Characteristics of Ultrasound and Magnetic Resonance Imaging of Normal Testes and Epididymis Besides Angiography of Testicular Artery in Dromedary Camel.

Decreasing male fertility encouraged the investigators to innovate accurate diagnostic non-invasive methods for detection of changes in the testicular parenchyma. Ultrasonography (US) has the potential to be used in this manner for decades, but magnetic resonance imaging (MRI) is still of limited application in animals for this purpose. The current study was designed to describe appearances and quantitative MRI attributes of the normal testes, epididymis besides angiography of testicular artery in camels. About 30 apparently healthy male dromedary camels aged 8-14 years were slaughtered during the rutting season. Immediately after slaughtering, the male gonads (n = 30 pairs of testicles and epididymis) were subjected to morphometric evaluation using a Vernier caliper and ultrasound scanning. Epididymial sperms were evaluated for motility, vitality and abnormality. MRI was performed for testes (n=16) by using a 1.5T Excite-II MRI apparatus of Sigma. Radiography and angioarchitecture of testicular artery (n=24) were done. Camel testicular length, width, and depth showed non-significant differences between a Vernier caliper or sonar. The MRI results revealed that both the testis and epididymis have homogenously intermediate signal (T1) and testes have hyperintense signal, with slightly lower signal in the epididymis (T2). In conclusion, both the ultrasonography and MRI techniques, with each respective computer-assisted imaging, could be used to detect the histomorphological changes of the camels' testicles. However, US imaging remains the first diagnostic technique for evaluating the reproductive health in men for its lower cost and accuracy. MRI is beneficial when the sonograms are inconclusive and/or equivocal. It shows the examined tissues in greater anatomical details compared to ultrasonography. Further studies are needed to compare between characteristics of US and MRI of normal testes and epididymis with testicular artery angiography in living camel during rut season and non-rut season and between normal healthy and affected diseased genitalia.

Polydactyly MAS Classification.

BACKGROUND: Polydactyly is considered to be one of the common congenital hand anomalies. Classification of congenital hand anomalies by Swanson groups similar forms of deficits affected by specific embryological failures. Each type of polydactyly has its separate classification. This case series suggested classification that could include the radial and ulnar variants of polydactyly in one classification and direct the management in algorithmic approach. METHODS: Case series of 11 cases, who were diagnosed with polydactyly of the hand consecutively at King Abdulaziz Medical City in Jeddah, Saudi Arabia. Cases were described by physical assessment and x-ray, then categorized by the proposed MAS classification. RESULTS: Description of 11 cases by the suggested MAS classification: A- Soft tissue attachment. B-Bone attachment. I. Attached to metacarpal bone. II. Attached to the proximal phalanx. III. Attached to the middle phalanx. IV. Attached to the distal phalanx. C- Joint attachment. I. Attached to carpometacarpal joint. II. Attached to metacarpophalangeal joint. III. Attached to the proximal interphalangeal joint. IV. Attached to the distal interphalangeal joint. Treatment according to the algorithmic approach: type A, treat it with soft-tissue excision; type B, bony excision with or without reinsertion of abnormal muscle attachment; and type C, excision of collateral ligaments and reconstruction with or without K wire fixation and reinsertion of abnormal muscle attachment. CONCLUSIONS: MAS classification demonstrates a potential to be applied to both ulnar and radial polydactyly. It is simple, easy to recall, anatomically and surgically oriented for practical purposes. Thus, it needs to be validated in extensive studies.

Reduction and standardization of surgical instruments in pediatric inguinal hernia repair.

AIM: To standardize and reduce surgical instrumentation by >25% within a 9-month period for pediatric inguinal hernia repair (PIHR), using "improvement science" methodology. METHODS: We prospectively evaluated instruments used for PIHR in 56 consecutive cases by individual surgeons across two separate subspecialties, pediatric surgery (S) and pediatric urology (U), to measure actual number of instruments used compared with existing practice based on preference cards. Based on this evaluation, a single preference card was developed using only instruments that had been used in >50% of all cases. A subsequent series of 52 cases was analyzed to assess whether the new tray contained the ideal instrumentation. Cycle time (CT), to sterilize and package the instruments, and weights of the trays were measured before and after the intervention. A survey of operating room (OR) nurses and U and S surgeons was conducted before and after the introduction of the standardized tray to assess the impact and perception of standardization. RESULTS: Prior to creating the standardized tray, a U PIHR tray contained 96 instruments with a weight of 13.5 lbs, while the S set contained 51, weighing 11.2 lbs. The final standardized set comprised 28 instruments and weighed 7.8 lbs. Of 52 PIHRs performed after standardization, in three (6%) instances additional instruments were requested. CT was reduced from 11 to 8 min (U and S respectively) to <5 min for the single tray. Nurses and surgeons reported that quality, safety, and efficiency were improved, and that efforts should continue to standardize instrumentation for other common surgeries. CONCLUSIONS: Standardization of surgical equipment can be employed across disciplines with the potential to reduce costs and positively impact quality, safety, and efficiencies.