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Background Skin and soft-tissue infections (SSTIs) in children are increasingly common. The IDSA has published guidelines for SSTI treatment in children, adolescents, and adults but data in infants less than 2 months is sparse despite their higher risk of concomitant serious bacterial infection (SBI). Clinical work-up and management of these patients varies widely with little evidence to guide providers. Methods We retrospectively identified 536 patients, from 2007 to 2017, seen at our EDs or hospital-associated clinic and diagnosed with SSTI by ICD9/10 code. We excluded those with ill-appearance, prematurity, known immunodeficiency, skin disorder, previous SSTI, or previous procedure at infection site. Remaining patient's medical records were reviewed to confirm a SSTI. The total included study population was 182 (Figure 1). Data collected included demographics, type/location of infection, laboratory/imaging studies obtained, procedures performed, disposition, treatment, and treatment failure. Results Demographics are reported in Table 1. Mean age was 24.2 days (range 2–57 days). Of 182 patients, 13% had fever. 34% had a superficial infection (impetigo or pustulosis), 24% had cellulitis/scalded skin, 35% had an abscess/paronychia, and 7% had periorbital cellulitis. The most common SSTI locations were perineal/genital (30%) and head/scalp/face (23%). 63% of infants had a blood culture obtained and 4/114 grew a pathogenic bacteria. 52% had a wound culture and 72/95 grew a pathogenic bacteria. No infants had bacterial meningitis or a UTI (Table 2). 25% underwent incision/drainage and 93% received any antibiotic. The most commonly prescribed antibiotics were clindamycin and mupirocin. Of 80 non-admitted infants, 21% had an unscheduled return visit within 2 weeks (Table 3): 9% for treatment failure, 6% unrelated to SSTI, and 1% for missed SBI (1 patient with GAS bacteremia). Conclusion Most well-appearing infants with SSTI were afebrile. The majority of studied infants had blood cultures obtained but rates of clinically significant bacteremia were low. Management varied considerably and antibiotics were commonly administered. However, overall rates of SBI were low and there was only 1 case of missed SBI. Extensive evaluation of well-appearing infants with SSTI may be unnecessary. Disclosures All authors: No reported disclosures. [ABSTRACT FROM AUTHOR]

Background Human papilloma virus (HPV) is the most common sexually transmitted infection (STI) in the United States (US) and is associated with the development of cervical and anal dysplasia; however, little is known about the epidemiology of HPV in transgender persons. The objective of this study was to conduct a systematic review of the literature to evaluate the existing epidemiologic data on HPV infection prevalence as well as anal and cervical dysplasia in transgender persons. Methods The PubMed and Scopus databases were queried using the keyword "transgender" in combination with one of the following: PAP, cervical cancer, anogenital warts. The search generated 86 articles, when accounting for duplicates across searches. We included original research articles published from January 1969 to March 2019. Excluded were non-English articles, studies that did not have HPV or cytology testing data, and studies that did not have disaggregated transgender data. Results In total, 13 articles were included in the review, of which 9 focused on transgender women (TW), 3 on transgender men (TM), and 1 on both TW and TM. HPV DNA testing was performed in 10 studies, with 7 of those offering prevalence data for specific HPV genotypes. Overall, HPV prevalence in TW ranged from 15%-97.4%, with High Risk-HPV (HR-HPV) prevalence ranging from 13%-82.5%. Anal cytology data for TW was presented in 2 studies, both of which cited a 42% prevalence of abnormal cytology. Cervical or vaginal cytology was evaluated in 4 articles, 3 of which involved TM and 1 of which involved TW with neovaginas. Among TM, the prevalence of abnormal cervical cytology ranged from 6%-42%. Conclusion Our review highlights the lack of HPV research and the high variability of the existing data about the transgender population. Further study is needed to better understand not only the epidemiology of HPV and resultant dysplastic sequelae, but also to inform the development of transgender sensitive diagnostic methods for this infection. The diverse genital anatomy represented in the transgender community as well as the gender dysphoria these patient's experience during testing pose myriad diagnostic challenges that will need to be considered in the development of screening and diagnostic practices. Disclosures All authors: No reported disclosures. [ABSTRACT FROM AUTHOR]

Background Ocular gonorrhea infections (OGI) have been rarely reported in United States adults. Unlike other bacterial eye infections which may be treated with topical antibiotics, OGI is typically characterized by purulent conjunctivitis with profuse exudate and requires treatment with systemic antibiotics. Genital gonorrhea infections are increasing nationally and in New York City (NYC). New York State mandates prophylactic antibiotic treatment of newborns to prevent purulent conjunctivitis. We describe the number and characteristics of OGI case-patients diagnosed among NYC residents over a 12-year period. Methods We examined data from two different sources: (1) the NYC Health Department sexually transmitted infections (STI) surveillance registry (January 2006-October 2017) in which OGI cases were defined as laboratory-confirmed infection of the eye or eye appendages; and (2) a hospital discharge database (inpatient and emergency room) for NYC residents admitted to any New York State hospital (inpatient or emergency room discharges, January 2006–December 2016) in which cases of OGI were identified using diagnostic codes corresponding to OGI. We characterized de-duplicated OGI cases identified across these data sources for 2006–2017 and calculated the OGI rate/100,000 reported gonorrhea cases. Results Thirty-six OGI cases were identified in STI surveillance data and 55 additional cases in the hospital discharge database. Out of the total of 91 OGI cases, 20 (22%) were ≤1 year (11 males, 9 females), 3 (3.3%) were 2–14 years (all males), and 68 (74.7%) were ≥15 years old. Among the 68 adolescent/adult case-patients, the mean age was 29.04 ± 13.4 years. The majority were males (69.1%, 47/68,) and African American (42.6%, 29/68). The OGI rate in adolescents/adults was 39.95/100,000 gonorrhea cases (females, 35.76; males, 42.31); the rate remained almost constant since 2006 despite the increases in gonorrhea over the past decade. Conjunctivitis was the most common presentation (90.1% of all cases; 82/91), followed by eye appendage infections (2.2%; 2/91). The STI surveillance data revealed the diagnosis of OGI was made mainly by ocular culture (86.1%; 31/36), followed by nucleic acid amplification test (NAAT) (8.3%), or both culture and NAAT (5.6%). Conclusion OGI appear to be a rare disease in NYC. The majority of infections occurred among adolescents and adults, likely due to mandated newborn prophylaxis. Disclosures All authors: No reported disclosures. [ABSTRACT FROM AUTHOR]

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• Most dogs with natural CTVT presented with moderate to severe clinical disease. • Plasmacytic CTVT cytomorphology was more frequent than lymphocytic or mixed patterns. • No tumor resistance to chemotherapy was seen regardless of cytomorphological pattern. • Combination ivermectin/vincristine promoted tumor remission without enhancing adverse effects. • Combination ivermectin/vincristine was safe and efficacious for CTVT chemotherapy. Vincristine is the first-line drug for the chemotherapy of canine transmissible venereal tumor (CTVT). Drug resistance is related to tumor cyto-morphological patterns of CTVT. There are anti-cancer properties of ivermectin, thus, a combination of ivermectin and vincristine could be an effective chemo-therapeutic treatment regimen for CTVT. Study aims, therefore, were to (1) assess the frequency of CTVT cyto-morphologies, and (2) evaluate treatment efficacy and possible adverse reactions to vincristine compared with a combination vincristine and ivermectin. Dogs (n = 41) with CTVT were characterized by tumor cyto-morphology and disease severity and of those, 20 were randomly allocated into two groups. There was a control group (G-Vin; n = 10) in which there was treatment with vincristine; and an experimental group (G-Iv/Vin; n = 10) in which there was treatment with the ivermectin/vincristine combination. Although dogs in the G-Iv/Vin group had more severe disease at the beginning of the study (P = 0.0031), the number of weeks and chemotherapy sessions until tumor remission were similar among dogs of the two groups, indicating both treatments were effective. There was a decrease in the leukocyte counts (P = 0.0020), related to neutropenia (P = 0.0371) in the G-Vin but not the G-Iv/Vin treatment group. There was no tumor resistance that developed during the study regardless of the treatment regimen used or tumor cytomorphology. In summary, the use of the vincristine/ivermectin combination was well tolerated and efficacious for CTVT treatment. [ABSTRACT FROM AUTHOR]

Objective: This study investigated the clinicopathological traits and ultrasound features of female reproductive system extraosseous Ewing's sarcoma (EES) and explored the diagnostic value of ultrasonography for this condition., Methods: Cases of female pelvic EES diagnosed and treated at our hospital between June 2009 and June 2019 were included in this study. Pathology data and ultrasound manifestations were assessed retrospectively to summarize the clinical traits and ultrasound features of female reproductive system EES. Based on the results, recommendations for the ultrasonography-based diagnosis of this disease were proposed., Results: During the 10-year study period, 13 female patients were diagnosed with EES in the pelvic cavity based on the results of postoperative pathology tests. The age of the patients ranged from 8 mouth to 40 years, and no patients demonstrated specific clinical symptoms. However, an examination of tumor biomarkers revealed that certain patients had elevated levels of CA125. In the 13 patients, 19 lesions were identified, including 16 that involved the reproductive system. The primary ultrasound manifestation was uneven, low-echo solidity or cystic solidity, exhibiting large size, irregular shape, and unclear boundary. A few patients had concurrent ascites. Although some lesions lacked blood supply, the blood supply of most lesions was medium to abundant, and the blood flow was mostly characterized by low resistant. Almost none of the lesions were definitively diagnosed preoperatively., Conclusions: Preoperative definitive diagnosis of EES in the female reproductive system remains a great clinical challenge. Although certain clinical traits and ultrasound features are associated with this disease, and color Doppler ultrasonography might provide vital information indicating the presence of EES, the final diagnosis still depends on the pathological test results of the patients., (Copyright© by Editorial Board of Journal of Sichuan University (Medical Sciences).)

Postnatal penile length is a reliable, standardized, and widely used marker for the diagnosis of genitourinary pathology, as well as genetic and hormonal disorders. In contrast, prenatal diagnosis has not been developed equally and there is a lack of relevant literature. Our objective is to review the studies on fetal penile length, and apply findings to clinical practice. Although the most used technique is the outer penile length, there is no consensus regarding the appropriate technique for prenatal measurement. Several reports have provided reference data with high correlation. However, important issues like poor correlation with post-natal measures or presence of confounding variables are still present. Diagnosis of both a micropenis and macropenis can indicate related pathologies, and this information may benefit parental counseling and facilitate fetal management. Therefore, it is necessary to carry out prospective studies that provide reliable normative data.

Background Acyclovir-resistant (ACVr) herpes simplex virus (HSV) infection management is a challenge in patients with hematologic malignancies (HM) and hematopoietic cell transplant (HCT) recipients. Methods Retrospective review of patients aged ≥ 18 years with underlying HM and/or HCT and culture-positive ACVr HSV between 1/1/2009 and December 1/2017 at a tertiary cancer center. Clinical, laboratory, microbiological, and treatment data collected. Results 33 patients identified; 25 (76%) acute leukemias, 3 (9%) chronic myeloid leukemia/chronic lymphocytic leukemia (CML/CLL), 3 (9%) lymphoma, 2 (6%) other HM, and 32 (97%) had HCT. Median age of patients was 59 years (25–73) and 64% of them are females. HCT type: 22 (67%) matched unrelated donor, 3 (9%) cord blood, and 7 (21%) matched related donor. All patients were on acyclovir prophylaxis prior to diagnosis. The median time to onset of ACVr HSV infection was 147 days after transplant. Infection site: 16 (49%) oral, 10 (30%), ano-genital, 5 (15%) oral and esophagus/lung, 2 (6%) esophagus/lung. Pertinent laboratory data on day of viral culture (median/range): white blood cell (WBC) 4.6 cells/µL (0.1–85.9), absolute neutrophil count (ANC) 2,316 cells/µL (0–17,000), absolute lymphocyte count (ALC) 574.5 cells/µL (0–84,182). Serum creatinine at start and end of treatment are 0.8 mg/dL (0.32–1.98) and 0.92 mg/dL (0.36–2.7), respectively. The median duration of treatment was 30 days (4–116). Treatment: 20 (61%) foscarnet, 2 (6%) cidofovir, 4 (12%) foscarnet and cidofovir, 1 (3%) valacyclovir, 5 (15%) high-dose acyclovir, 1 (3%) unknown. 8 (24%) received adjunctive topical therapy: 5 imiquimod, 3 cidofovir. 31 included in outcome analysis (data missing in 2). Infection resolved in 15/31 (48%) while 5/31 (16%) had persistent infection. Median ANC and ALC in those with resolved vs. persistent infection (respectively): 3,082 cells/µL and 642 cells/µL vs. 1,895 cells/µL and 380 cells/µL with a trend toward lower ANC and ALC in patients with persistent infection. Overall mortality was 35% (9/31) while ACVr HSV attributable mortality was 6.4% (2/31). Conclusion ACVr HSV is predominantly encountered in allogeneic HCT, particularly the unrelated donor recipients, and lower ANC/ALC may predispose to persistent infection. Disclosures All authors: No reported disclosures. [ABSTRACT FROM AUTHOR]

Background Concurrent gonococcal infections could impact treatment success in cases of anatomic site-specific strains with different antimicrobial susceptibilities; however, little is known about same-patient differences in susceptibility as most antibiotic resistance surveillance is based on only male urethral isolates. Methods In August 2017, the enhanced Gonococcal Isolate Surveillance Project (eGISP) began collecting male and female genital and extragenital gonococcal isolates from patients in 12 STD clinics. Minimum Inhibitory Concentrations (MICs) for penicillin, tetracycline, ciprofloxacin, gentamicin, cefixime, ceftriaxone and azithromycin were determined by agar dilution. We identified patients with isolates from multiple anatomic sites of infection collected during the same clinic visit. Isolate sets were categorized as pairs or triplets based on the number of culture positive anatomic sites. We identified same-patient isolate sets with differing MICs (≥2 dilution difference) for each antibiotic, and identified if the difference affected susceptibility categorization. All isolates in a set were tested in the same batch run by the same laboratory. Results From August 2017-February 2019, 280 isolates were collected from 135 patients, representing 136 isolate sets (128 pairs and 8 triplets); one patient contributed 2 isolate sets. Of the 136 isolate sets, the majority (72; 53%) were grouped as genital and pharyngeal isolates (Table 1). Overall, 33 isolate sets (24%) had differing MICs for ≥1 antibiotic and 21 sets (15%) for ≥2 antibiotics. Across all anatomical site combinations, differing MICs were most common for ciprofloxacin (10.3%), penicillin (9.6%) and azithromycin (9.6%). Only 18 isolate sets (13%) demonstrated differing MICs where an isolate was considered susceptible and another was considered resistant or reduced-susceptible. Conclusion Among persons with concurrent gonococcal infections, MICs can vary by ≥2 dilutions between sites and may change susceptibility interpretation. Variation by the anatomic site can result from initial infection with multiple strains or differential development of resistance after infection. Continued surveillance of multi-site infections could help understand resistance development and inform patient management. Disclosures All authors: No reported disclosures. [ABSTRACT FROM AUTHOR]

Background While Pre-Exposure Prophylaxis (PrEP) has been shown to be effective in preventing the acquisition of HIV, the cost of care is considerable. Public health efforts should be directed to those at highest risk to minimize the cost of a quality-adjusted life-year (QALY). Given that sexually transmitted illnesses (STIs) increase the risk of acquiring HIV from 5–8 fold, their incidence rates can serve to define populations at highest risk for HIV within the community of men who have sex with men (MSM). Methods A retrospective cohort of PrEP patients with STI screening visits in two clinics in Dallas, Texas from January 2016 through April 2019 were reviewed. Three-site genital and extra-genital testing was routinely performed. Categorical variables were compared using Chi-Square. A binomial regression model was used to evaluate the odds of STI acquisition. Results 201 PrEP patients had 999 screening visits. 17 were in the first quartile, ages (18–24) 35.3% were Black, 70.6% MSM; 105 were in the second quartile, ages (25–37) 23.8% Black, 58.1% MSM; 56 third quartile, ages (38–49) 17.9% Black, 62.5% MSM; 23 patients in the fourth quartile, age ≥50, 8.7% were Black, 47.8% MSM. The younger age group, first quartile contributed 16 person-years (py); the second quartile, 102 py; third quartile, 48 py; fourth quartile, ≥50, 25 py. The incidence rates for Neisseria gonorrhoeae (GC) or Chlamydia trachomatis (CT) from any site were higher in the first quartile, 166/100 py, CI 150–174; second quartile, 92/100 py, CI- 85–96; third quartile, 62/100 py, CI 48–75 than in those in the fourth quartile, ≥50 years old, 44/100 py, CI 27–63. The incidence of any rectal GCor CT in the first quartile, 86/100 py, CI 63–98; second quartile, 53/100 py, CI 43–62; third quartile, 29/100 py, CI 18–43 and those in the fourth quartile, ≥50, 32/100 py, CI 17–52. In a binomial regression model, the odds of acquiring any GC or CT for a PrEP patient ≥50 revealed an adjusted OR of 0.40, CI, 0.20–0.79 (adjusted for race and sexual orientation) P = 0.009 when compared with patients less than 50. Conclusion PrEP patients fifty and older have the lowest odds of acquiring STIs. Younger age groups with higher incidences of STIs may represent those with more episodes of condomless sex, at higher risk for HIV. Disclosures All authors: No reported disclosures. [ABSTRACT FROM AUTHOR]

Background Congenital cytomegalovirus infection (cCMV) is a leading cause of hearing loss and neurodevelopmental disabilities. Although higher rates of CMV acquisition and reinfections with new virus strains are seen in women with STIs, the significance of CMV-STI co-infections during pregnancy and whether co-infections increase intrauterine transmission of CMV remains unclear. Higher rates of CMV genital shedding were seen in mothers of infants with cCMV compared with those with uninfected infants. The objective of this study was to determine the association between CMV seroprevalence and STIs and whether STIs during pregnancy influences CMV genital shedding. Methods Vaginal swabs from a cohort of CMV seropositive women in labor from a multi-center study were analyzed. After DNA extraction from vaginal swabs, PCR was performed for detection of CMV, Neisseria gonorrhoeae (GC) , Chlamydia trachomatis (CT) , Trichomonas vaginalis (TV) and Mycoplasma genitalium (MG). The prevalence of STIs in CMV seropositive pregnant women was determined in this cohort and CMV genital shedding rates were compared between groups with and without STIs. Results In this cohort, CMV genital shedding in late pregnancy was detectable in 13% (21/160) of women while rates of detection for MG, GC, CT and TV were 3%, 0.6%, 1.2% and 8%, respectively. CMV-STI co-infections were noted in 2.5% (4/160) of women. CMV genital shedding was documented in only one woman with STIs, compared with 12.5% (20/160) without STIs. Among women shedding CMV in the genital tract, CMV viral load levels ranged from 1.1 × 102 IU/mL to 2.2 × 104 IU/mL. Conclusion In a cohort of CMV seropositive women, the presence of STIs in late pregnancy did not increase CMV genital shedding. Our preliminary findings suggest CMV shedding is not associated with STIs detected late in pregnancy. Disclosures All authors: No reported disclosures. [ABSTRACT FROM AUTHOR]

Background The Philippines has the fastest-growing HIV epidemic in the Asia-Pacific. Concurrent sexually-transmitted infections increase the risk of HIV transmission and complications. The prevalence of Neisseria gonorrheae (NG) and Chlamydia trachomatis (CT) infection among Filipino HIV patients is unknown and screening is not universal. A symptom-based approach likely underestimates the prevalence of NG and CT among men who have sex with men (MSM). We determined the rectal, pharyngeal, and urethral prevalence of gonorrhea and chlamydia infection in our patient population using nucleic acid testing (NAT). Methods This is a single-center, prospective cross-sectional study at Philippine General Hospital. Following ethical approval and informed consent, pharyngeal, rectal, and urine samples from newly-diagnosed, treatment-naïve HIV adult patients were tested using the Xpert® CT/NG assay (Cepheid, Sunnydale, CA). Patients with recent (≤21 days) antibiotic use with activity against NG or CT were excluded. Demographic and clinical data were also collected. Results 46 subjects were enrolled. Mean age was 31 years (range 19–49), 83% (38/46) were male, 96% (44/46) were asymptomatic, and 92% (35/38) of the males were MSM. Median CD4 count was 225 cells/μL (range 0–1,335). The overall prevalence of CT/NG was 33% (15/46). Table 1 shows the prevalence of CT and NG by site. Four patients had both genital and rectal CT. More patients had rectal NG/CT compared with urethral and pharyngeal sites. No gonorrhea was found in the urine specimens; no chlamydia was found in the pharynx. Conclusion The prevalence of CT and NG among newly diagnosed Filipino HIV patients at 33% is sufficiently high to warrant routine NAT screening. Urine testing alone will miss a significant number of cases in an MSM-predominant population. We recommend NAT screening of both urethral and rectal sites for newly-diagnosed Filipino HIV patients. Disclosures All authors: No reported disclosures. [ABSTRACT FROM AUTHOR]

Background Non-cutaneous melanoma, including mucosal and uveal melanoma, is a rare neoplasm that accounts for only approximately 1% of all melanomas in the USA and 3.8% in Japan. Several studies have suggested that immune check point inhibitors (ICPis) have lower efficacy against non-cutaneous melanoma than cutaneous melanoma. To evaluate real-world outcomes, we conducted a retrospective analysis of nivolumab for non-cutaneous melanoma. Methods We reviewed 21 patients with unresectable or metastatic non-cutaneous melanoma treated with nivolumab in the first-line setting between Nov 2014 and Dec 2018. Response was assessed every 2-3 months by CT or MRI based on RECIST ver 1.1. Time-to-event analyses were calculated with Kaplan-Meier estimates. Adverse events were evaluated with CTCAE ver 4.0. Results Among the 21 patients, 13 were men and median age was 67 years (range, 47-85). Primary site was the nasal cavity or paranasal sinus/uvea/esophagus/rectum/genital/conjunctiva (n = 11/4/2/2/1/1). BRAF mutation was absent in all tumors. Overall response rate was 19% (95% confidence interval, 35-77%). With median follow-up for survivors of 13.1 months, 1-year overall survival was 59% (median, 8.2 months) and 1-year progression-free survival was 6.6% (median, 2.1 months). Six patients (29%) experienced immune-related adverse events (irAEs), including thyroid dysfunction (n = 4, all grade 2), liver enzyme elevation (n = 3, all grade 2), pigmentary change (n = 2, all grade 1), diabetes mellitus (n = 1, grade 3), and interstitial lung disease (n = 1, grade 2). All these irAEs were manageable. Regarding subsequent treatment, 6 patients received ipilimumab and 1 received pembrolizumab. However, no patient responded to subsequent ICPi. Conclusions In this retrospective analysis, nivolumab showed only modest efficacy against non-cutaneous melanoma and a manageable safety profile. Treatment for the unmet medical needs of non-cutaneous melanoma warrants further investigation. [ABSTRACT FROM AUTHOR]

Female genital tuberculosis (FGTB) is a rare form of tuberculosis (TB) affecting women of reproductive age. The clinical presentation is often misleading. We retrospectively collected cases of female genital tuberculosis (FGTB) diagnosed from 2006 to 2016 at our pathology department. The mean age was 39.92 years (range of 18–74 years). Most patients had reproductive age, with 30.76% postmenopausal women. Seven cases (53.84%) were addressed for histopathological analysis for clinical malignant suspicion. The diagnosis was made on eight surgical specimens (61.53%). Nine patients (69.23%) had multifocal TB. The most involved genital organs were fallopian tubes (63.84%), followed by ovaries (46.15%), endometrium (38.46%) and the cervix (23.07%). The macroscopic aspects of all resected specimens did not show the classic appearance of caseous necrosis. We found that most patients with genital tuberculosis present with clinical suspicion of malignancy leading to aggressive surgical management. [ABSTRACT FROM AUTHOR]

Aims: Very recent papers proposed a possible role for the expression of terminal deoxynucleotidyl transferase (TdT) in the tumourigenesis of gonadal and extragonadal germ cell-derived tumours (GCTs). Our multicentric study evaluated the magnitude of the immunoreactivity for TdT in GCTs, encompassing seminoma, dysgerminoma, mature teratoma and mixed GCTs., Methods and Results: The histological series was stained with both monoclonal and polyclonal antibodies, yielding a positivity of 80% of cases with well-defined nuclear reactivity. A significant difference in staining intensity between monoclonal and polyclonal antibodies was observed (p=0.005). However, exploiting western blot and more innovative proteomic approaches, no clear-cut evidence of the TdT protein was observed in the neoplastic tissues of the series., Conclusions: Alternatively to the pathogenetic link between TdT expression and GCTs tumourigenesis, we hypothesised the occurrence of a spurious immunohistochemical nuclear cross-reaction, a well-known phenomenon with important implications and a possible source of diagnostic pitfalls in routine practice for pathologists., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and permissions. Published by BMJ.)

We present the case of a 33-year-old male who presented to the Emergency Department having amputated his penis as a result of auditory hallucinations triggered by cannabis use. A successful microsurgical technique involving anastomosing the individual structures of the penile shaft enabled a successful cosmetic and functional outcome including restoration of erectile function. [ABSTRACT FROM AUTHOR]

Previous studies demonstrated complex architecture of the muscular system of Macrostomum species, especially in the rostrum area and the pharynx. However, little is known about the differences in muscular pattern between species of the genus. This study examines and compares the muscular systems of specimens belonging to three freshwater Macrostomum species (M. quiritium, M. tuba and M. velastylum), labeled with phalloidin-rhodamine and studied by confocal microscopy. Our results agree with the previous descriptions, confirming that the muscular patterns for the body wall, rostrum area, pharynx and caudal region differ among species. The muscles of the body wall follow the typical architecture, but the number of fibers in the species analyzed varies between dorsal and ventral surfaces, ranging from 80 to 100 fibers, this record being higher than previous observations. The arrangement of the fibers in the rostrum is complex, especially in the brain area. Macrostomum tuba and M. quiritium have a set of two muscles crossing at brain level and forming an "X," which is not evident in M. velastylum. We identified five different sets of fibers associated to the pharynx and mouth at ventral, medium and deep levels. These different sets are present in all three species studied. The caudal plate in M. tuba has an additional layer of diagonal fibers in the body wall, which is not evident in the other two species. The muscles of the reproductive system are independent of the body wall musculature in the species analyzed, but connected to the intestinal wall by specific fibers that may serve as an anchor. J. Morphol. 278:264-282, 2017. © 2016 Wiley Periodicals,Inc., (© 2016 Wiley Periodicals, Inc.)

The article presents a case study of a uterus didelphys or true double cervix in the reproductive tract of a buffalo heifer, which is the first record of such a case in buffalo cows. The genital tract had two cervical canals that were opened into separated uterine horns. The article describes uterus didelphys as a congenital anatomical defect of the female genital tract, caused by a failure of fusion of the caudal portions of the paramesonephric ducts during embryonic development.