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.

Isolated reversal of flow in the vertebral artery – A missed entity

Isolated reversal of flow in the vertebral artery is a rare phenomenon occurring in the general population and is due to intrinsic anatomical defects. The most common cause is subclavian stenosis; however, reversal of flow in the vertebral artery can occur regardless of any detection of anatomic deterioration. In this series, we report three asymptomatic cases where the extracranial Doppler scan preceding off-pump coronary arterial bypass grafting showed isolated reversal of flow in the vertebral artery. No signs of subclavian stenosis or steal syndrome were elicited. However, all patients subsequently suffered from a posterior circulation stroke following off-pump coronary arterial bypass grafting but recovered fully with medical management. We conclude that a detailed pre-operative neurological investigation can mitigate this risk and improve neurological outcomes following off-pump coronary arterial bypass grafting.

A new congenital cleft palate New Zealand rabbit model for surgical research

Cleft palate repair is a challenging procedure for cleft surgeons to teach, and in research, it can be difficult to evaluate different techniques and develop new treatments. In this study, a congenital cleft palate New Zealand rabbit model has been described and could be beneficial in future studies concerning cleft palate repair. Pregnant New Zealand rabbits received 1.0 mg dexamethasone injection intramuscularly once a day from the 13th gestation day (GD13) to GD16. On GD31. Newborn rabbits were delivered by cesarean sections, fed with a standardized gastric tube feeding method, and divided into two groups. The rate of survival and the incidence of cleft palate was calculated. Weight, appearance, behavior, maxillary occlusal view, and regional anatomic and histological comparisons were recorded within 1 month after birth. Infants from the two groups with similar physiological conditions were selected for continuous maxillofacial and mandibular Micro-CT scan and three-dimensional reconstruction analysis. Ten pregnant rabbits gave birth to 48 live infants. The survival and cleft palate rates were 65.6% and 60.4% respectively. Both groups survived over 1 month with no difference in weight, appearance, and behavior. The cleft type was stable, and anatomical defects, histological characteristics, and nasal-maxillary abnormalities of the cleft were similar to those of humans. There was no statistically significant difference in maxillary and mandible development between the two groups within one month after birth. This congenital cleft palate model is considered to have more research possibilities with efficient cleft induction, reliable feeding methods, stable anatomical defects, and maxillofacial development similar to those seen in humans.

A RARE CASE OF LEFT SIDED UNCOMPLICATED MORGAGNI HERNIA IN AN ADULT

Diaphragmatic hernias of Morgagni are anatomical defects in the anterior diaphragm that allow herniation of abdominal viscera into the thorax. They are the rarest of congenital diaphragmatic hernias and usually present in childhood with respiratory symptomatology. Adults are often asymptomatic or present with strangulation of visceral contents. We describe the case of a 60-year female presenting with chronic chest pain and diagnosed with a left sided Morgagni hernia, with stomach and greater omentum as its contents. She underwent thoracotomy repair of the hernia and the defect was repaired using polypropylene mesh. Keyword: Morgagni Hernia, Adult, Thoracotomy, Mesh Repair

MR defecography in obstructed Defecation syndrome

Background ODS is an emerging clinical problem, especially for adult female patients (80%–90%). The pathophysiology of ODS remains to be clearly defined. This is because anatomic defects, such as internal rectal prolapse and rectocele, may be associated with functional alterations, such as paradoxical puborectalis contraction and spastic external sphincter contraction. Aim of the Work Obstructed defecation syndrome (ODS) is a type of constipation characterized by fragmented stools, need for straining at defecation, sense of incomplete evacuation, tenesmus, urgency and pelvic heaviness. This study is aimed to assess and compare and matching the role of Dynamic magnetic resonance imaging (MRI defecography) with the cilincal diagnosis in such patients. Pateints and Methods This retrospective, case-control study was conducted on twenty patients suffering from obstructive defecation syndrome that have been diagnosed clinically. The patients age is ranged between 16 and 69 years old. Results Statistically MRI study showed significant anatomical defects (p < 0.05) as the followings: Most of patients had Rectocele (65%), Disenergic Pelvic Syndrome (DPS) because of pelvic floor descents in (55%) of patients. Intossusception(45%),Cystocele (30%), interocele(25%), Anismus(15%) and uterine prolapsed (15%) Conclusion MRI has good value to detect abnormalities pertinent to posterior compartment in pelvis. Results of MR imaging showed positive agreement with clinical diagnosis of ODS in65% of patients. MRI showed 90% sensitivity, specificity, positive and negative predictive values as well as accuracy. MRI assessment of the posterior pelvic compartment can be indicated to detect the anatomical defects and lead to more successfully patient management and subsequently decreases the rate of postoperative recurrence.

Síndrome de Mayer-Rokitansky-Kuster-Hauser (SMRKH): presentación de dos casos clínicos y revisión de la literatura

Antecedentes: El síndrome de Mayer-Rokitansky-Kuster-Hauser es una entidad que se presenta en 1 por cada 4.500-5.000 nacidos vivos y se caracteriza por cursar con amenorrea primaria en una paciente con desarrollo sexual secundario normal y un cariotipo 46 XX normal.Resumen del caso: Se presentan dos casos de dos niñas, la primera de 14 años que consulta por amenorrea y la segunda de 10 años de edad, que consultó por cistitis y sinequias de labios mayores. Posteriormente, en los estudios imaginológicos se evidencian anomalías en los genitales internos, como ausencia de útero y anomalías en las trompas uterinas y 2/3 superiores de la vagina.Conclusión: El SMRKH es una entidad que debe sospecharse en las pacientes que cursen con amenorrea primaria y un desarrollo sexual secundario normal, con cariotipo 46 XX, perfil hormonal normal y en donde las imágenes diagnósticas, la ecografía, en menor grado, y principalmente la resonancia magnética serán de gran ayuda para confirmar el diagnóstico.Abstract The Mayer-Rokitansky-Kuster-Hauser Syndrom is an entity with an incidence of 4500-5000 live born and the current presentation is a female with onset of normal secondary sexual characters, amenorrea with 46XX karyotype. We describe the clinical cases of two girls, the first, a 14 years old girl with amenorrhea and the second a 10 years old girl, with chronic cystitis and synechias of labium major. It was performed radiologic studies with abnomalites of internal genitalia, like uterus absent, and abnomalities of fallopian tubes and 2/3 upper vagina.Conclusion: The SMRKH is an entity to suspect in case of female patient with primary amenorrhea, normal onset of secondary sexual characteristics, 46XX karyotype, normal hormone profile and with radiological images like ultrasonography and MRI that confirms the anatomical defects.