Persistent Hymen in a Jersey Crossbred Heifer-A Novel Approach with Borescope

Background: Visualizing the internal genital organs in cattle using vaginoscope or endoscope is a costly affair and practically it is not possible to use this instrument in diagnosis of anatomical defects causing infertility under field conditions. An attempt was made to replace the costly instruments with low cost and easily available borescope in the diagnosis of persistent hymen in a Jersey crossbred heifer and the procedure has been reported for the benefit of field veterinarians and theriogenologists.Methods: A Jersey crossbred heifer with normal estrous cycle length and that failed to conceive even after 6 inseminations with fertile semen was presented to the Gynaecological ward. Rectal examination revealed a fluctuating swelling in the vagina. Vaginal examination revealed obstruction in the passage and the vaginal speculum could not be progressed into the vagina. Ultrasonographic examination revealed hypoechoic fluid in the vaginal cavity. A novel approach with borescope revealed a clear view of the membranous obstruction at the level of vagino-vestibular junction. Hence, the case was diagnosed as persistent hymen and hymenotomy was performed. Result: Upon hymenotomy, about two litres of thick, gummy, tenacious reddish brown colored mucus was evacuated from the vagina. The patency was checked and the animal was treated with antibiotics for three days. The animal was inseminated at the subsequent estrus on the 22nd day and pregnancy was confirmed on 45th day. The animal calved normally and delivered a live male calf. Thus, the borescope could be effectively used in the field of animal reproduction as an alternative tool for the diagnosis of developmental defects in the vagina.

Usefulness of high definition sialoendoscope for evaluation of lacrimal drainage system in congenital nasolacrimal duct obstruction

Purpose: Sialoendoscope was used as a dacryoendoscope, high- definition images of the lacrimal drainage system (LDS) were captured and its performance in congenital nasolacrimal duct obstruction (CNLDO) is reported. Methods: Nasal endoscopy was done as the first in all the cases using a 0°, 2.7 mm nasal endoscope (Karl Stroz Tutlingan Germany). This was followed by Dacryoendoscopy (DEN) of the lacrimal drainage system from puncta till the valve of Hasner. DEN was performed under general anaesthesia in 26 children (including 17 primary and 9 failed probing cases). All cases were examined using 0.8 mm sialoendoscope (Karl Storz, Tuttlingen, Germany) with fibreoptic light transmission with a side port for irrigation. Results: We were able to obtain high-definition images of canaliculi, lacrimal sac, sac duct junction, proximal, mid and distal segments of nasolacrimal duct in all the children with CNLDO. In 17 primary cases 16 had distal membranous obstruction and I case had proximal canalicular obstruction. In nine children with history of failed probing, five had membranous obstruction, two had dacryoliths, two had NLD malformation at different levels. An overall success rate of 88.4% was achieved. Conclusion: Sialoendoscope can be used as high-definition dacryoendoscope for diagnostic and therapeutic use in CNLDO. Useful information can be obtained on dacryoendoscopy in complex CNLDO cases.

Endonasal dacryocystorhinostomy in the treatment of acute abscessed dacryocystitis

Aim. Estimation of acute abscessed dacryocystitis endosurgery treatment long term results. Methods. A retrospective analysis of a group including 16 patients with acute dacryocystitis and lacrimal sac abscess in whom endonasal dacryocystorhinostomy was performed as a primary procedure. Mean age was 57 years. All operations were performed under general anesthesia. To remove the mucous membrane of the lateral wall of the nose and the medial wall of the lacrimal sac, we used the Coblator® II radio wave cold plasma ablator (RF8000E) (USA). The bone window was formed using a SONOCA 185 ultrasonic bone dissector from Soring (Germany) with an oscillation frequency of 35 kHz. The operation was completed by bicanalicular intubation with FCI’s Bika silicone system. Results. Mean post-op follow-up period was 6 months. Lacrimal ducts passability was achieved in 13 of 16 patients (81,25 %). Three patients (18,75 %) had recurrent epiphora after surgery and underwent reoperations. In one of them (6,25 %) granuloma formation around the dacryostoma was found and in two (12,5 %) membranous obstruction of the anastomosis occurred. In all the patients pain has ceased within 3 days post-oр. Medial eyelids edema and erythema have gradually ceased in 2 days and completely resolved in 7–10 days. Conclusions. Success rate (81,25 %) in long-term functional results of endonasal dacryocystorhinostomy operations shows high efficacy of our methods of nasolacrimal anastomosis formation in the treatment of patients with acute dacryocystitis and lacrimal sac abscess. Key words: endonasal dacryocystorhinostomy; lacrimal sac abscess; ultrasound bone dissection; cold plasma ablation.

Balloon cavoplasty in membranous obstruction of vena cava

A hepatic venous outflow tract obstruction at any level is considered as Budd Chiari syndrome (BCS). Primary BCS is usually due to a congenital membrane causing the obstruction; referred to as membranous obstruction of vena Cava (MOVC). In the past MOVC was predominantly treated through surgery, percutaneous transluminal balloon angioplasty (PTBA) is an alternative and effective form of treatment. Case scenario of a 32-year-old gentleman presented himself with complaints of hematemesis for one year and hematochezia for three months. Hepatomegaly was noted. An ultrasonogram revealed a dilated IVC, till its hepatic portion, and also the Hepatic Veins. There was a fibrous membrane like structure of about 5 mm thickness that was obstructing the IVC flow. Patient was taken up for venogram for conformation of diagnosis and intervention. 6F NIH catheter was introduced from Femoral vein, an injection into the IVC showed contrast not flowing into right atrium and there was a membranous obstruction for the forward flow. A Brockenbrough’s trans-septal needle with Mullins Sheath was used to puncture the membrane and right atrium was entered. A 22 mm Inouye mitral valvuloplasty balloon (Single Balloon, Toray Medical, Tokyo) was taken and positioned at the membrane and inflated and deflated several times with incremental pressures till the waist of the balloon disappeared. Conclusion membranous obstruction of vena cava (MOVC) is a common cause of primary Budd Chiari syndrome. Percutaneous transluminal angioplasty using Inoue or mansfield balloon with or without stenting is a safe and effective treatment option.

Rare Case of Membranous Obstruction at the Origin of Left Pulmonary Artery: Role of Perioperative Echocardiography to Evaluate the Anatomy of Pulmonary Artery

ABSTRACT Branch pulmonary artery (PA) stenosis may occur as an isolated finding or in conjunction with other cardiac malformations; it may be congenital or acquired postoperatively. Branch PAs need to be assessed individually to determine the adequacy of their size, whether they are confluent or nonconfluent, any stenosis at origin or distally, and severity of stenosis. Certain lesions, such as supravalvar pulmonary stenosis, or stenosis at the branch PAs bifurcation, are better dealt with at surgery. Thus, perioperative transthoracic and transesophageal echocardiography (TEE) assume a very important role in precisely evaluating the anatomy of main and branch PAs. How to cite this article Bhat IH, Damodaran S, Mandal B. Rare Case of Membranous Obstruction at the Origin of Left Pulmonary Artery: Role of Perioperative Echocardiography to Evaluate the Anatomy of Pulmonary Artery. J Perioper Echocardiogr 2017;5(2):74-76.