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Nature Jun 2024The subpectoral diverticulum (SPD) is an extension of the respiratory system in birds that is located between the primary muscles responsible for flapping the wing. Here...
The subpectoral diverticulum (SPD) is an extension of the respiratory system in birds that is located between the primary muscles responsible for flapping the wing. Here we survey the pulmonary apparatus in 68 avian species, and show that the SPD was present in virtually all of the soaring taxa investigated but absent in non-soarers. We find that this structure evolved independently with soaring flight at least seven times, which indicates that the diverticulum might have a functional and adaptive relationship with this flight style. Using the soaring hawks Buteo jamaicensis and Buteo swainsoni as models, we show that the SPD is not integral for ventilation, that an inflated SPD can increase the moment arm of cranial parts of the pectoralis, and that pectoralis muscle fascicles are significantly shorter in soaring hawks than in non-soaring birds. This coupling of an SPD-mediated increase in pectoralis leverage with force-specialized muscle architecture produces a pneumatic system that is adapted for the isometric contractile conditions expected in soaring flight. The discovery of a mechanical role for the respiratory system in avian locomotion underscores the functional complexity and heterogeneity of this organ system, and suggests that pulmonary diverticula are likely to have other undiscovered secondary functions. These data provide a mechanistic explanation for the repeated appearance of the SPD in soaring lineages and show that the respiratory system can be co-opted to provide biomechanical solutions to the challenges of flight and thereby influence the evolution of avian volancy.
Topics: Animals; Flight, Animal; Pectoralis Muscles; Wings, Animal; Lung; Birds; Hawks; Respiratory System; Biomechanical Phenomena; Biological Evolution; Models, Biological
PubMed: 38867039
DOI: 10.1038/s41586-024-07485-y -
BMC Urology Jun 2024Various complications following hypospadias surgery present distinct manifestations when examined with ultrasound. Utilizing high-frequency ultrasound, clinicians can...
PURPOSE
Various complications following hypospadias surgery present distinct manifestations when examined with ultrasound. Utilizing high-frequency ultrasound, clinicians can promptly identify these complications and initiate appropriate treatment. The aim of this study is to catalogue the ultrasonographic presentations of various postoperative complications following hypospadias surgery, thereby providing a reference for ultrasonographic diagnosis.
METHODS
Ultrasonic images of post-hypospadias surgery from October 1, 2015, to June 30, 2023, recorded at the Plastic Surgery Hospital of the Chinese Academy of Medical Sciences, serve as the basis for this investigation. Drawing on patient clinical diagnoses, this study compiles and selects representative ultrasound images of diverse complications.
RESULTS
The study encompassed a total of 121 subjects; 26 demonstrated urethral stricture on ultrasonic images, two presented local urethral dilation, six showed intraurethral hair-like structures, 17 revealed intraurethral septum, two exhibited intraurethral fold, one had urethral calculus, one displayed urethral calcification, 12 indicated intraurethral urine accumulation, and two showed urethral diverticulum.
CONCLUSION
Ultrasound examination is helpful for postoperative diagnosis following hypospadias, detecting complications such as urethral stricture, urethral hair growth, and urethral diverticulum, which can help doctors choose appropriate clinical treatment strategies.
Topics: Humans; Hypospadias; Male; Postoperative Complications; Ultrasonography; Child, Preschool; Infant; Child; Urethral Stricture; Adolescent; Urethral Diseases; Retrospective Studies
PubMed: 38862925
DOI: 10.1186/s12894-024-01491-y -
Cirugia Y Cirujanos 2024Superior mesenteric artery syndrome (SMAS) is a rare cause of duodenal obstruction which is characterized by compression of the duodenum due to narrowing of the space... (Review)
Review
Superior mesenteric artery syndrome (SMAS) is a rare cause of duodenal obstruction which is characterized by compression of the duodenum due to narrowing of the space between the superior mesenteric artery and aorta. Incomplete duodenal obstruction due to SMAS in neonates is rarely reported in the literature. In this case, it is a full-term 2-day-old male with the complaint of recurrent vomiting starting soon after birth. The patient was diagnosed with SMAS and duodenoduodenostomy was performed. Accompanying Meckel's diverticulum was excised.
Topics: Humans; Meckel Diverticulum; Superior Mesenteric Artery Syndrome; Male; Infant, Newborn; Duodenostomy; Duodenal Obstruction; Vomiting
PubMed: 38862114
DOI: 10.24875/CIRU.22000281 -
Cureus May 2024Lemmel syndrome, characterized by biliary and pancreatic duct obstruction secondary to a periampullary duodenal diverticulum (PAD), remains a rare and often overlooked...
Lemmel syndrome, characterized by biliary and pancreatic duct obstruction secondary to a periampullary duodenal diverticulum (PAD), remains a rare and often overlooked diagnosis. Although duodenal diverticula are found in approximately 23% of the population, only about 5% of these cases lead to complications such as obstructions. A new case of Lemmel syndrome is demonstrated in the article about a middle-aged woman with chronic epigastric pain and right upper abdominal quadrant initially misdiagnosed as cholelithiasis. The accuracy of diagnosis was made possible by multimodal imaging methods, such as ultrasound, magnetic resonance cholangiopancreatography (MRCP), and computed tomography (CT) with oral contrast when a diffuse common bile duct was compressed by a PAD. Additionally, it highlights the necessity of including Lemmel syndrome in cases where patients have dilated bile ducts without calculi or mass lesions while emphasizing advanced imaging techniques for the revelation of structural malformations that underlay these conditions. The endoscopic intervention was minimally invasive but effective in relieving symptoms through sphincterotomy followed by laparoscopic cholecystectomy and biliary stent placement, thus making a point of the need for multiple disciplinary approaches toward treatment rare phenomenon like this one. This case report not only sheds light on the diagnostic and therapeutic avenues for Lemmel syndrome but also serves as a valuable educational resource for healthcare professionals. It emphasizes the need for heightened clinical vigilance and the adept use of imaging modalities in cases of biliary obstruction with obscure etiology. By contributing to the growing knowledge of this rare condition, we aim to facilitate timely diagnosis and optimize patient outcomes.
PubMed: 38860101
DOI: 10.7759/cureus.60097 -
Cureus May 2024The most prevalent congenital gastrointestinal tract abnormality is Meckel's diverticulum. It is discovered in most instances incidentally. It can be observed as...
The most prevalent congenital gastrointestinal tract abnormality is Meckel's diverticulum. It is discovered in most instances incidentally. It can be observed as painless bleeding in the gastrointestinal tract. However, it can occasionally result in acute intestinal obstruction, which frequently masks the actual clinical presentation. This is a case of a four-and-a-half-year-old male child who presented with features of obstruction, which, on further evaluation, revealed ileoileal intussusception. An emergency surgical intervention was planned with an exploratory laparotomy and a reduction of intussusception. This case emphasizes the urgency of diagnosing and managing intussusception to prevent serious consequences such as bowel ischemia, bowel necrosis, bowel perforation, peritonitis, and sepsis. It stands as a stark reminder for medical professionals to stay vigilant for these critical gastrointestinal emergencies, and immediate treatment with a multidisciplinary approach is recommended to significantly enhance patient outcomes.
PubMed: 38860094
DOI: 10.7759/cureus.60073 -
Gastrointestinal Endoscopy Jun 2024Submucosal tunneling endoscopic septum division (STESD) is a valid endoscopic modality for treating esophageal diverticula. However, it requires highly skilled...
BACKGROUND AND AIMS
Submucosal tunneling endoscopic septum division (STESD) is a valid endoscopic modality for treating esophageal diverticula. However, it requires highly skilled endoscopists. Here we propose a modified STESD method.
METHODS
This is a single center prospective case series. We consecutively enrolled 8 patients diagnosed with esophageal diverticula. All the patients underwent the modified STESD by one experienced endoscopist.
RESULTS
Only one patient had intraoperative bleeding and was successfully stopped endoscopically. The size of the diverticula were 3.16 ± 1.14 cm as mean ± SD. The operation time ranged from 27 to 68 min with the mean value of 40.88 min. The number of clips ranged from 4 to 8. The success rate was 100%. None of the patients had symptom recurrences during 2 - 25 months of follow-up.
CONCLUSIONS
The modified STESD method for esophageal diverticula is effective and safe, further large prospective controlled studies are needed.
PubMed: 38851455
DOI: 10.1016/j.gie.2024.05.025 -
Obstetrics and Gynecology Jun 2024Ectopic prostatic tissue in female patients is rare. It is theorized that the presence of prostatic tissue in female patients is likely a Wolffian remnant or...
BACKGROUND
Ectopic prostatic tissue in female patients is rare. It is theorized that the presence of prostatic tissue in female patients is likely a Wolffian remnant or transformation of hormonally mediated tissue of the uterus, cervix, Skene's gland, and, rarely, periurethral tissue. Due to the increase in the use of testosterone and gender-affirming therapies, it is important to understand the role of testosterone in mediating the presence of ectopic prostatic tissue.
CASE
We present a case of ectopic prostatic tissue in a urethral diverticulum in a female patient with exposure to testosterone hormone therapy and review the literature on this finding.
CONCLUSION
Although rare, ectopic prostatic tissue should be considered in the differential diagnosis of anterior vaginal cysts, especially in the setting of testosterone supplementation.
PubMed: 38843528
DOI: 10.1097/AOG.0000000000005638 -
Surgical Neurology International 2024C5 palsy (C5P) is a recognized potential postoperative complication of cervical spine surgery but has rarely been reported following an open esophageal diverticulectomy.
BACKGROUND
C5 palsy (C5P) is a recognized potential postoperative complication of cervical spine surgery but has rarely been reported following an open esophageal diverticulectomy.
METHODS
A 61-year-old underwent an open esophageal diverticulectomy for symptomatic Zencker's diverticulum.
RESULTS
Postoperatively, she presented with right upper extremity weakness and sensory deficits consistent with a C5P that was later confirmed by electromyography.
CONCLUSION
The potential for C5P after esophageal diverticulectomy for symptomatic Zencker's diverticulum is rare. Postoperative recognition and appropriate management are critical to recovery.
PubMed: 38840618
DOI: 10.25259/SNI_264_2024 -
The American Journal of Case Reports Jun 2024BACKGROUND We present an exceptional case of asystole and tracheal diverticulum rupture as a result of cardiopulmonary resuscitation (CPR) immediately following...
BACKGROUND We present an exceptional case of asystole and tracheal diverticulum rupture as a result of cardiopulmonary resuscitation (CPR) immediately following laparoscopic cholecystectomy performed at Riga 1st Hospital. Tracheal rupture after tracheal intubation is a severe but very rare complication that can be fatal. We present an incidental finding of the tracheal diverticulum and its rupture during CPR. CASE REPORT A 71-year-old woman (American Society of Anesthesiologists class II, body mass index 28.58) underwent a planned laparoscopic cholecystectomy. Preoperative chest X-ray showed no abnormalities. Endotracheal intubation was performed, with the first attempt with a 7-mm inner diameter cuffed endotracheal tube without an introducer. Five minutes after rapid desufflation of the pneumoperitoneum, severe bradycardia and hypotension occurred, followed by asystole. CPR was performed for a total of 2 min, until spontaneous circulation returned. Twenty hours after surgery, subcutaneous emphysema appeared on the chest. Computed tomography scan of the chest revealed subcutaneous neck emphysema, bilateral pneumothorax, extensive pneumomediastinitis, and a pocket-like, air-filled tissue defect measuring 10×32 mm in the distal third of the trachea, with suspected rupture. Two hours after the diagnosis was established, the emergent surgery was performed. The patient was completely recovered after 15 days. CONCLUSIONS Our case illustrates that tracheal diverticula is sometimes diagnosed by accident and too late, which then can lead to life-threatening situations. Tracheal rupture can be made not only by mechanical piercing by an endotracheal tube but also during interventions, such as CPR. Rapid desufflation of the pneumoperitoneum can lead to asystole, induced by the Bezold-Jarisch reflex.
Topics: Humans; Aged; Female; Cholecystectomy, Laparoscopic; Diverticulum; Tracheal Diseases; Intubation, Intratracheal; Cardiopulmonary Resuscitation; Heart Arrest; Rupture; Rupture, Spontaneous
PubMed: 38840414
DOI: 10.12659/AJCR.943639 -
Journal of Nuclear Medicine Technology Jun 2024In a 32-y-old man with neurofibromatosis type 1, F-FDG PET/CT incidentally revealed a vesicourachal diverticulum, a rare anatomic variant. The PET/CT, performed for...
In a 32-y-old man with neurofibromatosis type 1, F-FDG PET/CT incidentally revealed a vesicourachal diverticulum, a rare anatomic variant. The PET/CT, performed for staging a malignant peripheral nerve sheath tumor, highlighted a distinctive F-FDG-avid pattern crucial for accurate diagnosis. Recognizing such features enhances disease assessment and clarifies distinctions between benign urogenital anomalies and malignancies in F-FDG PET/CT staging.
Topics: Humans; Positron Emission Tomography Computed Tomography; Fluorodeoxyglucose F18; Incidental Findings; Male; Adult; Diverticulum; Cell Transformation, Neoplastic; Neoplasm Staging; Neurofibromatosis 1; Urinary Bladder
PubMed: 38839116
DOI: 10.2967/jnmt.123.266570