Lateral Wall Research Articles

Iatrogenic Erosion of Orbital Walls due to Expanding Hydrogel Explant.

Hydrogel scleral buckles are a hydrophilic explant that may lead to significant delayed complications. They can insidiously enlarge over decades and may mimic an orbital tumor or cyst. The authors report a case of an expansive hydrogel scleral explant in a previously eviscerated socket. A 58-year-old male presented with a 2-week history of severe pain in his left anophthalmic socket. And 31 years prior, he had sustained OS trauma and undergone a series of surgeries. Details of these procedures were unavailable; however, he had ultimately proceeded to globe evisceration. MRI revealed a large lobulated cyst-like orbital mass with internal calcification, which had expanded the left orbit with erosion of the medial wall, lateral wall, and roof. It extended to involve the ethmoid and frontal paranasal sinuses. He proceeded to a lateral orbitotomy, revealing the lesion to be an expanded hydrogel scleral buckle explant. Postoperatively, there was a significant improvement in his pain.

Ayurvedic management of Nasa Arsha w.s.r. to Nasal Polyp: A Case Report

Nasa Arsha is one among the Nasagata Roga explained in Ayurvedic classics. When the Prakupit Dosha gets localised in the Ghran Pradesh, the person gets the symptoms like Pratishyaya (cold), Atim Matra Kshavathu (excessive sneezing), Kruchchhra Uchchhawas (difficulty in breathing), Putinasya (fetor nasalis), Shirah Shul (headache), Anunasik Vakya Dukha (difficulty in nasal letters). Nasal polyp is oedematous grape-like protrusions most often originating in the upper part of the nose around the osteomeatal complex on the lateral wall. The surface epithelium tends to be smooth and consists of pale translucent tissue which distinguishes them from the more vascular mucosa of the nasal cavity. Polyps can vary widely in size and should be considered a bilateral condition. Rare cases of unilateral polyps should only be diagnosed. Shikhari Taila, known for its anti-inflammatory and antihistaminic properties, this medicated oil penetrates deep into the fine channels, facilitating Sroto Shodhan (cleansing of the channels).

Factors That Limit Evaluation of Velopharyngeal Closure During Nasopharyngoscopy.

To assess the quality of nasopharyngoscopy video recordings used for velopharyngeal insufficiency (VPI) surgical planning and identify factors that limit evaluation of velopharyngeal closure. Prospective observational study. Metropolitan-based hospitals with craniofacial clinics in the United States and Canada. One-hundred and forty-two (142) patients with VPI across 10 hospitals. Nasopharyngoscopy video recordings used for VPI surgical planning . Ratability of nasopharyngoscopy video recordings, with "ratable" defined as the video (1) visualized the velum, lateral pharyngeal wall, and posterior pharyngeal walls at some point during speech production and (2) contained an oral speech sample at the phrase level or above. One-hundred and forty-two (142) nasopharyngoscopy video recordings were obtained from patients undergoing VPI evaluation, of which 59.9% (n=85) were ratable. A multilevel logistic regression model was used to identify factors that influenced the quality of nasopharyngoscopy video recordings. Factors associated with unratable nasopharyngoscopy videos were age (P=.030), sex (P=.005*), type of scope camera used (P=.039), presence of compensatory misarticulations (P=.008), and a limited speech sample (P=.040). A substantial proportion of nasopharyngoscopy video recordings obtained during VPI evaluation are not sufficient for rating velopharyngeal closure. Lack of ratability could impact the surgery selected to treat VPI. Younger patients, those with limited speech samples, or patients with extensive compensatory articulations may be more successful in completing other VPI imaging techniques, such as videofluoroscopy or magnetic resonance imaging.

Prediction of lateral wall deflections of excavations in water-rich sands by a modified multivariate-adaptive-regression-splines method

Prediction of lateral wall deflections of excavations in water-rich sands by a modified multivariate-adaptive-regression-splines method

Clinical results of 100 cases of modified eversion carotid endarterectomy

Objective: The primary goal of this study is to explore the safety and effectiveness of a new modified eversion carotid endarterectomy (MECEA). Methods: This is a retrospective case series study. One hundred patients were consecutively treated with MECEA by the same operator at Department of Vascular Surgery,Peking Union Medical College Hospital from January 2019 to December 2023. There were 77 males and 23 females. The age was (66.0±8.6)years (range: 39 to 85 years). Twenty-four (24.0%) patients were symptomatic with the degree of carotid stenosis over 50%,76 patients (76.0%) were asymptomatic with the degree of stenosis over 70%. All these patients meet the indication of carotid endarterectomy. The main difference between MECEA and traditional eversion carotid endarterectomy was the anterior,lateral,and posterior walls of the internal carotid artery were incised obliquely from the origin of the internal carotid artery toward the common carotid artery,leaving the wall of internal carotid artery intact at the bifurcation. The surgical process,cardiovascular and cerebrovascular complications and other surgical complications were recorded. The incidences of complications,restenosis of intraoperative target lesions and re-intervention were collected during follow-up. Results: All procedures were performed successfully under general anesthesia. The total operation time was (36.5±10.1)minutes (range: 22 to 65 minutes),and carotid clamping time was (15.0±6.3)minutes (range: 7 to 31 minutes). One patient (1.0%) occurred postoperative cerebrovascular accident,1 patient (1.0%) developed cerebral hyperperfusion syndrome (CHS),and another 1 patient (1.0%) suffered myocardial infarction. All these patients were recovered after medical treatment within a week. The follow-up time(M(IQR)) was 24 (28) months (range: 6 to 62 months). Two patients (2.0%) were reported to have hemodynamically significant restenosis within 2 years,with one patient requiring intervention. No patient suffered from ipsilateral ischemic stroke. Conclusions: MECEA is a safe and effective surgical method of treating carotid artery stenosis. This method can reduce carotid clamping time and lowers the risk of ischemic stroke. Meantime,it preserves the integrity of the adventitia at the bifurcation of carotid artery,reduces the chance of restenosis. Moreover,it might be helpful to prevent postoperative CHS due to reducing damage to the carotid body and carotid sinus nerve.

Imaging and clinical significance of tubular cell in lateral facial recess

Objective:To observe the position and morphology of tubular cell in lateral facial recess by CT scanning and surgical finding, and its clinical significance. Methods:Thirty patients（32 ears） with cholesteatoma and/or adhesive otitis media requiring radical mastoidectomy and tympanoplasty were included in this study. To observe the morphology of the tubular cell in the lateral facial recess cavity through temporal bone HRCT and surgery, and to analyze its relationship with the facial nerve. Results:Tubular cell were found in 59.4%（19/32） ears by temporal bone HRCT and through surgeon. The length ranged from 1.5-6.5 mm, with median length of 2.5 mm. All of them opened in the facial recess, ran on the posterior wall of the facial recess, and even reached the bottom of the inferior tympanic cavity or the level of the inferior wall of the external auditory canal（sagittal view and surgical findings）. Probing from the inside out, the tubular cell located between the second genu of the facial nerve and the chorda tympani, which was a part of the lateral wall of the facial nerve（facial crest）. When the tubular cell is occupied by granulation tissue, it is easy to be regarded as the facial nerve. Fully drilling out the tubular cell is helpful to cut down the facial nerve crest. In the study, the follow-up and/or postoperative no facial paralysis happens during the operation and in the follow up. Conclusion:Preoperative temporal bone HRCT can clearly show the tubular cell in the lateral facial recess cavity. Comprehensive and accurate identification of these structures is helpful to fully cut down the facial nerve crest and remove the hidden lesions in the posterior tympanic cavity.

Male Patient having a Spigelian Hernia, Prince Osman Digna Referral Hospital, Port Sudan City, Red Sea State, Sudan; 2024: A Case Report

Background: Spigelian hernia is a rare type of abdominal hernias; it occurs through a defect in Spigelian aponeurosis of transverse abdominis (Spiegel's fascia). Methods: A 65 years old male, presented to our refer clinic at Prince Osman Digna Referral Hospital; Port Sudan City; Red Sea State; Sudan, on July 2024, complaining of lower abdominal swelling for 2 months without features of obstruction or strangulation; following heavy lifting, obvious during standing and walking, disappear when lying down; and was not associated with gastrointestinal track disturbances. Patient had history of recurrent repaired right inguinal hernia, para-umbilical hernia, and transurethral resection prostatectomy for Benign Prostatic Hyperplasia. No family history of similar conditions. Result: Abdominal examination showed: positive visible cough impulse revealed reducible mass at the left lower abdomen, oval in shape about 15*15cm, without features of peritonism. CT abdomen showed: left lower lateral abdominal wall hernia defect lateral to the rectus abdominis muscle measuring (3*3.7 cm) with hernia sac lie between the external and internal oblique muscles containing bowel loops. Patient diagnosed as Spigelian hernia and planned for mesh hernioplasty. Intra-operative findings revealed: the hernia sac passed through the internal oblique and transverse abdominis muscles, it contained sigmoid colon which released smoothly, sac excised, external oblique aponeurosis sutured by nylon 2, prolene mesh fix onlay, no intraoperative complications. Post-operative course was smooth. Conclusion and recommendations: Spigelian hernia has to be suspected among patients having repeated abdominal hernias. Early diagnosis using CT Abdomen and urgent surgical intervention for such cases were highly recommended.

Extended pelvic evisceration with lateral wall resection in malignant tumors

Patients with tumor involvement of lateral pelvic sidewall represent a peculiar category and were not assessed as the candidates for curative surgery up until recent years. The aim of the current review of literature is to display the working results of the most experienced surgical oncologists in pelvic surgery. We have analyzed issue-related articles, which were published from 1967 till 2023, considering the free margin status as a key prognostic factor. It is elucidated that R0 resection could be achieved in more than a half cases, 5 year overall survival ran up to 50 %, and postoperative mortality was less than 7 %. The majority of authors described high morbidity though (up to 82 %). Exenteration with laterally extended endopelvic resection could improve overall survival rate in patients with locally advanced pelvic malignancies granting sensible patient selection in expert medical care unit.

Interrater reliability of different scoring systems for drug-induced sleep endoscopy

PurposeTo explore the interobserver reliability of drug-induced sleep endoscopy (DISE) for patients with obstructive sleep apnea syndrome (OSAS) of two classification systems.MethodsDISE examinations were recorded digitally for all patients and were evaluated independently by five examiners blinded to all patient data. Areas of obstruction were rated using VOTE (velum, oropharynx lateral wall, tongue base, epiglottis) classification and PTLTbE (palate, tonsils, lateral pharyngeal wall, tongue base, epiglottis) classification. Additionally, palatal coupling was assessed during the jaw thrust maneuver. Interobserver reliability was evaluated with Fleiss’ kappa for categorical data and linearly weighted kappa for ordinal data.ResultsIn total, 123 patients were included in this study, 92 males and 31 females, with a mean (SD) age of 50.7 (12.1) years and a body mass index (BMI) of 28.3 (5.0) kg/m2. The mean apnea-hypopnea index was 22.2 (18) per hour, and the Epworth Sleepiness Scale was 7.3 (2.3). In our cohort, the interobserver reliability for the VOTE classification ranged from 0.32 to 0.59 and for the PTLTbE classification from 0.23 to 0.49 over all assessed levels, indicating fair to moderate interobserver reliability. The weighted kappa for palatal coupling was 0.37. In the VOTE classification, the level with the best agreement was the velum, while in PTLTbE, the best agreement was observed for tonsillar obstruction.ConclusionThe interrater agreement was fair to moderate for both classifications, with no clear superiority for one classification. The large variability shows the need to objectively quantify upper airway collapse during DISE and natural sleep endoscopy.

Complex blunt traumatic abdominal wall hernias: Experience from a high-volume abdominal core health center

BackgroundTraumatic abdominal wall hernias are rare and commonly involve the lateral abdominal wall due to shearing off the oblique and transversus abdominis muscles from the iliac crest. The vast majority of the current literature focuses on the index trauma admission, includes few patients, and provides little to no detail about the hernia repair itself. We aim to report our center’s high-volume experience with a definitive repair of chronic traumatic lateral abdominal wall hernias. MethodsAll patients who underwent lateral abdominal wall hernia repair performed at our institution from January 2015 through August 2023 were identified in the Abdominal Core Health Quality Collaborative. Only patients with blunt trauma etiology were included. Hernia characteristics, operative techniques, postoperative outcomes, and long-term patient-reported outcomes were extracted from the Abdominal Core Health Quality Collaborative database and supplemented with a manual chart review. ResultsForty-three patients with traumatic lateral abdominal wall hernias underwent repair within the study period. Elective repair occurred at a median of 3 years after a traumatic event. Nearly half of the patients had a recurrent hernia (41.9%) and most had a lumbar (L4) component (79.1%). The mean hernia width was 16.2 cm, and 30.2% had concomitant midline defects. Transversus abdominis release was performed in 88.4% of patients; 74.5% had heavy-weight polypropylene mesh placed and 76.7% had mesh fixation. Superficial surgical site infection occurred in 11.6% of patients, and 7% had a surgical site occurrence. At a mean follow-up of 1.9 years, 3 patients (7%) developed a hernia recurrence, which was noted on physical examination or imaging. One patient was reoperated on for recurrence, and 1 patient underwent partial mesh removal because of a chronic mesh infection. ConclusionIn the largest series of definitive repairs of complex lateral abdominal wall post-traumatic hernias to date, elective open complex abdominal wall reconstruction is safe and associated with low morbidity and hernia recurrence rates.

The Relationship Between the Kansas City Cardiomyopathy Questionnaire and Electrocardiographic Parameters in Predicting Outcomes After Cardiac Resynchronization Therapy

Background: Cardiac resynchronization therapy (CRT) is an essential treatment for patients with symptomatic heart failure and ventricular conduction abnormalities. Low-ejection-fraction (EF) cardiomyopathy often involves a wide QRS complex displaying a left bundle branch block (LBBB) morphology and markedly delayed activation of the LV lateral wall. Following CRT, patients with heart failure and LBBB have better outcomes and quality-of-life improvements. Various electrocardiographic and clinical parameters are thought to be able to predict this improvement. The Kansas City Cardiomyopathy Questionnaire (KCCQ) is a reliable tool for measuring these patients’ quality of life. Methods: This is an observational prospective study featuring over 69 individuals diagnosed with cardiac failure and dilatative cardiomyopathy with low-EF and major LBBB. This study analyzed the correlations between patient outcomes and demographic, clinical, and electrocardiographic parameters. Results: Following the analysis, we observed correlations between the QRS area, intraprocedural systolic blood pressure, Q-LV interval, the R-wave amplitude in the right precordial leads and the CRT outcomes indicated by the KCCQ score. Conclusions: The parameters found and their correlation with the KCCQ score show how CRT therapy impacts patients’ quality of life, symptom burden, and functional status.

Abscopal effect-induced spontaneous regression of distant metastases in malignant mesenchymal tumor: a case report

The abscopal effect refers to an anti-tumor response that occurs in areas where radiotherapy (RT) has not been directly administered but is triggered by the immune system. We presented a case of an undifferentiated pleomorphic sarcoma with three relapses that showed a complete response after distant metastatic disease. The tumor was initially detected in the left pectoral muscle. Fifteen months after adjuvant RT and chemotherapy, a nearby recurrent lesion was surgically removed. Another 15 months later, a second recurrence appeared on the left lateral chest wall. The patient underwent a third surgery and received adjuvant radiation, but distant metastases were discovered 6 months later. Shortly after a biopsy confirmed distant metastasis, all metastatic foci went into spontaneous remission. This phenomenon is identified as the abscopal effect. The patient experienced no metastasis or local recurrences during follow-up and showed a complete response to the abscopal effect for 36 months. The abscopal effect in malignant mesenchymal tumors is extremely rare.

Distinguishing Wolff-Parkinson-White Syndrome From Fasciculoventricular Pathway Using QRS-T Angle Analysis.

Wolff-Parkinson-White (WPW) syndrome and fasciculoventricular pathway (FVP) present electrocardiographic manifestations characterized by delta waves, differentiating these two is challenging. Specifically, WPW type B with QRS width ≤120ms, resembles typical FVP features. Because of the presence of repolarization abnormalities in WPW syndrome, our hypothesis centered on the potential utility of the QRS-T angle for distinguishing WPW syndrome from FVP. To determine the discriminative value of the QRS-T angle for delineating WPW syndrome from FVP. We included cases of WPW syndrome treated with catheter ablation and FVP diagnosed via adenosine triphosphate administration between 2007 and 2023. We excluded cases with WPW type A, QRS width >120ms, intermittent WPW, congenital heart disease or myocardial damage, ablation history, tachycardia, palpitations within 3 months, and WPW syndrome featuring an accessory pathway on the left lateral wall. Eventually, we identified 40 and 54 patients from the WPW and FVP groups, respectively. The QRS-T angle was compared between the WPW and FVP cohorts. The QRS-T angle in the WPW group was significantly larger than in the FVP group (45.7 ± 46.3° vs. 17.8 ± 13.9°, p < 0.001). Receiver operating characteristic curve analysis with a sensitivity and specificity of 65.0% and 72.6%, respectively, demonstrated that the optimal cut-off value for the QRS-T angle was 22° for distinguishing WPW from FVP. Remarkably, all cases with a QRS-T angle >65° were within the WPW group. The QRS-T angle can offer promising utility in differentiating WPW syndrome from FVP.

Morphing of the Frontal view - Rhinoplasty as a surface contour operation.

Patients undergoing surgery in 2019. Encounters were divided into three: First visit: history taking, a list of desires & physical examination, photography. Second visit: photo analysis was presented as well as the hypothesis of correction expressed by morphing. (Morphing with Adobe Photoshop software). We termed the differences between light and shade of the lateral nasal walls, the dorsum and the BDL (brow dome line) and NCL (nose cheek line) as the "Chiaroscuro of the nose". This term is significant in the process of morphing of the frontal view. We used this method of morphing in the simulation process of 126 patients. The age range was 15-59 years old. 67% (84) were females and 33% (42) were males. 43% (54) of the cases were revision cases. At the post-operative visits, all patients were more satisfied with their operative result than with their "morphed" simulation. The chiaroscuro concept of the nose is an essential step in the analysis and morphing processes of the frontal view and a logical tool in creating a realistic surgical game plan. The morphing of the frontal view enables the surgeon and patients to discuss the possible result with more details and refinements. Morphing may be a good option to educate young surgeons in preoperative consultation and operating theatre.

Impact of the uroperitoneum on the development of paralytic ileus: a preclinical study in the pig model.

The intraperitoneal leak of urine is considered as a major cause of peritoneal inflammatory reaction that could lead to paralytic ileus. Our aim was to document the effect of urine on the peritoneal surface. Seven white minipigs (one control-six tests) underwent standardized general anaesthesia. In three test pigs urine was aspirated from the bladder and instilled in the peritoneal cavity. In the remaining three pigs a continuous urine leak was created through section of the ureter. At 4 and 10h laparoscopic harvesting of slices of the parietal peritoneum at the level of the Douglas pouch, lateral pelvic wall and subdiaphragmatic area was performed. Ileum slices were also obtained at 10h. The slices were microscopically evaluated for inflammatory infiltrate (INI) of the peritoneum according to the Sydney system classification. The presence of urine in the peritoneum induces distention of the ileum. At 4h, a light-moderate INI was observed to two pigs of both test groups but not to the control pig. At 10h a light-moderate INI appeared in the peritoneal slices of the control pig. Moreover, three out of six pigs of both test groups showed some degree of INI of the parietal peritoneum. The histologic evaluation of the slices of the distended ileum did not reveal INI. The intraperitoneal urine induces distention of the bowel but no inflammation of the visceral peritoneum in the short term (10h). Other than inflammation mechanisms through which the urine induces small ileum distention should be investigated.

Evaluation of Posterior Superior Alveolar Canal in Individuals With Cleft Lip and Palate Using Cone Beam Computed Tomography.

To evaluate the posterior superior alveolar canal (PSAC) in individuals with cleft lip and palate (CLP) by comparing them with individuals with no cleft lip and palate (NC) using cone beam computed tomography (CBCT). This is a cross-sectional, analytical study with a prospective sample. CBCT scans of 29 individuals with no cleft and palate (Group I) and 29 individuals with cleft lip and palate (Group II) were used. PSAC was evaluated and compared for its position, diameter, and distance between the individuals with CLP and NC using CBCT scans. The mean age of individuals in Group I and II were 12.93 and 11.82 years, respectively. The distribution of individuals based on gender comprised of 51.7% males and 48.3% females in both the study groups. PSAC was present in both right and left maxillary sinus in 100% of the study subjects of Group I and Group II. The most prevalent position of PSAC in Group I and Group II was on the lower third and middle third of lateral wall of maxillary sinus, respectively. The mean diameter was higher in Group II (1.2962 mm) when compared to Group I (1.0897 mm) which showed statistically significant value (P = .008). The promising results obtained from the present study demonstrates the importance of knowing the precise anatomical location of the PSAC in individuals with cleft lip and palate by using CBCT which is reliable, less time consuming and cost effective imaging tool.

Management of Neglected Facial Fracture: A Case Report

Introduction: Neglected fracture occurs where there has been a delay of more than 30 days. The maxillofacial fracture complex is the most common fracture in traffic accidents. The most common maxillofacial fractures are Naso-Orbito-Etmoid (NOE), Lefort fracture, Zygomatic Complex (ZMC), Palate Fracture, and Parasymphysis Fracture. Neglected fractures lead to delayed treatment, worsening conditions, and even disability. Case: A 52-year-old male patient presents with complaints of facial bone fracture after being involved in a motor vehicle accident. CT scan examination showed: Multiple fractures of the bilateral nasal bones, interethmoidal septum, anterior walls of bilateral frontal sinuses, bilateral lamina papyracea of the ethmoid bone, anterior, medial, and lateral walls of bilateral maxillary bones all support Le Fort II. fracture, extending to bilateral dentoalveolar processes, bilateral zygomatic bones, and right mandibular parasymphysis. Case Management: The ORIF technique was used for the upper, middle, and lower face fractures in a preferred order. The palatal reduction and fixation step was frequently the first in this sequence. When proper occlusion was achieved, it was maintained by intermaxillary fixation. Conclusion: There was a significant result in correcting the functional, mastication, and aesthetic of the mid and lower face by using surgical management of facial fractures using ORIF. Keywords: Facial fracture, Neglected fracture, ORIF

Scala Tympani Volume Influences Initial 6-Month Hearing Preservation With Lateral Wall Electrode Arrays.

To examine the effects of scala tympani (ST) volume, cochlear duct length (CDL), and angular insertion depth (AID) on low-frequency hearing preservation for cochlear implant (CI) recipients of lateral wall electrode arrays. A retrospective review identified 45 adult CI recipients of 24-, 28-, or 31.5-mm lateral wall electrode arrays with preoperative unaided hearing thresholds ≤45 decibel hearing level (dB HL) at 250 Hz. All patients underwent preoperative and postoperative computed tomography to evaluate cochlear morphology and electrode array position. A linear mixed effects model evaluated effects of ST volume, CDL, AID, preoperative low-frequency pure-tone average (LFPTA; 125, 250, and 500 Hz), age at surgery, and biological sex on the postoperative change in LFPTA at activation and 6 months post-activation. There were significant main effects of ST volume (p = 0.044), age (p = 0.028), and biological sex (p = 0.003), indicating better low-frequency hearing preservation for CI recipients with larger ST volumes, younger age at surgery, and female biological sex. Although CDL positively correlated with ST volume (r = 0.74, p < 0.001), there was no significant main effect of CDL (p = 0.367). A broad range in AID of the most apical electrode contact was observed (301.4°-681.8°); however, there was no significant main effect of AID on low-frequency hearing preservation (p = 0.700). During the initial 6 months following implantation, intrinsic factors such as cochlear morphology may have a greater impact on low-frequency hearing preservation than apical positioning of a flexible lateral wall electrode array when using soft surgical techniques. 3 Laryngoscope, 2024.

Conservative surgical repair of placenta increta invading into uterine septum: case report

BackgroundThe prevalence of placenta accreta spectrum is on the rise, primarily as a consequence of an increasing number of Cesarean sections. Nevertheless, uterine anomalies, particularly uterine septum, pose a notable risk factor for its occurrence. While there are limited case reports documenting the association between uterine septum and placenta adherence, most of these cases have been linked to prior hysteroscopic treatment of the septum. Notably, this case represents the first-reported instance in which a uterine septum was preoperatively diagnosed in association with placenta increta adherent to it, and subsequently managed conservatively.Case presentationA 30-year-old pregnant Egyptian female patient, who had undergone two previous cesarean sections, was diagnosed with placenta increta and had an incomplete uterine septum. She was admitted to Elshatby University Hospital in December 2021. During her surgery, it was found that the placenta was adherent to right lower aspect of the septum, as well as the right anterior, lateral, and posterior uterine walls. A conservative surgical approach was scheduled and successfully performed, and 3 months later, an ultrasound examination revealed that the uterus had returned to its normal size, with no evidence of isthmocele or synechiae. The only abnormality noted was the presence of the septum.ConclusionUltrasound plays a crucial role in diagnosing placenta accreta and identifying any additional uterine abnormalities that may guide the planning of conservative treatment. Uterine septum represents a risk factor for placental adherence, as the placenta can indeed become adherent to it. Muscle defects may become apparent following placental separation and can often be effectively managed through the use of running sutures, obviating the need for resection of the affected portion.Trial registration clinicaltrials.gov, registered on 27 April 2021, registration number: NCT04866888, https://clinicaltrials.gov/ct2/show/NCT04866888.

Water wave interactions with surface-piercing vertical barriers in a rectangular tank: Connections with Bloch waves and quasimodes

Eigenmodes are studied for a fluid-filled rectangular tank containing one or more vertical barriers, and on which either Dirichlet or Neumann boundary conditions are prescribed on the lateral walls. In the case where the tank contains a single barrier, the geometry of the tank is equivalent to the unit cell of the cognate periodic array, and its eigenmodes are equivalent to standing Bloch waves. As the submergence depth of the barrier increases, it is shown that the passbands (i.e. frequency intervals in which the periodic array supports Bloch waves) become thinner, and that this effect becomes stronger at higher frequencies. The eigenmodes of a uniform array of vertical barriers in a rectangular tank are also considered. They are found to be a superposition of left- and right-propagating Bloch waves, which couple together at the lateral walls of the tank. A homotopy procedure is used to relate the eigenmodes to the quasimodes of the same uniform array in a fluid of infinite horizontal extent, and the quasimodes are shown to govern the response of the array to incident waves. Qualitative features of the mode shapes are typically preserved by the homotopy, which suggests that the resonant responses of the array in an infinite fluid can be understood in terms of modes of the array in a finite tank.