Ventral Wall Research Articles

V08-08 ROBOTIC EXTRAPERITONEAL EXTRAVESICAL PROSTATE ADENOMECTOMY WITH RUNNING SUTURE OF THE BLADDER NECK ONTO THE INTRAPROSTATIC URETHRA

You have accessJournal of UrologyBPH & Bladder Outlet Obstruction (V08)1 Apr 2020V08-08 ROBOTIC EXTRAPERITONEAL EXTRAVESICAL PROSTATE ADENOMECTOMY WITH RUNNING SUTURE OF THE BLADDER NECK ONTO THE INTRAPROSTATIC URETHRA Mustafa Tutal*, Christian Padevit, Beat Foerster, Anja Sauck, Christoph Schregel, Kevin Horton, and Hubert John Mustafa Tutal*Mustafa Tutal* More articles by this author , Christian PadevitChristian Padevit More articles by this author , Beat FoersterBeat Foerster More articles by this author , Anja SauckAnja Sauck More articles by this author , Christoph SchregelChristoph Schregel More articles by this author , Kevin HortonKevin Horton More articles by this author , and Hubert JohnHubert John More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000909.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Robotic prostate adenomectomy was first reported by Sotelo et al. in transperitoneal and by John et al. in extraperitoneal approach. Meanwhile simple robotic prostatectomies have been modified with transperitoneal or extraperitoneal access using transvesical or extravesical enucleation techniques. We demonstrate our routinely preferred technique with extraperitoneal approach, extravesical prostate adenomectomy and bladder neck reconstruction by running suture of the bladder neck with the intraprostatic urethra. METHODS: Standardized extraperitoneal access is performed with balloon dilatation and placement of a 4-arm daVinci Xi® System under visual control of the instrument tips. The Santorini Plexus is ligated with 3-0 Monocryl to prevent back flow bleeding. The bladder neck is prepared and dissected around the indwelling catheter. Depending on the position of the ureteral orifices, ureteral stents are placed to exclude postoperative ureteral obstruction. The enucleation of the prostate gland is performed with blunt dissection and visually controlled bipolar coagulation of penetrating vessels from the prostate capsule. Preliminary dorsal fixation of the bladder neck to the posterior prostate capsule is performed with 4-0 Stratafix® barbed suture to prevent further tension and additionally minimize capsular bleeding. Thereafter, the urethral tract is reconstructed by direct continuous double armed suture 4-0 Stratafix® according to van Velthoven of the bladder neck with the intraprostatic urethral stump - thereby excluding the prostatic fossa totally. If necessary longitudinal running suture of the ventral bladder neck closes the urinary bladder and patency is tested. The prostate capsule is adapted onto the ventral bladder wall. A suprapubic catheter is placed, the specimen removed and a drain placed between the anterior bladder wall and prostate capsule according to surgeon preference. RESULTS: No irrigation is needed, the indwelling catheter is removed after 24h-48h and the patient discharged after 2-3 days. Cystography excludes urinary leak after 5 days. CONCLUSIONS: This extraperitoneal extravesical robotic adenomectomy provides a minimal invasive procedure in large BPH, thus avoiding significant blood loss, postoperative bleeding, infections and urgencies associated with the enucleated fossa, bladder neck stenosis and urethral injury. The demonstrated operative technique has become our standard after development of our Millin program over 10 years and more than 60 cases. Source of Funding: None © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e737-e737 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Mustafa Tutal* More articles by this author Christian Padevit More articles by this author Beat Foerster More articles by this author Anja Sauck More articles by this author Christoph Schregel More articles by this author Kevin Horton More articles by this author Hubert John More articles by this author Expand All Advertisement PDF downloadLoading ...

SPARC: Distinct Patterns of Leptin Secretion Elicited by Electrical Stimulation of Different Stomach Regions in Fasted Anesthetized Rats

BACKGROUNDThe discovery that the stomach secretes the hormone leptin, plus the finding that vagal afferents express receptors for leptin, in addition to the recognized role of adipocytes in the secretion of the adipokine, have initiated extensive investigations into leptin’s possible roles in the control of feeding. The gastric secretion of leptin and its binding sites on vagal afferents suggest the possibility that gastric electrical stimulation (GES) might produce leptin secretion and modulate visceral sensory information arising from the stomach and relayed to the brain. Such a pathway might have therapeutic potential for treating GI disorders (gastroparesis, eating disorders, etc.).AIMSTo explore or map defined gastric regional patterns of leptin release, secretion of the hormone to GES at different sites was measured in terms of both amplitude and time course.METHODSIn fasted (18 hrs.), anesthetized (Isoflurane) SD rats (n = 49), patch electrodes were sutured on ventral stomach wall, a strain gauge was attached to duodenum, and a catheter was inserted into left femoral artery. Stimulation (biphasic, 0.3mA, 0.2ms, 10Hz, 20s‐on‐40s‐off; 5 cycles) was applied from 0 to 5 min. The gastric antrum, corpus and forestomach were each divided into three regions corresponding to the distance between the lower esophageal sphincter (LES) and the greater curvature (GC); each of the three gastric compartments (verified post mortem) was stimulated near the LES, at a mid‐point, and near the GC. Multiple blood samples (0.15ml/each) were collected to measure leptin concentrations.RESULTSStimulation of much of the antrum (mid‐and near‐GC antral regions) evoked fast, robust and long‐lasting leptin secretion. Stimulation of the corpus in a more limited area (mid‐corpus) produced moderate, long‐lasting leptin secretion. Stimulation of a limited forestomach area (mid‐forestomach) yielded a mild, short‐interval leptin secretion. For the effective loci, leptin secretion amplitude changes in post‐stim time points of 5, 15, and 30 min, respectively, compared to control values, were: Mid‐antrum: +58%, +70%, +48%; Near‐GC antrum: +43%, +70%, +33%; Mid‐corpus: +25%. +38%, +38%; and Mid‐forestomach: +38%, +22%, +8%.DISCUSSIONGastric leptin is secreted by both exocrine and endocrine pathways. Antrum sensitivity to stimulation may reflect higher density of leptin‐secretory epithelium, corpus may have moderate density leptin‐related epithelium. Without leptin‐related epithelium in forestomach, leptin release may be caused indirectly.CONCLUSIONOur findings reveal that GES in different stomach regions can produce strikingly different leptin secretion patterns. Selectively modulating leptin secretion with GES applied to different stomach regions could be used as a neuromodulation strategy to treat GI disorders such as gastroparesis, obesity, and various eating disorders.Support or Funding InformationFUNDING: SPARC/NIH OT2 OD023847NIDDK/NIH R01 DK027627

Application value of preoperative high-resolution magnetic resonance vessel wall imaging evaluation on symptomatic middle cerebral artery stenosis stenting

Objective To investigate the value of preoperative high-resolution magnetic resonance vessel wall imaging (HRMR-VWI) in stenosis stenting for symptomatic middle cerebral artery. Methods The clinical data of 35 patients with atherosclerotic stenosis in middle cerebral artery (MCA) M1 segment who were treated with stenting therapy (stenting angioplasty) at Department of Neurosurgery, Tianjin Huanhu Hospital from August 2011 to May 2019 were analyzed retrospectively. HRMR-VWI results were used to evaluate the location, composition and stability of plaques before operation. The mortality and morbidity at 30 days post operation were determined by clinical follow-up. The ischemic stroke and restenosis rates at 12 months post operation were confirmed by imaging follow-up. Results The preoperative HRMR-VWI of 35 patients showed that the plaques in 15 cases were located on the ventral vessel wall, those in 12 on the inferior, and those in 8 on the upper vessel wall. Seven patients had unstable plaques in the M1 segment of MCA. The stents were successfully placed in 35 patients and well adhered with smooth blood flow. Technical complications occurred in 2 (5.7%) patients. One patient (2.8%) died of cerebral hernia due to reperfusion hemorrhage in 30 days after surgery, although decompressive craniectomy and hematoma clearing were performed. One patient (2.8%) had residual neurological dysfunction. Twelve months after the operation, no ischemic stroke occurred in 34 patients, and no restenosis occurred in the 5 patients who were followed up by imaging. Conclusion HRMR-VWI has a high diagnostic value for the location and stability of plaques in stenotic sites of MCA, which could improve the safety and effectiveness of stenting of MCA M1 segment stenosis. Key words: Middle cerebral artery; Endovascular procedures; Stents; Atherosclerotic stenosis; High resolution magnetic resonance vessel wall imaging

Function of Arl4aa in the Initiation of Hematopoiesis in Zebrafish byMaintaining Golgi Complex Integrity in Hemogenic Endothelium.

SummaryADP-ribosylation factor-like 4aa (Arl4aa) is a member of the ADP-ribosylation factor family. It is expressed in hematopoietic tissue during embryonic development, but its function was unknown. Zebrafish arl4aa is preferentially expressed in the ventral wall of the dorsal aorta (VDA) at 24 and 36 hpf and in caudal hematopoietic tissue at 48 hpf. Morpholino knockdown and transcription activator-like effector nuclease (TALEN) knockout of arl4aa significantly reduced expression of genes associated with definitive hematopoietic stem cells (HSCs). Golgi complex integrity in VDA was disrupted as shown by transmission electron microscopy and immunostaining of Golgi membrane Giantin. Mechanistically, arl4aa knockdown reduced Notch signaling in the VDA and its target gene expression. Protein expression of NICD was also reduced. Effects of arl4aa knockdown on definitive hematopoiesis could be restored by NICD expression. This study identified arl4aa as a factor regulating initiation of definitive HSCs by maintaining the integrity of Golgi complex and, secondarily, maturation of the Notch receptor.

Comparison of abdominal binder use versus no abdominal binder use after ventral abdominal wall hernia repair . A randomized controlled trial

Background: Hernia repair is most common surgical procedure in a surgical setting.Ventral hernias are defined as non-inguinal, no hiatal defect in abdominal wall fascia.Abdominal binders are usually recommended in routine after repair of ventral hernias.Abdominal binder is a belt which is wide enough to surrounds the abdominal region and supports the wound. Findings reported in previous studies are better with binders.
 Objective: To compare the outcome of binder use versus no abdominal binder use after ventral abdominal wall hernia repair
 Material & methods: This Randomized Controlled Trial was done at Department of Surgery, Central Park Teaching Hospital Lahore for 6 months. Sixty patients were included and underwent ventral hernia repair under general anesthesia. Then patients were randomly divided in two groups. Group A for Abdominal Binder and Group B for without Abdominal Binder by using lottery method. During 6 weeks, patients were followed-up in OPD fortnightly. Patient were evaluated for pain, Pulmonary Function Assessment on spirometer, Physical Function Assessment by 6 minutes’ walk test, Seroma formation assessment, wound infection, wound dehiscence and patients satisfaction.Data was analyzed in SPSS version 20.
 Results: In this study, the mean age of patients was 42.36±8.52years in binder group while 45.11±10.22years in non-binder group. There were 12 males and 18 females in binder group while 16 males and 14 females in non-binder group. At the end of study, the mean pain score was 0.0±0.0 in binder group while 0.7±0.1 in non-binder group (p<0.05), the mean FEV1 was 90.21±6.39 in binder group while 89.91±12.30 in non-binder group (p>0.05) and the mean 6MWT was 559.49±52.10m in binder group while 514.79±42.39m in non-binder group (p<0.05). Seroma formation occur in 2 (6.7%) cases in binder group while in 8 (26.7%) in non-binder group (p<0.05). Wound infection occurred in 1 (3.3%) in binder group while in 6 (20%) cases of non-binder group (p<0.05) While wound dehiscence was not observed in any case in binder group (0%) but in 2 (6.7%) cases in non-binder group (p>0.05).
 Conclusion: Thus results of this study showed that abdominal binder can help to improve the physical condition as well as can well manage wound.

Cloacal exstrophy misdiagnosed as bladder exstrophy

Abstract Cloacal exstrophy (CE) is the most serious and complex congenital ventral abdominal wall defect. It has also been reported as one of the rarest congenital anomalies. A 9-month-old boy suffering from bladder exstrophy due to the presence of a lower anterior abdomen wall defect that drains urine was referred to a paediatric surgery outpatient clinic. Magnetic resonance imaging (MRI) revealed a small urinary bladder connected to the rectum, and there is a fistula connected from the urinary bladder to the anterior abdominal wall, which was previously misinterpreted as a ureteral orifice in the abdominal wall. CE presented a wide range of pictures that varied from case to case. We reported the case referred to our hospital as a misdiagnosis of bladder exstrophy.

A magnetic resonance imaging study of local anesthetic spread in patients receiving an erector spinae plane block.

Despite the popularity of the erector spinae plane (ESP) block, both the mechanism of the block and the extent of injectate spread is unclear. This study used magnetic resonance imaging (MRI) to evaluate the spread of local anesthetic injectate following ESP blocks in six patients with pain. Six patients received a left-sided ultrasound-guided ESP block at the T10 level. The injectate contained 29.7 mL of 0.25% bupivacaine and 0.3 mL of gadolinium in the first patient, with an additional 5 mL (50 mg) of triamcinolone in the subsequent five patients. Sensory block to pinprick and cold as well as pain score (with 0 indicating no pain and 10 being maximum pain) were assessed 20 and 30 min respectively following the ESP block. MRI was performed one hour after the block. The injectate spread into the intercostal space and neural foramina in all six patients, but the extent of cephalocaudal spread was variable, with a median [interquartile range] spread of 9 [5-11] and 3 [2-6] levels for the intercostal space and neural foramina, respectively. The injectate also spread extensively within the erector spinae muscles. Spread to the epidural space was seen in two patients. Sensory block was achieved in both ventral and dorsal dermatomes in all patients, though the extent was variable. Our study showed that the ESP block injectate consistently spread to the erector spinae muscles, neural foramina, and intercostal space. It was associated with sensory changes and pain relief in the dorsal and ventral thoracic and abdominal walls. Nevertheless, the extent of spread to the neural foramina and intercostal space, and the sensory block itself, was highly variable.

Prune belly syndrome in surviving males can be caused by Hemizygous missense mutations in the X-linked Filamin A gene

BackgroundPrune belly syndrome (PBS) is a rare, multi-system congenital myopathy primarily affecting males that is poorly described genetically. Phenotypically, its morbidity spans from mild to lethal, however, all isolated PBS cases manifest three cardinal pathological features: 1) wrinkled flaccid ventral abdominal wall with skeletal muscle deficiency, 2) urinary tract dilation with poorly contractile smooth muscle, and 3) intra-abdominal undescended testes. Despite evidence for a genetic basis, previously reported PBS autosomal candidate genes only account for one consanguineous family and single cases.MethodsWe performed whole exome sequencing (WES) of two maternal adult half-brothers with syndromic PBS (PBS + Otopalatodigital spectrum disorder [OPDSD]) and two unrelated sporadic individuals with isolated PBS and further functionally validated the identified mutations.ResultsWe identified three unreported hemizygous missense point mutations in the X-chromosome gene Filamin A (FLNA) (c.4952 C > T (p.A1448V), c.6727C > T (p.C2160R), c.5966 G > A (p.G2236E)) in two related cases and two unrelated sporadic individuals. Two of the three PBS mutations map to the highly regulatory, stretch-sensing Ig19–21 region of FLNA and enhance binding to intracellular tails of the transmembrane receptor β-integrin 1 (ITGβ1).ConclusionsFLNA is a regulatory actin-crosslinking protein that functions in smooth muscle cells as a mechanosensing molecular scaffold, transmitting force signals from the actin-myosin motor units and cytoskeleton via binding partners to the extracellular matrix. This is the first evidence for an X-linked cause of PBS in multiple unrelated individuals and expands the phenotypic spectrum associated with FLNA in males surviving even into adulthood.

Relationship between rectal abdominis muscle position and physiological umbilical herniation and return: A morphological and morphometric study.

The herniation of the intestinal loop (IL) in the extraembryonic coelom and its return to abdominal cavity is in parallel with the formation of the rectal abdominis muscle (RAM). Using high-resolution magnetic resonance imaging data of human fetuses (n = 19, CRL22-69 mm; stored at Kyoto Collection), this study aimed to analyze the relationship between the development of RAM and phase of IL herniation. The RAM runs at the lateral part of the abdominal wall in the small samples in the herniation phase. The position was shifted to the midline area in the larger samples in the herniation phase. According to fetal growth, the caudal ends of the muscles extended along the umbilical ring towards the pubis, though the caudal part of the RAMs were thin and faint in most of the samples. Length measurements related with the growth of the abdominal wall including RAM and abdominal circumference showed positive correlation with fetal growth. On the contrary, diastasis of RAMs and the width and area of the umbilical ring were almost constant according to fetal growth. Such morphometric value showed no obvious changes regardless of the phases of herniation. The ratio of the width and diastasis of the RAMs to the circumference was decreased, indicating that the closure of the ventral body wall was influenced by growth differences. The present data indicate that the formation of the abdominal wall including RAM is independent of the phase of IL herniation, whether in the extraembryonic coelom or in the abdominal cavity.

Correlation Between Peritonitis and Incisional Infections in Horses

Surgical site infection of abdominal incisions is an important complication after laparotomy with increased risk of incisional hernia formation in horses. This study aims to evaluate the healing process of abdominal incisions and correlate peritonitis with the occurrence of surgical site infection and incisional hernias. Nine horses underwent standardized laparotomy, intestinal exploration, and induced septic peritonitis. Standardized relaparotomy was performed two (n = 3), four (n = 3), and six (n = 3) months later to evaluate the abdominal cavity for adhesions and to collect the sutured ventral abdominal wall to evaluate and prepare it for histopathological and tensile strength study. All horses presented with endotoxemia, controllable peritonitis, heat and touch-sensitive ventral abdominal edema and surgical wound infection with presence of purulent discharge. Adhesion of the cecum or colon to the internal portion of the surgical wound was observed. Healing of the infected surgical wounds occurred by second intention and a space between the rectus abdominis muscles developed because of the presence of a scar, which was related to incisional hernia. In the histopathological evaluation, the collagen content increased, and the inflammation decreased over time. The tensile strength increased over time and was highest after 6 months. After the second surgical intervention, there was no infection of the surgical wound in any of the animals and healing by first intention occurred. Surgical site infection may be a symptom of peritonitis in horses recovering from abdominal surgery. Infected surgical wounds heal by second intention, which favors the spacing of rectus abdominis muscle and the formation of incisional hernia.

Origin and role of the cerebrospinal fluid bidirectional flow in the central canal.

Circulation of the cerebrospinal fluid (CSF) contributes to body axis formation and brain development. Here, we investigated the unexplained origins of the CSF flow bidirectionality in the central canal of the spinal cord of 30 hpf zebrafish embryos and its impact on development. Experiments combined with modeling and simulations demonstrate that the CSF flow is generated locally by caudally-polarized motile cilia along the ventral wall of the central canal. The closed geometry of the canal imposes the average flow rate to be null, explaining the reported bidirectionality. We also demonstrate that at this early stage, motile cilia ensure the proper formation of the central canal. Furthermore, we demonstrate that the bidirectional flow accelerates the transport of particles in the CSF via a coupled convective-diffusive transport process. Our study demonstrates that cilia activity combined with muscle contractions sustain the long-range transport of extracellular lipidic particles, enabling embryonic growth.

The Fgf8 subfamily (Fgf8, Fgf17 and Fgf18) is required for closure of the embryonic ventral body wall.

ABSTRACTThe closure of the embryonic ventral body wall in amniotes is an important morphogenetic event and is essential for life. Defects in human ventral wall closure are a major class of birth defect and a significant health burden. Despite this, very little is understood about how the ventral body wall is formed. Here, we show that fibroblast growth factor (FGF) ligands FGF8, FGF17 and FGF18 are essential for this process. Conditional mouse mutants for these genes display subtle migratory defects in the abdominal muscles of the ventral body wall and an enlarged umbilical ring, through which the internal organs are extruded. By refining where and when these genes are required using different Cre lines, we show that Fgf8 and Fgf17 are required in the presomitic mesoderm, whereas Fgf18 is required in the somites. This study identifies complex and multifactorial origins of ventral wall defects and has important implications for understanding their origins during embryonic development.

Fetal Autopsy Showing Two Ventral Body Wall Defects: An Unusual Presentation

Thoracoschisis and gastroschisis are types of ventral body wall defects. Usually thoracoabdominoschisis presents as a continuous defect. Here the authors present the case of autopsy of 18 weeks old fetus with two well-separated ventral body wall defects. Thoracoschisis was a right lateral thoracic wall defect while gastroschisis, a midline infraumblical abdominal wall defect. Through the right lateral thoracic wall parts of two organs appeared to be protruding. On dissection, 8th and 9th ribs with the liver and the lower lobe of the right lung were herniating outside the body. The right lung was haemorrhagic. Various embryological theories on ventral body wall defects have been discussed in view of the present case.

Utility of CT in the diagnosis of an incarcerated Spigelian hernia without palpable abdominal mass

Introduction: Spigelian hernia is a rare type of ventral abdominal wall hernia. We report the case of an incarcerated Spigelian hernia without palpable abdominal mass diagnosed by computed tomography (CT) scan. Case Report: We report a case of a 63-year-old obese male patient with no particular pathological or surgical history received for bowel obstruction. The abdominal CT concluded to an incarcerated Spigelian hernia whereas this diagnosis was not considered at the clinical examination in the absence of visible or palpable mass on the anterolateral abdominal wall. Conclusion: This case report illustrates the key place of CT scan in this form of clinical presentation of Spigelian hernia.

Topographical and biometrical anatomy of duodenum in prenatal goats

To record the morphogenesis of different segments of duodenum, a study was conducted on the duodenum of formalin fixed 36 non-descript goat embryos/foeti. Embryos/foeti were equally divided into 3 groups as Gr-I (early prenatal period), aged between 23 to 50 days of gestation, Gr-II (mid prenatal period) between 51 to 100 days of gestation and Gr-III (late prenatal period) between 101 days to till kidding. The morphological observations were recorded after performing dissection through ventral abdominal wall. The duodenum was first time demarcated from other segments of small intestine at 43 days of gestation. At 45 days of gestation, the duodenum was devisable into three segments (cranial, descending and ascending). A constriction was observed first time between pyloric part of stomach and duodenum at 51 days of gestation. A distinct ‘S’ shaped curve (ansa sigmoidea) was observed at 51 days of gestation. A fold of peritoneum between descending and ascending part of duodenum was discernible at 92 days of gestation and related with ventral surface of right kidney at 97 days of gestation. The luminal surface of duodenum showed presence of villi at 75 days of gestation and longitudinal folds at 150 days of gestation. The mean length and diameter of the different segments of duodenum were significantly correlated with age of foeti.

Post-operative pain after laparoscopic ventral hernia repair, the impact of mesh soakage with bupivacaine solution versus normal saline solution: A randomised controlled trial (HAPPIEST Trial).

Background and Aims:Early postoperative pain after laparoscopic ventral hernia repair remains a concern for patients. Local application of anaesthetic agent in the surgical dissection area can potentially overcome this problem. The objective of this study was to evaluate the impact of soaking mesh in 0.5% bupivacaine solution as compared to normal saline solution on the post-operative pain.Methodology:We conducted a parallel-design double-blind randomised controlled trial. Adult patients with uncomplicated ventral abdominal wall hernias were included in the trial. Mesh was soaked in 0.5% solution of bupivacaine before application in patients in the intervention arm, whereas it was soaked in normal saline solution for patients in the control arm. Post-operative pain was assessed by trained staff at 6 h and 24 h from surgery. It was graded on visual analogue scale (VAS) from 0 to 10.Results:Trial was conducted from 16 November, 2015, to 15 September, 2017. During the study period, a total of 114 patients were randomised. Nine patients were excluded after randomisation. A total of 55 patients were analysed in the intervention arm and 50 patients were analysed in the control arm. Mean pain score at VAS at 6 h after laparoscopic ventral hernia repair in the intervention arm was 5.05 ± 1.2, whereas in the control arm, it was 5.54 ± 1.1 and the difference was statistically significant (P = 0.03-independent sample t-test). Mean pain score at VAS at 24 h after laparoscopic ventral hernia repair in the intervention arm was 3.16 ± 1.2, whereas in the control arm, it was 3.58 ± 1.4 and the difference was not statistically significant (P = 0.11-independent sample t-test).Conclusion:Soakage of mesh in 0.5% bupivacaine solution before application in laparoscopic ventral hernia repair significantly reduces early post-operative pain.Trial Registration: Trial was registered with clinicaltrials. gov (NCT03035617)URL: https://clinicaltrials. gov

The Pentalogy of Cantrell: A Case Report

Pentalogy of Cantrell (PC) is a rare anomaly marked by the coexistence of omphalocele and ectopia cordis. Pentalogy of Cantrell comprises of the following five characteristics: midline, upper abdominal wall disorder (e.g. omphalocele, gastroschisis); defect of lower sternum (i.e. cleft sternum or absent sternum); anterior diaphragmatic defect (i.e. hypoplastic diaphragm, anterior diaphragmatic hernia); pericardial abnormality (e.g. ectopia cordis); congenital abnormalities of the heart (e.g. tetralogy of Fallot, ventricular septal defect, atrial septal defect). Toyama classified this syndrome into: class I – the occurrence of all 5 defects; class – II the occurrence of 4 defects with intracardiac and ventral abdominal wall abnormalities definitely present; class III – an incomplete expression of the disorders showing various combinations of defects, although sternal anomalies are definitely present. The incidence is estimated 5.5 – 7.9 per 1 million live births with male predominance. PC can be diagnosed since antenatal through ultrasonography examination. Unfortunately, the mortality rate is quite high with minimal survival rate even with surgical reconstruction. We present a case of one-day old infant whom was referred from West Nusa Tenggara with suspicion of PC syndrome and neonatal pneumonia. The baby was born through cesarean section with mild asphyxia, birth weight was 3000 gram and body length was 48 cm. There was no family and pregnancy risk factor. The multidisciplinary team consist of neonatologist, pediatric cardiologist and pediatric surgeon was teamed up to handle this case. There were some abnormalities in complete blood counts such as decreasing number of lymphocyte and neutrophil percentage and also increasing basophil percentage. Chest and abdominal X-ray showed a suspicion of pneumonia but this didn’t align with our physical examination. Echocardiography showed the infant had congenital heart defects such as Taussig Bing anomaly, single atrium, mild valvular pulmonary stenosis, mild tricuspid regurgitation and mesocardia. Genetic testing and further radiologic examination other than plain X-ray were not done in this case. There was no further intervention for this patient other than regular echocardiography and antibiotic topical treatment.

Hypospadias in a Sheltie puppy: A case report

Hypospadias in dogs is a rare pathology in the veterinary practice. The manifestation of hypospadias in dogs is diverse, since there is a varying degree of damage to the urogenital apparatus. The owners of a Sheltie puppy at the age of 3 days came to the clinic due to the difficulty of determining sex, the presence of inflammation of the anus and abdominal skin, defecation and urination violations. Clinical examination of the puppy showed a blind-closed preputial sac, absence of the ventral wall of the prepuce and an open urogenital urine trough was located in its place in the abdominal wall area. On examination of the puppy at the age of 28 days, hyperaemia and swelling of the anus were noted, as well as prolapse of the rectum. Findings of the examination at the age of 4 months consisted of drying of the mucous part of the open urogenital canal chute and accumulation of pus in the underdeveloped preputial sac. Bilateral cryptorchidism and the absence of the scrotum were also found out. A decision on the surgical treatment was made. The anus and the opening of the urethra were separated to form a urethrostomy in the scrotum and restore the integrity of the anus. On the 5th post operative day, oedema and stricture of the reconstructed urethra resulted in difficulty urinating, followed by the formation of urinary fistula in the perineal region below the anus opening. As a result of the chosen surgical treatment approach, the problem with contact dermatitis of the perineum and pollakiuria was solved.

Radiographic Appearance And Measurements Of Thoracic Structures Using Four Radiographic Projections In Goats

No one can deny the role of radiography in the diagnosis of different affections of the different regions of the animal’s body especially the thoracic cavity and its structures. Therefore, the present study was carried out to compare different radiographic projections on the positional variation, the visibility, and the measurements of different thoracic structures in goats. Moreover, the different angles formed between some of these structures were determined, measured, and their uses were declared. Twelve healthy native-breed goats were assigned for this study. Their ages and weights ranged between 2 4 years and 13 21 kg, respectively. The goats were subjected to a thorax examination using 4 different radiographic projections: right lateral view (RLV), left lateral view (LLV), dorsoventral view (DVV), and ventrodorsal view (VDV). The findings exhibited on both RLV and LLV were compared, and the DVV and VDV were also differentiated. The radiographic examinations included the inspection of the sternum, ribs, thoracic vertebrae, diaphragm, and its crura, and some of the intra-thoracic structures. Cardiac short axis (CSA), cardiac long axis (CLA), vertebral heart score (VHS), and different angles between the different thoracic structures were measured. The results conclusively revealed that there was no significant difference between the RLV and LLV regarding the values of different thoracic structures except for the cranial lobar pulmonary (CLP) arteries and veins, CSA, the ventral wall of caudal vena cava (CVC), and the mean length of CVC. The visibility of the CLP vessels had a more clear presentation on LLV. The RLV clearly identified the CVC, while the LLV enabled a better visualization of the aorta. The measured values obtained from the sternal (DVV) and dorsal (VDV) views were nearly similar, except; the shape of the heart, the heart shifted into left on the VDV and the CVC and aorta were better seen on VDV and DVV, respectively.

Late Devonian antiarch remains (placoderm fish) from the Gilberton Formation, north Queensland

New Devonian fish remains are described from the lower part of the Gilberton Formation of north Queensland, the first identifiable specimens found since the original specimen was described in 1936. They include the first determinable dermal skull bones from this deposit. Some dermal bones of the trunk armour are closely associated, and of similar size with morphology consistent with coming from the same fish, permitting a provisional reconstruction of the ventral wall of trunk armour. The new morphological evidence indicates a form close to the antiarch Remigolepis, and a likely age of late Famennian for the lower fossiliferous strata of the Gilberton Formation.