Novel autopsy and genetic findings in an acardiac twin: case report and literature review

ABSTRACT Twin reversed arterial perfusion (TRAP) sequence is a rare complication of monochorionic twinning whereby a donor twin perfuses an acardiac twin via aberrant vascular anastomoses. The resulting paradoxical retrograde blood flow supplying the acardiac twin is oxygen-poor, leading to some of the most severe malformations encountered in humans. Though the first descriptions of acardiac twins date back to at least the 16th century, the pathophysiologic processes which underpin the development of TRAP sequence are still being elucidated. Theories on the pathogenesis of TRAP sequence include deficiencies intrinsic to the embryo and primary abnormalities of the placental vasculature. Autopsy studies continue to provide clues to the underlying pathogenesis of TRAP sequence, and the characterization of the spectrum of manifestations that can be observed in acardiac twins. Herein, we present the clinical, autopsy, and molecular findings in a unique case of TRAP sequence. Novel findings include a primitive cloaca-like structure and chromosomal aberrations involving 6q11.1 and 15q25.1.

Desgarro agudo del esfínter anal postparto con reparación inmediata / Immediate repair of acute postpartum anal sphincter tear: case report

Las lesiones obstétricas del esfínter anal pueden ocurrir durante el parto vaginal espontáneamente o secundariamente a la episiotomía. Su riesgo se estima en un 26% y son la causa más frecuente de incontinencia anal en mujeres jóvenes. Las lesiones de grado 4 de Sultan, también llamadas cloaca traumática, implican la ruptura completa del esfínter y la comunicación de la cavidad vaginal con el canal anal. La reparación es siempre quirúrgica, para lo que se han descrito diferentes técnicas, aunque ninguna ha demostrado ser superior. Presentamos el caso de una paciente primípara de 23 años con una cloaca traumática posparto. La reparación quirúrgica se realizó de inmediato con una técnica de overlapping. El postoperatorio fue sin complicaciones y al año presenta continencia anal completa. (AU)

Obstetric anal sphincter injuries can occur spontaneously or as a consequence of an episiotomy during vaginal delivery. Their risk is estimated at 26% and they are the most frequent cause of anal incontinence in young women. Sultan grade 4 injuries, also called traumatic cloaca, involve complete rupture of the sphincter and communication of the vaginal cavity with the anal canal. The repair is always surgical, for which different techniques have been described, although none have proven to be superior. We present the case of a 23-year-old primiparous patient with a postpartum traumatic cloaca. Surgical repair was performed immediately with an overlapping technique. The postoperative period was without complications and one year later she presents complete anal continence. (AU)

The features of MRI in spectrum of fetal cloaca malformation / 中华放射学杂志

Objective:To explore the features and application value of MRI in the spectrum of fetal cloaca malformation.Methods:The clinical, MRI and ultrasound data of 6 fetuses with spectrum of cloaca malformation were retrospectively analyzed in Guangzhou Women and Children′s Medical Center Affiliated to Guangzhou Medical University from January 2017 to February 2021, and the MRI features of each subtype were analyzed.Results:Among the 6 fetuses of spectrum of the cloaca malformation, 5 were confirmed by postnatal imaging and surgery, and 1 was confirmed by induced labor autopsy, including 3 persistent cloaca, 1 posterior cloaca, 1 cloaca variant, and 1 urogenital sinus. The high signal on T 1WI of the rectal meconium disappeared or became weaker, and the signal on T 2WI of meconium of the dilated colon increased in the 3 cases of persistent cloaca and 1 case of posterior cloaca. All 6 cases showed colonic dilatation. All cases except 1 persistent cloaca showed vaginal and/or uterine effusion. Two cases of persistent cloaca, 1 case of posterior cloaca and 1 case of cloaca variant showed duplicated genital tract. Two cases of persistent cloaca showed only 1 perineal opening, which opened at the urethral orifice. One case of cloaca variant showed 2 openings, which opened at the urethral orifice and in front of the normal anus, respectively. Conclusion:Prenatal MRI can help to clarify the diagnosis of cloacal malformation spectrum and to determine its specific classification.

Diagnóstico prenatal del complejo onfalocele, extrofia cloacal, ano imperforado y defecto de la columna vertebral (complejo OEIS) / Prenatal diagnosis of omphalocele, cloacal exstrophy, imperforate anus and spinal anomalies complex (OEIS complex)

RESUMEN El complejo onfalocele, extrofia de la cloaca, ano imperforado y anomalías de la columna vertebral (Complejo OEIS) es una combinación de malformaciones congénitas severas y extremadamente raras. Su incidencia es estimada en 1 por cada 200.000 - 400.000 nacidos vivos. La aparición de los casos es esporádica y no tiene una etiología conocida. Algunos han sido asociados a exposiciones ambientales, causas genéticas y procedimientos de fertilización in vitro. El mecanismo de desarrollo parece asociado a alteraciones de la blastogénesis temprana o defecto de la migración mesodérmica durante el período embrionario. El diagnóstico prenatal puede realizarse a las 16 semanas de gestación, aunque en ocasiones es posible un diagnóstico más temprano. Su diagnóstico definitivo se realiza con los hallazgos de la necropsia. La mayoría de los recién nacidos supervivientes necesitan múltiples cirugías con complicaciones potenciales y no siempre se alcanza los resultados deseados. Se presenta un caso de diagnóstico prenatal de onfalocele, extrofia de la cloaca, ano imperforado y anomalías de la columna vertebral (complejo OEIS).

ABSTRACT Omphalocele, cloacal exstrophy, imperforate anus and spinal anomalies complex (OEIS complex) is a combination of severe and extremely rare congenital malformations. Its incidence is estimated at 1 per 200,000 - 400,000 live births. The occurrence of cases is sporadic and has no known etiology. Some have been associated with environmental exposures, genetic causes, and in vitro fertilization procedures. The mechanism of development appears to be associated with alterations in early blastogenesis or defect in mesodermal migration during the embryonic period. Prenatal diagnosis can be made at 16 weeks of gestation, although earlier diagnosis is sometimes possible. Definitive diagnosis is made necropsy findings. Most surviving newborns require multiple surgeries with potential complications and the desired results are not always achieved. A case of prenatal diagnosis of omphalocele, cloacal exstrophy, imperforate anus and spinal anomalies (OEIS complex) is presented.

First comprehensive report of bacteria spp. associated with cloaca of Laudakia nupta (Sauria: Agamidae) in Iran using molecular studies / 한국실험동물학회지

Iran bears a remarkable variety of reptiles. One of the lizard families occurring in Iran is the Family Agamidae which is widely are distributed throughout the old world. The large-scaled rock agamid, Laudakia nupta, is one of the well-known agamid. There are few reports of cloacal microbial on reptiles hence their function in cloacae remains unknown. Laudakia nupta usually live in rural and urban areas and close vicinity to man, they are likely to play an important role in the spread of disease that may be caused by these microorganisms and their transmission to man. Therefore, the aim of this study was to identify the bacterial flora colonizing the cloacal region of Laudakia nupta using molecular studies. The cloacal fluids were directly placed on nutrient agar (NA) plates and incubated at 25 ± 2 ℃ for 48 h. The resulting bacterial colonies were transferred to fresh nutrient agar (NA) plates for molecular studies. Twelve isolates were obtained from 17 specimens of Laudakia nupta. All bacteria isolates were identified as Bacillus subtillis (5), Bacillus cereus (4), Bacillus sp. (1), Pseudomonas putida (1), and Pseudomonas sp. (1) based on partial sequences of the 16 s rRNA gene. This is the first comprehensive report of bacteria spp. associated with cloaca of Laudakia nupta using molecular studies. In this research, we found that Laudakia nupta can be a carrier of bacteria which can transfer microorganisms to hosts.

Comb, cloaca and feet scores and testis morphometry in male broiler breeders at two different ages / Escores de crista, cloaca e de pé e morfometria testicular em galos de matriz pesada em duas diferentes idades

In broiler breeder roosters, the weight of the testes is positively associated with daily sperm production and fertility. In birds, the testes are located in the coelomic cavity, not being accessible to reproductive evaluation as mammalian testes. The reproductive evaluation of roosters is based on phenotypic traits. Any changes on testes will be reflected on fertility levels. The aim of this paper was to evaluate the potential of association of phenotypic traits as body weight (BW), comb scores (COS), cloaca scores (CLS) and feet scores (FS) with testicular morphometric parameters in adult Cobb® Mx roosters in two ages (25 and 45 weeks of age). The low BW roosters had lower testes weight (TW), smaller seminiferous tubule diameter (STD) and lower comb and cloaca scores than the medium and high BW roosters (P≤0.05). Heavy roosters had the highest COS and bigger seminiferous epithelium height (SEH). There was no statistical difference between the BW categories in FS and volumetric proportion of seminiferous tubule (ST) and interstitial tissue (IT). Considering the age effect, roosters with 45 weeks of age had lower TW and ST than 25-week roosters. Positive, moderate and significant correlation was found between testes weight and phenotypic characteristics as BW, COS and CLS in 45week roosters. A positive, moderate and significant correlation was found between body weight and histologic testicular characteristics as STD and SHE in both evaluated ages. In conclusion, there is a regression in the testes weight with age and it is more intense in Cobb® Mx roosters with lower BW. Furthermore, it is concluded that the BW positively influences the testes weight and histological quality of the testes. COS and CLS can be used with moderate potential prediction to identify roosters with low testes weight at 45 weeks of age.(AU)

Em galos de matriz pesada sabe-se que o peso dos testículos pode ser associado positivamente com a produção diária de espermatozoides e que alterações nos testículos irão refletir na fertilidade. Nas aves, os testículos estão localizados dentro da cavidade celomática, e, portanto, não são acessíveis para exame andrológico direto, como em mamíferos. A avaliação reprodutiva de galos se baseia principalmente em características fenotípicas. Buscou-se avaliar o potencial de associação de alguns parâmetros fenotípicos, como peso corporal (PC), escores de crista (ECR), escores de cloaca (ECL) e escores de pés (EP), com parâmetros morfológicos de testículos em galos Cobb® Mx em duas idades (25 e 45 semanas de idade). Galos leves apresentaram menor peso testicular (PT), menor diâmetro de túbulo seminífero (DT), e menores ECR e ECL que galos médios e pesados (P≤0.05). Galos pesados apresentaram os maiores ECR e maiores valores para altura do epitélio seminífero (AE), e DT. Não houve diferença estatisticamente significativa entre as categorias de peso para escores de pé e proporções de túbulo seminífero (TS) e interstício (INT). Considerando-se o efeito da idade, galos com 45 semanas de idade apresentaram menores PT e TS que galos com 25 semanas de idade. Correlação positiva, moderada e significativa foi encontrada entre peso de testículo e características fenotípicas como ECR, ECL e PC em galos de 45 semanas de idade. Foi encontrada correlação positiva, moderada e significativa entre PC e características testiculares como DT e AE nas duas idades avaliadas. Conclui-se que em galos Cobb® Mx ocorre regressão do testículo com o avanço da idade, e ela é mais intensa em galos com menor peso corporal. Conclui-se que o PC tem influência positiva no peso e índices histomorfométricos dos testículos, e que escores de crista e de cloaca podem ser utilizados com potencial moderado de predição para identificar galos com baixo peso de testículos em galos com 45 semanas de idade.(AU)

Sphincteroplasty and perineoplasty with skin advancement flap in management of traumatic cloacal defect / Esfincteroplastia e perineoplastia com retalho cutâneo de avanço no tratamento de defeito cloacal traumático

ABSTRACT Background: Traumatic cloacal defect (TCD) is the condition that occurs in 0.3% of women who have experienced the third/fourth-degree perineal laceration during traumatic Natural Vaginal Delivery (NVD). This condition has many undesirable effects in their lives. Surgery is the best way to repair this deformity and will improve the quality of life in these patients. Design: In this study, we prospectively studied 19 patients who were referred to the hospital with symptoms of TCD within years 2011 and 2015 with the mean of 2.6-yrs follow-up. They all underwent sphincteroplasty and perineoplasty with skin advancement flap. Results: Of all 19 patients, incontinence to solid faeces in 16 patients (84%), incontinence to liquid stool in 15 patients (78%) and incontinence to flatus in 4 patients (21%) were completely resolved. The FI score was decreased from the mean of 12.7 to 2.6. Sexual function was significantly improved in all of them and dyspareunia was completely disappeared in 9 patients (50%). The quality of life score was increased from the mean of 45 to 95. Post-operation complications were occurred in 3 of patients (wound infection in 2-cases and recto-vaginal fistula in another). Conclusion: Our findings show that sphincteroplasty and perineoplasty with skin advancement flap is an effective surgical technique to repair the perineal body due to its benefits and few complications. In this study, there was significant improvement in quality of life of almost all patients after this reconstructive surgery. Consulting with a colorectal surgeon is recommended for these cases.

RESUMO Experiência: Defeito cloacal traumático (RCT) é a condição que ocorre em 0,3% das mulheres que sofreram laceração perineal de terceiro/quarto grau durante um parto vaginal natural (PNV) traumático. Essa condição causa muitos efeitos indesejáveis em suas vidas. A cirurgia é a melhor forma de reparar essa deformidade, e melhorará a qualidade de vida nessas pacientes. Modelo: Nesse estudo, estudamos prospectivamente 19 pacientes que foram encaminhadas ao hospital com sintomas de RCT entre 2011 e 2015, com uma media de 2,6 anos de seguimento. Todas foram submetidas a uma esfincteroplastia e perineoplastia, com retalho cutâneo de avanço. Resultados: Da totalidade de 19 pacientes, a incontinência para fezes sólidas em 16 pacientes (84%), a incontinência para fezes líquidas em 15 pacientes (78%) e a incontinência para flatos em quatro pacientes (21%) foram completamente resolvidas. Ocorreu redução no escore FI, de uma media de 12,7 para 2,6. A função sexual melhorou significativamente em todas as pacientes, e a dispareunia desapareceu completamente em nove pacientes (50%). O escore para qualidade de vida melhorou, da media de 45 para 95. Ocorreram complicações pós-operatórias em três pacientes (infecção da ferida em dois casos e fistula retovaginal no caso restante). Conclusão: Nossos achados demonstram que a esfincteroplastia e a perineoplastia com retalho cutâneo de avanço é técnica cirúrgica efetiva para o reparo do corpo perineal, graças a seus benefícios e às poucas complicações. Nesse estudo, foi observada melhora siga na qualidade de vida de praticamente todas as pacientes em seguida a essa cirurgia reconstrutiva. Para tais casos, é recomendável uma consulta com um cirurgião colorretal.

Características y enfoque terapéutico de pacientes con malformaciones anorrectales en dos Hospitales sampedranos / Clinical characteristics and therapeutic approach of patients with Anorrectal Malformations in two Hospitals of San Pedro Sula

Antecedentes: Las malformaciones anorrec-tales (MAR) se componen de una amplia gama de anormalidades que se asocian con varias patologías. Afectan tanto al sexo masculino como femenino, en algunos casos incluyen al aparato urinario y genital. Objetivo: Describir las características clínicas y el enfoque tera-péutico de pacientes con Malformaciones Anorrectales en dos Hospitales de San Pedro Sula, Honduras, durante los años 2012 al 2016. Pacientes y Métodos: Estudio cuantitativo, descriptivo, transversal, realizado en pacientes con malformación anorrectal del Hospital Nacional Dr. Mario Catarino Rivas y el Hospital de Niños Quemados y Cirugía Pediátrica Ruth Paz. La muestra fueron 94 pacientes, la infor-mación se obtuvo del expediente clínico y se procesó en el software estadístico IBM SPSS 22. Resultados: En cuanto al sexo, 53.2% (n=50) eran mujeres y 46.8% (n=44) hombres, 30.9% (n=29) tenían un año de edad, 51.1% (n=48) provenían del departamento de Cortés. En los hombres, se encontró fístula perineal en 30.2% (n=14) pacientes y en las mujeres se encontró fístula rectovestibular en 37.3% (n=19), se encontró asociación a otro tipo de malformaciones congénitas en 29% (n=27) de los pacientes. El tratamiento consistió en colostomía protectora seguido de Anorrecto-plastía sagital posterior tipo Peña y por último el programa de dilataciones anorrectalesa 59.6% (n=56) y 85.3% no presentó complica-ciones quirúrgicas. Conclusiones: Las mal- formaciones anorrectales en este estudio afec-taron más a las mujeres que a los hombres, la edad que predominó fueron los pacientes de 1 año, procedentes en su mayoría del departa-mento de Cortés, especí camente de San Pedro Sula...(AU)

Experiencia inicial del impacto de la reparación con colgajos de cloaca traumática postparto en la calidad de vida / Initial experience, of the impact of the repair, with postpartum traumatic cloaca flaps, on the quality of life

Introducción: La incontinencia fecal mayor es un trastorno que modifica significativamente la calidad devida. Un grupo particularmente afectado son las mujeres con antecedentes de trauma obstétrico. Dentrode ellos, los más graves son los de cuarto grado que involucran la totalidad de las capas del tabique rectovaginal, produciendo una comunicación completa entre la luz rectal y la vagina, generando una cloaca. Sibien la incidencia de éstas, es de alrededor del 0,3% de los partos, el efecto que tiene sobre las pacienteses devastador. El único tratamiento efectivo para este tipo de lesiones es la reparación quirúrgica.Objetivo: Evaluar el impacto que presenta la corrección quirúrgica de la cloaca por trauma obstétrico en lacalidad de vida de las afectadas.Material y Métodos: Análisis prospectivo secundario y ampliado de una serie consecutiva de pacientestratadas por desgarro perineal completo tipo cloaca durante el año 2013. Se evaluó la demografía de lamuestra, la paridad de las pacientes, el tiempo medio hasta la consulta desde el último parto, la manometríapre y postoperatoria, la evaluación de incontinencia fecal pre y postoperatorio. Para valorar la severidad dela incontinencia fecal se utilizó el índice CCF-FIS y el índice de severidad de incontinencia fecal (FISI). Parala evaluación de calidad de vida se utilizó la encuesta FIQLS de la Sociedad Americana de Cirujanos delColon y Recto (ASCRS).Resultados: Tres pacientes fueron intervenidas entre enero de 2013 y diciembre de 2013. En el examenfísico, el 100% de las pacientes presentaron una cloaca perineal. El score CCF-FIS preoperatorio fue del16,7 (16 a 18 puntos). El puntaje de FISI pre-operatorio fue de 54,3 (52 a 57). Las tres pacientes refirieronalteraciones en su actividad social y sexual. Se reevaluaron las pacientes al tercer mes de postoperatorio yluego del cierre de la colostomía...

Introduction: The major fecal incontinence is a disorder that significantly change the quality of life. Aparticularly affected group are women with a history of obstetric trauma and presenting demonstrationsimmediately. Among them, the most serious are the fourth degree involving all the layers of the rectovaginalseptum, producing a complete communication between the rectal lumen and vagina, creating a sewer.Although their incidence is about 0.3% of births, the effect on patients is devastating.Objective: To evaluate the impact making the surgical correction of the cloaca by obstetrical trauma in thequality of life of those affected.Material and Methods: Secondary and expanded Prospective analysis of a consecutive series of patientstreated by complete perineal tear type cloaca in 2013. The demographics of the sample was evaluated theparity of the patients, the median time to the query from the last delivery, pre and postoperative manometry,assessment of pre-and postoperative fecal incontinence. To assess the severity of fecal incontinence CCFFISindex and the severity of fecal incontinence (FISI) was used. The FIQLS survey by the American Societyof Colon and Rectal Surgeons (ASCRS) was used for the evaluation of quality of lifeResults: Three patients were operated between January 2013 and December 2013 on physical examination, 100% of patients had a perineal cloaca. The CCF-FIS preoperative score was 16.67 (16-18 points). Thescore FISI pre-surgery was 54.33 (52-57). The three patients reported changes in their social and sexualactivity. Patients at the third month after surgery and after colostomy closure were reassessed...

Salmonella sp. em ovos e cloacas de galinhas e seu risco para asaúde pública / Salmonella sp. on eggs and chickens sewers and your risk for public health

Objetivo: Avaliar a presença de Salmonella sp. em ovos e cloacas de galinhas, provenientes de dois sítios no Rio Grande do Sul, sendo um para consumo próprio e o outro para comércio. Métodos: A amostra deste estudo foi constituída por 30 galinhase 17 ovos, sendo 22 galinhas e 10 ovos provenientes de um sítio que as utiliza para consumo próprio, localizado na cidade de Águas Claras, RS e 8 galinhas e 7 ovos oriundos de um sitio que as comercializa, localizado na cidade de Torres, RS. O isolamento da Salmonella foi feito em meios agar MacConkey e agar Salmonella/Shigella e suaidentificação e confirmação foi feita por série bioquímica. Resultados: Observou-se a presença de Salmonella sp. no sítio para consumo próprio em 13,6% das aves e 80% dos ovos, já no sítio que as comercializa, não houve contaminação tanto nas galinhas quanto nos ovos analisados. Conclusão: a Salmonella sp. é um agente frequentemente encontrado no ambiente e essas aves são portadoras naturais da bactéria, justificando sua presença no que as utiliza para próprio consumo, e, devido ao uso de antibiótico nas galinhas do sitio comercial, a ausência dela.

Caracterización de cepas de Escherichia coli enteropatogénico (EPEC) aisladas durante el proceso de faena de pollos / Characterization of enteropathogenic Escherichiia coli (EPEC) strains isolated during the chicken slaughtering process

En Argentina, Escherichia coli enteropatogénico (EPEC) es uno de los agentes más prevalentes aislados de niños con diarrea. Debido a que la contaminación con este patotipo en productos de pollo podría ocurrir durante el proceso de faena, nos planteamos como objetivo aislar y caracterizar EPEC de muestras de animales vivos (cloacas), carcasas evisceradas sin lavar, carcasas lavadas y agua del tanque de enfriamiento. Se caracterizaron 29 aislamientos de EPEC que presentaron una amplia variedad de serotipos, algunos de los cuales (O2:H40, O8:H19 y O108:H9) han sido informados en otras especies animales. También se encontró el serotipo O45:H8, aislado con anterioridad de niños con diarrea. Se detectaron aislamientos de los serotipos O2:H40, O108:H9 y O123:H32 en distintas etapas del proceso de faena, lo que sugiere que el procesamiento no se realiza en forma adecuada. Se torna necesario reforzar las medidas de control e higiene en las distintas etapas del proceso para disminuir la contaminación microbiana

In Argentina, EPEC is one of the most prevalent agents isolated from children with diarrhea. Because contamination with this pathotype could occur during slaughter, the aim of this study was to isolate and characterize EPEC strains obtained from live animals (cloacae), eviscerated carcasses, washed carcasses and water from chillers. Twenty nine isolates of atypical EPEC were characterized. These isolates presented a wide variety of serotypes, some of which (O2:H40, O8:H19 and O108:H9) had been reported in other animal species. Serotype O45:H8, previously isolated from children with diarrhea was also found. Isolates of serotypes O2:H40, O108:H9 and O123:H32 were detected at different stages of the slaughtering process, suggesting that the process is not adequately performed. This latter fact highlights the importance of reinforcing control and hygienic measures at different stages of the chicken slaughtering process in order to reduce microbial contamination

Omphalocele, exstrophy of cloaca, imperforate anus and spinal defect (OEIS Complex) with overlapping features of body stalk anomaly (limb body wall complex).

OEIS is an extremely rare constellation of malformations, which includes omphalocele, exstrophy of cloaca, imperforate anus, and spinal defect. We report here autopsy findings in a case of OEIS complex, which apart from the major anomalies of the complex had bilateral club foot that is, congenital talipes equinovarus, right hydroureter, and body stalk anomaly. The umbilical cord was absent, and the umbilical vessels were embedded in an amniotic sheet, which connected the skin margin of the anterior body wall defect to the placenta, this feature being the hallmark of limb body wall complex (LBWC). This case further supports the view that OEIS and LBWC represent a continuous spectrum of abnormalities rather than separate conditions and may share a common etiology and pathogenetic mechanism as proposed by some authors.

Escores de cloaca e de crista e morfometria testicular em galos de matriz pesada com 71 semanas de idade e três categorias de peso corporal / Cloaca and comb scores and testicular morphometry in broiler breeder roosters at 71 weeks of age and three body weight categories

Em galos de matriz pesada, o peso dos testículos se associa positivamente com a produção diária de espermatozoides e com a fertilidade. Contudo, os testículos de aves se localizam na cavidade abdominal, não sendo acessíveis para exame andrológico como os testículos de mamíferos. A avaliação reprodutiva de galos de matriz pesada é subjetiva e se baseia em características como peso corporal (PC), qualidade de pés e pernas e morfologia de cloaca e crista. Estudos que validem o potencial de associação dessas características fenotípicas com parâmetros da morfometria testicular são raros, principalmente quando se consideram galos de matriz pesada manejados em lotes comerciais. Escores de cloaca e de crista e parâmetros da morfometria testicular foram avaliados em galos Cobb 500 Slow adultos das categorias de PC leve (<4,300kg), médio (entre 4,300 e 5,250kg) e pesado (≥5,250kg). O coeficiente de variação para PC foi de 12%. Os galos da categoria de PC pesado apresentaram testículos mais pesados e maiores escores de cloaca e de crista do que os galos da categoria de PC leve. Não houve diferença estatística entre as categorias de PC, considerando-se índice gonadossomático, porcentagens de túbulo seminífero e de tecido intersticial, diâmetro de túbulo seminífero e altura de epitélio seminífero. Correlação positiva, moderada e significativa foi observada entre peso de testículo e características de PC, escores de cloaca e de crista, diâmetro de túbulo seminífero e altura de epitélio seminífero. Um dos seis galos da categoria de PC leve avaliados quanto à histologia de testículo apresentou atrofia testicular. Em galos Cobb 500 Slow, conclui-se que o PC influencia o peso e a qualidade histológica de testículos e que os escores de cloaca e de crista podem ser utilizados com potencial moderado de predição para identificar galos com baixo peso de testículos...

In broiler breeder roosters the weight of the testes is positively associated with daily sperm production and fertility. However, the avian testes are located in the abdominal cavity, not being accessible for reproductive evaluation as mammalian testes. The reproductive evaluation of broiler breeder roosters is subjective and is based on characteristics such as body weight (BW), quality of feet and legs and morphology of cloaca and comb. Studies that validate the potential of associating these phenotype characteristics with testicular morphometric parameters are rare, especially when broiler breeder roosters of commercial flocks are considered. Cloaca and comb scores and testicular morphometric parameters were evaluated in adult Cobb 500 Slow roosters with low (<4.300kg), medium (between 4.300 and 5.250kg) and high (≥5.250kg) BW categories. The coefficient of variation for BW was 12%. The high BW roosters have heavier testes and higher cloaca and comb scores than the low BW roosters. There was no statistical difference between the BW categories in gonadosomatic index, percentage of seminiferous tubule and interstitial tissue, diameter of the seminiferous tubule and height of the seminiferous epithelium. Testis weight is positive, moderate and significantly correlated with BW, cloaca and comb scores, diameter of seminiferous tubule and height of seminiferous epithelium. One of six low BW roosters evaluated for histology of the testis had testicular atrophy. We conclude that in Cobb 500 Slow roosters BW influences the weight and histological quality of the testes. Besides this, cloaca and comb scores can be used with moderate prediction potential to identify roosters with underweight testes...

Clinical experience with persistent cloaca / 대한외과학회지

PURPOSE: Persistent cloaca is one of the most severe types of anorectal malformation. Appropriate initial drainage is difficult due to their various malformations and hydrocolpos or dilated urinary bladder. Corrective surgery also differs among individual patients. We describe our experiences with the surgical management of children with persistent cloaca. METHODS: We retrospectively reviewed 16 children diagnosed with persistent cloaca at Asan Medical Center. RESULTS: Sixteen patients were managed in their neonatal period. Twelve patients had enlarged bladder or vagina at birth. Three patients, who did not undergo cystostomy or vaginostomy at first operation, had earlier complications after surgery or required drainage tube insertion. One patient who did not undergo hydrocolpos drainage died of sepsis and complications. Nine patients underwent corrective surgery; posterior sagittal anorectovaginourethroplasty using the Pena method. Three patients required additional operations due to complications after surgery. CONCLUSION: Patients found to have anatomical malformations before colostomy, as well as hydrocolpos and bladder enlargement, require a vaginostomy with or without a cystostomy to reduce complications. Follow-up is required in patients with hydrocolpos and bladder enlargement to determine whether vaginal drainage improves dilated bladder. Continuous long-term follow-up examination is required to determine the long-term results of corrective surgery.

Análisis de 200 casos pediátricos de malformaciones anorectales / Analysis of 200 cases of pediatric anorectal malformation

Las malformaciones anorectales son una patología frecuente en el Servicio de Cirugía General del Hospital Nacional de Niños, sin embargo, en Costa Rica las publicaciones sobre el tema han sido pocas. El objetivo de este trabajo es analizar los pacientes operados netre 1998 y 2008, para conocer el detalle de los tratamientos usados y determinar cuál ha sido la experiencia, algo muy recomendable para que, con base en los hallazgos, se procesen las sugerencias para mejorar. Material y métodos: Se revisaron los expedientes y se examinaron los pacientes con malformaciones anorectales operados entre 1990 y 2008, controlados en la sección especializada de la Consulta Externa del Servicio de Cirugía General del Hospital Nacional de Niños. Los pacientes fueron agrupados de acuerdo con su tipo de anomalía, y fueron examinados para determinar: malformaciones congénitas asociadas, tipo de malformación anorectal, tipo de cirugía, complicaciones, y resultados de los siguientes exámenes: ultrasonido de abdomen, CUMS, colografía distal y sus resultados funcionales, después de los tres años de edad. Los datos de los pacientes se digitaron en una base de datos del programa Excel, para analizarlos y tener una clara visión de los procedimientos empleados con cada grupo y de los resultados obtenidos. Resultados: Se controlaron 200 casos operados entre 1998 y 2008; en todos se estudiaron las malformaciones congénitas asociadas y su malformación anal, y se encontraron distintos tipos que fueron clasificados de la siguiente forma: los que tenían fístula, que se agruparon por el sitio donde la fístula desembocaba: a cuello vesical, 12 casos, uretra prostática, 12 casos, uretra bulbar, 18 casos, vestibular, 26 casos, perineal, 92 casos, estenosis anal, 12 casos; los que no tenían fístula: altos, 16 casos, o bajos, 3 casos, y finalmente, las malformaciones cloacales, tanto las altas, 2 casos, como las bajas, 7 casos. Todos los pacientes fueron operados con la técnica...

Despite the high frequency of anorectal malformations treated at the General Surgery Service of the National Children’s Hospital, there exists a dearth of national medical publications related to this pathology. The aim of this investigation is to verify the treatment details of 200 patients who underwent anorectal surgery between 1998 and 2008 as well as to determine our experience. Any recommendations will be based on the findings of this study.Materials and methods: Two hundred patients of the Dr. Carlos Sáenz National Children’s Hospital were studied. This group presented anorectal malformations, were treated between 1998 and 2008 and received follow up care at the General Surgery outpatient clinic.The patients were grouped according to their type of anomaly and were examined for the following: associated congenital malformations, type of anorectal anomaly, type of surgery, complications and the results of the following tests: abdominal ultrasound, CUMS, distal colography and the functional results after three years of age. All of the data was collected from the patients’ medical files. This information was then transferred to an Excel data sheet for further analysis and in order to have a clear picture of the conduct that was followed with each group of patients. Results:The groups were made using the following classification: those patients with a fistula were grouped according to the location of the opening: bladder neck (12 cases), prostate (12 cases), bulbar (18 cases), vestibular (26 cases), perineal (92 cases), anal stenosis (12 cases). Those who had no fistula: high (16 cases) or low (3 cases). Finally, the cloacae malformations, both high cases (2 cases) and low cases (7cases). All of the patients underwent surgery using the Peña technique with the corresponding modifications. No patients were treated with the laparoscopic technique. Conclusion: Because we consider these cases to be highly complex...

Pesquisa de Cryptococcus neoformans e Candida spp. em excretas de psitacídeos e passeriformes cativos / Research on Cryptococcus neoformans and Candida spp. in the excretas of captive psittacisittacines and passeriformes / Investigación de Cryptococcus neoformans y Candida spp. en excretas de psittacidae y psittaciformes cautivos

As leveduras podem causar diversas doenças no homem e animais. Nas aves, as leveduras estão envolvidas principalmente em lesões no trato respiratório e digestório. Entre as leveduras patogênicas, Cryptococcus neoformans vem se destacando pela alta prevalência de criptococose humana em pacientes imunodeprimidos. Assim, os objetivos deste estudo foram identificar C. neoformans e outras leveduras patogênicas na cloaca e coana de passeriformes e psitaciformes e em excretas coletadas do fundo de gaiolas de aviários. Foram obtidas 29 amostras de 15 aves manifestando algum sinal respiratório, provenientes do Ambulatório de Animais Selvagens da UFPR (n=6) e da Clínica Veterinária Vida Livre (n= 23). As amostras foram semeadas em Ágar Sabouraud e Ágar Níger e mantidas a 300ºC por até 30 dias. Todas as colônias foram analisadas quanto à macro e micromorfologia. Para aquelas identificadas como leveduras, foram realizadas as provas bioquímicas: assimilação de carbono e nitrogênio e formação de tubo germinativo para identificação de Candida albicans. As amostras de excreta dos aviários (n=8) foram misturadas com solução fisiológica contendo antibiótico e o sobrenadante foi semeado em Ágar Níger. Nenhuma amostra das aves apresentou resultado positivo para C. neoformans, porém identificaram-se amostras positivas para C. albicans (duas amostras de coana), C. famata (uma amostra de coana) e C. tropicalis (uma amostra de coana). As excretas foram negativas para C. neoformans. Portanto, apesar de não ter sido isolado C. neoformans, outras leveduras patogênicas foram isoladas, demonstrando a importância dessas aves como possíveis veiculadoras de doenças para humanos.

The yeasts can cause many diseases in man and animals. On birds, the yeasts are involved mainly in respiratory and digestive tract lesions. Among pathogenic yeast, Cryptococcus neoformans is an important cause of human cryptococcisis associated with immunocompromised states. The purpose of this study is to identify the occurrence of C. neoformans and other pathogenic yeasts in cloacae and choana from passeriformes and psittacines as well as in excretas from poultry cages. Twenty nine samples from fifteen birds showing some respiratory symptom, from Veterinary Hospital of UFPR (n = 6) and Vida Livre Veterinary Clinic (n = 23), were collected. The samples were spread in Sabouraud dextrose Agar and Staib medium and kept at 30°C and observed for 30 days. All colonies were analyzed with respect to its micro and macromorphology. Biochemical assays were conducted for samples presenting yeasts: carbon and nitrogen assimilation profile and germ tube for Candida albicans identification. Samples from birds’ extracts (n = 8) were diluted in sterile saline solution with antibiotic and the supernatant was inoculated in spread on Niger seed agar. All samples were negative for Cryptococcus neoformans, however, C. albicans (two samples from choana), C. famata (one sample from choana) and C. tropicalis (choana) were found. Excretas from bird cages were negative to C. neoformans. Results suggested that birds harbor various pathogenic species of yeast, but not C. neoformans, and the result showed potential danger to carry diseases to humans.

Las levaduras pueden causar diversas enfermedades en el hombre y animales. En las aves, las levaduras están involucradas principalmente en lesiones en el tracto respiratorio y digestivo. Entre las levaduras patogénicas, Cryptococcus neoformans viene destacándose por la alta incidencia de cryptococcus humana en pacientes inmune deprimidos. Así, el objetivo de este estudio fueron identificar C. neoformans y otras levaduras patogénicas en la cloaca y coana de psittacidae y psittaciformes y en excretas colectadas de las jaulas de pajareras. Fueron obtenidas 29 muestras de quince (15) aves manifestando algún señal respiratorio, provenientes del Ambulatorio de Animales Salvajes de la UFPR (n=6) y de la Clínica Veterinaria Vida Livre (n= 23). Las muestras fueron sembradas en Ágar Sabouraud y Ágar Níger y mantenidas a 30ºC hasta 30 días. Todas las colonias fueron analizadas cuanto a la macro y micromorfología. Para aquellas identificadas como levaduras, fueron realizadas las pruebas bioquímicas: asimilación de carbono y nitrógeno, y formación de tubo germinativo para identificación de Candida albicans. Las muestras de excreta de los pajareros (n=8) fueron mezcladas con solución fisiológica conteniendo antibiótico y el sobrenadante fue sembrado en Ágar Níger. Ninguna muestra de las aves presentó resultado positivo para C. neoformans, pero se identificaron muestras positivas para C. albicans (dos muestras de coana), C. famata (una muestra de coana) y C. tropicalis (una nuestra de coana). Las excretas fueron negativas para C. neoformans. Por lo tanto, a pesar de no haber sido aislado C. neoformans, otras levaduras patogénicas fueron aisladas, demostrando que esas aves son posibles transmisoras de enfermedades para los seres humanos.

Aerobic bacterial microflora of Broad-snouted caiman (Caiman latirostris) oral cavity and cloaca, originating from Parque Zoológico Arruda Câmara, Paraíba, Brazil / Microflora bacteriana aeróbica da cavidade oral e cloaca de jacaré-de-papo-amarelo (Caiman latirostris) procedentes do Zoológico de João Pessoa, PB, Brasil

The objective of this study was to isolate and identify the aerobic bacterial microflora from the oral cavity mucosa and cloaca's samples, collected from Broad-snouted caiman (Caiman latirostris), born and bred in captivity at Parque Zoológico Arruda Câmara, João Pessoa, Paraíba, Brazil. The most common bacteria were Staphylococcus sp. (14.74%), Corynebacterium sp. (13.68%), Escherichia coli (13.68%) and Shigella sp. (11.58%), and the less common were Citrobacter sp. (1.05%), Klebsiella pneumoniae (1.05%) and Salmonella sp. (1.05%).This emphasizes the importance of these microorganisms' participation in infectious processes (sepsis) and injuries caused by crocodilians.

O presente estudo teve como objetivo isolar e identificar a microflora bacteriana aeróbica presente na mucosa da cavidade oral e da cloaca de exemplares de jacarés-de-papo-amarelo(Caiman latirostris) nascidos e criados em cativeiro no Parque Zoológico Arruda Câmara, localizado na cidade de João Pessoa - PB. As bactérias mais freqüentes foram Staphylococcus sp.(14,74%), Corynebacterium sp. (13,68%), Escherichia coli (13,68%) e Shigella sp. (11,58%), e as menos prevalentes foram Citrobacter sp.(1,05%), Klebsiella pneumoniae (1,05%) e Salmonella sp. (1,05%). Ressalta-se a importância da participação desses microrganismos em processos infecciosos (septicemias) e em feridas provocadas por crocodilianos.

Perineal Reconstructive Surgery of a Cloaca-Like Perineal Defect: A Case Report

The perineal defect in female genitalia results from multiple etiologies, including obstetric injury, sexual assaults, and perineal trauma. Untreated defects may lead to significant physical, functional, and esthetic complaints. Numerous reconstruction methods are used for a perineal defect, but various complications, such as fecal impaction, fecal incontinence, and wound disruption, are introduced. We report a case of a 40-yr-old woman with a cloaca-like perineal defect, who was treated with reconstructive surgery of the perineal defect and recovered with a good anatomical and functional outcome.

Surgical treatment of traumatic cloaca / Tratamento cirúrgico da cloaca pós-trauma

PURPOSE: To assess the functional results of surgical treatment of traumatic cloaca by a technique including reconstructive plastic surgery of the perineal body and of the rectovaginal septum using the puborectal and external sphincter muscles. METHODS: Six female patients were submitted to surgical treatment for correction of the cloaca over a period of 5 years (2002 to 2007). Loop sigmoidostomy was parformed in two patients. The mean duration of symptoms before surgical treatment was 97.5 months (4 months to 36 years), mean patient age was 36 years (17 to 58 years) and the follow-up period was 14.6 months (6 months to 2 years). RESULTS: Five patients (83.3 percent) regained fecal and flatus continence and one patient had flatus incontinence. DISCUSSION: Surgical treatment yields good results, is safe and involves low rates of complications.

INTRODUÇÃO: A causa mais comum da cloaca é o trauma obstétrico. O objetivo desse trabalho é avaliar os resultados do tratamento cirúrgico empregando-se plástica reconstrutiva do corpo perineal e do septo reto vaginal. MÉTODOS: Foram operadas seis mulheres, num período de 5 anos (2002-2007). Sigmoidostomia em alça foi realizada em duas pacientes. O tempo médio de duração dos sintomas no pré-operatório foi de 97,5 meses (4 meses a 36 anos), a faixa etária média foi de 36 anos (17-58) e o período de seguimento foi de 14,6 meses (6 meses - 2 anos). RESULTADOS: Cinco pacientes (83,3 por cento) recuperaram a continência anal para fezes e flatos e uma paciente permaneceu com incontinência para gases. DISCUSSÃO: O tratamento cirúrgico da cloaca pós-trauma apresentou bons resultados, sendo considerado um procedimento seguro, com baixo índice de complicação.

Clinical Characteristics of Children with Persistent Cloaca: A Urological Perspective / 대한비뇨기과학회지

PURPOSE: Persistent cloaca is a rare multiple anomalous condition which involves the gastrointestinal, neurological and urogenital systems. We evaluated the clinical characteristics and urogenital anomalies of patients with persistent cloaca, and we investigated the factors that must be considered from a urological perspective. MATERIALS AND METHODS: We retrospectively reviewed the medical records of 11 patients who were diagnosed with persistent cloaca at our institution during the last 7 years. RESULTS: Nine of the 11 patients who were followed up at the urology clinic were subjected to this study. Nonspecific abnormalities, such as antenatal hydronephrosis, were noted in 5 of 9 patients. The chief complaints upon visits to the urologic clinic were recurrent urinary tract infections in 3, preoperative evaluation before neurosurgery in 3, urinary incontinence in 1, urinary retention in 1 and an elevated creatinine level in 1. The urological anomalies included 2 cases of renal agenesis and 1 horseshoe kidney. Vesicoureteral reflux was noted in 6 patients, and 4 of these patients underwent antireflux surgery. Videourodynamic study was performed in 8 patients and all of them were diagnosed with neurogenic bladder. Currently, 5 children are on intermittent catheterization, 2 have undergone vesicostomy and 2 void spontaneously. CONCLUSIONS: Most patients with persistent cloaca had urological anomalies of the upper urinary tract and neurogenic bladder. Therefore, a multidisciplinary approach for diagnosis and treatment from various departments, including the urology, pediatric surgery, neurosurgery departments is mandatory.