients are limited. To evaluate clinical characteristics, treatment (medical/arrhythmia ablation/surgical) results, and outcome of Ebstein's anomaly patients, and to determine factors affecting arrhythmia presence and mortality. Clinical data, echocardiography, treatment results, and outcomes of patients followed in our centre between 2000 and 2017 were retrospectively evaluated. A total of 79 patients (61 children, median diagnosis age: 1.5 years [1 day-24 years]) were included. Eight patients (10.1%) were deceased during the study period. Common associated anomalies were atrial septal defect/patent foramen ovale (56.9%), mitral regurgitation (25.3%), pulmonary stenosis/atresia (17.7%), and ventricular septal defect (16.5%). Genetic diseases/congenital anomalies were present in 5/3.8%. Tricuspid regurgitation was present in 75.9%, and severe in 50%. Arrhythmias were detected in 30.4%, and accessory pathway-mediated re-entrant tachycardia was the most common (67%). Wolff-Parkinson-White syndrome was present in 12.7%. Twenty-one ablation procedures (radiofrequency ablation [85.7%]/cryoablation [14.3%]) were performed in 16 patients (median age: 13.3 years [4.9-17]). Acute success/recurrence rates: 87.5/25%. Surgery was performed in 31.6% (median age: 6.5 years [4 days-29 years]), 7.6% were operated during the first month, and 12.6% during the first year. Second surgery was required in 28%. Perioperative mortality rate was 12%, and median mortality age was 25 days (1 day-17 years). Median follow-up period was 5.3 years (1 day-32 years). Older diagnosis age (p = 0.005) and mild-moderate mitral regurgitation (p = 0.036) were associated with arrhythmias. Younger age at diagnosis (p = 0.012), younger age at first surgery (p = 0.004), surgery before age three years (p = 0.037), and presence of pulmonary atresia (p = 0.000014) were associated with mortality. Gender, diagnosis age, congenital anomalies/genetic disorders, tricuspid regurgitation, arrhythmias, and surgery history did not have an independent effect on survival. In children and young adults presenting with Ebstein's anomaly, younger age at presentation and at surgery, surgery before age three years, pulmonary atresia were associated with death. Ablation procedures can be successfully performed but recurrence rate is still high.

Global, regional, and national survey on burden and Quality of Care Index (QCI) of orofacial clefts: Global burden of disease systematic analysis 1990-2019.

Orofacial clefts are the most common craniofacial anomalies that include a variety of conditions affecting the lips and oral cavity. They remain a significant global public health challenge. Despite this, the quality of care for orofacial clefts has not been investigated at global and country levels. We aimed to measure the quality-of-care index (QCI) for orofacial clefts worldwide. We used the 2019 Global Burden of Disease data to create a multifactorial index (QCI) to assess orofacial clefts globally and nationally. By utilizing data on incidence, prevalence, years of life lost, and years lived with disability, we defined four ratios to indirectly reflect the quality of healthcare. Subsequently, we conducted a principal component analysis to identify the most critical variables that could account for the observed variability. The outcome of this analysis was defined as the QCI for orofacial clefts. Following this, we tracked the QCI trends among males and females worldwide across various regions and countries, considering factors such as the socio-demographic index and World Bank classifications. Globally, the QCI for orofacial clefts exhibited a consistent upward trend from 1990 to 2019 (66.4 to 90.2) overall and for females (82.9 to 94.3) and males (72.8 to 93.6). In the year 2019, the top five countries with the highest QCI scores were as follows: Norway (QCI = 99.9), Ireland (99.4), France (99.4), Germany (99.3), the Netherlands (99.3), and Malta (99.3). Conversely, the five countries with the lowest QCI scores on a global scale in 2019 were Somalia (59.1), Niger (67.6), Burkina Faso (72.6), Ethiopia (73.0), and Mali (74.4). Gender difference showed a converging trend from 1990 to 2019 (optimal gender disparity ratio (GDR): 123 vs. 163 countries), and the GDR showed a move toward optimization (between 0.95 and 1.05) in the better and worse parts of the world. Despite the positive results regarding the QCI for orofacial clefts worldwide, some countries showed a slight negative trend.

Myocardial Bridging, Unusual Cause of Myocardial Infarction; Case Report and Review of Literature.

Myocardial bridging is a common coronary anomaly. Although it is considered to be a benign condition, it can rarely be complicated by myocardial infarction. Clinicians should be suspicious of myocardial bridging as an etiology of myocardial infarction when other more common etiologies have been excluded. High resolution CT angiography is the gold standard for diagnostic evaluation, with the length and depth of the bridge, and response to conservative therapies guiding clinical decision making on surgical correction. Myocardial bridging is a congenital coronary anomaly in which the coronary arteries pass through the heart muscle rather than lying on its surface. It is typically a benign condition, and most patients are asymptomatic. However, some may experience symptoms of angina. In rare cases, patients can present with myocardial ischemia or infarction. In this report, we present the case of a 38-year-old female who presented with a 2-month history of chest pain. Further evaluation with coronary computed tomography angiography (CCTA) revealed myocardial bridging. Subsequently, she developed a myocardial infarction, a rare complication of this condition. We discuss this uncommon complication of a common anomaly.

Supratentorial Intracranial Anomalies in Myelomeningocele Patients.

To assess associated cerebral supratentorial anomalies in patients who underwent myelomeningocele repair in hopes of developing a better morphological apprehension of the forebrain?s anomalies in this category of patients. This retrospective observational study assessed 426 pediatric patients who underwent myelomeningocele repair between January 2013 and December 2020. Cranial MRIs with T1- and T2-weighted sequences were obtained as part of the postoperative assessment to determine the presence of associated supratentorial anomalies in pediatric patients following myelomeningocele repair. The most common supratentorial anomalies identified in patients who underwent myelomeningocele repair are associated with the configuration of the corpus callosum (CC). Moreover, the complete agenesis of the CC was noticed in 9 (2.1%) subjects, whereas partial agenesis was identified in 148 (34.7%) subjects. Hypoplasia of the CC was observed in three (0.7%) patients. Gray matter heterotopia were the second most commonly observed supratentorial anomalies in 110 (25.8%) patients. Furthermore, the absence of the septum pellucidum was observed in two (0.47%) of the total patients. The widening of the interhemispheric fissure and abnormal maturation of the white matter were observed in 10 (2.34%) patients and 11 (2.58%) patients, respectively. Polymicrogyria, a consequence of abnormal cortical organization, was identified in 22.53% of the patients (96 patients) included in our series. This study confirms that, except for hydrocephalus and Chiari malformation, other associated cerebral supratentorial anomalies may be observed in patients with myelomeningocele. However, only limited research has confirmed the interconnection between the cerebral supratentorial anomalies and cognitive function. Therefore, this study emphasizes the necessity for further supplementary studies, in conjunction with accurate postnatal followups, in order to assess the real significance and repercussions of these anomalies on neurological development and also to establish how these structural changes in brain anatomy translate clinically.

Mitral Valve Prolapse Caused by TLL1 Gain-of-Function Mutation.

Mitral valve prolapse (MVP) is a common cardiac valvular anomaly that can be caused by mutations in genes of various biological pathways. Individuals of three generations of a kindred presented with apparently dominant heredity of isolated MVP. Clinical evaluation and echocardiography for all complying family members (n=13). Whole exome and genome sequencing data of two affected individuals were analyzed, delineating shared heterozygous variants, further tested for segregation within the kindred (Sanger sequencing). Tolloid Like 1 (TLL1) enzymatic activity was assayed in media of HEK293 cells transfected with wild-type versus mutant TLL1. The only heterozygous variant segregating in the affected kindred as expected for dominant heredity of MVP was p.T253A, within the catalytic domain of TLL1. Of eight heterozygotes, six had MVP and two had trivial mitral regurgitation. Activity assay in extra-cellular media of HEK293-transfected cells showed that over time (12 hours), the enzymatic activity of the mutated TLL1 protein was X3.4 higher than that of the wild type. Our genetic and biochemical studies show that a TLL1 Gain-of-Function mutation, prolonging the half-life of TLL1 active protein in the extracellular matrix (ECM), causes autosomal dominant MVP with variable expressivity. TLL1 encodes an extracellular metalloprotease regulating ECM composition and maintenance. Heterozygous Loss-of-Function TLL1 mutations have been previously shown to cause autosomal dominant atrial septal defects. Our findings enable novel insights into molecular pathways of valvular physiology and disease, the role of TLL1 in human development, and the differing phenotypes of Loss-of-Function and Gain-of-Function mutations of the same gene.

CT Angiography of the Upper Extremities: Review of Acute Arterial Entities.

Historically, evaluation of the upper extremity vasculature was performed using digital subtraction angiography. With the advancement of cross-sectional imaging and submillimeter isotropic data acquisition, CT angiography (CTA) has become an excellent noninvasive diagnostic tool for evaluation of the vasculature of the upper extremities. CTA allows quick evaluation of vessel patency and irregularity and achievement of the anatomic detail needed in preoperative planning. When interpreting CTA of the upper extremities, radiologists must be familiar with the normal vascular anatomy, common vascular anomalies, and pitfalls or artifacts that may mimic or mask abnormality. In this review, the authors provide an overview of the utility of CTA of the upper extremities. Also discussed are CTA techniques and the use of several newer technologies including dual-energy and photon-counting detector CT. The utility of CTA in patients with upper extremity trauma is explored, with a focus on assessing vascular injury. Other vascular abnormalities including infection, acute limb ischemia, and vasculitis are discussed. It is imperative for radiologists to be accustomed to CTA of the upper extremities in diagnosing acute vascular abnormalities and to recognize common pitfalls and mimics of these abnormalities. ©RSNA, 2025 Supplemental material is available for this article.

Rare Congenital Anomalous Origin of the Coronary Arteries: A Series of Three Cases

Introduction: Congenital coronary anomalies are found in 0.3% to 5.6% of the population and can be classified according to alterations in origin, distribution or course. Although benign in most cases, they can be associated with sudden death in young adults, especially after strenuous physical exercise. We report three rare cases of anomalous coronary arteries found incidentally by coronary angiography. Case Report: The first case refers to a 79-year-old man who underwent cardiac catheterization for etiological investigation of heart failure, showing a non-obstructive interruption of the left anterior descending artery (LAD) after the origin of the first diagonal branch, with the continuation of its middle and distal segments from the right coronary artery (RCA), which crosses to the left side at the atrial level and reaches the apex cordis. The second case is a 56-year-old woman with stable angina and a treadmill exercise test suggestive of myocardial ischemia. Coronary angiography revealed an anomalous origin of the RCA from the distal segment of the left circumflex artery (LCxA). The third and last case is a 64-year-old woman in whom coronary angiography revealed an anomalous origin of the LCxA from the proximal third of the RCA. Discussion: Coronary artery anomalies are a heterogeneous group whose diagnosis mostly occurs incidentally. They differ from anatomical variations in their rarity and greater association with adverse events, such as myocardial ischemia and sudden death. The cases presented address different anomalous origins: a LAD with duplicated origin, a single coronary artery with the emergence of the RCA in the distal third of the LCxA, and the anomalous origin of the LCxA from the RCA, one of the most common coronary anomalies. The three cases reported were patients over 50 years old, which shows the need to individualize cases and risks as regarding to anomalous origins of the coronary arteries.

Prevalence of Dental Anomalies in Pediatric Patients at King Saud University Dental Hospital, Riyadh, Saudi Arabia-A Radiographic Analysis.

To record the prevalence of dental anomalies in children visiting King Saud Dental Hospital, Riyadh, Saudi Arabia. This cross-sectional study involved radiographic examination of children aged 6 to 14 years who visited King Saud Dental Hospital, Riyadh, Saudi Arabia, in the past five years. Four dental interns were trained in three consecutive sessions by a pediatric dentist and evaluated the orthopantomograms of the children. The recorded anomalies were divided into four categories: tooth number, size, position, and general. Descriptive statistics were derived and chi-square tests performed to report prevalence and significance among genders, medical histories, and dental anomalies. The significance level was set at p < 0.05. Of the 1987 radiographs studied, 268 (13.48%) children had dental anomalies. The sample consisted of 51.1% female and 48.5% male children, with a mean age of 11.87 ± 2.1 years. Most study participants had mixed dentition and were healthy. The prevalence of dental anomalies reported in this study was as follows: 4.6% hypodontia, 2.7% ectopic eruption, 1.63% taurodontism, 1.2% infra-occluded molars, 1.1% impacted teeth, 0.75% root dilaceration, and 0.65% supernumerary teeth. Significant correlations were found between gender and ectopic eruption (p = 0.02) and between medical history and hypodontia (p = 0.00), ectopic eruption (p = 0.048), and root dilaceration (p = 0.03). This study showed that hypodontia was the most common dental anomaly, followed by ectopic eruption and taurodontism. The findings of this study may guide dentists in better understanding, diagnosing, and treating dental anomalies in children in Riyadh, Saudi Arabia.

Imaging of common coronary artery anomalies and imaging features important for clinical decision-making.

Anomalous coronary arteries are associated with sudden cardiac death, although only in a relatively small percentage. Although this has been a field of study for years and there are many ongoing studies of larger patient cohorts and longer term follow-up, important questions remain at present in clinical decision-making, particularly whether or not to have surgery. Advanced imaging techniques including coronary computed tomography (CT) and cardiac magnetic resonance (MR) play an important role in the workup of patients with known or suspected anomalies including delineating origin and course as well as defining presence of high-risk imaging features. Multidisciplinary decision-making is important when considering whether patients might need to undergo surgery. This review will describe types of anomalies, imaging techniques, and features as well as types of surgeries and postoperative imaging with highlights of imaging and surgical literature and several case examples.

Molecular aspects of pathogenesis of chronic lymphocytic leukemia

Introduction. Chronic lymphocytic leukemia (CLL) is the most common leukemia type in adults. CLL is characterized by significant changes in the patient's genome, including both various mutations and epigenetic changes. These changes currently play an important role in the diagnosis, prognosis and treatment of the disease. The aim of the work is to review the scientific literature on genetic mutations that occur in chronic lymphocytic leukemia. Material and methods. The following databases were used to search for published studies: PubMed, Web of Science, EBSCOhost and Scopus. The search was performed in the time period from the date of creation of the corresponding databases to October 2024. A study was considered suitable if it was original, included the clinical and pathogenetic features of CLL. Results. From the presented analysis of sources, it could be concluded that the main genetic changes in CLL are chromosomal mutations. Moreover, the most common anomalies are del(13q14) and del(17p). The microenvironment in CLL is also very important. The behavior of CLL cells depends on signals originating from non-tumor cells in the microenvironment. The tumor genome of many patients with CLL is characterized by the presence of mutations in the genes of the variable region of the heavy chain of immunoglobulins, while in other patients the above-mentioned genes do not contain mutations, which is associated with an unfavorable prognosis of the disease. Conclusions. The review analyzes various types of anomalies in CLL. The main stages of the pathogenetic mechanism in the evolution of the disease and possible methods of treatment depending on the genetic mutation are also examined.

FREQUENCY OF CARDIAC ANOMALIES IN PATIENTS WITH CLEFT LIP AND PALATE PRESENTED AT HAYATABAD MEDICAL COMPLEX

Cleft lip and/or palate are among the most common congenital craniofacial anomalies and are often associated with other systemic anomalies, including congenital cardiac anomalies (CCAs). The identification of CCAs in these patients is crucial for optimizing surgical outcomes and long-term health. Objective: To determine the frequency and types of congenital cardiac anomalies (CCAs) in patients with cleft lip and/or palate. Methods: This cross-sectional study was conducted at the burns and plastic surgery unit, Hayatabad Medical Complex, Peshawar. Children aged 3 to 10 years with cleft lip, cleft palate, or both were included. All patients underwent a detailed echocardiographic evaluation to identify CCAs, which were categorized as Atrial septal defect (ASD), Ventricular septal defect (VSD) and Mitral regurgitation. Results: Out of 73 patients included, 13.7% were found to have CCAs. The most common anomalies were atrial septal defect (6.8%), ventricular septal defect (4.1%), and mitral regurgitation (2.7%). ASD was observed exclusively in males, while VSD was more common in females. The younger age group (3–6 years) showed a higher prevalence of ASD. No significant associations were observed between CCAs and socioeconomic status or cleft type. Conclusion: Congenital cardiac anomalies are prevalent in patients with cleft lip and palate, with atrial septal defect and ventricular septal defect being the most common.

Congenital Anterior Urethral Diverticulum: A Case Report

Congenital anomalies of lower urinary tract are most common anomalies found in children, but congenital anterior urethral diverticulum is a very rare cause. Here we present 11 month old male child presented with soft cystic swelling in the ventral side of the penile shaft and underwent open diverticulectomy.

Circumflex left aortic arch: a new vascular ring anomaly in dogs.

To describe the circumflex left aortic arch as a new form of canine congenital vascular ring anomaly leading to esophageal constriction. 3 large-breed dogs of variable age: a 9-month-old entire male German Shepherd Dog-Rottweiler cross, a 17-week-old entire male German Shepherd Dog, and a 9-year-old neutered female Labrador Retriever, seen between April 2022 and May 2023. Dogs presented for chronic postprandial regurgitation and poor growth. One dog presented for a hard mass on the caudal mandibular region. Computed tomography revealed a normal leftward-oriented cranial half and an abnormal caudal half of the aortic arch crossing toward the right dorsal hemithorax leading to esophageal constriction in all dogs. In addition, 1 dog presented with a right patent ductus arteriosus and 1 with an aberrant right subclavian artery. Circumflex left aortic arch is a newly discovered rare type of congenital vascular ring anomaly in dogs, which presents a similar anatomical derangement to the human form. Clinical signs include postprandial regurgitation and poor growth. Circumflex left aortic arch vascular anomaly cannot be surgically corrected via the left thoracotomy that is commonly used for the more common vascular ring anomalies in dogs. Computed tomography is a useful diagnostic modality for the diagnosis of this condition, detection of concomitant congenital vascular malformations, evaluation of associated pathologies, and surgical planning.

Liver Lesions in Estuarine Dolphins in the Indian River Lagoon, Florida: Does Microcystin Play a Role?

Microcystin (MC), a hepatotoxin produced by cyanobacteria, was introduced into the Indian River Lagoon (IRL), Florida, in 2005 through freshwater outflows. Since then, MC has been detected in humans, domestic animals, and wildlife in the lagoon. Potential public health effects associated with MC exposure along the IRL include an increased risk of non-alcoholic liver disease among area residents. Yet, there are limited studies characterizing liver disease, as well as the potential role of MC, in humans and animals in this region. Thus, histopathology reports (n = 133) were reviewed in the stranded common bottlenose dolphin (Tursiops truncatus truncatus) (n = 156, 2005-2024) to describe liver lesions in this important IRL sentinel. Liver and fecal samples (n = 161) from stranded individuals were screened for MC via an enzyme immunoassay (ELISA). These samples were then confirmed via the 2-methyl-3-methoxy-4-phenylbutyric acid technique (MMPB) to evaluate whether liver histopathologic lesions were linked to MC exposure. Minimally invasive MC screening methods were also assessed using respiratory swabs and vapor. Inflammation (24%, n = 32), fibrosis (23%, n = 31), lipidosis/vacuolation (11%, n = 15), and necrosis (11%, n = 14) were the most common liver anomalies observed. These non-specific lesions have been reported to be associated with MC exposure in numerous species in the peer-reviewed literature. Ten bottlenose dolphins tested positive for the toxin via ELISA, including two individuals with hepatic lipidosis, but none were confirmed by MMPB. Thus, this study did not provide evidence for MC-induced liver disease in IRL bottlenose dolphins. Other causes should be considered for the lesions observed (e.g., heavy metals, metabolic disease, and endoparasites). Respiratory swabs require further validation as a pre-mortem MC screening tool in free-ranging wildlife.

Kidner Procedure Without Implant Fixation in Accessory Navicular Patient, has a Good Outcome After 1-Year Evaluation at Prof. IGNG Ngoerah Hospital: A Case Report

Introduction: The accessory navicular bone (ANB) is a common developmental anomaly that may cause foot pain, morbidity, and even flatfoot deformity in symptomatic individuals. The Kidner procedure is a widely accepted surgical treatment for symptomatic ANB, typically involving removal of the ANB and reattachment of the posterior tibial tendon. This case report presents a successful 1-year follow-up outcome of an implantless Kidner procedure in a patient with type II ANB. Case Presentation: A 44-year-old female patient presented with a 3-month history of medial-sided left foot pain, aggravated by walking long distances. Physical examination revealed a bony prominence on the inner side of the left foot, with tenderness on palpation. Radiographs demonstrated a type II ANB. The patient underwent an implantless Kidner procedure under general anesthesia, which involved excision of the accessory navicular, osteotomy of the true navicular, and advancement of the tibialis posterior tendon using ethibond sutures. Postoperative follow-ups at 3, 6, and 12 months showed gradual improvement in the American Orthopedic Foot and Ankle Society (AOFAS) score from 75 to 85 and 90, respectively, with no complications or recurrence of symptoms. Discussion: The presence of ANB, particularly type II, can result in foot pain and associated complications, requiring surgical intervention if conservative measures fail. The implantless Kidner procedure presented in this case report demonstrates favorable outcomes in symptom resolution and functional improvement. The use of sutures instead of hardware materials for tendon fixation in this modified procedure appears to be safe and effective. Conclusion: The implantless Kidner procedure is a viable surgical option for the management of symptomatic type II ANB, providing satisfactory results and functional improvement at 1-year follow-up. Further research with larger sample sizes and longer follow-up periods is needed to validate the long-term efficacy of this modified technique.