Umbilical Area Research Articles

Dermoscopy of Umbilical Lesions-A Systematic Review.

Background: The umbilicus is a fibrous remnant located in the centre of the abdomen. Various entities may be encountered in this special anatomical location; however, little is known about their dermoscopic presentation. The aim of this study was to provide a comprehensive summary of existing evidence on dermoscopic features of umbilical lesions. Methods: Studies assessing dermoscopic images of umbilical lesions were included in this study. No age, ethnicity or skin phototype restrictions were applied. Papers assessing lesions outside of the umbilical area, lacking dermoscopic images and/or dermoscopic description and not related to the topic were excluded. Embase, Medline and Cochrane Library were searched from inception to the end of May 2023. The Joanna Briggs Institute critical appraisal tools were used to evaluate the risk of bias of the selected studies. The quality and the level of evidence of included studies were assessed according to the Oxford 2011 Levels of Evidence. Thirty-four studies reporting a total of 39 lesions met the inclusion criteria and were included in qualitative analysis. Results: A qualitative synthesis of the following entities was performed: melanoma, nevi, basal cell carcinoma, fibroepithelioma of Pinkus, Sister Mary Joseph nodule, mycosis fungoides, dermatofibroma, endometriosis, epidermal cyst, granuloma, intravascular papillary endothelial hyperplasia, lichen planus, omphalolith, seborrheic keratosis, and syringoma. Conclusions: Dermoscopy is a non-invasive technique that may be useful in the differential diagnosis of umbilical lesions. The main limitations of this study were lack of a high level of evidence in the studies and the lack of uniformity in applied dermoscopic terminology between included studies.

Combination of Urachal and Omphalomesenteric Duct Remnant: A Rare Case Reports

Umbilical problems encountered in the pediatric population are often associated with retained umbilical cord structures or with failure of the umbilical ring to close at birth. This article reported a case of umbilical anomalies in 3-years old male, with a chief complaint of a lump on the umbilical area a urinary discharge from the umbilical since birth. Incidence of patent vitelointestinal duct (omphalomesenteric duct) varies from 1 in 5000-8000 while patent urachus are still rare, ranging from 1-2 per 100000. The combination of both anomalies is very rare, only 12 reported cases since 1898 until 2016. Ultrasound can play an important diagnostic role for these types of anomalies if performed by expert. In our case, the ultrasound was not able to confirm the diagnosis due to a lot of gas in the abdomen. Based on clinical data and histopathologic examination, the patient was diagnosed with combination of urachal and omphalomesenteric duct remnant.

Outcomes after ventral hernia repair using the extended totally extraperitoneal approach: Initial experience from the Philippines.

Newer extraperitoneal techniques of laparoscopic ventral/incisional hernia repair (LVIHR) have been continually introduced since the popularity of the laparoscopic intraperitoneal onlay mesh technique began in 1993. One of which is the extended totally extraperitoneal (eTEP) approach allowing wide mesh augmentation, concurrent repair of diastasis recti, and performance of transversus abdominis release (TAR) for large/complex hernias. However, minimally invasive/laparoendoscopic ventral hernia repair is not yet widely adopted in the Philippines. We aim to share our preliminary experience with LVIHR using the eTEP approach. This was a retrospective review of all consecutive eTEP repairs for ventral hernia between January 2019 and September 2023. The clinical profiles of all patients were gathered. Hernia characteristics, operative profile, and postoperative outcomes were reported. Thirty-five patients were included in the study with a mean age of 54.7; 60% were incisional hernias, and the most common hernia location was the umbilical area. A defect size between 4 and 10 cm was reported in 54.3%. eTEP-TAR was necessary in 12 patients. At a median follow-up of 16 months, two patients developed seroma, one hematoma, and two surgical site infections. All were successfully managed conservatively. Only one patient developed recurrence. eTEP approach is safe and feasible for repairing ventral hernias. Our preliminary experience showed acceptable outcomes similar to the published literature. Surgeons interested in this technique should be familiar with the abdominal wall anatomy, carefully select patients during preoperative planning, and undergo mentorship with hernia surgeons experienced with the technique to shorten the learning curve.

Ultrasound‐guided modified subcostal transversus abdominis plane block in a foal undergoing omphalectomy

SummaryA 7‐day‐old, 60 kg, Purebred Spanish Horse filly was referred with the mare to Complutense University of Madrid, Veterinary teaching hospital for elective omphalectomy. Upon admission, clinical examination was unremarkable except for a thickening of the umbilical area. Haematology and biochemistry values were within the normal range. On abdominal ultrasound (US) examination, a well‐defined, rounded (24 mm of diameter) area that contained heterogeneous material with numerous hyperechoic foci with acoustic shadowing was seen within the inner portion of the umbilical pedicle, between both umbilical arteries. Surgical correction with omphalectomy was scheduled. To provide perioperative analgesia, the transversus abdominis plane (TAP) block was considered. Under general anaesthesia, TAP block was performed in both left and right hemi‐abdominal walls with a modified subcostal approach with two‐site injections. A spinal needle was inserted under US guidance. During surgery, end‐tidal concentration of isoflurane was maintained at 0.7%–0.9%. Surgery was completed uneventfully and no signs of nociceptive input were observed, suggesting an adequate level of analgesia. Therefore, this TAP block technique may be considered to provide analgesia for surgical procedures involving the abdominal wall in foals.

Umbilical cord variables in relation to gestational age by using ultrasonography in normal pregnancy and PIH women

To determine whether the antenatal assessment of CSA of umbilical cord variables is different in PIH compared with healthy pregnant women by using ultrasonography and to assess its relationship with gestational age.This study was conducted in the Department of Radio-diagnosis, Sri Siddhartha Medical College, among 600 (300 normal &300 PIH) pregnant women who underwent a routine prenatal gestational sonogram ranging from 28 to 39 weeks of age.There was a significant difference observed between two groups in all umbilical cord variables except umbilical artery area. Mean ± S.D of the CSA of the umbilical cord variables for each gestational age were studied in normal and PIH women.We found that the mean value of UCA and WJA was increased till 36 weeks then it decline sharply in the normal group whereas in PIH group, the mean value of UCA increases till 36 weeks then it attain plateau and the mean value of WJA increases even after 36 weeks. Our study was first of its kind to document the CSA of UC variables and their growth pattern according to gestation age, which can be used as an informational basis for both normal and PIH pregnant women.

Blue-brownish Nodule in the Umbilical Area: A Quiz.

Abstract is missing (Quiz)

Free-Hand MIS TLIF without 3D Navigation-How to Achieve Low Radiation Exposure for Both Surgeon and Patient.

Transforaminal lumbar interbody fusion (TLIF) is one of the most frequently performed spinal fusion techniques, and this minimally invasive (MIS) approach has advantages over the traditional open approach. A drawback is the higher radiation exposure for the surgeon when conventional fluoroscopy (2D-fluoroscopy) is used. While computer-assisted navigation (CAN) reduce the surgeon's radiation exposure, the patient's exposure is higher. When we investigated 2D-fluoroscopically guided and 3D-navigated MIS TLIF in a randomized controlled trial, we detected low radiation doses for both the surgeon and the patient in the 2D-fluoroscopy group. Therefore, we extended the dataset, and herein, we report the radiation-sparing surgical technique of 2D-fluoroscopy-guided MIS TLIF. Monosegmental and bisegmental MIS TLIF was performed on 24 patients in adherence to advanced radiation protection principles and a radiation-sparing surgical protocol. Dedicated dosemeters recorded patient and surgeon radiation exposure. For safety assessment, pedicle screw accuracy was graded according to the Gertzbein-Robbins classification. In total, 99 of 102 (97.1%) pedicle screws were correctly positioned (Gertzbein grade A/B). No breach caused neurological symptoms or necessitated revision surgery. The effective radiation dose to the surgeon was 41 ± 12 µSv per segment. Fluoroscopy time was 64 ± 34 s and 75 ± 43 radiographic images per segment were performed. Patient radiation doses at the neck, chest, and umbilical area were 65 ± 40, 123 ± 116, and 823 ± 862 µSv per segment, respectively. Using a dedicated radiation-sparing free-hand technique, 2D-fluoroscopy-guided MIS TLIF is successfully achievable with low radiation exposure to both the surgeon and the patient. With this technique, the maximum annual radiation exposure to the surgeon will not be exceeded, even with workday use.

The use of a 4.7 mg deslorelin slow release implant in male dogs in the field.

Slow-release GnRH agonist implants (SRI) are used for reversible medical downregulation of testicular function in male dogs as an alternative to surgery. The 4.7 mg deslorelin SRI should reduce testosterone after 6-8 weeks and induce castration-like effects for 6 months (mon). However, some individual variation is described in the field in regard to onset and duration of effect. For this reason, we aimed to study the effects of the 4.7 mg deslorelin SRI in a larger cohort. In total 50 intact, healthy male dogs (12-48 months, mon; 9-40 kg) were treated with a 4.7 mg deslorelin SRI into the umbilical area (TG, n=45) or served as untreated controls (CG, n=5). CG dogs were surgically castrated after measurement of testicular dimensions and blood sampling for testosterone. In TG, SRIs remained for 5 mon in place and subsequently 3-7 male dogs were surgically castrated at removal (week, W 0) or 1, 2, 3, 4, 5, 6, 7, 8 or 10 weeks later. Examination parameters were testicular dimensions (before treatment, at 4, 8, 12 W, 5 mon, weekly until castration), testosterone (before treatment, at 8 W, 5 mon, castration) and testicular histology (castration). Whereas examination parameters did not differ between CG and TG before treatment, testicular volume and testosterone was significantly reduced at all time points during treatment. In all but 3 (8 W) and 2 male dogs (5 mon) testosterone was basal during treatment before removal, whereas the parameters were significantly reduced compared to pre-treatment in the respective dogs. After implant removal, testosterone and testicular volumes increased. However, different to earlier studies, the "restart" was more variable with individual basal testosterone until W7, but also physiological testosterone concentrations in W2. Similarly, histological testicular findings at castration were quite variable: besides an arrest on spermatogonia and spermatocytes, elongated spermatids with normal spermatogenesis were found in individual dogs. Our study confirms the efficacy of the deslorelin SRI, but also individual variation especially regarding reversibility of effects on endocrine and germinative testicular function. Deslorelin SRIs offer a suitable alternative to surgical castration with individual variation to be considered when used in clinical practice.

Umbilical Outpouchings in two Danish herds raising pigs with minimal use of antibiotics - Results from a field trial evaluating the efficacy of autogenous vaccines and iodine application.

In Denmark, a Pure Pork concept for raising pigs without antibiotics was initiated in 2015 by the Danish Crown slaughterhouse cooperative. Pure Pork herds are characterised by minimal use of antibiotics and pigs are mainly treated individually. An increased prevalence of pigs suffering from umbilical outpouchings (UO) is a considerable challenge for Pure Pork producers. Umbilical outpouchings in pigs are challenging due to reduced welfare and increased workload and cost for the farmer. Therefore, Pure Pork producers require means other than antibiotic treatment to prevent UO. The primary objective of this study was therefore to evaluate the effect of autogenous sow vaccines based on bacteria isolated from the inflamed umbilici of piglets and a 7% iodine treatment at birth on the risk of pigs developing UO during the first 12 weeks of life. In addition, umbilical clinical and necropsy findings were presented, including variation over time and an identification of risk factors. A total of 5852 live-born piglets were included at birth from two Pure Pork herds. In this study, UO was defined as the presence of a rounded outpouching and/or a small firm protrusion at the umbilical area. Among 5614 pigs examined at weeks 5 and 12 and/or at death a total of 534 (9.5%) pigs were recorded with UO. The incidence of outpouchings was 10.2% for Herd A and 8.8% for Herd B. In the present field trial, neither autogenous vaccination of sows nor a 7% iodine spray on the umbilical area of new-born piglets had a statistically significant effect on the incidence of UO, but there was a tendency for a lower risk of UO in pigs treated with iodine spray at birth in one herd (OR = 0.7, p=0.07), which might be worth investigating further. The risk factors for UO identified in this study included sow parity in one herd with more UO pigs from second parity sows and older compared to gilts (OR = 2.0, p=0.02), batch in the second herd, and sex in both herds with male pigs at lower risk of UO development compared to female pigs (OR = 0.8, p=0.006). Furthermore, antibiotic treatment as an indicator of the presence of other diseases resulted in a higher risk of UO compared to untreated pigs (OR = 1.9, p<0.0001). The presence of UO in one pig varied over time; For UO pigs examined alive at both week 5 and 12, 136 pigs (2.4%) had an UO record at week 5 but not at week 12 and 179 pigs (3.2%) did not have an UO at week 5 but a UO record at week 12. For 115 pigs (2.0%) an UO was recorded both at week 5 and week 12.

Bone marrow metastasis of breast cancer and chronic lymphocytic leukemia: A coincidence

Objectives. We present an extremely rare case of breast cancer with metastasis to the bone marrow, which was also simultaneously diagnosed with chronic lymphocytic leukemia (CLL). Case Presentation. A 56-year-old female with a history of routine blood transfusions presented with chronic fatigue and recurrent right upper quadrant abdominal pain due to cholecystitis. Additionally, nodules were palpable in both breasts, which were subsequently detected as suspicious calcified lesions on ultrasound. Leukocytosis and bi-cytopenia were found. Cholecystectomy was performed and biopsies from some tissues were conducted. Gall bladder and subcutaneous tissue from the umbilical area showed neoplastic cells suggestive of breast carcinoma. Bone marrow biopsy showed CLL and non-hematopoietic cells identical to the previously detected neoplastic cells. Immunohistochemistry revealed that the breast carcinoma was ER-positive, PR-positive, and HER2negative. Outcome. After a thorough investigation, the bone marrow depression was proven to result from a metastatic bone marrow lesion from breast cancer diagnosed concurrently with CLL. Conclusions. This circumstance obliged clinicians to be more considerate of the diagnostic approach and treatment of patients with neoplasm presenting with cytopenia. It is to avoid underdiagnosis and ensure that every pathology in the bone marrow is investigated and managed accordingly.

Management of Bleeding due to Vitamin K Deficiency in Neonates: A Case Report

Vitamin K deficiency bleeding (VKDB) is an uncommon and life-threatening bleeding condition in infancy. This study aimed to present a case of bleeding due to vitamin K deficiency in neonates. A 7-day-old male infant presented to an emergency department (ED) following bleeding from an umbilical stump for 3 hours upon arrival at the hospital. On examination of the general condition, the patient is in good health, responsive, conscious and active tonus. Physical examination revealed there were no petechiae, purpura, or ecchymoses. On the abdomen region, there was minimal bleeding in an umbilical area with periumbilical hemorrhagic crusting. Intense palpation revealed mild tenderness near the periumbilical area. When the umbilical area was palpated deeply, a thin, watery blood fluid oozed out. The results of routine blood laboratory examinations showed within normal limits (Hb 12 g/dL, leukocytes 6.9x103/μL, and platelets 150x10³/μL). This patient was diagnosed with bleeding due to vitamin K deficiency. The management given is in the form of a subcutaneous injection of vitamin K 10 mg for 3 days. After administration of the third injection, the patient's condition improves, and the umbilical hemorrhage subsides.

Symptomatic reponible umbilical hernia in the rabbit

A case of umbilical hernia in a 7-month-old female rabbit was presented to the Surgery Clinic of the Veterinary Faculty, University of Sarajevo. The owner noticed inappetence and lethargy four days before arrival at the clinic. Clinical parameters on physical examination were within the physiological range. Bruxism and lethargy were noted as signs of discomfort due to gas accumulation in colon. A reponible, nonpainful mass in the umbilical scar area was palpated but intestinal peristalsis was not altered. General anesthesia was induced by intramuscular administration of ketamine with medetomidine and maintained with isoflurane. Surgical treatment of hernia included the peritoneal sac dissection and amputation, repositioning of small intestines, and correction of abdominal wall defect. Intraoperative multimodal analgesia approach was used to reduce inhalant anesthesia requirements and to prevent pain-related and stress-related complications. In this case report we described a surgical and veterinary treatment of the reponible umbilical hernia in a rabbit.

Fusceulimoides kohtsukai gen. et sp. nov., a Minute Eulimid Gastropod Parasitic on the Little Brittle Star Ophiactis savignyi in Central Japan.

Gastropods of over a dozen genera in the family Eulimidae have been identified as parasites of brittle stars, and many more remain to be discovered and described for a comprehensive understanding of the evolutionary history of their host-parasite relationships. In this study, we describe Fusceulimoides kohtsukai gen. et sp. nov., parasitic on the little brittle star, Ophiactis savignyi (Ophiactidae), in Kanagawa, central Japan. The new genus is distinguished from other eulimid genera by the combination of following seven conchological characters: (1) a very small size of up to 1.7 mm high, (2) a colorless translucent appearance, (3) a conical pupiform shape with a paucispiral protoconch, (4) slightly convex teleoconch whorls, (5) a remarkably large body whorl occupying 65-70% of the total shell height, (6) a broad, somewhat squarish and laterally expanded aperture with a strongly curved outer lip, and (7) a developed parietal callus without an indentation or depression in the umbilical area. A multi-locus molecular phylogeny revealed its distant relationship to Hemiliostraca + Pyramidelloides, a previously known clade of ophiuroid parasites, thereby suggesting multiple origins of this host-parasite association in Eulimidae.

Upper gastrointestinal duplication complicated by perforation in a child

Gastrointestinal duplications are rare congenital malformations occurring in embryonic period of development of digestive system. These abnormalities are usually found in infancy or early childhood. Clinical presentation is extremely diverse depending on dimensions, localization and type of duplication. The authors present duplication of antral and pyloric parts of the stomach, the 1st segment of the duodenum and pancreatic tail. Mother with a 6-month-old child turned to the hospital. According to the mother, the child was sick for about 3 days when episodes of periodic anxiety first appeared. Upon admission, abdominal neoplasm was suspected after ultrasound. On the second day after admission, anxiety increased. There was impairment of appetite, and the child rejected food. Abdominal asymmetry in umbilical area was observed. Considering clinical data on intestinal obstruction, emergency transverse right-sided laparotomy was performed. A tubular structure was found resembling intestinal tube was found between the stomach and transverse colon. Surgeon found duplication of antral and pyloric parts of the stomach, the 1st segment of the duodenum and its perforation. During further revision, additional pancreatic tail was diagnosed. En-bloc resection of gastrointestinal duplications was carried out. Postoperative period was uneventful. Enteral feeding was initiated after 5 days, and the patient was transferred to surgical unit. The child was discharged after 12 postoperative days.

Fetal and placental development in early gestation of hyper-prolific sows

Modern hyper-prolific sows produce large litters with a high within-litter variation in birth weight and an increased number of low-birth-weight piglets per litter with higher mortality rates and lower growth rates compared to heavier littermates. This study aimed to describe fetal development in hyper-prolific sows, to characterize differences between large and small fetuses, and to determine when within-litter variation in fetal weight can be detected. Forty-seven multiparous sows were blood-sampled and slaughtered at day 28, 33, 45, 50, and 56 of gestation. Number of fetuses were counted, fetal body and organ weights were measured, and the intrauterine positioning was recorded. Length, width, and area of each placenta was measured and the fetus weight/placental weight ratio was calculated. The umbilical cords of the smallest, medium and the largest fetus of each litter were sampled for histological analysis. In total measurements were obtained for 1161 fetuses. The results revealed no difference in fetal survival between the gestational days (P > 0.05). Intrauterine positioning near the cervix significantly reduced fetal weight at day 56 (P < 0.05). Total litter weight and average fetal weight increased with gestational age and individual fetal weight was negatively affected by litter size from day 33 and onwards (P < 0.05). The coefficient of variation for within-litter variation in fetal weight was higher at day 28 compared to the other gestational days (P < 0.05). Relative brain- and heart weights decreased from day 28–56 (P < 0.001). Small fetuses had relatively heavier brains and hearts at day 45, 50 and 56 (P < 0.001). Size of placenta, fetus weight/placental weight ratio and length of umbilical cord increased with gestational age (P < 0.001). There was a positive correlation between size of placenta and weight of individual fetus (P < 0.001), the weight of the fetus was positively correlated with umbilical cord length (P < 0.001) and the umbilical cross-sectional area was correlated to fetal weight at day 56 (P < 0.01). Individual fetal weight was positively correlated to the fetus weight/placental weight ratio (P < 0.001). In conclusion, fetal growth was affected by litter size, placental weight, and -area, and umbilical cord length. Lightweight fetuses were characterized by having placentas with lower weight and area and shorter umbilical cords. Lastly, within-litter variation in fetal weight was detectable at day 28, and the coefficient of variance remained stable from day 33–56.

A Rare Cause of Sister Mary Joseph Nodule

A 67-year-old man with hepatitis B–related cirrhosis received liver transplantation because of hepatic decompensation, and small hepatomas were found in the resected liver. The postoperative course was uneventful, but the α-fetoprotein level rose from 5 ng/mL to 107 ng/mL 1 year after transplantation. Whole body computed tomography scans failed to find any recurrent tumor. The α-fetoprotein level continued to increase, and was 413.2 ng/mL 18 months after transplantation. An abdominal computed tomography revealed an enhancing lesion over the umbilical area (Figure A, arrow). An abdominal ultrasound revealed a hypoechoic tumor in the subcutaneous area with increased blood flow (Figure B, arrow). Ultrasound-guided biopsy revealed atypical oval to epithelioid-shaped tumor cells with high N/C ratio, eosinophilic cytoplasm, and hyperchromatic nuclei (Figure C). Immunohistochemical studies demonstrated that the tumor cells were glypican-3(+), Hep-par-1(+), CK19(-), and CK7(-). A diagnosis of umbilical metastatic hepatocellular carcinoma was made (Figure D). He received surgical resection followed by sorafenib therapy. He had no evidence of recurrence in the following 6 months.

Umbilical Cord Biometry and Fetal Abdominal Skinfold Assessment as Potential Biomarkers for Fetal Macrosomia in a Gestational Diabetes Romanian Cohort.

Backgroundand Objectives: Gestational diabetes mellitus (GDM) is a pregnancy-associated pathology commonly resulting in macrosomic fetuses, a known culprit of obstetric complications. We aimed to evaluate the potential of umbilical cord biometry and fetal abdominal skinfold assessment as screening tools for fetal macrosomia in gestational diabetes mellitus pregnant women. Materials and methods: This was a prospective case–control study conducted on pregnant patients presenting at 24–28 weeks of gestation in a tertiary-level maternity hospital in Northern Romania. Fetal biometry, fetal weight estimation, umbilical cord area and circumference, areas of the umbilical vein and arteries, Wharton jelly (WJ) area and abdominal fold thickness measurements were performed. Results: A total of 51 patients were enrolled in the study, 26 patients in the GDM group and 25 patients in the non-GDM group. There was no evidence in favor of umbilical cord area and WJ amount assessments as predictors of fetal macrosomia (p > 0.05). However, there was a statistically significant difference in the abdominal skinfold measurement during the second trimester between macrosomic and normal-weight newborns in the GDM patient group (p = 0.016). The second-trimester abdominal circumference was statistically significantly correlated with fetal macrosomia at term in the GDM patient group with a p value of 0.003, as well as when considering the global prevalence of macrosomia in the studied populations, 0.001, when considering both populations. Conclusions: The measurements of cord and WJ could not be established as predictors of fetal macrosomia in our study populations, nor differentiate between pregnancies with and without GDM. Abdominal skinfold measurement and abdominal circumference measured during the second trimester may be important markers of fetal metabolic status in pregnancies complicated by GDM.

The first international Delphi consensus statement on Laparoscopic Gastrointestinal surgery

BackgroundLaparoscopic surgery has almost replaced open surgery in many areas of Gastro-Intestinal (GI) surgery. There is currently no published expert consensus statement on the principles of laparoscopic GI surgery. This may have affected the training of new surgeons. This exercise aimed to achieve an expert consensus on important principles of laparoscopic GI surgery. MethodsA committee of 38 international experts in laparoscopic GI surgery proposed and voted on 149 statements in two rounds following a strict modified Delphi protocol. ResultsA consensus was achieved on 133 statements after two rounds of voting. All experts agreed on tailoring the first port site to the patient, whereas 84.2% advised avoiding the umbilical area for pneumoperitoneum in patients who had a prior midline laparotomy. Moreover, 86.8% agreed on closing all 15 mm ports irrespective of the patient's body mass index.There was a 100% consensus on using cartridges of appropriate height for stapling, checking the doughnuts after using circular staplers, and keeping the vibrating blade of the ultrasonic energy device in view and away from vascular structures.An 84.2% advised avoiding drain insertion through a ≥10 mm port site as it increases the risk of port-site hernia. There was 94.7% consensus on adding laparoscopic retrieval bags to the operating count and ensuring any surgical specimen left inside for later removal is added to the operating count. ConclusionThirty-eight experts achieved a consensus on 133 statements concerning various aspects of laparoscopic GI Surgery. Increased awareness of these could facilitate training and improve patient outcomes.

Isolation and Identification of Salmonella typhimurium in an Umbilical Area from Chicks in Kerbala City

One hundred samples ofumbilicus were taken from chicks .Out of these, 27 (27%) were positive.The most common of bacterial isolates were Salmonella typhimurium. The biochemical tests for allisolates, whether from chicks, showed a positive test to check the production of hydrogen sulfide gas,the fermentation of glucose sugar, the use of citrate as a source of carbon, non-lactose fermentedandnegative for urease enzyme, the result found the most common infection in the cold weather February, they were found nine isolates (33.33%) more than other groups as 29.63%, 14.82 %and 11.11%,for January , November , December and October , respectively. The resultswere found a total of 27isolates were Salmonella spp., on the other hand 11 isolates wereidentified as Salmonella typhimurium(40.74%) by Vitek 2 compact system, , All Salmonella spp. showed high susceptibility againstNitrofurantoin, 27 (100%) and ciprofloxacin24 (88.8%), whereas they were highly resistance againstAmoxicillinCefotaxime, and Vancomycin 24 (88.8% ).. Chicks with umbilical area were found toharbor different pathogens and they are considered a source of infection during successive days in thelife of broilers chickens.

Sonographic evaluation of umbilical cord thickness in monochorionic diamniotic twin pregnancies.

To develop a nomogram of the thickness of the umbilical cord (UC) and its components in monochorionic diamniotic (MCDA) twin pregnancies. This prospective longitudinal study involved 47 MCDA twin pregnancies (94 fetuses) between 18 and 33weeks of gestation. Ultrasound assessments of UC cross-sections and measurements of the umbilical cord area (UCA), the umbilical vein area (UVA), the umbilical artery area (UAA), and the Wharton jelly area (WJA) were made. The UC measurements were correlated with gestational ages. Reference values for the gestational ages of MCDA pregnancies were determined and compared with those of dichorionic twins and singletons. The cases which developed selective intrauterine growth restriction were contrasted with normal cases. A positive correlation was found between all UC components and gestational age and fetal weight. The UCA of MCDA fetuses was significantly larger than that of DC fetuses (p<0.001) at the expense of a larger WJA (p<0.001) and similar to that of singleton pregnancies. The MCDA fetuses with an estimated fetal weight below the 10th percentile had a smaller UCA than fetuses with a normal estimated weight (p<0.001). The MCDA twins exhibited a thicker UC than that of dichorionic twins.