Fourth Case Research Articles

Moesziomyces aphidis Bloodstream Infection in Oncologic Patient: First Report in Poland

Moesziomyces spp. (Pseudozyma) is a genus recognized as a new opportunistic human pathogen, causing systemic infections including premature neonates and adult patients. These fungi’s natural resistance to caspofungin enables them to spread through vascular catheter colonization, making them a new etiological agent associated with fungal bloodstream infections (FBIs) and a significant contributor to high mortality rates. In this report, we present a case of fungemia caused by Moesziomyces aphidis species in a patient with medical history that revealed pancreatic cancer infiltrating the duodenum and bile ducts. During hospitalization, the M. aphidis was cultured twice from peripheral blood samples on Sabouraud agar. The strain was sensitive to amphotericin B and voriconazole. In vitro susceptibility testing revealed resistance to fluconazole, caspofungin, anidulafungin, and micafungin. Antifungal therapy with voriconazole resulted in the resolution of clinical symptoms associated with fungal infection. Related to M. aphidis fungemia, we reviewed a total of three cases in Europe published in the PubMed database between 2003 and 2024. To the best of our knowledge, this is the first case of M. aphidis FBI in Poland and the fourth case in an adult patient in Europe.

Placental mesenchymal dysplasia in a monochorionic-diamniotic twin pregnancy complicated with hydrops fetalis-with a review of literature.

Placental mesenchymal dysplasia (PMD) is a rare placental pathology that sonographically mimics gestational trophoblastic diseases. However, mesenchymal dysplasia can be distinguished from other conditions by the presence of villous edema and the absence of trophoblastic proliferation in the placental tissue. This pathology has been demonstrated to be associated with fetal growth restriction, Beckwith-Wiedemann syndrome, some chromosomal abnormalities and intrauterine fetal demise. A review of the literature revealed approximately 200 articles on PMD. Nevertheless, eight articles on PMD in twin pregnancies were identified, encompassing a total of nine cases. This is the tenth case of PMD in a twin pregnancy and the fourth case of monochorionic twins in the literature. The patient was a 28-year-old primigravid woman. A portion of the placenta exhibited sonographic features consistent with PMD. Both fetuses developed hydrops fetalis at 16weeks of gestation. The fetal karyotype demonstrated no abnormalities, and no additional major congenital anomalies were identified. Following pregnancy termination, a pathological examination confirmed PMD in the placental portion of one of the fetuses. This study aims to contribute to the existing literature on this condition, which can be challenging to diagnose and manage, particularly in twin pregnancies.

Teaching social inclusion, public policy and governance through active learning and educational games

How can an active learning approach enhance how key topics in public policy, public administration, and governance are taught? This article describes four educational game scenarios that illustrate decision-making processes in social inclusion policies. Various governance aspects can be examined through these games, including accountability reforms, crisis management, challenges in implementing artificial intelligence in social service provision, and market regulation. All these cases have been developed within the framework of the P-Cube project, an Erasmus + project that aims to foster active learning through the use of educational games for teaching public policy. The first case illustrates the effect of regulation on nursing home services, and aims to examine the implications of establishing independent agencies to regulate specific social sectors and the involvement and participation of the market and stakeholders in these regulatory bodies. The second case explores the application of artificial intelligence and automated decision-making in a surveillance system for detecting welfare fraud, in which the main learning objective is to discuss governance implications and consequences for social innovation and inclusion. The third case examines the implementation of alternative solutions for providing school meals to children from low-income families during the COVID-19 pandemic. The main objective here is to explore the role of participatory mechanisms in driving policy change and to identify the factors influencing their degree of effectiveness. The fourth case explores the potential ways of regulating the rights of workers employed in the digital platform-based economy. Our cases target graduate and postgraduate students in political science, public administration, public policy, social policy, and other related fields. They also offer valuable insights for practitioners, specifically public managers at different organizational levels.

Acute Pregnancy Fatty Liver Early Complicated by Pituitary Apoplexy

Authors present a case of a 26-year-old female at 37 weeks of gestation presenting concomitant pituitary apoplexy and acute fatty liver complicated with disseminated intravascular coagulation, leading to foetus death and hemorrhagic shock secondary to a massive uterine haemorrhage successfully managed in intensive care unit. To our knowledge, this is the fourth case reported in the literature.

HPB SO17 - A rare case of Goblet cell adenocarcinoma of appendix presenting as primary ampullary tumour

Abstract Background Goblet cell adenocarcinoma (GCA), formerly known as goblet cell carcinoid,is a rare appendiceal tumour with amphicrine differentiation that has distinct morphologic and clinical features compared to carcinomas seen elsewhere in the gastrointestinal tract. The tumour histologically resembles both carcinoids and adenocarcinomas. It is found in 0.3–0.9 % of appendectomy specimens; hence, ampullary GCAs are exceptionally uncommon. Method A 57-year-old Caucasian male presented with a two-month history of weight loss, pruritus, and dark urine. His blood tests revealed deranged liver enzymes. His past medical history was unremarkable. Abdominal CT identified a double duct sign, no detectable mass. Endoscopic ultrasound (EUS) revealed a dilated biliary system terminating in a slightly enlarged ampulla (15mm) without any obvious mass lesions. Endoscopic retrograde cholangiopancreatography (ERCP) was performed showing a distal common bile duct (CBD) stricture. Cytology samples were negative for malignancy, and stents were placed in the CBD and pancreatic duct (PD). Pancreaticoduodenectomy was advised given the high risk of malignancy. Results Histopathology report showed clusters of goblet-like mucinous cells in an infiltrative pattern, in addition to classic neuroendocrine tumor morphology, reminiscent of goblet cell adenocarcinoma of the appendix, staged as pT3pN1M0. This is consistent with primary ampullary GCA given the normal appendix on preoprative CT imaging. Conclusion To our knowledge, this is the fourth case of ampullary GCA report in medical literature. There is no consensus on adjunct chemotherapy regimen for systemic treatment. Chicago consensus group (2018) recommends following the colorectal cancer pathway for goblet cell adenocarcinoma. In our experience, given the anatomical location of the tumour and the normal appendix, FOLFIRINOX was offered in line with ampullary adenocarcinoma cancer pathway.

TMIC-45. CYTOMEGALOVIRUS PP65 ANTIGEN EXPRESSION FOLLOWING PP65-SPECIFIC DENDRITIC CELL VACCINATION IN MATCHED PRIMARY AND RECURRENT GLIOBLASTOMA SPECIMENS

Abstract BACKGROUND Human cytomegalovirus (HCMV) expression in glioblastoma (GBM) has been corroborated by multiple independent laboratories. HCMV genes have been directly linked to GBM cell proliferation, invasion, and angiogenesis. The HCMV tegument protein pp65 has served as a tumor-specific antigen in serial pp65 RNA-pulsed autologous dendritic cell (DC) vaccine trials. Here we report pp65 expression in matched primary and recurrent GBM samples from those trials following pp65-DC vaccination. METHODS Paired GBM specimens were collected from patients receiving pp65-DC vaccines according to ATTAC and ATTAC-GM clinical trials (NCT00639639). Of 23 treated patients, 9 cases were available for analysis. Formalin-fixed paraffin-embedded specimens were mounted on glass slides and stained for pp65 via immunohistochemistry (IHC). CD31 served as a control for tissue quality and to investigate the role of pp65 co-staining in the tumor perivascular niche. RESULTS Of 9 available cases, 5 were excluded due to poor tissue quality/absent CD31 staining on aged slides. Among the remaining four cases, three showed pp65 staining in non-vascular and perivascular areas within both primary and recurrent samples. However, recurrent specimens of these positive cases demonstrated a clear reduction in both intensity and distribution of pp65 staining within non-vascular regions but retained a strong positivity within the perivascular space. The fourth case showed absent pp65 staining and only weakly positive CD31 staining in both primary and recurrent specimens. Necrotic areas within pp65-positive slides showed minimal to no pp65 staining. CONCLUSIONS This study confirms HCMV pp65 expression in both primary and recurrent GBM following pp65-DC vaccination, with an interesting phenomenon of retained pp65 expression specifically in the perivascular niche. These findings support the role of HCMV in GBM angiogenesis and tumor progression as well as mechanisms of immune evasion following single antigen vaccine platforms. Our study reinforces the importance of tissue quality for proper HCMV detection in GBM.

Exploring Hypoglycemic Ketoacidosis in Nondiabetic Patients on Tirzepatide: Is Starvation the Culprit?

BACKGROUND Tirzepatide is a long-acting glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide-1 (GLP-1) receptor agonist administered via subcutaneous injection for weight reduction and treating type 2 diabetes. CASE REPORT We report case series of hypoglycemic ketoacidosis after the use of tirzepatide to treat nondiabetic patients with obesity from Kuwait. The first case was a 29-year-old woman with a body mass index (BMI) of 32 kg/m² who developed abdominal pain and vomiting after increasing the dose to 5 mg subcutaneously in week 5 of treatment. The second case was a 34-year-old woman with a BMI of 31.3 kg/m² who presented with abdominal pain, vomiting, and diarrhea after increasing the dose to 5 mg subcutaneously. The third case was a 17-year-old girl with a BMI of 30.4 kg/m2 who presented with abdominal pain, vomiting, and diarrhea in week 5 of treatment. The fourth case was a 26-year-old woman with a BMI of 30.8 kg/m² who presented with abdominal pain, frequent loose motions, and vomiting. The median blood sugar level was <3.89 mmol/L and high anion gap metabolic acidosis with ketosis occurred. All the patients required inpatient treatment with intravenous fluid and the correction of hypoglycemia and ketosis. CONCLUSIONS Tirzepatide can induce hypoglycemic ketoacidosis in nondiabetic patients with obesity when used for weight reduction. Measuring urine and serum ketone levels in patients with gastrointestinal symptoms who are taking dual GLP-1 and GIP receptor agonists is crucial. Medical supervision is recommended when this medication is prescribed.

Oncocytic lipoadenoma of the parotid gland: a case report and a review of the literature.

Oncocytic lipoadenomas are a rare sub-category of fat-containing tumors of the salivary glands. These tumors are characterized by their oncocyte-predominant epithelial component admixed with mature adipocytes. This condition has been rarely reported to affect the parotid and the submandibular glands. We report a case of a 69-year-old male who presented to our otolaryngology outpatient department with a complaint of a gradually growing right-sided infra-auricular neck mass. A surgical full mass excision was performed, and a histopathological evaluation yielded a tumor with oncocytes organized in tubular structures. This paper presents the fourth unusual case of a giant oncocytic lipoadenoma of the parotid gland measuring 11.5 × 10.5 × 11.5cm in anteroposterior, transverse, and cranial planes, respectively.

Abstract 442: Transradial Access For Neurointerventional Procedures In The Elderly Population

Introduction/Purpose Transradial access (TRA) has been shown to be both efficacious and safe across a range of neuro‐interventional procedures. The elderly population represents a sub‐population in which the benefits of TRA could be magnified given their increased risk of access site complications. However, this population may be at higher risk for access site and procedural failure due to their increased likelihood of vessel tortuosity and vascular disease. The current neuro‐interventional literature is lacking with respect to the safety and efficacy of trans‐radial access in the elderly population. Materials/Methods A retrospective review of patients older than 80 years who underwent diagnostic cerebral angiogram or neuro‐endovascular intervention through proximal and distal radial access from 2018 to 2023 at a single center was conducted. Results The mean age of patients who underwent diagnostic cerebral angiogram (N= 35) and endovascular intervention (N= 31) were 82.5 and 83.5 years, respectively (ranges from 80 to 94). Vascular sheath diameters used in the diagnostic and intervention groups were 5 and 5 to 7 French, respectively. Amongst patients in both the diagnostic and intervention groups, proximal radial access was used in 8 and 16 patients, respectively, and distal radial access was used in 27 and 15 patients, respectively. One distal radial access failure occurred in the diagnostic group due to the small diameter of the radial artery. In addition, a patient was switched to femoral access due to the aberrant origin of the right subclavian artery. In the intervention group, there were 4 radial access failures due to difficult anatomy. In the first case, the patient's aortic arch anatomy and proximal left common carotid artery tortuosity prevented guide catheter placement into the left carotid artery. In the second case, the catheter could not be navigated due to proximal left common carotid artery tortuosity. In the third case, the benchmark guide catheter could not be advanced into the left common carotid artery due to significant angulation. In the fourth and final case, the complex radial artery loop could not be navigated. Total failure rates in the diagnostic and intervention groups were 5.7% and 15.2 %, respectively. No access site or other procedural complications were noted. Conclusion Neuro‐interventions are increasingly important concerning the aging population. The benefits of the trans‐radial approach have been well documented as safe and efficacious, with minimal access site complications. Our findings add to the literature, demonstrating that the trans‐radial approach is safe and effective for performing cerebral angiography and neuro‐interventions in octogenarian patients with acceptable crossover and no access site complications

Parasagittal and parafalcine cystic meningiomas, as well as other cystic meningiomas case series and systematic literature review

Background and Importance: Cystic components in meningiomas are an infrequent finding and pose diagnostic and therapeutic challenges to neurosurgeons. This study aims to conduct a comprehensive assessment of the clinical characteristics and management approaches for cystic meningiomas (CMs). Case Presentation: The current research investigated rare cases of CM. In the first case (case 1), benign parasagittal CM showed malignant features, including brain swelling and midline shifting. In the second case (case 2), parafalcine CMs demonstrate rare histopathological analysis and have not been documented in previous studies. The third case involved a pregnant woman, while the fourth case showed improvement in an older patient after surgery and indicated that the removal of a CM can result in a good prognosis. All tumors were surgically removed at stage 1 (Simpson stage), and histopathology confirmed World Health Organization (WHO) grade 1 syncytial meningioma in cases 1, 3, and 4. Only case 2 showed grade 3 rhabdoid meningioma. Conclusion:We found that benign CM may cause more brain edema than high-grade meningiomas, especially when they invade the sinus. Parasagittal and parafalcine CM invade the superior sagittal sinus (SSS), making complete excision more challenging and riskier. The presence of the cyst facilitates the removal of the tumor and reduces the risks.

Acute Corrosive Acid Ingestion: A Case Series of Four Autopsies

Acute corrosive acid ingestion presents significant challenges in clinical and forensic pathology due to its severe and often fatal outcomes. This case series examines four autopsies involving fatal acid ingestion: three cases of hydrochloric acid (HCl) poisoning and one case of sulfuric acid (H₂SO₄) poisoning. Each case provides detailed autopsy findings, focusing on macroscopic and microscopic pathological changes. The first three cases of HCl poisoning revealed extensive tissue damage characterized by coagulative necrosis, particularly affecting the esophagus, stomach, and duodenum. Histological examination showed dense inflammatory infiltrate, submucosal edema, and significant hemorrhage, with patchy necrosis observed in the liver and kidneys. Pulmonary findings included alveolar edema and hemorrhage. The fourth case, involving H₂SO₄ ingestion, demonstrated more severe injuries with transmural necrosis and extensive hemorrhagic infiltration in the esophagus. The stomach exhibited full-thickness necrosis with a pronounced sulfurous odor, indicating severe chemical injury. Histopathological findings included extensive tissue dehydration and charring, with severe alveolar edema and hemorrhage in the lungs and extensive necrosis in the liver and kidneys. Comparative analysis of the histopathological changes highlighted the differences in tissue damage caused by these two acids. HCl primarily induced superficial necrosis with relatively preserved tissue architecture, while H₂SO₄ caused more extensive and deeper tissue damage due to its strong dehydrating and exothermic properties. Recognizing these differences is crucial for forensic pathologists in accurately diagnosing and differentiating cases of acid poisoning, ultimately enhancing diagnostic precision and clinical outcomes. This study underscores the severe and often fatal consequences of acute acid ingestion and aims to enhance the understanding of the pathological changes associated with such poisonings, thereby improving forensic and clinical evaluations.

Development of Landslide Risk Maps in the Rif Mountains of Morocco: Between Al Hoceïma and El Jebha

The Central Rif region in Morocco, from Al Jebha to Al Hoceïma, has a rich history of landslides causing significant disruptions. The recent violent earthquake of Al-Hoceïma in 2003 led to a large land movement that caused the temporary closure of Regional Road N° 610 near Kassita. Besides, winter episodes with extreme rainfall, such as the record 136 mm in March 2020 near the El Jebha town, also caused an exorbitant slope sliding that interrupted traffic on National Road N° 16. These two examples of slope sliding, among others, demonstrate the interest in understanding and managing landslide risks in this region and constitute the background of the research. Thus, the purpose of this research is to identify the most vulnerable areas to landslides in the Al Jebha and Al Hoceïma regions to support their development. To conduct this study, we followed a methodology based on the inventory of dominant soils and rock formations with their geotechnical characteristics. Then, we proceeded with the presentation of their spatial distribution in geotechnical maps, constituting the first results. Subsequently, we discussed assumptions regarding the calculation of critical angles, such as the bishop method and the height of the studied slopes, alongside the definition of calculation cases considering the effects of rainfall and seismic activity on slope stability. We then calculated the critical angle for each soil in the fourth cases defined using the Talren tool, representing the second set of results. Furthermore, we assessed the natural dips of the study area based on a Digital Elevation Model using GIS tools to compute the quantity Δ, describing the difference between the critical angle and natural dips of each soil type. This led us to define landslide risk levels based on the range of the quantity Δ. Finally, using these results, we established landslide risk maps for the fourth cases, which constitute the main result of this paper. These risk maps serve as crucial tools for government decision-makers, guiding infrastructure investments like roads and tourism toward low-risk areas, optimizing fund allocation, and enhancing landslide hazard management effectively.

Fibroadenoma With Multiple Epidermal Inclusion Cysts Masquerading as Malignancy: An Underreported Entity With Review of Literature.

Fibroadenomas in postmenopausal women are quite uncommon, and so are epidermal inclusion cysts in the breast. The coexistence of both is very rare, and very limited literature is available about this occurrence. We report a postmenopausal female patient with complaints of breast lump masquerading as malignancy on triple assessment which upon subsequent histopathological evaluation was confirmed to be fibroadenoma with intervening multiple epidermal inclusion cysts. In addition, the epidermal inclusions cysts were seen within the fibroadenoma without any association with the overlying skin and adnexa, adding to its rarity. So far, this is probably the fourth such case report to be documented in the literature with such coexistence and the first of its kind to be reported in a postmenopausal woman.

Combining optical genome mapping and RNA-seq for structural variants detection and interpretation in unsolved neurodevelopmental disorders

BackgroundStructural variations (SVs) are key genetic contributors to neurodevelopmental disorders (NDDs). Exome sequencing (ES), the current first-line tool for genetic testing of NDDs, falls short in SVs detection. This diagnostic gap is being actively addressed by new methods such as optical genome mapping (OGM).MethodsThis study evaluated the utility of combining OGM and RNA-seq in the detection and interpretation of SVs in ES-negative NDDs. OGM was performed in 43 patients with NDDs with inconclusive ES results. Candidate SVs were selected based on disease association and pathogenicity evaluation, and further validated or reconstructed by alternative methods, including long-read sequencing for a complex rearrangement event. RNA-Seq was performed on blood samples from patients with candidate SVs to facilitate interpretation of pathogenicity.ResultsOGM detected four candidate SVs, and RNA-seq confirmed the pathogenicity of three SVs in the patient cohort. This combined approach solved three cases—two cases with de novo SVs in genes associated with autosomal dominant NDDs, including a deletion encompassing the promoter and 5′UTR of MBD5 and an intragenic duplication of PAFAH1B1, and a third case possessing an intragenic duplication in trans with a pathogenic single-nucleotide variant of PLA2G6, associated with autosomal recessive NDDs. The expression alteration of the affected genes and the tandem positioning of two intragenic duplications were confirmed by RNA-seq. In the fourth case, OGM detected a complex rearrangement involving chromosomes 2 and 6, much more complex than the de novo t(2:6)(q13;q15) indicated by conventional cytogenetic analysis. Reconstruction showed that 17 segments of 6q15 spanning 9.3 Mb were disarranged and joined 2q11.2, with four breakpoints detected in the 5′ and 3′ non-coding region of the NDD-associated gene SYNCRIP. RNA-seq revealed largely preserved SYNCRIP expression, leaving the pathogenicity of this complex rearrangement event uncertain.ConclusionsSVs in ES-negative NDDs can be identified by OGM, which is particularly useful for SVs in non-coding regions not covered by ES. OGM helps to construct complex SVs and provides information on the location and orientation of duplications, which is crucial for pathogenicity interpretation. The integration of RNA-seq facilitates the interpretation of the functional consequences of SVs at the transcriptional level. These findings demonstrate the utility and feasibility of combining OGM and RNA-seq in ES-negative cases with NDDs.

Probing 4 × 4 quark mixing matrix

Without adhering to any specific model, we have presented 4 [Formula: see text] 4 quark mixing matrix as an extension of the 3 [Formula: see text] 3 Particle Data Group (PDG) parametrization of the Cabibbo–Kobayashi–Maskawa (CKM) matrix Using unitarity constraints as well as the hierarchy among the elements of the 3 [Formula: see text] 3 CKM matrix, we have found the hierarchy among the fourth row and fourth column elements of the 4 [Formula: see text] 4 quark mixing matrix. Further, for the fourth generation case, we have explicitly found the nine independent rephasing invariant parameters [Formula: see text]. Also, using phenomenological estimates of the fourth row and fourth column elements, we have numerically evaluated these nine parameters.

Police arrest-related death: about four cases and review of the literature.

Unexpected deaths may occur in individuals during a police arrest. These individuals usually have had both physical and emotional exertion, associated or not with agitation and restraint by police. Further investigations in these cases often show an impregnation with drugs. Autopsy findings may raise medico-legal problems in these cases.We report four cases of deaths during police arrest in which multiple factors contributed to the death. In the first two cases, there was a combination of emotional and physical stress due to police pursuit and, the presence of mechanical asphyxia. We noticed the presence of cannabis and amphetamine; however, we couldn't relate the death to a drug intoxication. In the third case, the deceased lost consciousness when he was arrested by the police with no link to the intervention of law enforcement authorities. Death in this case was due to sepsis complicating endocarditis. The fourth case reports a rare cause of asphyxia that can occur in a police arrest related to a drug package. Death was due to upper airway obstruction in this case.The forensic pathologist should take into consideration every factor when explaining these deaths. Thorough autopsy and investigations are critical to understand the cause and circumstances of death.

Influence of the position and dimensions of a U-shaped obstacle in a cavity containing a nanofluid on the thermal performances

The aim of this work is to study the effect of the position of an obstacle in the U-shaped with length lr = 0.6 H and height hr = 0.4 H, thickness wr = 0.2 H located inside a square cavity of two-dimensional length L and height H filled with a diamond–water nanofluid (solid volume fraction in the range of 0.05). The bottom wall of the cavity is brought to a constant hot temperature ( Th). The two side walls are cooled to a constant temperature Tf, and the upper wall of the cavity is adiabatic. The position of the obstacle in relation to the hot wall was studied in four cases: in the first case, the obstacle is placed on the vertical left side wall, the obstacle is placed on the upper in case 2, (against a hot wall), the obstacle is placed on the vertical right side wall in the case three, and the fourth case the obstacle is placed on the hot wall. The effect of the obstacle dimensions, such as its thickness, length, and width in the fourth case, on heat exchange inside the cavity was also studied. Numerical results were developed for Rayleigh numbers equal to 103 and 105 for the laminar and steady flow regime. According to the results obtained from the study, the effect of increasing the Rayleigh number on the heat transfer coefficient was observed in the four cases. We found that the position of the obstacle in the fourth case gives the best heat exchange compared to the cases studied, with a difference of 8.8%, 11%, and 8.9% for the first case, the second case, and the third case, respectively. We also noticed that an increase in the thickness, length, and height of the obstacle affects the heat exchange in the fourth case.

Median Arcuate Ligament Syndrome Involving a Celio-Mesenteric Trunk-a Lesson Learnt

Celio-mesenteric trunk (CMT) is a rare vascular variation of the ventral branches of the abdominal aorta that supply blood to the mesentery and the gut. This rare variation is seen in 2/100.000 population. The presence of this anomaly is associated with an increased risk of mesenteric ischemia in the case of proximal occlusion. Median arcuate ligament (MAL) syndrome is a controversial entity characterized by compression of the celiac axis by MAL causing post-prandial pain. We report the fourth case of MAL compression syndrome involving a CMT in the world.

Characteristics of unilateral and bilateral bovine twin foetuses

AbstractTwin pregnancy in cattle is undesirable for a number of reasons, including a higher abortion risk compared to pregnancies with a single foetus. Yet, the abortion risk is significantly influenced by the intrauterine location of the foetuses, that is, the abortion risk is several times higher if they are implanted in the same uterine horn (unilateral twin pregnancy) than if they are implanted with one foetus in each uterine horn (bilateral twin pregnancy). The reason for the higher abortion risk in unilateral twin pregnancies is unknown, but it may be related to malnutrition of the outermost foetus due to a limited placental capacity, as is the case for equine twin foetuses. A slaughterhouse study was performed and the foetuses of cattle pregnant with twins were measured. We identified 65 cases of twin pregnancies, of which 35 were unilateral twin pregnancies and 30 were bilateral twin pregnancies. There was no significant difference between the outermost and the more centrally located foetus in unilateral twin pregnancies in terms of body weight and length of the metacarpal diaphysis. Growth retardation of the outermost foetus could therefore not be confirmed as the cause of the higher abortion risk in unilateral bovine twin pregnancies. Four cases of pre‐slaughter foetal mortality were identified. In three of these cases, both twins were dead, of equal size and at a comparable level of degradation. In the fourth case, with approximately 40‐day‐old twin foetuses of equal size, only one of the foetuses showed signs of pre‐slaughter death.

Congenital unicuspid aortic valve in adults: Minireview and case series.

A unicuspid aortic valve (UAV) in adults is a very rare form of aortic valve (AV) malformation. UAV has two distinct subtypes, acommissural UAV and unicommissural, and can be differentiated by anatomical features, imaging modalities, and clinical presentation. With the development of significant AV lesion (s), surgical or transcatheter intervention will be required. The first part is a summarized review of UAV (anatomical features, clinical presentation, diagnostic modalities, and management). In the second part, we present a series of four patients diagnosed with UAV (3 unicommissural and 1 acommissural). The first case underwent balloon aortic valvuloplasty during childhood and surgical AV replacement later, with the progression to severe aortic stenosis (AS). The second case underwent a Ross procedure. The third and fourth cases were asymptomatic with moderate AS and mild-to-moderate AR and were kept on follow-up. In all the cases, transesophageal echocardiography confirmed the diagnosis of UAV with detailed morphological and functional assessment of AV.