Fibromuscular Tissue Research Articles

Medial Epicanthoplasty with the Skin Re-Draping Technique: Technical Refinements for Predictable outcomes.

The epicanthus is a common feature of the Asian eyes. A prominent medial epicanthal fold gives the impression of a blunted affect and the procedure for its removal, the medial epicanthoplasty, is a very commonly requested by Asian patients. This may be performed as an isolated procedure or more commonly in combination with the upper blepharoplasty. Many conventional medial epicanthoplasty techniques are based on skin flaps transposition and excisions, usually variations of the V-Y, W or Z-plasties (1-4). While these have been variably successful at correcting the epicanthal fold, the common problem is significant scarring in the medial canthal and lower eyelid regions (5-8). This is particularly problematic in Asian patients with greater tendencies for hypertrophic scarring and scar hypo or hyper-pigmentation (9). Recently, the skin re-draping method, designed with incisions limited within the margins of the medial canthus and precise and targeted disruption of the underlying fibromuscular tissues, has emerged as the preferred surgical technique for many Asian surgeons because of its effectiveness and superior aesthetic outcomes(6, 10-12). This technique delivers the most inconspicuous incisions and is advantageous because it is effective in eliminating epicanthal folds of various severities. Precise execution of this technique is difficult, given the complex 3-dimensional anatomy of the epicanthus. This paper presents a detailed explanation of surgical concepts of the skin re-draping epicanthoplasty and provide a step-by-step guide to performing this procedure in a safe and effective manner.

Use of laser in Pediatric Dentistry frenectomy surgery: A scoping review

The frenulum is a fold of the buccal mucosa made up of fibrous or fibromuscular tissue covered by a mucous membrane and may present an anomaly and may limit movements of the tongue or lips. Ankyglossia is an anomaly in the lingual frenulum characterized by limited movement, altering speech and swallowing. The treatment of this anomaly is called frenectomy, which is a small surgery, where the frenulum is excised, so that that region can move without limitations. Since the use of laser in dentistry has been growing nowadays, it has been a great ally in frenectomy surgeries because it presents better trans and postoperative conditions. The objective of this study is to report, the current scenario of laser frenectomy in Pediatric Dentistry. Methodology: This study was carried out through a systematic scoping review, using the keywords Lip frenulum, Lingual frenum, Laser therapy and Pediatric dentistry, pointing out the applications of lasers in frenectomy surgery in pediatric patients. Results: The search found 18 studies and noting that laser frenectomy is a safe procedure to be used in Pediatric Dentistry. Conclusion: It is concluded that the use of laser in frenectomy in pediatric dentistry patients is very well accepted by patients and dentists in relation to conventional surgery because it is less invasive, without intercurrences and less bleeding, positively interfering with the patient’s quality of life.

Multicystic renal dysplasia, a histomorphological spectrum: Seven years experience from a tertiary care hospital.

Multicystic dysplastic kidney (MCDK) is defined as the presence of multiple noncommunicating cysts of various sizes, detected sonographically, without evidence of functioning renal parenchyma on dimercaptosuccinic acid renal scan. It has an incidence of 1:4000 live births. They are more commonly diagnosed in boys, usually on the left side, but may also be bilateral. There is the presence of primitive ducts surrounded by fibromuscular connective tissue. These are because of the disturbed connection of the ureteric bud with renal blastema and abnormal division at the stage of metanephros, resulting in an abnormal metanephros differentiation. Thirty cases of MCDK were included to study their histomorphology along with their clinical features. Cases were retrieved from the last seven years (2015-2021) from the Department of Pathology, Maulana Azad Medical College. Age ranged from 10 days to 18 years. The cases were between 1 years and 5 years of age. Six out of 30 cases (20%) were infants with three of them being neonates. Twenty-one cases were males. All the cases had unilateral kidney involvement with the left kidney being involved in 20 out of 30 cases. Twenty-eight cases underwent nephrectomy in view of small contracted nonfunctional kidneys with one of them being horseshoe shaped. Five cases had associated hydronephrosis (two ipsilateral and three bilateral). One case had Hirshprung's disease, four had anorectal malformation, two had posterior urethral valves with vesicourethral reflux, one had duplex moiety, and one had undescended testes. On histopathological examination, all of them showed the presence of immature disorganized tubules surrounded by a collarette of immature mesenchymal stroma. One of the cases showed osteoid formation and four had areas of immature cartilage. Normal kidney parenchyma was seen at the periphery in four cases. This series has been presented to highlight the various histomorphological features of MCDK. MCDK can be managed conservatively in most of cases due to autoinvolution and, hence, needs to be differentiated from other close differentials like polycystic kidney disease, cystic nephroma, and cystic partially differentiated nephroblastoma in order to avoid unnecessary surgical intervention.

Comparative Histomorphological Study of Spleen in Goat, Sheep, Cow and Buffalo

Immunity in some animals, such as goats, stands for unique properties by which they withstand unpleasant environments. Spleen influences animals' immunity through its hematopoietic and immunological roles. Because of that, we emphasized the average morphological and histological properties of the Goat, Sheep, Cow and Buffalo spleen. We randomly collected three spleens for every species from healthy slaughtered Goats, Sheep, Cows and Buffalo. All the animals were adult and weighed about 71, 80, 400 and 500 grams, respectively. Histological cutting was followed according to the paraffin method; then, the samples were ready for microscopic exam. The structure results revealed that the spleen of animals is supported externally by a thick fibromuscular connective tissue capsule, which vascularizes by subcapsular sinus. Stromal trabeculae emerge from the capsule, entering the splenic parenchyma. The parenchyma of animals' spleen differentiates into white pulp, which organizes into the periarterial lymphatic sheath along with lymph nodules, red pulp ropes in splenic sinuses among splenic cords, and marginal zone in which macrophage occupies excellent importance. This study concluded that the amount of smooth muscle in the spleen septa in goats was more than in the rest of the experimental animals. Keywords: Histomorphology; Spleen; Goat; Sheep; Cow; Buffalo

Evaluating the Learning Curve for In-office Freehand Cognitive Fusion Transperineal Prostate Biopsy

To define the learning curve of the in-office, freehand MRI-ultrasound cognitive fusion transperineal prostate biopsy (CTPB) by assessing cancer detection, biopsy core quantity and quality, procedure times, and complications over the initial experience. We reviewed 110 consecutive CTPB performed March 2021-September 2022 by a urologist inexperienced with the PrecisionPoint platform. The study period was divided into quarters to assess for temporal variation in outcomes. Univariable and multivariable analysis modeled the learning curve. Across quarters, there were no differences in the detection of clinically significant prostate cancer (Q1:50%, Q2:52%, Q3:50%, Q4:48%, P>.9) or Gleason grade group upgrading by targeted vs systematic biopsy (P=.6). Median procedure times improved with experience (Q1:17minutes, Q2:14minutes, Q3:12minutes, Q4:13minutes, P=.018). On multivariable analysis, procedure times decreased by 1minute per 20 cases (P<.001). On linear regression, CTPB procedure times approximated transrectal biopsy times after 90 cases (P<.001). The histopathologic core quality did not differ, as evidenced by consistent core length (P=.13) and presence of minimal fibromuscular tissue (P>.9). The most common complications, hematuria and hematospermia, were similar across quarters (P=.7, P=.3, respectively). There was a single episode of urinary retention and no reported infections. There is no evidence of a learning curve for CTPB as shown by consistent clinically significant prostate cancer detection, high-quality biopsy cores, and low complications. However, CTPB procedural times begin to approximate cognitive targeted transrectal biopsy times after 90 cases.

DP15 ‘Unwell water’: the potential importance of environmental factors in skin cancer in people of colour

Abstract Ultraviolet radiation (UVR) is the most common environmental carcinogen to cause cutaneous squamous cell carcinoma (cSCC). However, other carcinogens may also play a role and should be suspected when cSCC occurs in people with skin of colour (SOC) in whom ultraviolet (UV)-induced cSCC is less common. We present the case of a South Asian female who presented with an aggressive cSCC, which we hypothesize was related to previous arsenic exposure. A 70-year-old Bangladeshi woman (skin phototype V) presented with a 4-cm diameter, tender, keratotic plaque at the base of her left thumb, which had been present for 12 years and was slowly enlarging. There was no associated lymphadenopathy. She also had multiple palmoplantar keratotic papules and two hyperkeratotic plaques in UV-protected areas on her trunk. Histology of the lesion on her thumb confirmed a cSCC with high-risk features: poorly differentiated, invasion 9.5 mm into fibromuscular tissue, perineural invasion (nerve diameter &amp;gt; 0.1 mm) and vascular invasion. The truncal plaques were confirmed to be SCC in situ. The cSCC was incompletely excised and subsequently showed extensive involvement of periosteal soft tissues with invasion into bone marrow. Staging computed tomography showed no evidence of nodal or distant metastatic disease. She subsequently underwent ray amputation and remains under close clinical surveillance. Given the cSCC location and her skin phototype, potential non-UV radiation (UVR) causes were explored. In view of the palmoplantar keratotic papules and SCC in situ, chronic arsenic exposure was suspected. Further questioning revealed a history of drinking well water in a rural village in Bangladesh throughout childhood and early adulthood, although exposure had stopped &amp;gt; 40 years ago. Arsenic exposure from contaminated groundwater was therefore considered to be the most likely diagnosis. She was started on long-term chemoprevention with acitretin. Arsenic is a potent human carcinogen and a well-recognized cause of cSCC; the latency period may be 30–40 years. Most cases are likely to be in people exposed through environmental arsenic exposure, such as contaminated groundwater, with some cases of exposure to arsenic-containing traditional medicines also reported. Carcinogenic mechanisms are uncertain but may involve dysregulation of the Hippo signalling pathway. In summary, although the incidence of UVR-related cSCC is lower, this case highlights the importance of considering risk factors, other than UVR, in cSCC arising in people with SOC. Identifying relevant carcinogens may require a detailed travel, social and cultural history and, more importantly, an awareness of the non-UVR causes of cSCC.

"Urethral-Sparing" Robotic Radical Prostatectomy: Critical Appraisal of the Safety of the Technique Based on the Histologic Characteristics of the Prostatic Urethra.

The prostatic urethra (PU) is conventionally resected during robot-assisted radical prostatectomy (RALP). Recent studies demonstrated the feasibility of the extended PU preservation (EPUP). To describe the histologic features of the PU. The PU was evaluated using cystoprostatectomy and RALP specimens. Cases of PU infiltration by prostate cancer or distortion by benign hyperplastic nodules were excluded. The thickness of the chorion and distance between the urothelium and prostate glands were measured. Prostate-specific antigen expression in the PU epithelium was evaluated with immunohistochemistry. Descriptive statistics were used. Six specimens of PU were examined. Histologically, the following layers of the PU were observed: (1) urothelium with basal membrane, (2) chorion, and (3) prostatic peri-urethral fibromuscular tissue. The chorion measures between 0.2 and 0.4 mm. There is not a distinct urethral muscle layer, but rather muscular fibers that originate near the prostatic stroma and are distributed around the PU. This muscular tissue appears to be mainly represented in the basal and apical urethra, but not in the middle urethra. The mean distance between the chorion and prostatic glands is 1.74 mm, with significant differences between base of the prostate, middle urethral portion, and apex (2.5 vs. 1.49 vs. 1.23 mm, respectively). PSA-expressing cells are abundant in the PU epithelium, coexisting with urothelial cells. The exiguity of thickness of the PU chorion, short distance from glandular tissue, and coexistence of PSA-expressing cells in the epithelium raise important concerns about the oncologic safety of EPUP.

THE TRIATRIAL HEART (COR TRIATRIATUM) – RARE ADULT CONGENITAL HEART DEFECT

Background: Cor triatriatum is a rare congenital cardiac malformation. Prevalence is only around 0.1% of the diagnosed congenital cardiovascular malformations. Historically the prevalence has been described around 0.4% in autopsies in patients with congenital heart disease. It is characterized by the presence of a membrane, usually, the endocardium and fibro-muscular tissue within one of the atrial chambers, dividing it into two, thereby giving the appearance of three atrial chambers. Case report: A 72-year-old patient presented to our cardiac surgery department with complaints of rhythm disorders, heart palpitations and shortness of breath. The patient has a history of mitral valve pathology. During the last six months, she has had a progression of these heart failure clinical manifestation and is reffered to our institution for mitral valvle surgery after selective coronary angiography. The echocardiography showed an abnormal membrane dividing the left atrium, and the diagnosis of cor triatriatum was fully made via transesophageal echocardiography. There were associated significant mitral valve and tricuspid valve regurgitations. Conclusion: CTS/cor triatrium sinister/ is a congenital acyanotic heart disease which rarely presents during adulthood. The symptoms in adults are similar to those of mitral valve stenosis. The prognosis of the patient with CTS depends on the size of the fenestration into the fibromuscular membrane. Corrective surgery is a treatment of choice for CTS.

Histological and Histochemical Features of the Newly Lactating Udderinlocal Breed She Goat (Caprice Hirccus)

Six samples of one day post parturition mammary glands of local breed goats were used for this work. The samplesof glands were dissected the tissue specimens were fixed in 10% formalin solution. The specimens were processedaccording to paraffin embedding technique, sectioned at 5-6μm and stained by hematoxylin and eosin, Masson’sTrichrom stains and Verhoff stain. The newly lactating mammary gland was covered by very thick, well glandularskin that measured 210.32±9.03μm. The mammary parenchyma was composed of groups of huge mammarylobes which separated by well vascular thick layer of inter lobar fibrous tissue that measured 986.19±23.10 μm(Thickness). The mean of surface area of mammary lobe was134785.48±15.89μm², it was consisted of numeroussmall size lobules that measured 9848.79±23.75μm² and separated from each other by thin layer of fibro muscularinter lobular connective tissue that measured 138.16±4.11 μm. The lobule was composed of mammary alveoliwhich revealed marked secretory activities. The mean surface area of alveolus was 784.79±19.09 μm² that linedby cuboidal cells that measured 14.11±1.09 μm. Duct system of newly lactating mammary gland was intra lobularduct, large inter lobar duct, largest lactiferous sinus, the lactiferous sinus was drainage to glandular cisterna thatopened into teat cisterna and the later opened into teat canal. Gland cisterna was huge chamber had wide irregularshaped lumen. The mucosa of gland cisterna had few mucosal folds which lined by simple cuboidal epitheliumand supported a lamina propria of dense fibro muscular connective tissue. The epithelium of cisterna which closeto the mammary lobules was supported thick layer of well vascular fibrous connective tissue. Teat cisterna wascomposed of mucosal folds that supported by fibro muscular layer with venous plexus.

A rare case of caries sicca right shoulder

Caries sicca is the classic dry form of tuberculosis of proximal humerus. Caries sicca is a fairly rare extrapulmonary presentation of bone tuberculosis. It accounts for 0.9 to 1.7 percent of all extrapulmonary tuberculosis cases. A 23-year-old female presented to the orthopaedics outpatient department with complaint of pain and restriction of shoulder movements for 6 months. The patient has no history of tuberculosis previously, but has a history of a family member suffering from pulmonary Koch. On clinical examination there was tenderness over the Greater tuberosity with restricted external rotation, abduction up to 30 degrees with further passive abduction being painful. There was marked wasting of deltoid and other muscles. Patient´s biopsy was taken for histopathology which showed normal morphology of bony trabeculae, fibromuscular and fatty tissue infiltration of chronic inflammatory cells and at places epithelioid granuloma with langhans giant cells and caseous necrosis which favor the diagnosis of tuberculosis. The patient was started on chemotherapy antitubercular drugs with intensive phase of 2 months and continuation phase of 7 months. During the treatment period the patients were followed up clinic radiologically and the satisfactory shoulder movements abduction up to 90 degrees achieved after 9 months and erythrocyte sedimentation rate (ESR) was considered as a prognostic factor for treatment.

Anatomical Study of the Dorsal Nasal Artery to Prevent Visual Complications during Dorsal Nasal Augmentation.

Summary:Dorsal nasal augmentation is a common injection associated with ocular complications. Digital compressions on both sides of the nose are recommended during injection. Considering the reported incidences of visual complications, this preventive technique may need an adjustment for more effectiveness to prevent blindness. Therefore, the dorsal nasal arteries (DNAs) were studied by conventional dissections in the subcutaneous and fibromuscular tissues of the nasal dorsum in 60 embalmed cadavers. The results showed that among the 60 faces, 32 faces had bilateral DNAs (53.3%), 23 had dorsal nasal plexus with minute arteries (38.3%), and five had a single dominant DNA (8.3%). The DNA originated from one of the four arterial sources, which influenced the location and course of the artery. These sources included the ophthalmic angular arteries in 21 faces (56.8%), terminal ophthalmic arteries in two faces (5.4%), lateral nasal arteries in 11 faces (29.7%) and facial angular arteries in three faces (8.1%). Consequently, the dominant dorsal nasal artery running close to the midline found in 8% of the cases could make side compressions during nasal dorsum augmentation less effective from preventing ocular complications. However, an adjustment of digital compressions which combines pinching and side compressions is suggested to improve the safety.

Possible IgG4-related respiratory disease (IgG4-RRD) - a rare presentation as a Pancoast tumour-like

IgG4-related respiratory disease (IgG4-RRD) is a recently recognized disease that can have multiple presentations. In many cases, the exclusion of malignancy is essential. We present a case of a male patient with right omalgia and supraclavicular swelling. Radiologic exams showed a lung mass suggestive of a Pancoast tumour in the right upper lobe. Patient underwent transthoracic biopsies that revealed fibromuscular tissue with fibrosis, lymphoplasmacytic infiltrate and a significant increase in IgG4 cells with 15% IgG4/IgG ratio. He started on prednisolone with clinical and radiologic improvement. As it is a heterogeneous disease it is important that clinicians are aware of the possible presentations.

Endometriosis of the Iliacus and Psoas Muscle: Case Report

Background: Endometriosis is a prevalent benign, inflammatory, estrogen-dependent disease that affects between 1% to 11.5% of women. Deep endometriosis is one of the three types of endometriosis. Described as “deeply infiltrating endometriosis” or “adenomyosis externa,” and it is characterized histopathologically as endometrial glands and stroma penetrating adjacent fibromuscular tissue, obliterating and substituting connective tissue septa. Objective: The present work aimed to report a case of endometriotic of the iliacus muscle and psoas muscle. Mention the place and time of the study. Conclusion: Deep endometriosis is rare to infiltrate the retropsoas area (iliacus, iliopsoas) and the diagnosis can be difficult, therefore a comprehensive patient assessment is necessary for adequate treatment. The use of appropriate imaging techniques, such as MRI and CT scans, is essential to show the lesions.

A Guide for Identification of Different Types of Hernias

A hernia is defined as an abnormal protrusion of a viscus or part of a viscus through a normal or abnormal opening in the cavity in which it is contained. It is an area of weakness or disruption of the fibromuscular tissues of the body wall. Inguinal hernia is the most common type of hernia (73%), followed by incisional (15%) and then femoral hernia (7%). This article describes these common types of hernias with an example each, along with their major characteristics and identification points.

MP10-05 UTILITY OF MRI AND TARGETED BIOPSY TO DIAGNOSE LOCAL CANCER RECURRENCE AFTER PROSTATECTOMY

You have accessJournal of UrologySurgical Technology & Simulation: Instrumentation & Technology I (MP10)1 Sep 2021MP10-05 UTILITY OF MRI AND TARGETED BIOPSY TO DIAGNOSE LOCAL CANCER RECURRENCE AFTER PROSTATECTOMY Cheyenne Williams, Michael Daneshvar, Nabila Khondakar, Jeunice Owens-Walton, Luke P. OConnor, Nitin Yerram, Patrick T. Gomella, Michael Ahdoot, Bradley R. Webster, Peter Choyke, Baris Turkbey, Maria Merino, Bradford Wood, and Peter Pinto Cheyenne WilliamsCheyenne Williams More articles by this author , Michael DaneshvarMichael Daneshvar More articles by this author , Nabila KhondakarNabila Khondakar More articles by this author , Jeunice Owens-WaltonJeunice Owens-Walton More articles by this author , Luke P. OConnorLuke P. OConnor More articles by this author , Nitin YerramNitin Yerram More articles by this author , Patrick T. GomellaPatrick T. Gomella More articles by this author , Michael AhdootMichael Ahdoot More articles by this author , Bradley R. WebsterBradley R. Webster More articles by this author , Peter ChoykePeter Choyke More articles by this author , Baris TurkbeyBaris Turkbey More articles by this author , Maria MerinoMaria Merino More articles by this author , Bradford WoodBradford Wood More articles by this author , and Peter PintoPeter Pinto More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001983.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Following radical prostatectomy (RP), biochemical recurrence (BCR) may be attributed to either metastasis, local cancer recurrence, or retained benign prostatic gland tissue. With increased utilization of prostate MRI, similar cross-sectional imaging in this setting can occasionally identify a suspicious lesion at the surgical site. We sought to explore the utility of urologist performed MRI Fusion-guided biopsy (Fbx) for diagnosing benign versus malignant retained prostate tissue in the prostatectomy bed and if imaging characteristics were predictive of local cancer recurrence. METHODS: Patients with BCR after RP with MRI visible lesion in the prostate bed between February 2015 and December 2020 were identified. Cancer detection via MRI-guided fusion biopsy using the UroNav platform was evaluated, and multivariable regression identified patient variables associated with confirmed local recurrence including RP Gleason Grade group (GG). Covariates evaluated included margin involvement, extraprostatic extension, PSA at BCR, and prostate bed lesion size on MRI. RESULTS: Ultimately, 23 patients with BCR and positive MRI underwent Fbx of the prostate bed at our institution Median age, PSA at BCR, and time to BCR were 67.8 years, 0.51 ng/mL, and 2.3 years. 6/23 (26%) patients had positive RP margins, and 9/23 (39.1%) had extraprostatic extension. Median prostate bed lesion size was 1.3 cm (IQR 0.25-1.95). 16/23 (69.5%) biopsies contained prostate adenocarcinoma, 4/23 (17.4%) biopsies contained benign prostate glands, and 3/23 (13.0%) biopsies contained fibromuscular tissue. Median cores per patient was 4 (IQR 2.5-5.5), and among patients with positive biopsies, median number of positive cores was 2.5 (0.5-4.75). In patients with benign biopsies, none had further evidence of metastasis at median follow-up of 13.5 months after Fbx and 182 months after RP. Meanwhile, 3/16 (18.8%) patients with positive Fbx had later metastasis. On multivariable regression, prostate bed lesion size (cm) was independently associated with diagnosing local recurrence on Fbx (OR =2.48, 95% CI:1.31- 4.69, p=0.016). CONCLUSIONS: This series demonstrates MRI fusion biopsy is a feasible familiar approach for urologists to evaluate for local recurrence in patients with BCR and imaging identifiable lesions at the prostate resection site, and prostate bed lesion size on post-RP imaging is predictive of local cancer recurrence. Source of Funding: The National Institute of Health (NIH) Medical Research Scholars Program, Foundation for the NIH, NIH Intramural Research Program © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e170-e170 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Cheyenne Williams More articles by this author Michael Daneshvar More articles by this author Nabila Khondakar More articles by this author Jeunice Owens-Walton More articles by this author Luke P. OConnor More articles by this author Nitin Yerram More articles by this author Patrick T. Gomella More articles by this author Michael Ahdoot More articles by this author Bradley R. Webster More articles by this author Peter Choyke More articles by this author Baris Turkbey More articles by this author Maria Merino More articles by this author Bradford Wood More articles by this author Peter Pinto More articles by this author Expand All Advertisement Loading ...

V03-06 ZINNER SYNDROME, ROBOTIC MANAGEMENT IN PEDIATRIC PATIENTS WITH SEMINAL VESICLE CYSTS

You have accessJournal of UrologyPediatrics (V03)1 Sep 2021V03-06 ZINNER SYNDROME, ROBOTIC MANAGEMENT IN PEDIATRIC PATIENTS WITH SEMINAL VESICLE CYSTS Igor Voznesensky, Thomas Shelton, Joseph Allen, Ihor Yosypiv, Erik Castle, and Aaron Martin Igor VoznesenskyIgor Voznesensky More articles by this author , Thomas SheltonThomas Shelton More articles by this author , Joseph AllenJoseph Allen More articles by this author , Ihor YosypivIhor Yosypiv More articles by this author , Erik CastleErik Castle More articles by this author , and Aaron MartinAaron Martin More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001991.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Zinner Syndrome is a rare congenital abnormality of the mesonephric (Wolffian) duct consisting of the triad of unilateral renal agenesis, ipsilateral seminal vesicle cyst and ipsilateral ejaculatory duct obstruction. While most patients with this anomaly are asymptomatic until the second or third decade of life, some may report nonspecific symptoms such as urinary urgency, dysuria, painful ejaculation, and perineal discomfort. Surgical resection of the cyst and the seminal vesicle is often necessitated because of the high rate of recurrence after conservative treatment. METHODS: Using the DaVinci robotic surgical system, we performed minimally invasive surgical management for two Zinner Syndrome patients, aged 14 and 17. For both procedures, cystoscopy was first utilized to identify the large posterior extravesical cystic masses and to cannulate the normal healthy contralateral ureter with a safety wire. We then incised the peritoneum, identifying and mobilizing the remnant distal ureteral stump and tracing towards the vas deferens. Once the seminal vesicle cyst was identified and mobilized from surrounding tissues, we proceeded to excise the SV cyst in its entirety. Due to the thin walled nature of the seminal vesical cyst in both patients, a small cystotomy was necessitated to facilitate complete excision. The cystotomy was then closed in standard fashion with pre-placed sensor wire used to facilitate identification and preservation of normal contralateral ureter. Lastly, the peritoneum was then reapproximated with running absorbable suture. RESULTS: Both patients were sent home the day following surgery. Post op imaging showed resolution of the seminal vesicle cysts and the patients reported symptomatic relief. Pathology demonstrated benign urothelium and underlying fibromuscular stromal tissue along with a portion of benign ureter. CONCLUSIONS: Using technology such as the DaVinci robot we can offer pediatric patients a minimally invasive approach for management even in the setting of rare pelvic pathology and clinical presentations. Source of Funding: n/a © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e224-e224 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Igor Voznesensky More articles by this author Thomas Shelton More articles by this author Joseph Allen More articles by this author Ihor Yosypiv More articles by this author Erik Castle More articles by this author Aaron Martin More articles by this author Expand All Advertisement Loading ...

A Histopathologic Approach to Uterine Niche: What to Expect and to Report in Hysteroscopy-Resected Isthmocele Specimens

As one of the emerging complications of caesarean sections (CSs), pathologists will have an important role in handling samples of uterine niches. An isthmocele is a defect at the site of a previous CS scar resulting in a variety of symptoms and niche-related subfertility. There is a deficiency in the literature of the histopathologic features of hysteroscopy-resected isthmocele ridges. Our aim is to fill this gap to highlight what to expect to see and what important findings to report to guide gynecologists to the results of hysteroscopic isthmoplasty in relation to symptoms improvement, fertility restoration, and potential complications. We found 22 cases of hysteroscopy-resected isthmoceles by performing a retrospective review study. The majority of the women were symptomatic with secondary infertility. The resected isthmocele edges were lined by endocervical, endometrial, and isthmic mucosa either combined or isolated depending on each case. Isthmoceles could be classified depending on the predominant lining mucosa into endocervical-isthmoendocervical (low) and endometrial-isthmic (high-intermediate) niches. This could be correlated with certain symptoms. The edges showed variably thickened fibrous and fibromuscular stromal tissue with characteristic thick-walled blood vessels. Some cases showed miscellaneous findings such as hemosiderin pigments with foreign body giant cell reaction and placental implantation site tissue reflecting a previous history of surgical repair and scar pregnancy. Cauterization artifacts may impose interpretation challenges for pathologists. Utility of certain special stains helps delineate the nature of badly cauterized tissues. It is important to report certain histologic findings in isthmocele samples to correlate with clinical findings and guide gynecologists.

Angiostrongylus costaricensis

Angiostrongylus costaricensis is a parasitic nematode and the causative agent of abdominal angiostrongyliasis (AA) in humans. This nematode was described in Costa Rica 50 years ago and since then it has been reported from the southern USA to northern Argentina and the Caribbean. The parasites have rodent definitive hosts that shed L1 larvae in their feces, and terrestrial mollusks as intermediate hosts that bear L3 in the fibromuscular tissues of the foot. Humans are accidental hosts, where presence of the parasite in mesenteric arteries leads to vasculitis and an intense granulomatous inflammatory eosinophilic reaction surrounding eggs or larvae located in the intestinal mucosa, preventing the release of L1 in feces.

Constrictive and Hypertrophic Strictures in Ileal Crohn’s Disease

Strictures in Crohn's disease (CD) are classically attributed to fibromuscular hypertrophy of the intestinal wall. We have identified and characterized CD-related ileal strictures that result instead from mural constriction (ie, reduced external circumference). Twenty-four strictures and internal controls from 17 adults with obstructive CD were analyzed by cross-sectional morphometry. The stricture-to-control circumference ratios (CRs) ranged from 0.53 to 1.7. Six strictures with CR ≥1.0, designated hypertrophic, had concentrically thickened walls, mean 3-fold increases in cross-sectional area and stainable fibromucular tissue, and high transmural inflammation scores. In contrast, 18 strictures with CR <1.0, designated constrictive, had thin, pliant walls, cross-sectional areas and stainable fibromuscular tissue comparable with control values, and low transmural inflammation scores. Eight mildly constrictive strictures also showed mild fibromuscular mural expansion that fell short of statistical significance. Twelve of 18 constrictive strictures (67%) occurred multiply (2-4 strictures per specimen) in contrast with hypertrophic strictures, all of which occurred singly (P= .01). Constriction correlated quantitatively with circumferential serosal fat wrapping (P= .003) and was associated with myenteric lymphocytic plexitis (P= .02). Disease duration was shortest among subjects with constrictive strictures and correlated with increasing circumference (CR ≤0.8, 6.3 ± 6.2 years; CR >0.8, 8.7 ± 6.4 years; and CR ≥1.00, 13.7 ± 5.0 years, respectively; P= .03). Constrictive ileal strictures in CD differ pathologically and clinically from hypertrophic strictures, featuring little or no fibromuscular mural expansion, frequent multiplicity, and earlier onset. Mesenteric fat wrapping and myenteric plexitis may contribute to their pathogenesis. Pathologic manifestations of constriction and hypertrophy can coexist, suggesting that stricture heterogeneity may be shaped in part by the dynamics of constrictive and hypertrophic processes.

Observational study of the Mamsavaha Strotas Dushti according to Rachana Sharir w. s. r. to Bahya Arsha

Arsha is a gift of modern diets and busy lifestyles &amp; many people are suffering from some sort of Anorectal disorder. It may be simple constipation to complex carcinoma, in which prominent disorder is Arsha. Derangement of Jatharagni leading to vitiation of Tridosha, mainly vata dosha these vitiated Doshas get localized in Gudavali and Pradhana dhamani which further vitiates Twak, Mamsa, and Meda Dhatus leads to development of Arsha. The perianal skin is most pain sensitive, due to rich nerve endings. Hence even a mild form of disorder can produce great discomfort to the patient. On the basis of observation and statistics we got positive response for this parameters Malabaddhata 23 (71.88%), Abhishyandiahar 23 (71.88%), Guruahar 27 (84.38%), Diwaswap 18 (56.25%), Adhyashana 27 (84.38%), Prushtayana 29 (90.63%), Vegavidharana 32 (100%), Shavathu 24 (75%), Mamsashotha 19 (59.38%), Siragranthi 26 (81.25%), Amlika 21 (65.62%), Paridaha 18 (56.25%), Atop 28 (81.25%), Antrakujan 22 (68.76%), Gudaparikartan 32 (100%). In histopathology report we found fibromuscular tissue, stratified squamous epithelium, dilated and congested blood vessels which is the moolsthana of mamsavaha strotas. That means mamsavaha strotas dusti is co related with bahya arsha. This shows that there is significant correlation of origin of Bahya Arsha from Mamsavaha strotas dushti.&#x0D; Keywords- Arsha, mamsavaha srotas, dushti, malabaddhata, guda, histopathology