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Background: Laparoscopic sleeve gastrectomy (LSG) is a standard procedure due to its low complication rates and favorable outcomes. However, limited data are available regarding the optimal size of linear staplers in relation to gastric wall thickness (GWT)., Methods: Between August 2016 and December 2020, we performed LSG in 70 patients with an average age, body weight, and body mass index of 42 years, 107 kg, and 40 kg/m2, respectively. We measured the GWT at the antrum, body, and fundus using resected specimens. We used an endo-linear stapler, and the closed staple height (CSH) was 1.75 mm., Results: We found that the average GWT at the antrum was significantly thicker than the GWT at the body and fundus. There was a statistically significant relationship between body weight and the GWT at the antrum and body and obstructive sleep apnea and the GWT at the body. The average CSH/GWT ratios were 0.55, 0.62, and 0.90 at the antrum, body, and fundus, respectively. However, in 20 patients (29%), the CSH/GWT ratio at the fundus area was 〓1.0, and only preoperative body weight was a significant predictor for a CSH/GWT ratio of 〓1.0., Conclusion: A light body weight may be related to a CSH/GWT ratio of 〓1.0 at the fundus., Key Points: GWT at the antrum was significantly thicker than that at the body and fundus. GWT at the antrum and body statistically correlated with body weight. Preoperative body weight was a predictor for CSH/GWT ratio of 〓1.0 at the fundus

OBJECTIVE We sought to investigate the clinical efficacy and safety of a novel endoscopic closure technique in repairing gastric wall defects after endoscopic full-thickness resection (EFTR) of gastric submucosal tumors (SMTs) originating from the muscularis propria layer. METHODS From December 2016 to December 2019, patients with gastric submucosal tumors were enrolled and clinicopathological data were collected. All SMTs were resected by EFTR and gastric wall defects were closed using a novel endoscopic closure technique. The feasibility, efficacy, and safety were evaluated. RESULTS A total of 21 patients with gastric SMTs were included in this study. Among the included SMTs, 15 tumors were located in the fundus of the stomach, and 6 were located in the upper body of the stomach. The average size of the lesions was 2.3 cm (range: 1.9-2.5 cm). All patients underwent EFTR and the gastric wall defect was closed by endoscopic closure. The average endoscopic closure time was 9 min (range: 7-15 min) and the average hospitalization stay length was five days (range: 4-6 days). One patient developed abdominal pain on the first day after the procedure and their body temperature increased; he received treatments such as anti-infection, antacid, and gastrointestinal decompression and was cured and discharged after 4 days. No instance of delayed bleeding, postoperative gastrointestinal fistula, or abdominal infection occurred. No case was transferred to surgery. The postoperative pathology profile included 18 stromal tumors and 3 leiomyomas. During the follow-up period (6-24 months), no case of residual or recurrence was recorded. CONCLUSION The described endoscopic loop ligation technique is feasible, effective, and safe for repairing gastric wall defects after EFTR for gastric submucosal tumors originating from the muscularis propria layer.

The strengths, directions and coupling of the movements of the stomach depend on the organisation of its musculature. Although the rat has been used as a model species to study gastric function, there is no detailed, quantitative study of the arrangement of the gastric muscles in rat. Here we provide a descriptive and quantitative account, and compare it with human gastric anatomy. The rat stomach has three components of the muscularis externa, a longitudinal coat, a circular coat and an internal oblique (sling) muscle in the region of the gastro-oesophageal junction. These layers are similar to human. Unlike human, the rat stomach is also equipped with paired muscular oesophago-pyloric ligaments that lie external to the longitudinal muscle. There is a prominent muscularis mucosae throughout the stomach and strands of smooth muscle occur in the mucosa, between the glands of the corpus and antrum. The striated muscle of the oesophageal wall reaches to the stomach, unlike the human, in which the wall of the distal oesophagus is smooth muscle. Thus, the continuity of gastric and oesophageal smooth muscle bundles, that occurs in human, does not occur in rat. Circular muscle bundles extend around the circumference of the stomach, in the fundus forming a cap of parallel muscle bundles. This arrangement favours co-ordinated circumferential contractions. Small bands of muscle make connections between the circular muscle bundles. This is consistent with a slower conduction of excitation orthogonal to the circular muscle bundles, across the corpus towards the distal antrum. The oblique muscle merged and became continuous with the circular muscle close to the gastro-oesophageal junction at the base of the fundus, and in the corpus, lateral to the lesser curvature. Quantitation of muscle thickness revealed gradients of thickness of both the longitudinal and circular muscle. This anatomical study provides essential data for interpreting gastric movements.

Background: Extrahepatic biliary apparatus comprises of gall bladder, cystic duct, hepatic ducts and common bile duct. Gall Bladder is a pear shaped hollow organ, which are situated in contact with the under surface of right lobe of liver. In adult the length is between 7-10 cm, maximum breadth being 3 cm and with a maximum capacity of 50 ml. The morphological and morphometric variations of gall bladder are common. These variations are well studied and documented by the earlier studies but its precise morphological types and its incidence are utmost important during diagnostic and therapeutic procedures. Hence, comprehensive knowledge of variations of gall bladder will be important to avoid complications during surgical procedures and radiological interventions. Materials and Methods: The study was carried on 50 liver with Gallbladder specimens obtained from 10% formalin fixed cadavers of age group 50-60 years in the department of Anatomy. The gall bladder was observed, dissected carefully and studied for its parameters i.e. length and breadth using Vernier calipers. The variations in shape, its external morphological features and its position were also noted. Results: 52% of the gall bladder specimens had length ranging between 7 – 10cms. 68% of the specimens had transverse diameter ranging between 3 – 5cms. Various shapes observed were Pear shape, Hourglass shape, Retort shape, Cylindrical shape and Flask or Irregular shaped. The commonest shape observed and recorded in this study was Pear shaped in 26 specimens (52%). Folded fundus (Phrygian cap) of gall bladder was found in 2 out of 50 specimens (4%) and Hartmann’s pouch was found in 7 out of 50 specimens (14%). Conclusion: The precise knowledge of the various morphological and morphometric variants of the gall bladder is important for the operating Surgeons and Radiologists. The preoperative diagnosis of these variations helps to reduce the complications like bleeding and biliary leaks. Keywords: Gal

The transthoracic approach for esophageal diverticulectomy saves dissection but limits the amount of antireflux surgery that can be done. However, the laparoscopic trans-hiatal approach usually limits access to large diverticula located at the mid-thoracic level. We describe a 67-year-old Thai man who had two giant epiphrenic diverticula (ED) (11 × 7.6 cm and 3.2 × 3.4 cm). The highest part of the fundus of the larger ED was 12.6 cm above the hiatus. Preoperative esophageal manometry and an upper gastrointestinal study showed no obvious features of motility disorder. In addition, the clinical evaluation of the esophagogastroduodenoscopy revealed a hiatal hernia. Laparoscopic trans-hiatal esophageal diverticulectomy with intraoperative assessment by endoscopy was carried out. A partial wrap using Dor fundoplication was constructed without myotomy. There were no postoperative related complications. We believe that tailor-made operations in unusual cases can be safe using combined techniques to reduce postoperative morbidity.

AmaçTürkiye ve ağırlıklı olarak Orta Anadolu nüfusuna hizmet veren Ankara ilindeki bir üçüncübasamak hastanede takip edilen patolojik miyopi (PM) olgularının, arka segment ve optikkoherens tomografi (OKT) bulgularını geriye dönük incelemek.YöntemGözlemsel, olgu kontrol çalışmasında, olguların tıbbi kayıtları geriye dönük olarak incelendi.Demografik veriler ve muayene bulguları dosyalardan elde edilirken, arka segment muayene veOKT bulguları sisteme kayıtlı renkli fundus fotoğrafları ve OKT görüntülerinin tecrübeli birretina uzmanı tarafından değerlendirilmesiyle elde edildi.BulgularÇalışmaya 142 PM olgusunun 265 gözü dahil edildi. Olguların ortalama yaşı 52,6 ± 17,1 (18 –65) idi. En sık arka segment bulgusu %92,9 ile peripapiller atrofi idi ve bunu %71,3 ile diffüz/lokalize koryoretinal atrofi bulgusu takip etti. Tilte disk ve posterior stafilom daha sonra gelen arkasegment muayene bulgularıydı. En sık rastlanan OKT bulguları ise sırasıyla %20,4 ile vitreomaküler ara yüzey bozuklukları, %14,6 ile aktif/skar koroid neovaskülarizasyonu ve %14,3 iledik yokuş eğim idi. Kubbe şekilli makula (%13,9), maküler atrofi (%12,0) ve arka prekortikalvitreus boşluğu (%10,0) ise diğer üç bulgudan daha az sık olan OKT bulguları idi.SonuçTürkiye ve Orta Anadolu popülasyonundaki PM olgularında en sık arka segment bulgusuperipapiller atrofiyken en sık OKT bulgusu vitreomaküler ara yüzey bozukluklarıydı.

This study aimed to show the proportion of fundus examinations in patients with diabetes who were scheduled for surgery. We retrospectively analyzed 455 consecutive patients with diabetes admitted for surgery. Just 49% had fundus examinations before hospitalization. The decision tree analysis showed that the type of family doctor was the first split associated with fundus examination; patients treated by a diabetes specialist were more likely to receive the examination. In this subgroup, glycated hemoglobin levels ≥8.0% and age ≥71 years were associated with a lower proportion of receiving the examination. In patients whose family doctor was not a diabetes specialist, glycated hemoglobin levels, We investigated the proportion of fundus examinations in patients with diabetes scheduled for surgery. Only approximately half of these patients had fundus examination. Clinical variables associated with receiving the examination were not identical between diabetes specialists and non‐specialists.

Background Endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) using a lumen-apposing metal stent (LAMS) has rendered endoscopic gallbladder assessment through a stent possible, but an appropriate endoscope is required. We assessed the feasibility of peroral cholecystoscopy (POCC) using a multibending ultraslim endoscope passed through a LAMS after EUS-GBD. Methods 14 patients with a LAMS for EUS-GBD who consecutively underwent POCC were included. POCC was performed using a multibending endoscope inserted through the LAMS. The primary outcome was the technical success rate, defined as complete endoscopic examination of the gallbladder from the orifice of the cystic duct to the fundus. The types of intervention and adverse events were recorded. Results 17 POCCs were performed in 14 patients. Of the 17 POCCs, 15 (88.2 %) were technically successful. Narrow-band imaging endoscopy was performed in 12 procedures (70.6 %), and cholecystoscopy-guided target biopsies were obtained in six. Gallstone extraction was performed in two patients. After POCC, all LAMSs remained stable and no adverse events were observed. Conclusions POCC using a multibending ultraslim endoscope can be effectively and safely performed through a LAMS after EUS-GBD.

Objectives: Vaginal hysterectomy is one of the oldest but still rarely used minimally invasive techniques. Although new surgical methods making use of robots in laparoscopy have been introduced recently, when compared with vaginal hysterectomy, these approaches do not offer significant benefits for the patients and the doctors operating on them. The purpose of this study was a thorough analysis of vaginal removal of non-prolapsed uterus with benign pathology. Material and methods: The analysis included data of 1148 women who underwent vaginal hysterectomy in the Clinic of Surgical, Endoscopic and Oncological Gynecology between 2002 and 2014. A group of patients operated on were assessed, and data from the surgeries were obtained paying attention to such aspects as the operating time, the evaluation of morphotic blood elements, the type of perioperative complications, and the length of postoperative hospital stay. Additionally, all vaginal hysterectomies were divided into groups and analyzed taking into consideration uterus weight. Results: Vaginal hysterectomy was performed even in cases of earlier abdominal surgeries. The mean operating time was and 69.51 ± 28.32 minutes. The patients left hospital after 2.93 days on average. The mean uterus weight was 179.69 ± 113.54 g. What is important, the enlarged uterus was not a significant obstacle during the surgery. In case of heavy uteri of more than 580g, when the fundus of the uterus reached above the navel, the attention was drawn to the need for careful preparatory procedures, which reduced the number of perioperative complications and thus had a significant influence on the length of the operation (p = 0.0170). Conclusions: Vaginal hysterectomy is an operating technique which is relatively easy to perform and safe for the patients because it involves a slight decrease of morphotic blood elements and a small number of mid- and postoperative complications. Vaginal hysterectomy is not a contraindication in case of large uteri, even those of more than 1000 g; however, in such cases, a longer operating time and an increased number of perioperative complications must be taken into consideration.

Objective Postpartum hemorrhage is a leading cause of maternal morbidity and mortality worldwide. Uterine atony is the most common cause of bleeding accounting for ∼80 % of cases of postpartum hemorrhage. To reduce maternal morbidity and mortality due to bleeding caused by uterine atony even under limited resources, a simple and effective procedure that can be easily applied by all obstetricians and junior physicians is required. The aim of this study was to evaluate the efficacy of novel three vertical compression sutures for severe postpartum hemorrhage. Design Two vertical sutures are transfixed, one on each side of the lower uterine segment, from anterior to posterior over the bladder reflection avoiding the endometrial cavity, and tied over the fundus. The lateral sutures should be placed approximately 2 cm from the lateral edge of the lower uterus and approximately 4 cm from the cornual border, because the uterus widens upward from below. The third vertical suture is placed in the midline at the same level as the two vertical sutures, passing the endometrial cavity from anterior to posterior, and is tied in the middle of the fundus, where the three sutures are positioned side-by-side. Results We report 25 cases of postpartum hemorrhage secondary to life-threatening severe uterine atony treated with this novel approach of using three vertical compression sutures. Success was achieved in 24/25 (96 %) of cases treated with three vertical sutures, without requiring hysterectomy except one. Conclusions To reduce maternal morbidity and mortality, three vertical compression sutures as a novel technique, can be attempted before applying other more complex interventions. It does not require any extra skill or training, and is an ideal option as its simplicity allows it to be performed by all obstetricians, including junior obstetric staff.

Following a classical paper by Dr. Keith A. Kelly published in this journal, and over the past 40 years, there has been increased understanding of the functions of different regions of the stomach, specifically the fundus, antrum, and pylorus. Several of the important physiological principles were based on in vivo animal studies that led to the appreciation of regional function and control mechanisms. These include the roles of the extrinsic parasympathetic vagal innervation, the gastric enteric nervous system and electrical syncytium consisting of pacemaker cells and smooth muscle cells, and duodenogastric reflexes providing feedback regulation following the arrival of food and hydrogen ions stimulating the release of hormones and vagal afferent mechanisms that inhibit gastric motility and stimulate pyloric contractility. Further insights on the role of regional motor functions in gastric emptying were obtained from observations in patients following diverse gastric surgeries or bariatric procedures, including fundoplication, Billroth I and sleeve gastrectomy, and sleeve gastroplasty. Antropyloroduodenal manometry and measurements of pyloric diameter and distensibility index provided important assessments of the role of antral hypomotility and pylorospasm, and these constitute specific targets for individualized treatment of patients with gastroparesis. Moreover, in patients with upper gastrointestinal symptoms suggestive of gastroparesis, the availability of measurements of gastric accommodation and pharmacological agents to reduce gastric sensitivity or enhance gastric accommodation provide additional specific targets for individualized treatment. It is anticipated that, in the future, such physiological measurements will be applied in patients to optimize choice of therapy, possibly including identifying the best candidate for pyloric interventions.

Introduction: CHD is a condition, which is frequent in pediatrics in the Caucasian population, remains rare in the Black population, and exceptional in sub-Saharan Africa. The Patient: We report this first Togolese case of bilateral congenital dislocation of the hip associated with genu recurvatum observed in a newborn received on the second day of life. The Primary Diagnoses, Interventions, and Outcomes: The pediatric examination had noted extension of lower limbs. The thighs were in adduction with a stiff bilateral genu recurvatum. The abduction of the thighs on the pelvis was considerably limited. The Barlow and Ortolani maneuvers showed a protrusion. There was also a camptodactyly of the thumbs and a cleft palate. The rest of the examination was normal. Ultrasound of the hip showed a bilateral congenital dislocation of the hip with an estimated acetabular fundus of 7 mm on both the right and left sides. Ultrasound and radiography of the knees were normal. Conclusion: Clinical examination at birth is the key step in diagnosis of congenital hip dislocation. In situations where diagnosis is difficult, ultrasound is of capital importance. Treatment is in the majority of cases orthopedic.

Uterine rupture is a rare but catastrophic complication seen in obstetrical practice. The most crucial predisposing factor is previous caesarean scar and it is generally being reported during labor in patients with scarred uterus. Although rare, rupture of an unscarred uterus is one of the most terrible obstetric complications, resulting in maternal and fetal jeopardy. Shoulder dystocia is one of the most difficult complications of labour that is unpredictable and therefore unpreventable. In neglected cases, grave maternal complications like obstructed labour and rupture of uterus can occur. Very rarely, the reverse, uterine rupture leading to shoulder dystocia can also occur. The present case is reported to emphasize the importance of early recognition of this condition. A 32 year old gravida 5 para 2 live 2 abortion 2 with 9 month period of gestation presented to labor room with shoulder dystocia, with history of fundal pressure. After delivery of head, pain subsided and the trunk failed to deliver. Her previous two deliveries were by normal vaginal delivery 8 years and 5 years back respectively. She had previous two abortions 6 years and 3 years back respectively. Both were spontaneous expulsion followed by dilatation and curettage. On examination, clinical diagnosis of rupture uterus was made and patient was taken up for laparotomy. On laparotomy, fetal body and limbs along with the placenta was seen lying in the abdominal cavity and head was in uterus. Baby of 2.34 kg was extracted as breech. A linear rupture of around 10-12 centimeter was present at fundo-posterior region. Uterus was repaired in 3 layers and bilateral tubal ligation was done. Patient was discharged on post- operative day 10 without any complications.In women with high risk for uterine rupture, delivery must be conducted at tertiary hospitals where facilities for emergency caesarean is available. In these patients, if shoulder dystocia occurs, rupture of the uterus must be suspected as an underlying cause. Assisted fundal pressure during delivery can result in trauma even to the unscarred uterus and cause traumatic uterine rupture. Early diagnosis is vital if maternal morbidity is to be reduced.

We present a case of gastric varices (GV) in the fundus treated by endoscopic ultrasound (EUS)-guided coil deployment with sclerotherapy. A 46-year-old man with a previous history of fatty liver and obesity presented to the emergency department with abdominal pain. Contrast computed tomography (CT) showed chronic liver disease, splenomegaly, and GV. Esophagogastroduodenoscopy (EGD) showed GV in the fundus. Follow-up EGD 6 months later revealed an increase in GV diameter to over 20 mm. Balloon-occluded retrograde transvenous obliteration appeared difficult due to the small caliber of the gastrorenal shunt observed on contrast CT. We performed EUS-guided coil deployment with sclerotherapy. The coil was deployed using a 19-gauge needle under EUS and fluoroscopic guidance. Next, 5% ethanolamine oleate with contrast medium was injected into GV using a 22-gauge needle. GV was reduced without complications, and no GV growth or hemorrhage was observed during 8 months of follow-up.

In this article, we introduce a very low-price smartphone fundus camera device with basic amenities. It has become very fruitful toward undergraduate teaching at the bedside or in the outpatient department, especially where there are no facilities for the fundus camera unit. A fundus camera unit is an essential part of retina clinic, and it is very costly. Fundus photographs are very essential for disease diagnosis, its follow-up, and for disease monitoring. It cannot be carried to the camp side. Commercially, available fundus cameras are the alternative to this, but again very costly. Almost zero price this innovation helps the students to see the fundus pathologies with their own eyes and make them more clinically oriented.

Inversion of the uterus is defined as the turning inside out of the fundus into the uterine cavity. According to the literature, uterine inversion occurs in 1/20,000 or even 1/1,584 deliveries. Mortality rates following acute uterine inversion were reported by some authors to have been as high as 80%. Therefore, it is very important to make an early diagnosis. The shorter the time between the moment of uterine inversion and its repositioning, the better the results of conservative treatment, and bigger chance of avoiding surgical management. The article presents two cases of patients hospitalised in 2010 – 2011 in the Gynaecologic and Obstetrics Department of the Regional Polyclinic Hospital in Kalisz, Central Poland, diagnosed with acute uterine inversion in accordance with the applicable classification. Surgical management was applied in one of the patients. The other patient was managed in a conservative manner. Both women were discharged from the hospital in a good general condition.

Resumen El vaciamiento gástrico normal refleja un esfuerzo coordinado entre diferentes regiones del estómago y el duodeno, y también una modulación extrínseca por parte del sistema nervioso central y factores del intestino distal. Los principales eventos relacionados con el vaciamiento gástrico normal incluyen el fondo de relajación para acomodar la comida, contracciones antrales para triturar partículas grandes de comida, contracción pilórica para permitir la liberación de comida del estómago y coordinación antropiloroduodenal de los fenómenos motores de relajación. La dismotilidad gástrica incluye el vaciamiento tardío del estómago (gastroparesia), vaciamiento gástrico acelerado (síndrome de dumping) y otras disfunciones motoras, como el deterioro del fondo de distensión, que se encuentra con mayor frecuencia en la dispepsia funcional. Los síntomas de la gastroparesia son inespecíficos y pueden simular otros trastornos estructurales. Abstract Normal gastric emptying reflects a coordinated effort between different regions of the stomach and the duodenum, and also an extrinsic modulation by the central nervous system and distal bowel factors. The main events related to normal gastric emptying include relaxation of the fundus to accommodate food, antral contractions to triturate large food particles, the opening of the pyloric sphincter to allow the release of food from the stomach, and anthropyloroduodenal coordination for motor relaxation. Gastric dysmotility includes delayed emptying of the stomach (gastroparesis), accelerated gastric emptying (dumping syndrome), and other motor dysfunctions, e.g., deterioration of the distending fundus, most often found in functional dyspepsia. The symptoms of gastroparesis are nonspecific and may mimic other structural disorders.

Background: The modern cataract surgery involves implantation of posterior chamber intraocular lens (PCIOL) when the posterior capsule is intact. However, in case of weak or no capsular support, PCIOL implantation is not possible. In such situations, implantation of secondary Iris claw lens (ICIOL) or Scleral fixated IOL(SFIOL) remains as treatment options. The aim of this study was to compare the efficacy of ICIOL and SFIOL in terms of visual outcomes and complications in aphakic patients. Methods: This prospective randomized study was done from January 2019 to December 2019. Forty aphakic patients fulfilling inclusion criteria, who attended the ophthalmology outpatient department of VVPF’s Medical college and hospital, Ahmednagar were included in this study. These patients were randomly divided into two groups such as Group 1 included 20 patients who underwent ICIOL implantation and Group 2 included 20 patients who underwent SFIOL implantation. The preoperative and postoperative evaluation was done with visual acuity, slit-lamp examination, IOP, fundus examination for the follow up period of 6 months. Results were analysed with Chi square test and t-test using SPSS software. Results: 85% ICIOL and 80% of SFIOL patients had final Best Corrected Visual Acuity (BCVA) of 6/18-6/6. Surgical time in ICIOL was significantly less than SFIOL group (p=0.00). Suture related complications were significantly more in SFIOL group. However, oval pupil and pigment dispersion were seen more in ICIOL group but were harmless. One patient in SFIOL group developed Cystoid Macular Edema (CME) which persisted till final follow up and 1 haptic of ICIOL was disenclavated which was re-enclavated. Conclusion: Comparable final visual outcome was found between ICIOL group and SFIOL group. However, Implantation of ICIOL required less surgical time with fewer complications and hence is a better alternative to SFIOL implantation in correction of aphakia.

Aim: Needle perforations can present with various clinical manifestations, management depends on the clinical presentation. Our aim is to know the outcome in all cases of needle penetration with different clinical presentation. Study Design: We have done retrospective study of block related globe perforation cases who presented to the vitreo retina Department at Sarojini Devi Eye Hospital. We collected the data of these patients from the medical records who presented during January 2017 to December 2017. Materials and Methods: All patients who presented to our department underwent detailed ocular examination. Apart from history BCVA, slit lamp examination, fundus examination and b scan in patients with hazy media due to vitreous haemorrhage done. Results: Total 11 patients presented to our department, patients with retinal breaks barrage laser done, did not require any further procedure. These patients had good outcome due to peripheral retinal break. 1. Patients with retinal breaks and vitreous haemorrhage without retinal detachment also had good outcome; 2. Patients with retinal detachment and delayed presentation had poor anatomical and visual outcome; 3. Patients with pale retina and patients where retinal detachment (RD) associated with choroidal detachment (CD) had poor visual outcome. Conclusion: Iatrogenic ocular perforation is an ocular emergency, need to be treated immediately to prevent blindness. Keywords: CD, Globe perforation, Retinal break, PVR, RD, VH.

Introduction: Rupture in an unscarred uterus prior to onset of labor in third trimester is a rare event and very few cases have been reported in literature so far. Case Report 1: We describe a case of a primigravida who presented in emergency with pain abdomen with placenta praevia and severe oligominos. An ultrasound was conducted which reported bicornuate unicollis uterus with single live foetus 33+4 weeks having severe oligohydromnios (AFI=2) with placenta anterior and reaching upto internal os in one cornua, the other cornua was empty. A MRI was conducted, which was also inconclusive. She was taken up for laprotomy, peroperatively pregnancy was present in left horn of uterus which had ruptured with intact amniotic sac and was covered with omentum, the placenta was covering the lower half of the left horn and the right horn looked like normal uterus and was empty. The omentum was carefully separated and baby that was delivered weighed 700gms. The left horn was excised and then uterus was closed in layers. Patient was followed up for 6 months, mother was doing well, though baby was 5 kg which was less than the weight for that age and had slow developmental milestones. Case Report 2: Our second case was a 30 years old gravida 5, para 2, abortion 2 woman with 8 months amenorrhea. She was referred with chief complaint of pain abdomen. On examination, she looked almost stable. Even though she was pale; vital signs were within normal parameters. An ultrasound was conducted which showed single live intrauterine foetus 29+2 weeks with absent liquor with placenta praevia with placenta acreta. Emergency laprotomy was decided in view of placenta acreta. It was found to be an abdominal pregnancy. Amnion along with omentum and blood clot matting sac like structure sitting over the fundus with placenta perforating the fundus small incision was given at the fundus and baby weighing 1.15 kg delivered through it. Placenta did not separate and so decision of hysterectomy taken.

Introduction: One of the most important and commonly performed surgeries in the abdominal region is the surgery of gall bladder. Hence it is desirable for the surgeons who are operating in the region of gall bladder and biliary tract to know the possible variations in the anatomy of gall bladder that can be confronted. The present study describes the anatomic variations of gall bladder and its clinical importance. Materials and Methods: 50 gall bladder specimens procured from embalmed human adult cadavers of both sexes available in Anatomy Department of MVJ Medical College, Bangalore were studied. The different parameters studied were the measurements of gall bladder which included its length & breadth, shape, position & external variations. Results: The mean length and breadth of the gall bladder was found to be 6.79 cm& 2.81 cm respectively. The various shapes of the gall bladder noted were pear shaped (52%), flask shaped (28%), cylindrical (12%), irregular (4%) and hour-glass (4%). In 49(98%) specimens, the position of gall bladder was beneath the right lobe of the liver. Gall bladder was intrahepatic in position in 1 (2%) specimen. The external variations of gall bladder observed in 9(18%) specimens were in the form of folding of the neck, folded fundus (phrygian cap) & hartmann’s pouch. Conclusion: The knowledge of the possible anatomic variations of the gall bladder is of utmost significance to radiologists who should detect them preoperatively using special radiological procedures and to surgeons during laparoscopic cholecystectomy to reduce the incidence of post-operative complications. Keywords: Gall Bladder, Hartmann’s pouch, Morphology, Phrygian cap, Variations.

Objective Management of small vestibular schwannomas has evolved to where observation with interval imaging is an accepted treatment strategy. Loss of residual hearing is a known complication of observation. Magnetic resonance imaging (MRI) may provide critical information to assist in determining which tumors are at highest risk of hearing loss. We wished to determine what effect fundal cap size and cochlear fluid-attenuated inversion recovery (FLAIR) signal had on the progression of hearing loss in a large cohort of observed subjects. Study design Retrospective chart review. Setting Tertiary academic referral center. Patients Three hundred ninety-three adults with a vestibular schwannoma who underwent expectant management with serial audiograms and MRI. Interventions Audiogram and MRI. Main outcome measures Hearing outcomes included pure-tone average and word discrimination score (WRS). Cochlear FLAIR signal was measured as a ratio between the affected and nonaffected cochlea. Cerebrospinal fluid fundal cap was measured from the most lateral aspect of the tumor to the fundus of the internal auditory canal. Results An increased cochlear FLAIR ratio was associated with a worse initial WRS (p = 0.0001, β=-0.25). A multivariate regression analysis demonstrated the variables fundal cap and initial WRS to significantly predict change in WRS over time. The larger the fundal cap size, the smaller the change in the WRS (p = 0.047, β=-0.35). Conclusions Cerebrospinal fluid fundal cap size predicts the natural history of hearing in vestibular schwannoma patients. The presence of a smaller fundal cap is correlated with a greater risk of progression of hearing loss and should be a variable considered in the management of small vestibular schwannomas.

We aimed to investigate the hypothesis that preoperative thickness of the abdominal cavity influenced on the gastrojejunostomy position and the incidence of delayed gastric emptying (DGE) after pancreatoduodenectomy.Between January 2009 and December 2018, consecutive patients who underwent subtotal stomach-preserving pancreatoduodenectomy were retrospectively reviewed. Thickness of the abdominal cavity at the level of the celiac axis (TACC) and umbilicus (TACU) were measured using computed tomography before surgery. The ventral deviation of the gastrojejunostomy was evaluated as the sagittal fundus anastomotic angle (SFAA) using sagittal computed tomography images taken after surgery.A total of 281 patients were included. Of these, clinically relevant DGE (CR-DGE) was observed in 47 patients. TACC was significantly correlated with SFAA (R = 0.53, P 0.001). Both TACC and SFAA were significantly greater in patients with CR-DGE compared to those without CR-DGE. In contrast, TACU was not associated with SFAA and the incidence of CR-DGE. Multivariate analysis revealed that TACC110 mm (odds ratio, 3.07; p = 0.002) and pancreatic fistula (odds ratio, 2.71; p = 0.013) were identified as independent risk factors for CR-DGE.Thickness of the upper abdominal cavity had a significant influence on gastrojejunal anatomic position and the development of CR-DGE after pancreatoduodenectomy.

Aims To investigate the uptake rate variance of fundus examination for diabetes-related complications among demographically and geographically diverse communities and examine determinants that influence this rate focusing on outpatient eye care clinic accessibility at community level. Methods Data of 20,904 participants with diabetes from 228 communities in 2015 were collected from the nationwide Community Health Survey and Statistics Korea. Outpatient eye care clinic accessibility was measured by the number of eye clinics per 1000 population. Multilevel analysis was conducted to assess the fundus examination uptake rate across communities and examine the association of individual- and community-level determinants with this rate. Results The uptake rate among patients with diabetes was 34.8% and varied across communities. At the individual level, determinants related to knowledge and awareness were significantly positively associated with fundus examination uptake. At the community level, increases in the number of eye clinics were associated with significant increases in fundus examination uptake (OR 1.21; 95% CI 1.03–1.43). Conclusions Based on the result that outpatient eye care clinic accessibility was significantly associated with the uptake rate across communities, improving accessibility may be an important factor and should be considered when developing interventions for promoting regular diabetic retinopathy screening. This will lead to earlier detection of complications and minimize diabetes-related visual impairment.

To better understand the critically endangered Chinese pangolin (Manis pentadactyla)’s adaptation to highly specialized prey, and to enrich the acknowledge of this species’ natural dietary, we performed anatomic observation and contents analysis on the stomach of an accidental death of Chinese pangolin. The stomach is C-shaped and consists of the cardia, fundus, body, and pylorus, weight 136.5 g, volume 120 mL, and the curve length of lesser and greater curvatures is 9.1 cm and 25.1 cm, respectively. The inner wall of the stomach is covered with the milky layer of mucosa which forms 9–10 spiral folds lapping the cardia and fundus, arranged alternately with ditches and ridges, accounting for approximately 30% of the inner surface of the stomach. These folds are soft to touch and reddish. The inner surface of the greater curvature has a pie-shaped appendix that protrudes and opens into the stomach cavity; it looks like fat tissue and is kermesinus. The pyloric tunica muscularis is thick, and the pyloric sphincter is developed. There is a mulberry-like bulge at the pylorus, named the pyloric pillow, and the pyloric gland lies below it; the pyloric pits are the size of a pen tip. The surface of pyloric pillow and nearby it is covered with yellowish spinous processes and pyloric teeth. The main component of the stomach contents was found to be the diced chitin exoskeletons of Carebara sp. with small amounts of straw, roots, and small stones, which were evenly mixed with stomach juices (pH 3). The fresh weight of the contents was 29.03 g, which accounted for approximately one-quarter of the stomach cavity volume. This study has shown that there was an adaptation of the stomach of Chinese pangolin to its diet.

Background Ectopic spleen is extremely rare. Most cases are congenital, acquired ectopic spleen may be a consequence of surgery or trauma to the spleen. The ectopic spleen in the gastric wall we reported is even rarer. Case presentation We report a 41-year-old female patient, with a past history of splenectomy, who presented with heartburn. Gastroscopy revealed a swelling in the fundus in the stomach. Ultrasonography and computed tomographic examination suggested the possibility of gastrointestinal stromal tumor. We performed endoscopic resection of the mass. Pathological examination of the resected mass showed ectopic spleen. Conclusion When a patient with a history of splenectomy presents with a gastric submucosal tumor, ectopic spleen should also be considered in the differential diagnoses. And minimally invasive endoscopic treatment can achieve the purpose of diagnosis and treatment for unobvious submucosal tumors.

Purpose To present a case of activation of Leber hereditary optic neuropathy (LHON) following head and ocular trauma of the fellow eye in the patient with no remarkable symptoms and normal visual acuity prior to trauma. Case summary A 31-year-old healthy man was referred to our hospital after a traffic accident. He had blowout fractures of medial and inferior orbital wall of the left eye, subcutaneous hematoma of the left forehead, and bony fragment that compressed the left optic nerve. Initially, best-corrected visual acuity (BCVA) was 20/20 in the right and 20/1000 in the left eyes. Relative afferent pupillary defect of the left eye was apparent, and fundus examination revealed choroidal rupture circumferentially crossing the macular area. Nine months later, the patient complained with gradual vision loss in the right eye, which was the contralateral eye of the ocular trauma. BCVA was 20/200, and perimetry revealed cecocentral scotoma in the right eye. BCVA in both eyes reduced to 20/2000 1 year post-trauma. Visual evoked potentials revealed markedly decreased in amplitudes and elongated latencies for both eyes. Mitochondrial DNA analysis revealed a G11778A mutation; therefore, a diagnosis of activation of LHON followed by trauma was made for the previously unaffected carrier. Conclusions This is a case in which activation of LHON occurred in a healthy carrier following head and ocular trauma of the fellow eye. This observation suggests the possibility that LHON activation in healthy carriers may occur in patients who experience head or ocular trauma even in the fellow eye.

Study Objective To evaluate the histology of the uterine septum after its complete hysteroscopic excision. Design Case series. Setting II Gynecological and Obstetric Unit of the University of Bari, Italy and Pathological Anatomy Department of the University of Bari, Italy. Patients 35 patients between 25 and 41 years old diagnosed with uterine septum by 3D ultrasound as per ESHRE/ESGE 2013/Salim 2003 criteria. Office hysteroscopy was also performed to define the anatomy of the uterine cavity and to exclude the presence of other endometrial pathology. Interventions Operative hysteroscopic septum resection was performed. The septum was initially incised with a “L shape” bipolar electrode with the 5 mm Bipolar Mini-Resectoscope (Karl Storz, Germany). Then, using the bipolar loop, two triangles of the septum were excised in parallel, obtaining uninterrupted entire septum-long strips, from the fundus to the apex of the septum. The strips were immediately removed from the uterus and reassembled “in vitro” in order to reconstruct the macroscopic 3D structure of the septum for a complete morphological and histological evaluation. Measurements and Main Results Patients presented an average BMI of 24,8 and were all nulliparous. Histologic evaluation of the uterine septa showed a different conformation of the muscle bundles along the septum. In the apex and edges of the septum, the muscle cells were arranged in nodules circumscribed by a thin area of collagen fibers. Medium size vessels were distributed in the collagen fibers around the muscle cells. Only few capillary vessels are present in the muscle nodules. This pattern is very similar to the cell arrangement of leiomyomas. In the core of the septa, near the base, the muscle bundles show a linear course, with concurrent collagen fibers and vessels. All the above-mentioned characteristics were consistently present in every patient. On high-power histological fields (200x), the muscle portion ranged from 48,3 ± 1,8% (mean 6,0) in the apex and borders, to 48,5 ± 1,3% (mean 6,0) in the core. The collagen fibers ranged from 27.1 ± 1.1% (mean 4,0) in the apex and borders, to 26.7 ± 1.3% (mean 5,0) in the core. Conclusion This study allowed us, by removing the entire septum as a whole structure, to redefine the concept of the septum as a complex structure based on islands of muscle fibers irregularly arranged in vertex, in a context of collagen tissue, similar to the structure of myomas. It appears to deeply involve the anterior and posterior uterine wall, resembling a “reverse letter H”.

Hysteropexia abdominalis anterior - suturing of the uterus to the anterior abdominal wall is a relatively new operation. Although it was first adopted by Koeberl) back in 1869, it was forgotten until the 80s. The free Coeberl suffered from strong constipation, which did not give in to any cure, the cause of which Koeberl saw in the pressure on the rectum of the bent back of the uterus. The patient reached such a state that energetic intervention was necessary. In view of these indications, Koeberl decided to make the womb and to strengthen the uterus in the abdominal wound in such a position that its body could not be thrown backwards. Opening the abdominal cavity, the operator removed the healthy ovary; the resulting leg, i.e. broad ligament, tube and lig. ovarii sewed it into the abdominal wound. The result was satisfactory. Ten years later, Schroeder) performed this operation on a patient with a posterior bend of the uterus and a small ovarian cyst, accompanied, in addition, by the dance of St. Witt. After removing the cyst, he sewed the leg to the anterior abdominal wall. In 1880, L. Tait) performed two operations, one in February, the other in April. In both cases, it was about the backward bends; In addition, the patients suffered from ovarian inflammation, which did not respond to any other methods of treatment. The operator removed the inflamed, slightly enlarged ovaries, lifted the uterus and, when suturing the abdominal wound, passed the needle so that it captured part of the tissue in the area of ​​the fundus of the uterus and, thus, sewed the fundus of the uterus to the abdominal wall. In both cases, the results were satisfactory, at least until 1883. In 1881, he also, in one case of persistent retroflexio uteri, performed a blanching and a ligament of the right ovary and a left wide ligament in the belly. This case is cited by Snger in Centr. f.Gyn. 1888, No. 2.

Background Postpartum hemorrhage is a leading cause of maternal morbidity and mortality worldwide, with uterine atony responsible in 80% of cases. In intractable cases, hysterectomy is the final treatment, but it has complications. Many doctors in developing countries with high maternal mortality rates from postpartum hemorrhage can perform cesarean deliveries but cannot perform hysterectomy. Patients with postpartum hemorrhage who need hysterectomy in these countries will die in such cases, whereas, if doctors know this simple, easily learned technique, such patients may survive. Technique Esike's technique is a uterine-compression method that uses supplies generally available at delivery hospitals. Six sutures are placed in the lower uterine segment, three anteriorly and three posteriorly. Starting with the middle sutures, the sutures are tied at the fundus with the help of an assistant to provide uterine compression. The more laterally placed sutures are then tied similarly, resulting in uterine compression and stoppage of postpartum hemorrhage. Experience Esike's technique was used in controlling life-threatening, uncontrollable postpartum hemorrhage in 18 women and was successful in 16 (89%) without requiring hysterectomy. Conclusion Esike's technique is effective in controlling life-threatening postpartum hemorrhage and can be used in low-resource settings with commonly available supplies and performed by doctors with a common level of training.

Intrauterine devices (IUDs) are the most commonly used method of long-acting reversible contraception. IUD malpositions are described as expulsion, embedding, displacement, and perforation, which may cause contraception failure, organ injury, hemorrhage, and infection. The aim of the study was to evaluate the relationship between displacement and IUD positioning in the uterus, and uterine dimensions as measured using transvaginal ultrasonography. Three-hundred and eighty-four patients who had TCu380A devices inserted at a tertiary hospital were evaluated at insertion and at 1 month, 3 months, and 6 months after insertion. At the insertion visit, demographic characteristics, history of menorrhagia, dysmenorrhea, previous IUD displacement, and obstetric history were recorded. Transvaginal ultrasonographic measurement of the uterine cavity, uterine length, uterine width, cervix length, cervix width, transverse diameter of the uterine cavity, the distance between the tip of the IUD and the fundus, and endometrium were measured to evaluate IUD displacement. Sixteen of 384 patients had displacement. There were significant differences in times between last pregnancy outcomes and IUD insertion and dysmenorrhea history (p = 0.004 and p = 0.028, respectively). Among TCu380A users, women with 7.5 mm IUD endometrium distances had a higher risk for displacement with a sensitivity of 81% and specificity of 37.5% (AUC: 0.607, 95% CI 0.51-0.70). Women with uterus width less than 41.5 mm were more likely to have displacement with a sensitivity of 53.8% and a specificity of 75% (AUC: 0.673, 95% CI 0.60–0.75). IUD endometrium distance and uterus width are important parameters for displacement for TCu380A.

Our aim is to demonstrate the feasibility of real-time ultrasound-assisted insertion of the Elipse® intragastric balloon for the treatment of overweight and obese patients. A plastic gastric phantom filled with water was created to mimic the gastric lumen and to test the operator’s ability to recognize the capsule containing the balloon inside. In the clinical phase, we tested the operator’s ability to recognize the swallowed capsule and its progressive filling in the gastric lumen by means of ultrasound in 36 consecutive patients with a mean body mass index of 35 in an outpatient setting. The ultrasound hyperechoic signal of the capsule in the gastric lumen was visible early on and was confirmed after the injection of a few milliliters of saline solution in the capsule with a cyst-like shape. The insertion of the balloon was successful in all cases at the first attempt, and the complete filling was monitored in real-time without the need for fluoroscopy. Postprocedure symptoms were limited to the first 24–48 h and were controlled by symptomatic therapy; endoscopic removal of the balloon because of painful distal gastric migration was necessary in one case after 3 months. After a learning curve, we were able to demonstrate the placement of the balloon capsule inside the fundus of the stomach under ultrasound guidance without fluoroscopy in all patients in an outpatient setting.

We performed a retrospective cohort study including people diagnosed with diabetes from 2006 to 2015 according to the Korean National Health Insurance Service-National Sample Cohort database, to analyze the changes in the prevalence, screening rate, and treatment patterns for diabetic retinopathy (DR) over 10 years. The proportion of people who underwent fundus screening for DR steadily increased over the past decade. The prevalence of DR increased from 13.4% in 2006 to 15.9% in 2015, while that of proliferative DR steadily decreased from 1.29% in 2006 to 1.16% in 2015. The proportion of patients undergoing retinal photocoagulation constantly decreased. The prevalence of DR increased over the past decade, while its severity seemed to have improved, with a decreased rate of proliferative DR and retinal photocoagulation. A higher proportion of patients underwent ophthalmic screening using fundus examination, but still less than 30% of patients with diabetes underwent comprehensive examination in 2015.

A mass lesion of the gastric cardia or fundus causing an alteration in the normal regular, translucent gastric fundal air shadow on a frontal erect chest radiograph is referred to as “the Kirklin sign.” Here we present “Pseudo-Kirklin sign” observed on the frontal radiograph of a 46-year-old male patient due to a soft tissue shadow/contour deformity of the fundal gas shadow caused by pseudocyst of the pancreas. We evaluated the patient using plain radiography, contrast enhanced computed tomography, magnetic resonance imaging, and endoscopic ultrasound (EUS) with the cyst drained under EUS guidance. So far only two cases of mediastinal pseudocysts have been drained successfully by EUS-guided aspiration.

The aim of this study was to clarify the muscular architecture of the abdominal part of the esophagus and the stomach. This study investigated 60 embalmed Korean adult cadavers. The circular and oblique fibers of the stomach that originated from the abdominal part of the esophagus crossed each other in the cardia. The arrangement of the circular fibers of the stomach differed between its anterior and posterior surfaces in all specimens (100%). On the posterior surface of the stomach, the circular and longitudinal fibers on the greater curvature merged and ran parallel toward the fundus. The three layers of the musculature of the stomach have different arrangements in different regions of the stomach and are connected to each other. Understanding the muscular architecture of the stomach and the abdominal part of the esophagus can be helpful when evaluating stomach motility and performing various types of gastrectomy. Clin. Anat. 33:530-537, 2020. © 2019 Wiley Periodicals, Inc.

Elevated levels of serum uric acid (SUA) were considered to be risk factors for cardiovascular disease, it has been found to be associated with increased arteriosclerosis. The aim of this study was to explore the gender specific relationship between SUA and fundus arteriosclerosis in a healthy population. In a retrospective cross-sectional study, 23474 individuals without diabetes and hypertension were included in the present study. SUA levels were cut to four groups as Q1 to Q4, according to the quartiles. The odds ratio and 95% confidence interval of different SUA levels were estimated by a binomial logistic regression model. A restrictive cubic spline method was used to estimate the dose-response relationship between SUA and fundus arteriosclerosis. Subgroup analysis was performed to find the gender-specific association between SUA and incident fundus arteriosclerosis. In males, after adjusting for confounding factors, the highest SUA level was significantly associated with the risk of incident fundus arteriosclerosis. The OR with 95%CI for Q4 was 1.44(1.18, 1.76), Q1 as a reference. Specially, for females, SUA level was not associated with the incidence of fundus arteriosclerosis. In conclusion, elevated levels of SUA were associated with the incidence of fundus arteriosclerosis in males, but not in females.

Introduction. The pathogenesis of dysbacterioses associated with antibiotic therapy is an urgent medical problem, although some other exogenous and endogenous factors may contribute to the microbiocenosis distortion in the host organism. Purpose. The paper was aimed at studying the morphofunctional state of the stomach and caecum of albino rats after the course of clarithromycin. Material and methods. 30 mature albino male rats weighting 200,0±20,0 g were involved into the experiment. Antibiotic was given to the rodents as a food supplement during their two-meals-a-day feeding. Portions of the stomach and caecum have been studied. Serial paraffin sections were analyzed by using the “Konus” light microscope. Morphometric characteristics of the tissue structures were obtained by the Sigeta X 1 mm/100 Div.x0.01mm stage micrometer. Results and conclusions. In 12 out of 30 subjects, the comparative volume of the caecum was almost twice as less than the volume of the stomach due to a significant enlargement of its fundus, caused by isometric flattening and convergence between its mucous membrane and muscular tunic. In 18 experimental animals, the volumetric capacity of the caecum was twice as larger than the stomach. In contrast, a decrease in the volume of the cecum is associated with a thickening of its wall and increased formation of folds of the mucous membrane that is, probably, caused by insufficient entering of metabolic by-products from the small intestine.

Background Gastric bronchogenic cysts (BCs) are extremely rare cystic masses caused by abnormal development of the respiratory system during the embryonic period. Gastric bronchial cysts are rare lesions first reported in 1956; as of 2019, only 37 cases are available in the MEDLINE/PubMed online databases. BCs usually have no clinical symptoms in the early stage, and their imaging findings also lack specificity. Therefore, they are difficult to diagnose before histopathological examination. Case summary A 55-year-old woman presented at our hospital with intermittent epigastric pain. She had a slightly high level of serum carbohydrate antigen 72-4 (CA 72-4). Endoscopic ultrasound found that a cystic mass originated from the submucosa of the posterior gastric wall near the cardia, indicating a diagnosis of cystic hygroma of the stomach. Furthermore, a computed tomography scan demonstrated a quasi-circular cystic mass closely related to the lesser curvature of the gastric fundus with a low density. Because the imaging examinations did not suggest a malignancy and the patient required complete resection, she underwent laparoscopic surgery. As an intraoperative finding, this cystic lesion was located in the posterior wall of the fundus and contained some yellow viscous liquid. Finally, the pathologists verified that the cyst in the fundus was a gastric BC. The patient recovered well with normal CA 72-4 levels, and her course was uneventful at 10 mo. Conclusion This is a valuable report as it describes an extremely rare case of gastric BC. Moreover, this is the first case of BC to present with elevated CA 72-4 levels.

In recent years, the development of Assisted Reproductive Technique, the egg and embryo donation changed substantially the role of the uterus in recent years. It provided a higher chance for a pregnancy even in women over 45 years or post-menopause. In fact, the number of aged patients and in peri/post-menopause in pregnancy is nowadays increasing, but it increases obstetrical and neonatal related problems. The human uterus is richly innervated and modified especially during pregnancy and labor, and it is endowed with different sensory, parasympathetic, sympathetic and peptidergic neurofibers. They are differently distributed in uterine fundus, body and cervix, and they are mainly observed in the stroma and around arterial vessel walls in the myometrial and endometrial layers. Many neurotransmitters playing important roles in reproductive physiology are released after stimulation by adrenergic or cholinergic nerve fibers (the so called sympathetic/parasympathetic co-transmission). Immunohistochemical study demonstrated the localization and quantitative distribution of neurofibers in the fundus, the body and cervix of young women of childbearing age. Adrenergic and cholinergic effects of the autonomous nervous system are the most implicated in the uterine functionality. In such aged women, the Adrenergic and AChE neurofibers distribution in the fundus, body and cervix is progressively reduced by increasing age. Adrenergic and AChE neurotransmitters were closely associated with the uterine arteries and myometrial smooth muscles, and they reduced markedly by ageing. The Adrenergic and AChE neurofibers decreasing has a dramatical and negative impact on uterine physiology, as the reduction of pregnancy chance and uterine growth, and the increase of abortion risk and prematurity.

Ultra–wide-field imaging and ultra–wide-field intravenous fundus fluorescein angiography using Optos 200Tx reveal the characteristics of retinopathy of prematurity at different stages, which have the potential to screen, diagnose, and follow-up for retinopathy of prematurity., Purpose: To determine the feasibility of ultra–wide-field imaging and ultra–wide-field intravenous fundus fluorescein angiography (UWF-IV-FFA) in infants with retinopathy of prematurity (ROP) using Optos 200Tx. Methods: We performed Optos 200Tx capturing on 32 premature infants (14 females) and UWF-IV-FFA with Optos 200Tx on 12 of the 32 infants between April 2017 and July 2018 at the affiliated eye hospital of Wenzhou Medical University and analyzed their fundus images. Results: Ultra–wide-field color images were acquired from 32 infants (64 eyes). UWF-IV-FFA was performed successfully in 12 premature infants (24 eyes). No adverse events were observed. The ultra–wide-field Optos 200Tx color images and UWF-IV-FFA images revealed Stages 1, 2, and 3 ROP and aggressive posterior ROP. Conclusion: Ultra–wide-field imaging and intravenous fundus fluorescein angiography using Optos 200Tx are feasible in infants with ROP, which have the potential to screen, diagnose, and follow-up for ROP.

Background: Iris microhemangiomatosis is a rare vascular iris tumor, with potential severe complications such as increased intraocular pressure (IOP). We aim to describe a case report of a patient presenting with hyphema secondary to iris microhemangiomatosis triggered by excessive high blood pressure. Case Presentation: A 74-year-old woman was treated for hypertensive crisis. After her high blood pressure had been controlled and stabilized, she was discharged home. However, the same day, she complained about an acute decrease in vision in her left eye. Best corrected visual acuity was 20/20 on the right eye and 20/200 on the left eye. On biomicroscopy, a hyphema was seen. Iris neovascularization was absent, IOP and fundus examination were normal. After spontaneous resolution of the hyphema, a fluorescein angiography of the anterior segment was performed, which revealed bilateral subtle early hyperfluorescence with late staining scattered at the pupillary margin. The patient was diagnosed with iris microhemangiomatosis. During the follow-up of 24 months, the blood pressure was stable and well controlled. The patient did not experience any recurrent hemorrhage. Discussion and Conclusion: Spontaneous hyphema is the most common complication of iris vascular tumors. We report the occurrence of a spontaneous hyphema triggered by uncontrolled blood pressure in a patient with a very rare condition, i.e., iris microhemangiomatosis. In order to avoid complications of microhemangiomatosis such as uncontrolled glaucoma or recurrent bleeding requiring surgery, blood pressure should be monitored closely and controlled.

Summary Background and aim Endoscopic submucosal dissection (ESD) of gastric stromal tumors is becoming increasingly common. However, there have been few studies analyzing the therapeutic efficacy and safety of this technique on large (≥ 3 cm) gastric stromal tumors (LGSTs). The aim of this study was to determine the feasibility of ESD for the removal of LGSTs and to investigate the clinical safety and efficacy of ESD for this indication. Methods A retrospective analysis was carried out on 82 patients with LGSTs who underwent an ESD. Data on therapeutic outcomes and follow-up were collected for an analysis of the rates of en block resection and complete resection. A logistic regression model was used to identify potential risk factors for ESD-related complications, and a receiver operating characteristic (ROC) curve was generated for qualifying independent risk factors. Results En bloc resection was achieved in 81 lesions (98.8%), and complete resection was achieved in 80 lesions (97.6%). The rates of intraoperative and postoperative bleeding were 6.1% and 3.7%, respectively. The accidental perforation rate was 12.2%, the postoperative perforation rate was 3.7%, the intentional perforation rate was 28.0%, and the postoperative infection rate was 12.2%. There was no postoperative mortality. LGSTs originating from the deep muscularis propria (MP) layer (OR = 4.905, 95% CI: 1.362–17.658, P = 0.015), located at the gastric fundus (OR = 4.927, 95% CI:1.308–18.558, P = 0.018) and with an irregular shape (OR = 4.842, 95% CI: 1.242–18.870, P = 0.023) increased the rate of complications. The prediction model that incorporated these factors demonstrated an area under the ROC curve of 0.77 (95% CI: 0.66–0.89). No tumor recurrence or distant metastasis was observed during the follow-up period, which ranged from 6–36 months. Conclusions ESD is a feasible, safe, effective and minimally invasive approach for the resection of LGSTs. Tumors originating from the deep MP layer, located at the fundus and with an irregular shape were identified as risk factors for the development of complications.

BACKGROUND Gestational hypertension is a disorder of blood pressure that arises because of presence of pregnancy and the visual system may be involved. We wanted to estimate the prevalence of retinopathy in Pregnancy Induced Hypertension, and find the correlation between the fundus changes with the level of hypertension. METHODS This hospital based prospective study was conducted between January 2016 to August 2017 at the SRM MCH & RC, a suburban tertiary care hospital at SRM university campus. Pupils were dilated with 0.5% tropicamide eye drops and fundus examination done with direct ophthalmoscope. All available demographic data of fundus findings of pregnancy induced hypertension patients visiting the hospital during the study period were examined and recorded. RESULTS Mean age of the population in our study was 22.61 ± 2.76 years with a range of 21 – 25 years. 67 (67%) were primigravidae and 33 (33%) were multigravidae. Fundus findings were seen in 23 (23%) cases with Pregnancy Induced Hypertension. Grade I changes were seen in 13 cases (13%), Grade II changes were seen in 5 case (5%) and Grade III changes were seen in 3 cases (3%). Bilateral serous retinal detachment (grade-IV) was seen in 2 cases (2%). CONCLUSIONS Ophthalmoscopy should be done routinely in all cases of PIH to interpret the vascular changes. Though the definitive management will depend on other factors, a suggestive diagnosis by fundoscopy will guide the obstetric management of the patient.

Highlights • Ischemic gastric necrosis could be provoked by acute gastric dilatation. • Early diagnosis is crucial to increase survival from fundic gastric necrosis. • Conservative treatments should be considered as first-line management. • Surgical treatment is advised when massive gastric necrosis is encountered., Introduction Gastric fundus ischemia is a rare event, which does not account for many significant clinical studies. This disorder could have different etiologies, but authors agree that a prompt diagnosis and a proper treatment could avoid dangerous complications and ultimately the death of the patient. Presentation of case We herein report an interesting idiopathic case of acute gastric dilatation and fundus ischemia of an 83-year-old Caucasic woman who was admitted to the Emergency Department complaining of abdominal discomfort, vomiting and constipation. Discussion In literature, only a few case reports about this condition are reported. Possible risk factors, etiologies, and the different therapeutic options available for this condition are examined, in order to try to favor clinicians to formulate a timely diagnosis and provide patients with rapid healthcare services. Conclusion Further investigations are still needed to analyze the pathophysiological pathways responsible of gastric fundus ischemia and to provide a definitive treatment to this dangerous disorder.

Diabetics is a severe disease which affects the different parts of the human body. Due to variations of sugar level the blood vessels present in the retina get damaged. This disease is known as Diabetic Retinopathy (DR). Early identification of diabetic retinopathy will prevent vision loss. Exudates, Haemorrhages, Micro aneurysms are the primary symptoms of Diabetic Retinopathy. To diagnose the abnormalities, the ophthalmologists use fundus images which are captured after applyingdrugs inside the patient’s eye. These drugsmay causeinconvenience to the patient’s eyes. So we developed an automatedsystem to detect retinal lesions with help of non-dilated retinal fundus images. In our proposed system pre-processed images are segmented by new technology called region growing method. In this approach after pre-processing step, certain features are extracted by using Gabor Wavelet method. Adaptive boosting classifier is proposed to investigate the abnormality level of the disease. This result is compared with various segmentation techniques. This method achieved sensitivity of 100% and specificity of 98.8% with accuracy of 98.4%.

The mechanical properties of the stomach wall help to explain its function of storing, mixing, and emptying in health and disease. However, much remains unknown about its mechanical properties, especially regarding regional heterogeneities and wall microstructure. Consequently, the present study aimed to assess regional differences in the mechanical properties and microstructure of the stomach wall. In general, the stomach wall and the different tissue layers exhibited a nonlinear stress-stretch relationship. Regional differences were found in the mechanical response and the microstructure. The highest stresses of the entire stomach wall in longitudinal direction were found in the corpus (201.5 kPa), where food is ground followed by the antrum (73.1 kPa) and the fundus (26.6 kPa). In contrast, the maximum stresses in circumferential direction were 39.7 kPa, 26.2 kPa, and 15.7 kPa for the antrum, fundus, and corpus, respectively. Independent of the fibre orientation and with respect to the biaxial loading direction, partially clear anisotropic responses were detected in the intact wall and the muscular layer. In contrast, the innermost mucosal layer featured isotropic mechanical characteristics. Pronounced layers of circumferential and longitudinal muscle fibres were found in the fundus only, whereas corpus and antrum contained almost exclusively circumferential orientated muscle fibres. This specific stomach structure mirrors functional differences in the fundus as well as corpus and antrum. Within this study, the load transfer mechanisms, connected with these wavy layers but also in total with the stomach wall’s microstructure, are discussed. Statement of significance This article examines for the first time the layer-specific mechanical and histological properties of the stomach wall attending to the location of the sample. Moreover, both mechanical behaviour and microstructure were explicitly match identifying the heterogeneous characteristics of the stomach. On the one hand, the results of this study contribute to the understanding of stomach mechanics and thus to their functional understanding of stomach motility. On the other hand, they are relevant to the fields of constitutive formulation of stomach tissue, whole stomach mechanics, and stomach-derived scaffolds i.e., tissue-engineering grafts.