MINIMALLY INVASIVE SURGICAL REPAIR FOR ABDOMINAL WALL HERNIAS IN NONHUMAN PRIMATES, TWO CASES IN WESTERN LOWLAND GORILLAS (GORILLA GORILLA GORILLA).

A 33-yr-old female Western lowland gorilla (Gorilla gorilla gorilla) was diagnosed with a congenital umbilical hernia that was reducible and asymptomatic; change in the hernia was noted after parturition and concerns regarding increased risk of bowel incarceration developed. The hernia was successfully repaired with robot-assisted laparoscopic surgery. A 5-mon-old male Western lowland gorilla presented with bilateral inguinal hernias that were repaired via elective laparoscopic repair. In both cases, the gorillas did well without complications and never appeared to acknowledge wounds or exhibit signs of pain postoperatively. A literature review and interinstitutional survey was conducted to determine success rate of minimally invasive versus open repair of hernias in nonhuman primates (NHP). Of the cases identified, recurrence and/or wound morbidity was seen in 0% of laparoscopic repairs and 50% of open repairs. NHP may benefit from elective, minimally invasive surgical techniques that may reduce hernia recurrences and wound morbidity.

Power equalization-based disaggregated optical network using switched gain equalization controlled amplifiers.

Optical network disaggregation is an attractive agreement to avoid vendor lock-in in choosing desirable partners based on lead time of delivery and facilitates strong negotiations. Disaggregation of conventional coherent transceivers (XCVRs) with 400G ZR+ technologies (of similar bandwidth density and form factor QSFP-DD) allows operators to enjoy significant cost reduction and substantial power savings in high-capacity IP over a WDM transmission. However, interoperability between low power and high back-to-back required optical signal-to-noise ratio (OSNR) of ZR+ and high power with relatively lower back-to-back required OSNR of conventional coherent XCVRs limits the performance of the latter, which makes disaggregation more complex. This can be avoided by equalizing the power of ZR+ and conventional XCVRs, by wavelength-selective switches (WSSs) in re-configurable optical add/drop multiplexers. However, such power equalization can lead to lower link OSNR, originating from insertion loss and penalty caused by cascaded WSSs. In this Letter, we use a dynamic gain equalizer of a switched gain equalization controlled (SGEC) amplifier at each in-line amplifier site to equalize the powers, without introducing insertion loss or filter penalty. We report a field trial of a low power 400G-ZR+ QSFP-DD-DCO as an alien channel over ten high-power coherent host channels, interoperating with open forward error correction, between two different vendors. We obtain a similar Q-margin in the absence and presence of 400-ZR+ channel, suggesting the equalization by SGEC amplifiers. We further simulate the power and OSNR evolution of channels along the field trial link to verify the equalization. Simulation results are consistent with that of the field trial.

Comparative Study of Combination of Oral Tranexamic Acid With Modified Kligman's Formula Versus Oral Tranexamic Acid With Azelaic Acid 15% in the Treatment of Melasma.

Background Melasma is a persistent skin condition affecting individuals of Asian, African, and Hispanic backgrounds. It causes dark patches on sun-exposed areas of the face. The exact causes are unclear, but UV light and hormonal factors play a role. Melasma significantly impacts physical appearance and quality of life, causing emotional and social distress. Objective The objective was to compare the efficacy of a combination of oral tranexamic acid and modified Kligman's formula vs. oral tranexamic acid and 15% azelaic acid. Material and methods This two-year interventional study occurred at the Outpatient Department of Dermatology, Venereology, and Leprosy in Sawangi, Maharashtra. It included male and female patients aged 18-50 with melasma seeking treatment. Ethical approval was obtained, and data collection involved medical histories, skin examinations, and calculating the Melasma Area and Severity Index (MASI). Results The study found no significant association between age groups and subject distribution in Groups A and B. Significant differences were observed in MASI scores within each group over time. There was a significant difference in mean MASI scores between Group A and Group B at the eight-week mark. A burning sensation was significantly associated with the groups, while no significant association was found for erythema. Conclusion This study concludes that combining oral tranexamic acid with a modified Kligman's formula is more effective in treating melasma than combining oral tranexamic acid with azelaic acid 15%.

Cystic malformation of cystic duct: 10 cases and review of literature.

AIM: To evaluate cystic malformations of the cystic duct. METHODS: Over a 2-year period, we came across 10 cases of cystic malformation of the cystic duct among patients who were investigated in our radiology department with ultrasonography, multidetector computed tomography, or magnetic resonance imaging for abdominal complaints. Radiological diagnosis of cystic malformation of the cystic duct was made on the basis of a dilated, nonvascular cystic structure near the porta hepatis, and visualization of a clear communication with either the gallbladder, normal caliber cystic duct and/or common bile duct (CBD) on at least one imaging modality. RESULTS: Four of 10 patients had saccular dilatation of the cystic duct. Six patients had fusiform dilatation of the cystic duct, and two of these had only mild fusiform dilatation. Two patients had associated CBD dilatation and one had associated cystic duct calculi and malignancy. CONCLUSION: Cystic malformations of the cystic duct should be recognized as a distinct type of choledochal cyst and should be added as type VI cyst in Todani's classification.

Sonographic evaluation of gastrointestinal obstruction in infants: a pictorial essay.

Traditionally, gastrointestinal contrast studies have been the mainstay of evaluating infantile gastrointestinal problems. Because of technological advancements, good ultrasonography (USG) machines can provide high-resolution images with graphic anatomical clarity, especially in infants and children and thus change the traditional diagnostic trends. In this article, we illustrate the USG appearances of various causes of gastrointestinal obstruction in infants and discuss the role of USG in their evaluation.

Avascular necrosis of spine: a rare appearance.

STUDY DESIGN: Avascular necrosis (AVN) of two contiguous vertebrae along with the intervening disc is presented. OBJECTIVES: AVN of two contiguous vertebrae and the intervening disc is a rare entity and can be confused with infective and neoplastic processes. We present the role of magnetic resonance imaging (MRI) in the diagnosis of AVN. SUMMARY OF BACKGROUND DATA: AVN of vertebral bodies is a known entity; however, involvement of two contiguous vertebrae along with the intervening disc is atypical. The imaging features can be confused with an infective etiology, which involves the disc more commonly as compared to AVN. Neoplastic destruction of vertebrae also needs to be ruled out in appropriate clinical situations. METHODS: Frontal and lateral radiographs of the lumbar spine were performed followed by an MRI. Subsequently CT-guided fine needle aspiration cytology was performed. RESULTS: These radiographic features were correlated with the clinical and pathologic findings. The MRI findings of a wedge-shaped lesion with classic fluid intensity (hyperintense signal, like that of cerebrospinal fluid on T2-weighted images) are characteristic of AVN. Fine needle aspiration cytology confirmed the diagnosis and excluded an infective or a neoplastic process. CONCLUSIONS: The MRI findings described in this report are very characteristic of AVN of spine. Clinical and radiologic correlation could help in making the diagnosis and avoid unnecessary investigations.