Left Horn Research Articles

Morphometry of the hyoid bone: a radiological anatomy study

Objectives: The hyoid bone occupies a strategic position and participates in vital functions. The aim of this study was to examine the morphometry of the hyoid bone and define its location according to the vertebral level on 3D computed tomography (CT) images. Methods: This study was conducted using 3D–CT images of 216 patients (104 males, 112 females) aged between 10–98 years. The vertebral level of the hyoid bone was determined for each decade. Furthermore, the anterior-posterior length of the hyoid bone, the length and height of the greater horn, the height and width of the body, the distance between the posterior ends of the greater horn, and the distance of the hyoid bone to the vertebral column and the angle between right and left greater horn was measured. Results: The hyoid bone was most commonly located at C3 and C2–C3 vertebral level in females (35.7%) and C3 in males (38.5%). No statistically significant difference was found between right and left sides concerning the length and height of the greater horn. Conclusion: Knowing the radiological anatomy, morphometric properties and vertebral levels of the hyoid bone will contribute to the surgical planning of this region and the hyoid bone. In addition, our study will provide data on the morphometric properties of hyoid bone in forensic and anthropological research.

Considering intrauterine location in a model of fetal growth restriction after maternal titanium dioxide nanoparticle inhalation.

Fetal growth restriction (FGR) is a condition with several underlying etiologies including gestational disease (e.g., preeclampsia, gestational diabetes) and xenobiotic exposure (e.g., environmental contaminants, pharmaceuticals, recreational drugs). Rodent models allow study of FGR pathogenesis. However, given the multiparous rodent pregnancy, fetal growth variability within uterine horns may arise. To ascertain whether intrauterine position is a determinant of fetal growth, we redesigned fetal weight analysis to include litter size and maternal weight. Our FGR model is produced by exposing pregnant Sprague Dawley rats to aerosolized titanium dioxide nanoparticles at 9.44 ± 0.26 mg/m3 on gestational day (GD) 4, GD 12 or GD 17 or 9.53 ± 1.01 mg/m3 between GD 4-GD 19. In this study fetal weight data was reorganized by intrauterine location (i.e., right/left uterine horn and ovarian/middle/vaginal position) and normalized by maternal weight and number of feti per uterine horn. A significant difference in fetal weight in the middle location in controls (0.061 g ± 0.001 vs. 0.055 g ± 0.002), GD 4 (0.033 g ± 0.003 vs. 0.049 g ± 0.004), and GD 17 (0.047 g ± 0.002 vs. 0.038 g ± 0.002) exposed animals was identified. Additionally, GD 4 exposure produced significantly smaller feti in the right uterine horn at the ovarian end (0.052 g ± 0.003 vs. 0.029 g ± 0.003) and middle of the right uterine horn (0.060 g ± 0.001 vs. 0.033 g ± 0.003). GD 17 exposure produced significantly smaller feti in the left uterine horn middle location (0.055g ± 0.002 vs. 0.033 ± 0.002). Placental weights were unaffected, and placental efficiency was reduced in the right uterine horn middle location after GD 17 exposure (5.74 g ± 0.16 vs. 5.09 g ± 0.14). These findings identified: (1) differences in fetal weight of controls between the right and left horns in the middle position, and (2) differential effects of single whole-body pulmonary exposure to titanium dioxide nanoparticles on fetal weight by position and window of maternal exposure. In conclusion, these results indicate that consideration for intrauterine position, maternal weight, and number of feti per horn provides a more sensitive assessment of FGR from rodent reproductive and developmental studies.

Ruptured ectopic pregnancy in the rudimentary horn of a Unicornuate uterus. A case report.

Ectopic pregnancy in rudimentary horn of a Unicornuate uterus is a very rare phenomenon, and usually presents in second trimester with rupture and hemoperitoneum. Diagnosis before its rupture is very challenging.
 We are presenting a case report of ruptured ectopic pregnancy in rudimentary horn of a Unicornuate uterus. A 26 years old gravida 4 para 2 with one early miscarriage, having first vaginal delivery and second delivery by Caesarean section due to fetal distress, presented in emergency with 4 months amenorrhea, severe lower abdominal pain for 2 days and signs and symptoms of shock. There was severe anemia and abdominal tenderness. Ultrasound showed, left ruptured ectopic pregnancy with 16 weeks size dead fetus present in the pelvic cavity and massive hemoperitoneum. After resuscitation laparotomy was performed. There was ruptured left rudimentary horn pregnancy. The horn was reserved and uterus was repaired. Multiple blood transfusions were done. Post-operative period remained uneventful.

Messenger RNA Expression of Selected Factors at Different Sites of the Bovine Endometrium Associated With Uterine Health.

Recent studies have elucidated the role of several pro-inflammatory factors as mediators of inflammatory processes in the bovine endometrium. Only few studies, however, have analyzed samples collected from different regions of the uterus of the same animal. In this study, we tested the hypothesis that on a molecular level, clinical endometritis is characterized by inflammatory responses spread over the entire endometrium. Furthermore, we assume that subclinical endometritis is described by an inflammation of local regions of the uterus. Therefore, the objective of this study was to assess the mRNA expression of uterus-associated pro-inflammatory factors at five pre-defined endometrial sites, i.e., corpus uteri, left horn base, left horn tip, right horn base, and right horn tip, in cows with clinical and subclinical endometritis and in healthy controls. We analyzed the mRNA expression of interleukin 1 alpha, interleukin 1 beta, C-X-C motif chemokine ligand 8, prostaglandin-endoperoxide synthase 2, protein tyrosine phosphatase receptor type C, carcinoembryonic antigen related cell adhesion molecule 1, and mucin 4 and 16. Based on vaginoscopy and endometrial cytology (≥ 5% polymorphonuclear neutrophils) between 28 to 34 days in milk, 18 Simmental cows were categorized in clinical endometritis group (n = 7), subclinical endometritis group (n = 4), and healthy group (n = 7). In general, the analyses revealed a great variation of mRNA expression between sites and animals. Differences were found between different uterine health statuses, but the variation between the sampling sites within the groups was not significant (P > 0.05). This indicates that inflammatory processes at the end of the postpartum period can be regarded as multi-focal or spread throughout the uterus independent from the uterine health status.

A case of fetal maceration in a dog

Fetal maceration is a process which is characterized by enzymatic autolysis of cells and degeneration of connective tissue. In this case, fetal maceration was described in a female dog. A 22 months old, 32 kg female Golden Retriever dog was brought to the Animal Hospital of Afyon Kocatepe University with the complaints of whitish and foul-smelling vaginal discharge, anorexia and weakness nearly two months. The body temperature, respiratory and pulse rates were at normal values. In the ultrasound examination, hyperechogenic areas were detected in the uterus. Before the ovariohysterectomy operation, an adhesion was determined between left uterine horn and the omentum. Furthermore, a huge solid and vascularized structure was detected in the left horn. After removal of the ovaries and the uterus, a foul-smelling mucous structure of brown-reddish fluid and fetal bone residues were found after incision and inspection to the uterus. Considering all findings, the patient was diagnosed with fetal maceration. In the postoperative period, the process was supported with systemic antibiotics and periodic wound care for the first seven days, recovery was achieved and no complications were encountered in the next six months. Since the case is rarely seen, veterinarians should not overlook this problem in bitches and they are recommended to use ultrasound in examinations.

Sex estimation based on the anthropometric measurements of thyroid cartilage using discriminant analysis

BackgroundThe morphometric analysis of the individual bones of the human skeleton can be used to estimate the sex of unidentified corpses. Our aims were as follows: to test whether thyroid cartilage can be used for forensic purposes as a predictor of biological sex; to establish the level of sexual dimorphism of the thyroid cartilage in a sample of adult subjects from a population of European Russia; and to test the accuracy of the morphometric parameters obtained from the thyroid cartilage.ResultsThe thyroid cartilage from 100 adults of known age (50 males and 50 females) was obtained during forensic examination; morphometric tests were conducted using Vernier Digital ROKTOOLS ABS DIN 862 0-200/6 inch with measurement accuracy ± 0.01 mm. The measured parameters were N = 31 for each subject. Intra- and inter-observer reproducibility was tested. Multivariate statistical analysis was applied to the measurements. To check the data set for normal distribution, the Kolmogorov-Smirnov test was used. Finally, to estimate the sex of the observed individuals, a stepwise discriminant analysis was conducted, using the Wilks’ lambda selection method. The most significant parameters were the outer distance between bases of inferior horn; the inner distance between distal ends of inferior horns; distance between distal ends of left superior and inferior horns; left superior horn length (distance between left superior horn distal end and base); distance between superior and inferior notches; thyroid angle; left lamina height (vertical line along left lamina middle); horizontal distance between anterior intermedium line and the right lamina posterior edge; distance between inferior thyroid notch and line connecting left and right thyroid laminae; and left superior horn thickness at mid-line. The stepwise discriminant analysis resulted in an equation with ten parameters.ConclusionsThe results of the current study indicated that in the European Russian population, the equation obtained in the stepwise discriminant analysis makes it possible to predict sex with a probability of 100% on the validation set. On the test set, the resultant accuracy was 100% for females and 100% for males. Our findings confirm the scientific evidence that the thyroid cartilage has a pronounced sexual dimorphism.

Intrauterine Gardnerella vaginalis Infection Results in Fetal Growth Restriction and Alveolar Septal Hypertrophy in a Rabbit Model.

Background: Gardnerella vaginalis (GV) is most frequently associated with bacterial vaginosis and is the second most common etiology causing intrauterine infection after Ureaplasma urealyticum. Intrauterine GV infection adversely affects pregnancy outcomes, resulting in preterm birth, fetal growth restriction, and neonatal pneumonia. The knowledge of how GV exerts its effects is limited. We developed an in vivo animal model to study its effects on fetal development.Materials and Methods: A survival mini-laparotomy was conducted on New Zealand rabbits on gestational day 21 (28 weeks of human pregnancy). In each dam, fetuses in the right uterine horn received intra-amniotic 0.5 × 102 colony-forming units of GV injections each, while their littermate controls in the left horn received sterile saline injections. A second laparotomy was performed seven days later. Assessment of the fetal pups, histopathology of the placenta and histomorphometric examination of the fetal lung tissues was done.Results: Three dams with a combined total of 12 fetuses were exposed to intra-amniotic GV, and 9 fetuses were unexposed. The weights of fetuses, placenta, and fetal lung were significantly lower in the GV group than the saline-inoculated control group [mean gross weight, GV (19.8 ± 3.8 g) vs. control (27.9 ± 1.7 g), p < 0.001; mean placenta weight, GV (5.5 ± 1.0 g) vs. control (6.5 ± 0.7 g), p = 0.027; mean fetal lung weight, GV (0.59 ± 0.11 g) vs. control (0.91 ± 0.08 g), p = 0.002. There was a two-fold increase in the multinucleated syncytiotrophoblasts in the placenta of the GV group than their littermate controls (82.9 ± 14.9 vs. 41.6 ± 13.4, p < 0.001). The mean alveolar septae of GV fetuses was significantly thicker than the control (14.8 ± 2.8 μm vs. 12.4 ± 3.8 μm, p = 0.007). Correspondingly, the proliferative index in the interalveolar septum was 1.8-fold higher in the GV group than controls (24.9 ± 6.6% vs. 14.2 ± 2.9%, p = 0.011). The number of alveoli and alveolar surface area did not vary between groups.Discussion: Low-dose intra-amniotic GV injection induces fetal growth restriction, increased placental multinucleated syncytiotrophoblasts and fetal lung re-modeling characterized by alveolar septal hypertrophy with cellular proliferative changes.Conclusion: This intra-amniotic model could be utilized in future studies to elucidate the acute and chronic effects of GV intrauterine infections.

Clinical utility of brain computed tomography in prediction of post-stroke delirium.

Delirium is a common and serious complication of stroke. Early prediction of delirium is important for preventive strategies and close monitoring of high-risk patients. Pre-existing degenerative and vascular changes in the brain could predispose to delirium. We aimed to determine if computed tomography (CT)-based indices could provide additional information about a risk of stroke-associated delirium beyond easiest-to-access clinical predictors. Using semi-quantitative scales (global cortical atrophy, age-related white matter changes, and Scheltens scale), we assessed global and regional brain atrophy and white matter changes in 88 stroke patients with delirium and 142 patients without delirium matched for age and stroke severity. Patients with delirium had greater global and local brain atrophy (the right temporal region, the left parieto-occipital region, the right frontal and occipital horn, and the right and left temporal horn) than patients without delirium. Scores of white matter changes did not differ between groups with exception of greater white matter damage in the right parieto-occipital area in patients with delirium. The discriminatory properties of studied radiological indices were modest (areas under receiver operator curves: 0.58-0.64). CT-based indices of brain atrophy and white matter changes do not provide additional information about a risk of post-stroke delirium beyond the most important clinical predictors.

Участие жировой ткани в заживлении сквозной операционной раны стенки матки крысы

Introduction. Data about the role of components of adipose tissue in the repair of damaged uterine walls are limited, although a number of authors claim that cell-based drugs from adipose tissue have a positive effect on the repair of damaged uterine walls in laboratory rodents. Meanwhile, stem cells derived from adipose tissue are considered to be the most promising type of cells in regenerative medicine. The aim of the studywas to evaluate the adipocyte components in the uterine wall of rats in healing after a full-thickness surgi-cal incision. Materials and methods. We conducted the study on 40 female Sprague Dawley rats. The animals were sub-jected to a full-thickness longitudinal incision in the wall of the right uterine horn, with the left one serving as an intact control. We carried out morphological examinations of the uterine walls daily in 5 animals from day 1 to 7 and on day 15. The sections from paraffin blocks were stained with hematoxylin and eosin and Mallory’s trichrome staining. Immunohistochemistry detected FABP4+ adipocytes and CD68+ macrophages. The morphometric study was carried out using the Leica system (Leica, Germany). The results underwent processing in the Statistica 12 software (StatSoft). Results. We noticed the period of the most active interaction of adipose tissue with the damaged horn to last from day 3 to 15 and coincide with the macrophage activation in the healing zone. The intact left uterine horn was not involved in the interaction processes with the mesenteric adipose tissue. Starting from day 3 FABP4+ cells in the uterine wall of the operated horn formed groups, creating rounded nest-like structures. Clusters of FABP4+ cells were localized in the healing zone, near the suture material, and in the perime-trium near the mesentery attachment sites. The changes over time of the indicators of the area of cell nests depended on the localization and duration of healing. There were no FABP4+ cells in the left intact horn. Conclusion. We characterized the morphological interaction of adipose tissue with the damaged uterine wall during the first two weeks after a full-thickness surgical incision of the rat uterine horn. The results of the study indicate that adipocytes take an active part in the healing after a surgical incision of the rat uterine wall at the earliest stages. Keywords: rat uterus, hysterotomy, healing, adipocytes, macrophages

Spreading of pathological TDP-43 along corticospinal tract axons induces ALS-like phenotypes in Atg5+/- mice.

Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disease, characterized by phosphorylated TDP-43 (pTDP-43)-positive inclusions in neurons and glial cells. However, the pathogenic mechanism that underlies ALS remains largely unknown. To investigate the effects of autophagy deficiency in the formation and spreading of pathological TDP-43 along corticospinal tract axons, TDP-43 preformed fibrils (PFFs) were prepared and unilaterally injected into the fifth layer of the left primary motor cortex (M1) or the left anterior horn of the seventh cervical spinal cord segment (C7) of Atg5+/- mice. After the injection of TDP-43 PFFs, the elevated levels of pTDP-43 were present in several pyramidal tract-associated regions of Atg5+/- mice. Additionally, the occurrence of spontaneous potentials detected by electromyography demonstrates evidence of lower motor neuron dysfunction in M1-TDP-43 PFFs-injected Atg5+/- mice, and prolonged central motor conduction time detected by motor evoked potentials provides evidence of upper motor neuron dysfunction in C7-TDP-43 PFFs-injected Atg5+/- mice. These results show that injection of TDP-43 PFFs into the M1 or C7 of Atg5+/- mice induces the spreading of pathological TDP-43 along corticospinal tract axons in both an anterograde and retrograde manner. Importantly, TDP-43 PFFs-injected Atg5+/- mice also display ALS-like motor dysfunction. Taken together, our findings provide direct evidence that TDP-43 PFFs-injected Atg5+/- mice exhibited ALS-like neuropathology and motor phenotypes, suggesting that autophagy deficiency promotes the formation and spreading of pathological TDP-43 in vivo.

Primary intraventricular central nervous system lymphoma of lateral ventricle in an immunocompetent patient

Primary CNS lymphoma (PCNSL) is a rare variant of extranodal non-Hodgkin's lymphoma and accounts for 3%–5% of all primary brain tumors. Their intraventricular location is extremely rare with only a few cases on record so far. All the reported cases showed bilateral ventricular involvement. We report the first case of unilateral lateral ventricle PCNL in a 22-year-old female who presented with intractable vomiting and headaches. Computed tomography (CT) followed by magnetic resonance imaging (MRI) revealed lobulated altered signal intensity lesion in the left temporal horn of lateral ventricle with surrounding peritumoral edema causing midline shift. With these imaging features, the diagnosis of intraventricular meningioma was suggested. Microscopic examination of the excised mass revealed round-to-ovoid tumor cells with scant eosinophilic cytoplasm with large and hyperchromatic nuclei, prominent nucleoli, irregular nuclear membrane, and frequent mitotic figures. The tumor cells are positive for leukocyte common antigen, CD20, CD10, CD43; and were negative for CD3, synaptophysin, chromagranin, pan-cytokeratin (pan-CK), Epstein-Barr virus (EBV), and glial fibrillary acidic protein. The Ki-67 was very high (80%). With these histopathological and immunohistochemistry (IHC) findings, diagnosis of NHL of diffuse large B cell type was rendered.

The impact of lateral localization of the procedure on the effectiveness of transplations of pre-implantation embryos in heifers-recipient

The article presents the results of a study of the efficiency of transcervical embryo transplantation obtained from donor- cows in vivo. The aim of the experiment was to compare the effectiveness of ipsilateral transfers randomized laterally from the uterine horn of embryos of different stages of development (blastocysts and morulas). The embryos were located in the left or right horn of the uterus of recipient heifers (n = 283 cows). It was experimentally established that the functional asymmetry of the ovaries of the recipients affects the level of survival of preimplantation embryos. Thus, in case of transfer to the left horn of the uterus of the recipients blastocysts 60.91% of pregnant heifers were found; morulas - 45.45%. In case of similar procedures in the right horn of the uterus - were found respectively 58.78% and 14.29% pregnant. The obtained results indicate the need for further scientific research to study the structural and physiological features that affect the survival rate of pre-implantation embryos.

Silent rupture of unscarred uterus at 32 weeks: Case reports

Introduction: Rupture in an unscarred uterus prior to onset of labor in third trimester is a rare event and very few cases have been reported in literature so far. Case Report 1: We describe a case of a primigravida who presented in emergency with pain abdomen with placenta praevia and severe oligominos. An ultrasound was conducted which reported bicornuate unicollis uterus with single live foetus 33+4 weeks having severe oligohydromnios (AFI=2) with placenta anterior and reaching upto internal os in one cornua, the other cornua was empty. A MRI was conducted, which was also inconclusive. She was taken up for laprotomy, peroperatively pregnancy was present in left horn of uterus which had ruptured with intact amniotic sac and was covered with omentum, the placenta was covering the lower half of the left horn and the right horn looked like normal uterus and was empty. The omentum was carefully separated and baby that was delivered weighed 700gms. The left horn was excised and then uterus was closed in layers. Patient was followed up for 6 months, mother was doing well, though baby was 5 kg which was less than the weight for that age and had slow developmental milestones. Case Report 2: Our second case was a 30 years old gravida 5, para 2, abortion 2 woman with 8 months amenorrhea. She was referred with chief complaint of pain abdomen. On examination, she looked almost stable. Even though she was pale; vital signs were within normal parameters. An ultrasound was conducted which showed single live intrauterine foetus 29+2 weeks with absent liquor with placenta praevia with placenta acreta. Emergency laprotomy was decided in view of placenta acreta. It was found to be an abdominal pregnancy. Amnion along with omentum and blood clot matting sac like structure sitting over the fundus with placenta perforating the fundus small incision was given at the fundus and baby weighing 1.15 kg delivered through it. Placenta did not separate and so decision of hysterectomy taken.

MBCL-46. TREATMENT OF RECURRENT WINGLESS-ACTIVATED MEDULLOBLASTOMA (Wnt-MB) INCORPORATING MARROW-ABLATIVE THIOTEPA AND CARBOPLATIN CHEMOTHERAPY (HDCx) AND AUTOLOGOUS HEMATOPOIETIC PROGENITOR CELL RESCUE (AuHPCR): A DUAL REPORT

BACKGROUNDWnt-MB infers an excellent prognosis, and metastatic disease is rare. However, specific treatment strategies and patterns of failure for patients with recurrent Wnt-MB are unknown. We report two cases of recurrent beta-catenin nucleopositive Wnt-MBs treated with an irradiation-sparing strategy, incorporating HDCx/AuHPCR. PATIENT 1: A nine-year-old female experienced local recurrence of a non-metastatic Wnt-MB nine months after gross total resection (GTR) followed by 18Gy craniospinal irradiation (CSI) with primary site boost to 54Gy, accompanied by weekly vincristine, followed by a maintenance regimen of nine cycles of cisplatin/lomustine/vincristine alternating with cyclophosphamide/vincristine every third cycle. GTR of the relapsed tumor was followed by three cycles of HDCx/AuHPCR. She is disease-free for over three years following relapse treatment. PATIENT 2: A 17-year-old male initially underwent GTR, followed by 23.4Gy CSI with 54Gy posterior fossa boost with concomitant weekly vincristine, followed by a maintenance regimen that included nine alternating cycles of vincristine/lomustine/cisplatin and cyclophosphamide/vincristine. Isolated right frontal horn metastatic recurrence developed 19 months post-treatment; three cycles of irinotecan/temozolomide/bevacizumab and gamma-knife radiosurgery produced complete response. A second isolated metastatic recurrence within the left frontal horn occurred 13 months post-treatment, which was treated with two cycles of cyclophosphamide/etoposide followed by two cycles of HDCx/AuHPCR. MRI of the brain showed no residual tumor one month post-treatment. He currently awaits follow-up stereotactic radiosurgery.CONCLUSIONPatients with recurrent Wnt-MB may be treated with curative intent using a multi-disciplinary approach that includes HDCx/AuHPCR, and minimization or avoidance of re-irradiation.

Laterality of Ovulation and Presence of the Embryo Do Not Affect Uterine Horn Blood Flow During the First Month of Gestation in Llamas

We determined if laterality of ovulation and intrauterine embryo location differentially induces changes in the mesometrial/endometrial vascularization area (MEVA) between uterine horns, during and after embryo migration, elongation and implantation in llamas. Adult, non-pregnant and non-lactating llamas (n = 30) were subjected to daily B-mode ultrasound scanning of their ovaries. Llamas with a growing follicle ≥8 mm in diameter in the left (n = 15) or right (n = 15) ovary were assigned to a single mating with an adult fertile or vasectomized male. Power-doppler ultrasonography was used to determine the MEVA in a cross section of the middle segment of both uterine horns. MEVA was determined by off-line measurements using the ImageJ software. MEVA measurements were performed before mating (day 0) and on days 5, 10, 15, 20, 25, and 30 after mating in pregnant [llamas with left- (n = 6) or right-sided (n = 6) ovulations] and non-pregnant [llamas with left- (n = 6) or right-sided (n = 6) ovulations] females. Ovulation was confirmed by the disappearance of a follicle (≥8 mm) detected previously. Pregnancy was confirmed by the presence of the embryo proper. MEVA was analyzed by one-way ANOVA for repeated measures using the MIXED Procedure in SAS. If significant (P ≤ 0.05) main effects or interactions were detected, Tukey's post-hoc test for multiple comparisons was used. Ovulation rate did not differ (P = 0.4) between females mated to an intact or vasectomized male and between right- or left-sided ovulations. Three females mated to the intact and 3 to the vasectomized male did not ovulate and were excluded of the study. First observation of fluid inside the gestational sac and of embryo proper, were made exclusively in the left uterine horn, on day 15.8 ± 3.8 and 22 ± 2.7, and 16.7± 2.6 and 27.5 ± 2.8 for pregnant llamas ovulating in the right and left ovary, respectively. Although the MEVA of both uterine horns was affected by time (P < 0.05), it was not affected by physiological status (pregnant vs. non-pregnant; P = 0.9) or laterality of ovulation (P = 0.4). Contrary to expectations, regardless of the laterality of ovulation, in pregnant llamas the left horn did not display a greater MEVA before or after embryo arrival, a trend that was observed during the first 30 days of gestation.

Laparoscopic Excision of a Noncommunicating Uterine Horn Pregnancy

Study Objective To describe the diagnostic challenge and surgical management of a noncommunicating uterine horn pregnancy. Design Clinical history, brief literature review, and video documentation. Setting Patient was placed in dorsal lithotomy for laparoscopic resection of a uterine horn pregnancy in a tertiary care center. Patients or Participants The patient was a 29 year old G1P0 female presenting with a live 11-week extrauterine pregnancy. Radiologic work-up with both pelvic ultrasound and MRI could not fully ascertain diagnosis. Differential diagnosis included tubal ectopic, horn pregnancy of a bicornuate uterus, interstitial pregnancy, and broad ligament pregnancy. Given this was a wanted pregnancy, intra-sac potassium chloride was not administered pre-operatively and the patient was consented for a diagnostic laparoscopy and possible removal of ectopic pregnancy. Interventions Laparoscopy Measurements and Main Results Diagnostic laparoscopy was undertaken where pelvic inspection revealed a right-sided normal appearing unicornuate uterus and a large left rudimentary noncommunicating horn distended by the pregnancy. The pregnancy was connected to the unicornuate uterus via a thick fibrous band. This confirmed a pregnancy in a Type II-B Mullerian anomaly as per the ASRM classification system. Such pregnancies are rare ranging from 1 in 75,000-150,000. Our video demonstrates a stepwise approach for the excision of such pregnancies including isolation of the ureter retroperitoneally, bladder dissection, use of peritoneal landmarks to ensure safe transection of the fibrous band, and use of hemostatic techniques such as vasopressin and advanced bipolar devices. In addition, we demonstrate a simple technique for oophoropexy where we stabilize a hypermobile ovary to the round ligament pedicle using a laparoscopic ligature device. Conclusion Rudimentary horn pregnancies are rare and pose a diagnostic challenge. Complications are common with >50% of such pregnancies presenting ruptured, thus resection is often recommended. We demonstrate that laparoscopy is a safe and feasible option to manage such pregnancies.

Pediatric Air Gunshot Penetrating Head Injury with Good Outcome: A Case Report

Abstract: Ball bearing (BB) and pellet guns are non-power guns but their related injuries have been reported worldwide. They represent a significant cause of injury especially among children and teenagers. Their potentially harmful and lethal effects have been well documented in the medical literature since the early 1980s. Fatality rate is closely related to the damaged part of the brain and the level of the damage. In this Case Report we documented a 6-years-old girl was getting shot at the head by herself, who initially want to play around, using her neighbour’s Air gun rifle. The pellet trajectory passed through the left frontal lobe, left temporal lobe, left posterior putamen, posteriorly left crus posterior of internal capsule, left occipital horn of lateral ventricle, left occipital lobe, and ended at left cerebral falx between both medial surfaces of occipital lobes. Directional slope of the pellet was medially upward, with its tracking left Intracerebral Hemorrhage (ICH) with perifocal edema and Intraventricular Hemorrhage (IVH) dominant in the left lateral ventricle. After 8 days management, the patient was discharged from our hospital with stable condition, GCS 15 without any significant neurological deficits. Intracranial intracerebral pellet due to air gun shot injury, may have fatal and lethal manifestation if the pellet damage the eloquent area and/or deep area of the brain (hypothalamus, thalamus and brain stem). If accessible the foreign body or pellet should be removed immediately for better outcome. Keywords: Head Injury, Air Gun Shot, Intracerebral Haemorrhage

Intraocular Silicone Oil Implant Migration in a Patient with a Craniopharyngioma

A 75-year-old male presented to the hospital with concern for failure to thrive and generalized weakness. He also experienced a fall three weeks prior to presentation. A non-contrast head computed tomography (CT) scan showed an intraventricular hyperdensity at the left frontal horn of the lateral ventricle initially concerning for intraventricular hemorrhage. However, the non-dependent locations of the hyperdensity favored silicone oil migration from prior left intraocular silicone oil implant injection. Patient was also found to have an incidental craniopharyngioma.

Modifications of extracellular matrix features in the left and right uterine horns during the embryo pre-implantation period in Vicugna pacos

More than 98% of the pregnancies in South American camelids is carried out in the left uterine horn (LUH). Hence, embryos originated from right-ovary ovulations have to migrate to the contralateral or left uterine horn (LUH) to implant and survive. A reason for this unique pattern of embryo implantation has not been elucidated yet. In general, embryo implantation involves an extensive extracellular matrix (ECM) remodeling within the endometrium, in which collagen and matrix metalloproteinases (MMPs) play an essential role. Deregulation of collagen and MMPs has been related to embryo implantation failure, miscarriage, and infertility. Therefore, we hypothesized that ECM components in camelids could be involved in differential embryo implantation and consequently the high incidence of left horn gestations. The aim of this study was to describe and compare changes in ECM components in the left and right uterine horn of non-pregnant and 15 days pregnant alpacas. To test this hypothesis, the collagen content was evaluated by specific staining with Picrosirius Red and using ImageJ 1.42q software. Subsequently, gene expression of the following components of the MMP pathway was determined: MMP-2, -3, -7, -9, and -14, MMP substrates (COL1A2 and COL3A1), MMP inhibitors (TIMP1 and TIMP2), LGMN, an MMP activator, and EMMPRIN, an extracellular matrix metalloproteinase inducer. Uterine horns of pregnant alpacas exhibited a marked decrease in collagen content. In contrast, transcript expression of COL1A2 and COL3A1 was higher in the LUH of pregnant alpacas. Gene expression of MMP-3, -7, -9, -14, LGMN, and EMMPRIN were also higher in the LUH of pregnant animals, whereas MMP-2 gene expression was higher in the LUH of both pregnant and non-pregnant alpacas. Expression of TIMP1 and TIMP2 increased during pregnancy, with higher values in the LUH. In conclusion, expression of ECM components displayed a specific pattern depending on the uterine side and the physiological status (pregnant vs non-pregnant) of the animal. The increased expression of ECM transcripts in the left uterine horn during early pregnancy in alpacas suggests the involvement of these molecules in a highly regulated process leading to the implantation process.

Laparoscopic metroplasty: reconstructive surgery for unicornuate uterus with noncommunicating, functional uterine horn

To demonstrate laparoscopic surgery for a patient with unicornuate uterus and a large hematometra in the noncommunicating uterine horn. Narrated video featuring the diagnostic tests and surgical management. Academic tertiary hospital. A 13-year-old woman, gravida 0 with menarche at 9 years old, had severe dysmenorrhea during her recent menstrual cycles. The results of transrectal three-dimensional sonography, hysteroscopy, and magnetic resonance imaging (MRI) were consistent for a uterine didelphys composed of a right unicornuate uterus and a left hemiuterus with hematometra and no connection to the cervix. Left adnexal endometrioma and ipsilateral renal agenesis were also noted. Laparoscopic adhesiolysis and enucleation of the left ovarian endometrioma were first performed. Then, implementing the concepts of Strassman unification method, a horizontal incision was made on the medial side of each hemicorpus, starting from the left rudimentary horn and ending at the fundal area of the right hemiuterus. The incision was carried deep enough to reach the endometrium. The opposing, reverted myometrium was then reapproximated from the lower end of the uterus to the upper fundal part in two layers, using absorbable bidirectional monofilament barbed suture. The outer serosal layer was closed with 1-0 Monocryl via a running continuous suture. On postoperative day 2, the patient was discharged uneventfully. Symptomatic relief and restoration of normal and functional anatomy. The patient has regular menstrual cycles with no recurrence of dysmenorrhea or ovarian endometrioma. At a 2-year postoperative follow-up evaluation, hysteroscopic examination revealed a single uterine cavity with a small fundal septum. The MRI scans showed an anteverted, symmetrical uterus. In comparison with the widely applied hemihysterectomy, reconstructive laparoscopic metroplasty not only effectively achieves symptomatic relief but also offers better uterine symmetry and a larger intrauterine cavity via unification of the uterus.