Intrathoracic Research Articles

Evaluation of sectional anatomic, micro-computed tomographic, and magnetic resonance imaging features of the thorax in Syrian hamsters (Mesocricetus auratus).

Clinically, the rodent thorax is important because of the variety of problems that may affect the heart, lungs, and other thoracic structures. Syrian hamsters are the most common pet and experimental hamster species. Sectional imaging of small mammals is widely increasing in use for clinical and research settings; however, no reports on the thoracic sectional imaging anatomy in this species have been made. Therefore, this study aimed at evaluating micro-computed tomography (MCT), magnetic resonance image (MRI), and gross sections of the Syrian hamster thorax. Eight healthy adult male and female Syrian hamsters were examined. Anesthetized hamsters were evaluated by MCT and 3 Tesla MRI. After imaging, the frozen slab sections were photographed, and identified anatomic structures were matched with structures on corresponding MCT and/or MRI images. Clinically relevant anatomic features of the Syrian hamster thorax that were identified on transverse and sagittal anatomic sections could be discerned on the corresponding MCT and MRI scans. The three matched images were exhibited the following features: (1) the narrow thoracic cavity and small lung space, (2) the heart positioning ventral and medial to lung, (3) heart ventricles locating towards the left side, and (4) parallel cardiac position relative to the sternum. The obtained results were similar to those have only been reported in rabbits, regardless of heart orientation and lung lobe covering the heart. The results of this study support the use of MCT and MRI as diagnostic tools in Syrian hamsters and provide reference values for the clinically relevant anatomic structures of thorax.

A novel COL3A1 gene variant associated with sudden death due to spontaneous pneumothorax.

Spontaneous pneumothorax (SP) is a condition defined by abnormal gas accumulation in the chest cavity. Mutations of the collagen type III alpha 1 chain, COL3A1 gene, are primarily linked to vascular Ehlers-Danlos syndrome (vEDS); however, they can also contribute to structural changes in the tissue, like bullae of the lungs. In this case report, we present a young, thinly built boy who died due to a spontaneous pneumothorax. Post-mortem genetic testing revealed a novel COL3A1 mutation, likely contributing to the pathogenic events underlying death due to spontaneous pneumothorax. We recommend implementing genetic testing of correlative or causative genes in the context of SP.

Anatomical Studies on the Morphology and Topography of Cavity Lymphnodes in Pigs

The lymphatic system, supported by the lymphatic vessels, is a vascular network in higher vertebrates, having essential roles, such as regulating tissue pressure, monitoring the immune system and absorbing fats from the diet. The lymphatic vessels constitute an unidirectional system that transports fluids and proteins, taking them from the interstitial space and returning them to the bloodstream. Objectives: The objectives pursued in this study are the following: to identify the topography of the main cavity lymph nodes and the morphological and topographic variants that may occur; to identify the main interspecific histological characteristics of vessels and lymph nodes in pigs. Materials and methods: The study was carried out on 20 animals weighing 25-30 kg, aged about 3.5 months, of both sexes. They came from private breeders. Ultrasonographic investigations were also performed on half of them. The macro- and microscopic anatomical studies as well as the ultrasonographic investigations were performed at the Faculty of Veterinary Medicine in Bucharest. For macroscopic and topographic analysis, lymph nodes in both the thoracic and abdominal cavities were examined "in situ". Results. Caudal mediastinal lymph nodes were always fewer in number (between one and three). They were associated with the esophagus, immediately behind the tracheobronchial and ventral lymph nodes of the aorta. The afferents originated from the pericardium, the caudal part of the mediastinum and the corresponding part of the esophagus. The efferents connected to the tracheobronchial lymph nodes or could also approach some thoraco-aortic lymph nodes. The lumbo-aortic lymph nodes were located on the lateral surfaces of the aorta, starting from the diaphragmatic orifice to the origin of the deep iliac circumflex artery. The iliac lymphocenters were represented by large lymph nodes that formed a bundle at the origin of the celiac artery. Colic lymph nodes were located along the path of the right colonic artery. Splenic lymph nodes were placed on the path of the homonymous vessels. Their topography was between the aorta and the hilum of the spleen. In this sector there could be 2-4 lymph nodes, but there were others (2-5) located along the upper quarter of the spleen. The jejunal lymph nodes formed a double chain in the middle of the jejuno-ileum meso, about 30 cm long. The caudal mesenteric lymph nodes were reduced, located dorsally by the descending colon on the path of the caudal mesenteric artery. Conclusions. In the case of mediastinal lymph nodes, the anterior ones are present, but their topography differs significantly from individual to individual. The most important groups of visceral lymph nodes are jejunal and colic. The most important parietal lymphocenter is the ileosacral one. In it, we were able to describe for the first time some individual variants, namely: lateral iliac lymph nodes dominant in volume compared to the medial ones, the absence in some cases (10%) of anorectal lymph nodes in some specimens, in which, however, a compensation was observed by the development of a chain of small units on the path of the median sacral artery.

Diagnostic Challenges and Innovations in Thoracic Endometriosis (TE)

Endometriosis is a condition characterized by the presence of endometrial tissue in ectopic locations outside the gynecological organs. Thoracic endometriosis (TE) is a rare and underdiagnosed condition characterized by the presence of endometrial-like tissue in the thoracic cavity, leading to cyclical respiratory symptoms. TE is often misdiagnosed or overlooked, primarily due to its nonspecific symptoms. Advancements in imaging techniques and biomarkers research are promising in improving the diagnosis of TE. High-resolution imaging modalities, such as high-resolution computed tomography (HRCT) and magnetic resonance imaging (MRI), provide detailed visualization of pleural and pulmonary lesions and leverage hormonal responsiveness for dynamic imaging during the menstrual cycle. The identification of novel biomarkers, such as cystatin C and circulating microRNAs, highlights the potential for non-invasive diagnostic tools that can stratify patients based on disease severity and guide personalized treatment strategies. Early diagnosis and treatment of thoracic endometriosis are crucial to prevent severe complications such as recurrent pneumothorax, pleural adhesions, and progressive lung damage. Timely intervention also reduces the burden of chronic pain and improves quality of life, enabling more effective management of this underdiagnosed condition. The aim of this paper is to explore current diagnostic possibilities for TE, particularly through the lens of advanced diagnostic innovations, and assess their potential to improve outcomes for patients with this complex condition.

Blind nasoenteric tube placement risks: A case report of misplacement into the pleural cavity.

Enteral nutrition is a critical component of care for critically ill patients. However, the blind insertion of a nasoenteric tube, despite being a simple procedure, carries inherent risks that necessitate a reevaluation of the technique. A case of a 60-year-old female experienced the rare yet critical complication of a misplaced nasoenteric tube entering the thoracic cavity during a blind insertion procedure for enteral nutrition following a liver transplant. Following liver transplantation, the patient was diagnosed with severe pneumonia, a right-sided hydropneumothorax, and severe malnutrition. After the misplacement of the nasoenteric tube into the pleural cavity was detected from the chest X-ray, the tube was immediately removed, and the pneumothorax was actively managed. Subsequently, with the support of contrast radiography, the nasoenteric tube was successfully reinserted to provide the patient with nutritional support and promote rehabilitation. The patient responded well to the intervention and was discharged in stable condition following complete recovery. The case prompts a reevaluation of blind placement techniques and calls for the adoption of more reliable technologies to prevent similar incidents and ensure patient safety, such as electromagnetic and visualized guided placement technique.

Intravenous meropenem and intraperitoneal use of 10% aqueous extract of Schinus terebinthifolius Raddi (Anacardiaceae) in elderly rats after induction of autogenous fecal peritonitis.

To evaluate intravenous meropenem and intraperitoneal 10% aqueous extract of Schinus terebinthifolius (aroeira) in elderly rats after autogenous fecal peritonitis. Thirty 18-month-old Wistar rats underwent peritonitis with 4 mL/kg of autogenous fecal solution. They were stratified into groups: control without treatment; study I, treated with meropenem (40 mg/kg); and study II, treated with meropenem at the same dose and intraperitoneal 10% aqueous extract of aroeira. The animals were monitored for 15 days until euthanasia. The study was approved by Ethics Committee. There was no significant weight loss in the study-II group (p = 0.6277), while the study-I group showed partially recovered weight (p = 0.0187). The study-II group had 90% negative blood cultures, while the study-I group had in 50% of the animals (p = 0.1479). Survival in the study-II group was higher than in study-I group (p = 0.0462). The morbidity score for abdominal and thoracic cavity was lower in the study-II group as compared with study-I group (p = 0.0001). The use of meropenem associated with the intraperitoneal 10% aqueous aroeira extract after induction of autogenous fecal peritonitis in elderly rats produced greater survival, less weight loss, and lower morbidity compared to the use of meropenem alone.

ECG-Gated Cardiac Multidetector CT Evaluation of the Normal Pulmonary Valve and Right Ventricular Outflow Tract in Dogs.

With the advancement in imaging technology, ECG-gated cardiac multidetector computed tomography (MDCT) has emerged as a tool for the anatomic evaluation of the pulmonary valve and right ventricular outflow tract (RVOT) in human medicine. Currently, the evaluation of the pulmonary valve relies primarily on echocardiographic examination. However, the bi-dimensional nature of this technique and the location/orientation of the pulmonary valve in the thoracic cavity can pose challenges. In human medicine, ECG-gated MDCT distinguishes four main anatomic components of the pulmonary valve and RVOT: the pulmonary valve leaflets, the sinotubular junction, the anatomic ventriculo-arterial junction and the hemodynamic ventriculo-arterial junction. Hence, this study aimed to describe the computed tomographic findings of the normal RVOT and pulmonary cusps in a population of dogs. This is an anatomic prospective descriptive study. A total of 24 dogs underwent a complete echocardiographic examination and an ECG-gated MDCT to rule out pulmonary valve abnormalities. Multiplanar reconstruction of the pulmonary valve was obtained. Additionally, hearts from three dogs euthanized for reasons unrelated to the study were collected and their gross and histological findings were compared with the CT images. The ECG-gated MDCT provided good visualization of the pulmonary valve leaflets, the sinotubular junction, the anatomic ventriculo-arterial junction and the hemodynamic ventriculo-arterial junction. Notably, the short-axis view of the pulmonary valve anatomy resembled the 'Mercedes-Benz sign' characteristic of the aortic valve in all dogs. In conclusion, this study provides the first description of the CT anatomy of the RVOT in dogs without pulmonary valve and RVOT abnormalities.

Pharmacokinetics of cisplatin in the systemic versus hyperthermic intrathoracic or intraperitoneal chemotherapy

ObjectiveTo compare the pharmacokinetics and adverse effects of cisplatin administered via intravenous infusion for systemic chemotherapy (SC) versus injection into the perfusate during hyperthermic intrathoracic chemotherapy (HITHOC) or hyperthermic intraperitoneal chemotherapy (HIPEC).MethodsTotal 60 patients who received SC, HITHOC, or HIPEC in the Department of Oncology, Tangdu Hospital, were enrolled into this study. After administering same dose of cisplatin (40 mg) via either intravenous infusion (SC group) or injection into the perfusate during the HITHOC or HIPEC procedure, concentration of cisplatin in the plasma as well as in the hyperthermic perfusate at various time points was quantified by HPLC analysis. The area under the plasma or perfusate concentration–time curve over the last 24h dosing interval (AUC0–24h), mean residence time over the 24 h (MRT0–24h), terminal elimination half-life (t1/2z), time to peak concentration (Tmax), apparent clearance (Clz/F), and peak concentration (Cmax) in the perfusate and plasma were compared.ResultsIn the perfusate, the AUC0–24h (64.32 ± 27.12 µg/mL·h) and Cmax (21.62 ± 5.88 µg/mL) were significantly higher in the HITHOC group compared to that in the HIPEC group (31.68 ± 13.29 µg/mL·h and 16.96 ± 5.54 µg/mL, respectively, p ≤ 0.01). In contrast, MRT0–∞, t1/2z, and Clz/F were significantly lower in the HITHOC group compared to that in the HIPEC group (p < 0.01). In the plasma, average AUC0–24h and Cmax of the HITHOC group were 2.57 ± 0.55 µg/mL·h and 0.26 ± 0.08 µg/mL, respectively, which were significantly lower than that of systemic chemotherapy (SC) group (3.26 ± 0.56 µg/mL·h and 0.69 ± 0.14 µg/mL, respectively, p < 0.01), but no difference compared to that of HIPEC group (3.02 ± 0.52 µg/mL·h and 0.40 ± 0.15 µg/mL, respectively, p > 0.05). In contrast, MRT0-24h and Tmax in the plasma of HITHOC group were significantly longer compared to that of SC group (p < 0.05), but no significant difference compared to that of HIPEC group (p > 0.05). Absolute bioavailability of cisplatin in the thoracic (HITHOC group) and abdominal (HIPEC group) cavities was 20 and 10 times higher than that in the blood administered intravenously (SC group), respectively. There was no significant difference in the incidence of adverse events among the three groups (p < 0.05).ConclusionThe current study demonstrated that, in the perfusate, AUC0–24h and Cmax of cisplatin was significantly higher in the group of HITHOC compared to that of HIPEC, and that, in the plasma, AUC0–24h and Cmax of cisplatin was lower in the group of HITHOC compared to that of HIPEC or SC group. This study provided pharmacokinetic evidence to further support the concept that topical application of chemotherapeutic drug through minimally invasive HITHOC or HIPEC may enhance local exposure compared to systemic chemotherapy for the patients with malignant pleural effusion or ascites.

Idiopathic pulmonary hemosiderosis: challenges of differential diagnosis

Idiopathic pulmonary hemosiderosis (IPH) is a rare disease of unclear etiology that belongs to interstitial lung diseases and is characterized by a triad of symptoms: hemoptysis, iron deficiency anemia, and diffuse interstitial changes on computed tomography (CT) of the chest cavity. IPH can occur at any age, but the disease develops in childhood in 80% of cases, more often before 10 years of age. A significant proportion of pulmonary hemosiderosis cases in this age group remain undiagnosed. The purpose of the study is to demonstrate a clinical case illustrating the features of differential diagnosis and therapy of IPH during the COVID-19 pandemic. Conclusion. An 8-year-old girl was diagnosed with IPH based on fever, shortness of breath, weakness, and severe iron-deficient anemia. The chest CT scan revealed diffuse interstitial ground-glass opacity in lungs. The lung biopsy revealed hemosiderin deposits and hemosiderophages in the alveolar lumens. Treatment with systemic glucocorticoids (SGC) and azathioprine was effective. The patient was followed for 3 years.

The impact of restricted chests on long-term lung function parameters following lung transplantation in patients with interstitial lung disease

Abstract OBJECTIVES In patients with interstitial lung disease (ILD), the diaphragm typically rises as the lungs chronically shrink. However, the grade of restriction differs in each patient. It is currently unknown, how disparities between actual and predicted recipient total lung capacity (TLC), impact changes in lung function parameters and long-term outcomes following lung transplantation (LTx). METHODS This retrospective study included 170 LTx for the patients with ILD performed in a European high-volume LTx center between 09/2011 and 12/2022. The preoperative median ratio of recipient actual to predicted (a/p) TLC was 0.55. Patients were stratified into two groups: low a/p TLC ratio group, corresponding to a more restricted chest cavity (&amp;lt; 0.55: n = 85), and high a/p TLC ratio group, corresponding to a more preserved chest cavity (≥ 0.55: n = 85). Perioperative and long-term outcomes, including lung function and overall survival, were analyzed. RESULTS Between the two groups, tracheostomy and reintubation rates, length of mechanical ventilation, ICU-stay and hospital-stay were not significantly different. Although lung function measurements obtained early after LTx were better in the high a/p TLC ratio group, no significant differences were observed in the long term. 5-year overall survival was not significantly different between the two groups. CONCLUSIONS Although LTx for ILD patients with a restricted chest is considered technically more challenging, the perioperative course is similar to ILD patients with a preserved chest. In addition, no significant differences were observed between both groups in long-term lung function and overall survival, suggesting an improvement in chest wall compliance.

Leveraging anatomical constraints with uncertainty for pneumothorax segmentation.

Pneumothorax is a medical emergency caused by the abnormal accumulation of air in the pleural space-the potential space between the lungs and chest wall. On 2D chest radiographs, pneumothorax occurs within the thoracic cavity and outside of the mediastinum, and we refer to this area as "lung + space." While deep learning (DL) has increasingly been utilized to segment pneumothorax lesions in chest radiographs, many existing DL models employ an end-to-end approach. These models directly map chest radiographs to clinician-annotated lesion areas, often neglecting the vital domain knowledge that pneumothorax is inherently location-sensitive. We propose a novel approach that incorporates the lung + space as a constraint during DL model training for pneumothorax segmentation on 2D chest radiographs. To circumvent the need for additional annotations and to prevent potential label leakage on the target task, our method utilizes external datasets and an auxiliary task of lung segmentation. This approach generates a specific constraint of lung + space for each chest radiograph. Furthermore, we have incorporated a discriminator to eliminate unreliable constraints caused by the domain shift between the auxiliary and target datasets. Our results demonstrated considerable improvements, with average performance gains of 4.6%, 3.6%, and 3.3% regarding intersection over union, dice similarity coefficient, and Hausdorff distance. These results were consistent across six baseline models built on three architectures (U-Net, LinkNet, or PSPNet) and two backbones (VGG-11 or MobileOne-S0). We further conducted an ablation study to evaluate the contribution of each component in the proposed method and undertook several robustness studies on hyper-parameter selection to validate the stability of our method. The integration of domain knowledge in DL models for medical applications has often been underemphasized. Our research underscores the significance of incorporating medical domain knowledge about the location-specific nature of pneumothorax to enhance DL-based lesion segmentation and further bolster clinicians' trust in DL tools. Beyond pneumothorax, our approach is promising for other thoracic conditions that possess location-relevant characteristics.

Primary pulmonary meningioma — a rare lung tumor

BACKGROUND: Primary pulmonary meningioma is a rare and clinically non-diagnosable tumor. Foreign literature describes not more than 70 cases of this disease. The tumor represents a single solid node, not having any specific features, which does not allow for setting the clinical diagnosis before the pathologic examination. The disease has various occurrence rates both among women and men. The diagnosis is to be set based on the morphological examination of the surgical material with small dimensions of the tumor (or biopsy samples for cases of large tumor). CLINICAL CASE DESCRIPTION: The patient А. (54 years of age) with a history of combined treatment 9 years ago due to being diagnosed with рТ2аN1М0, stage IIIB cervical cancer. According to the results from the computed tomography of the chest cavity organs, in segments S8/9 of the lower lobe of the right lung, the findings included a subpleural solid mass lesion with the size of 14×11 mm. According to data from further examinations (computed tomography of the chest cavity organs, of the abdominal cavity and of the minor pelvis; magnetic resonance tomography of the brain; esophagogastroduodenoscopy; colonoscopy), no other abnormalities were detected. Surgical treatment was arranged at the extent of thoracoscopic atypical resection of the lower lobe of the right lung. Anatomic pathology examination report on the resected tumor indicates the presence of “Pulmonary meningioma”. CONCLUSION: This clinical case represents the first documented experience of surgical resection of primary pulmonary meningioma in Russia.

Morphological and Histological Study of The Liver and Gallbladder in the Iraqi Pin-Tailed Sandgrouse Pterocles alchata (L.1766)

A morphological and histological study was conducted on the liver and gallbladder in the Iraqi pin-tailed sandgrouse Pterocles alchata. Which were collected from the local market in the city of Baghdad, there were 8 samples and their ages ranged from 11 months to a year ،the organs were extracted for the purpose of Study after the animals were anaesthetized by inhaling Chloroform. The study showed that the liver is located at the upper part of the thoracic cavity; its weight is (0.14±7.63) gm, its length is (0.13 ±35.13) mm and its width is (0.68 ±31.00)mm. The liver consists of two large parts: The right lobe with a length (0.13±35.13) mm, and the left lobe with a length (0.3 3±28.50) mm and is characterized with a reddish-brown colour. The gallbladder is located at the visceral side of the right lobe of the liver, its length is (0.38±12.38) mm and its width is (0.31 ±5.88) mm. Further, it appears in oval or pear shape and has green colour; it consists of the head, body and neck. The liver parenchyma consists of hepatocyte cells arranged in the form of cords known as hepatic cords arranged radially towards the central vein, spread within the parenchyma of the liver portal area, surrounded by connective tissue. Besides, it includes the hepatic portal area, branch hepatic artery, bile duct lymphatic vessels, which are scattered within the connective tissue surrounding the portal area. The gallbladder consists of the mucous tunic consisting of elongated columnar cells with basal oval nuclei located, below them is the lamina propria, then a layer of smooth muscle fibers arranged to form the tunica muscularis, followed by the tunica serousa or adventitia, which consists of loose connective tissue.

Causal relationships between depression, emotional changes, and hiatal hernia: A Mendelian randomization analysis.

Hiatal hernia (HH) is a common gastrointestinal disorder characterized by the displacement of abdominal contents, particularly the stomach, into the thoracic cavity. This condition is frequently associated with gastroesophageal reflux disease (GERD) and can lead to various symptoms, including chronic cough and respiratory issues. Despite its prevalence, the mechanisms linking psychological factors to HH are not well understood. Observational studies have suggested correlations between mental health issues - such as stress, anxiety, and depression - and gastrointestinal disorders, indicating that emotional states may influence the development of HH. This study aims to clarify the causal relationships between mood swings, depression, and the risk of developing HH using Mendelian randomization (MR), a robust method that utilizes genetic variants as instrumental variables (IVs) to infer causality. Data for this MR analysis were obtained from publicly available genome-wide association studies (GWAS). We employed a bidirectional, 2-sample MR approach, using IVs associated with mood swings, depression, feelings of tension, and feelings of misery as exposures, with HH as the outcome. A reverse MR analysis was also conducted, treating HH as the exposure and the aforementioned emotional states as outcomes. The primary analytical method used was inverse variance weighting (IVW), supplemented by sensitivity analyses, including MR-Egger and weighted median methods. Our analysis revealed significant associations: mood swings (OR = 1.014; 95% CI = 1.001-1.027; P = .032), depression (OR = 1.019; 95% CI = 1.006-1.033; P = .003), feelings of tension (OR = 1.012; 95% CI = 1.004-1.020; P = .001), and feelings of misery (OR = 1.007; 95% CI = 1.003-1.010; P = .0001) significantly increased the risk of HH. Importantly, reverse MR analysis indicated no causal influence of HH on these emotional states. This study provides evidence that mood swings, depression, feelings of tension, and feelings of misery are significant risk factors for developing HH. These findings highlight the need to address psychological factors in the clinical management and prevention strategies for HH, potentially improving patient outcomes.

Intra-thoracic thyroid rests: an updated classification and case series.

Thyroid rests are common and arise during embryological development, with aberrant descent of thyroid tissue along the thyro-thymic tract. These give rise to a range of pathologies, including goitre formation and malignancy. Thyroid rests have been graded I-IV based on their connection to the thyroid gland proper - grade I is a short protuberance, grade II & III are connected via a pedicle and fibrous band respectively, and grade IV is completely disconnected. We propose the addition of grade V to describe entirely intra-thoracic disconnected rests. The recognition of Grade V is important, as failure of complete excision may lead to recurrence of a mediastinal goitre, also known as the 'forgotten goitre'. A retrospective review was performed to include all patients who underwent thyroidectomy for benign retrosternal thyroid disease from January 2015 to January 2022 at the University of Sydney Endocrine Surgical Unit. Data regarding patient demographics, pre-operative work-up, intra-operative findings, histopathology and complications were collated. Our unit performed 1087 thyroidectomies for benign retrosternal goitre during the study period. Twenty-six Grade V rests were identified in 20 patients (1.8%). Surgery was performed for compressive symptoms in 13 patients, seven were incidental. All patients underwent sternotomy or manubriotomy. It is important to recognize thyroid rests that are completely disconnected from the thyroid gland. Identification of these rests requires tailored pre-operative work-up, as excision requires access to the thoracic cavity for vascular control. Incomplete excision may lead to development or persistence of the "forgotten goitre" among other pathologies.

Lighting Innovations in Open Surgery of the Esophagus, Stomach and Diaphragm

Introduction. One of the main requirements for the successful implementation of any surgical intervention in thoracoabdominal surgery is a sufficient overview of the surgical field, which depends on the parameters of the surgical wound and its illumination. This requires not only to clinically evaluate diverse technical approaches, equipment and tools for lighting, but also to develop fundamentally new, qualitatively better ones with proven effectiveness. The aim of the study was to develop lighting LED retractors for "open" surgical interventions on the esophagus, stomach and diaphragm, and to evaluate their effectiveness in a comparative aspect. Material. Surgical access was evaluated using conventional (Fedorov, Kelly, Mikulich and mediastinal) and newly developed (renal mirror, wire, flexoelastic and mediastinal with LED illuminators) retractors on 97 human corpses. The level of illumination in the operating rooms was determined by a luxmeter. To comparatively assess the illumination of hard-to-reach places, conventional lighting tools were used (ceiling lamp, headlamp illuminator, endoscopic illuminator (optical tube) and a mediastinal retractor with a fixed light guide from the illuminator and the previously specified newly developed retractors. The measurements were carried out in the operating room of a surgical profile on a human analog, and in the dissecting room of the Bureau of forensic medical examination on 31 fresh, non-fixed corpses died at 42-67 of the conditions other than pathologies of the thoracic and abdominal cavities. Methods. Measurements were carried out: in subdiaphragmatic spaces; in the posterior (right) costal-mediastinal sinus, posterior mediastinum through a transchiatal access. A comparative assessment of surgical approaches was carried out according to the A.Y. Sozon-Yaroshevich criteria. The illumination parameters of hard-to-reach places were determined in terms of the best illumination, and retreating 4-7 cm to the lateral boundaries of the anatomical area. Results. The lowest illumination values of hard-to-reach places were obtained for ceiling-mounted lamps. The following average values are recorded for the headliner. The endoscopic illuminator (optical tube), a retractor with a fixed light guide had maximum average illumination values (p0.01), and a significant decrease in parameters was noted in the lateral boundaries of the anatomical regions. The newly developed retractors provided an average illumination of hard-to-reach places, comparable to the best values of light guide instruments (p0.01), not only directly under the instrument, but also at points of the extreme distance, where the decrease in average values turned out to be insignificant. The illumination values of the mediastinal retractor exceeded the best results of traditional illuminators and original retractors (p0.01). When comparing the parameters of surgical wounds, the angles of inclination of the axis of surgical action did not differ significantly when using traditional and original retractors (p0.01). Notably, in all cases, the value was more than 42°, therefore, sufficient conditions were created for direct visual control of these intervention zones. The angle of surgical action turned out to be greater when using conventional retractors in comparison with the newly developed ones in the posterior mediastinum, posterior (right) costo-mediastinal sinus, subhepatic space and left subdiaphragmatic space (p0.01). In addition, the value of this parameter never reached the critical value of 25°. The angle of intersection of the axis tilt of the surgical action and the incidence of the luminous flux in all hard-to-reach places of the abdominal cavity for the newly developed retractors with LED elements was less than 50°, which eliminates the possibility of direct sunlight entering the surgeon's view. Conclusion. Newly developed retractors combine functionality and ergonomics, have an aesthetic appearance, allow performing surgical interventions on the esophagus and stomach from thoracotomy and transchiatal accesses on a functioning lung and a working heart, with a slight decrease in the angle of surgical action, provide uniform illumination not only under the instrument, but also at the lateral borders of the anatomical area, eliminate visual discomfort (glare).

Management of endometriosis: a call to multidisciplinary approach.

Endometriosis is defined as the presence of endometrial-like glands and stroma outside of the uterus. There are three types of endometriotic lesions: superficial or peritoneal endometriosis, ovarian endometrioma, and deep infiltrating disease. Endometriosis not only occurs in the pelvis but also can be found in extrapelvic sites such as the gastrointestinal tract, upper abdominal viscera, genitourinary tract, abdominal wall, diaphragm, and thoracic cavity. After thorough history and physical examination is performed, imaging, such as ultrasound or magnetic resonance imaging (MRI), should be obtained if there is high suspicion for deep-infiltrating endometriosis to better assess visceral involvement. Endometriosis can be suspected based on symptoms, physical examination findings, and imaging. However, a definitive diagnosis requires histopathologic confirmation. Treatment options include expectant, medical, and surgical management. Endometriosis is largely a quality-of-life issue, and treatment should be tailored accordingly with empiric medical therapy frequently utilized. Medical management focuses on symptom improvement. Surgical management with excision of endometriosis is preferred over ablation or fulguration of endometriotic lesions. In the case of deep or extrapelvic endometriosis, treatment with a multidisciplinary team with experience in the treatment of advanced-stage endometriosis is essential to minimizing morbidity and increasing long-term success.

Electrocardiographic Early Changes After Abdominoplasty.

Abdominoplasty aims to reduce the abdominal excess tissue and tighten the abdominal wall. The tightening of the abdominal wall has structural and habitual consequences on the body, which might have an early effect on electrocardiography (ECG) of the patients through volumetric and pressure changes in thoracic and abdominal cavities. ECG serves as a diagnostic tool for assessing cardiac electrical conductions in routine clinical practice. In this study, we aimed to examine whether abdominoplasty has any discernible effect on early ECG results, with the goal of assessing potential cardiological benefits for the patients undergoing this procedure by comparing pre- and early postoperative ECGs. Study population included 49 patients who had abdominoplasty. ECG records before the procedure and 12-24h after the surgery were analyzed retrospectively. Patients had no known cardiac diseases and did not have any diagnosed arrhythmia. The mean age of the study population was 37.1 ± 8.5. The mean body mass index of the study population was 26.4. The mean weight of total removed abdominal skin tissue was 1057 grams. There were significant changes in ECG of the patients postoperatively. Heart rate was increased, and significant change was found in QRS axis (p < 0.001) and T wave axis (p < 0.001). Atrial conduction parameters such as PR duration (p < 0.001), Pmax duration (p = 0.001) and P-wave dispersion (p = 0.003) were significantly changed postoperatively. Ventricular conduction parameters such as QRS duration (p = 0.029), QT interval (p < 0.001), QTc (p < 0.001), TPe duration (p < 0.001), TPe / QT (p < 0.001) and TPe / QTc (p < 0.001) ratios were found significantly changed. Abdominoplasty changes the intra-abdominal pressure in the first 24h after the surgery, which may impact cardiac conduction. The understanding and recognition of possible early ECG changes is crucial during postoperative follow-up of the patients who undergo abdominoplasty surgery. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Characterization of Pulmonary Pathology in the Golden Syrian Hamster Model of COVID-19 Using Micro-Computed Tomography.

The Golden Syrian hamster is a well-characterized rodent model for severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2)-associated pneumonia. We sought to characterize the pulmonary disease course during SARS-CoV-2 infection (strain USA-WA1/2020) in the hamster model using micro-computed tomography (micro-CT) and compare radiologic observations with histopathologic findings. We observed a range of radiologic abnormalities, including ground glass opacities (GGOs), consolidations, air bronchograms, and pneumomediastinum. The appearance, distribution, and progression of these abnormalities in hamsters were similar to those observed in the lungs of coronavirus disease 2019 (COVID-19) patients by clinical CT and chest X-rays, and correlated with clinical signs and weight loss during the course of disease. Histopathological analysis of infected hamsters revealed lung pathology characteristic of COVID-19 pneumonia, and we observed a strong association between CT and histopathologic scorings. We also analyzed accumulation of air in the thoracic cavity by both manual and automated threshold-based segmentation and found that automated analysis significantly decreases the time needed for data analysis. Data presented here demonstrate that micro-CT imaging can be a major tool in preclinical investigative studies using animal models by providing early and detailed assessment of disease severity and outcomes.

Case Report: Anencephaly in an Unidentified Baby

Anencephaly is a congenital disorder affecting the central nervous system, characterized by the absence of a major portion of the brain, skull, and scalp, with an estimated prevalence of 0.5–2 per 1,000 births globally. This condition is a subset of Neural Tube Defects (NTDs), which affect approximately 300,000 newborns annually. This study aims to investigate the pathological and forensic aspects of a case of anencephaly in a female infant found deceased in Lingsar, West Lombok, on June 23, 2023. The methods employed case study included external and internal examinations to identify the structural abnormalities and potential cause of death. The external examination revealed open wounds on several parts of the body, and discoloration of the chest and abdominal cavities. Internal examination confirmed the absence of brain tissue, consistent with anencephaly. The findings indicate that the cause of death was directly attributed to the severe congenital anomaly, with no evidence of external factors contributing to mortality. The study concludes that anencephaly, while rare, remains a significant congenital disorder with profound implications for prenatal care and early detection. This case emphasizes the necessity of improving maternal nutrition, particularly folic acid supplementation, as a preventive strategy to reduce the incidence of NTDs. The findings also underscore the importance of interdisciplinary collaboration in handling forensic and medical investigations of congenital disorders, aiding in better understanding and management of similar cases in the future.