Incidentally discovered type 1 split cord malformation in an adult patient.

Split spinal cord syndrome (SCM), an entity of spinal dysraphisms, occurs rarely in adults and is associated with tethered cord syndrome, which commonly presents with back pain. Besides clinical findings, neuroimaging by Magnetic resonance imaging or computed tomography is needed for diagnosis. We report a case of a previously healthy 51-year-old man who presented for right upper abdominal quadrant pain. A computed tomography scan of the abdomen and pelvis incidentally discovered the diagnosis of type 1 SCM. This case highlights that SCM can remain asymptomatic throughout life to be diagnosed at one point by neuroimaging. Whenever no clinical complications exist, no surgical intervention might be indicated.

Trans-urethral resection of bladder tumor (TURBT) and radiofrequency ablation of renal tumor: Rare etiologies of chyluria.

Chyluria is a rare entity which is caused by abnormal communication between the lymphatic system and the urinary tract, which allows the passage of chyle into the urine. Whenever symptomatic, chyluria presents with lower urinary tract symptoms such as dysuria and hematuria. Multiple imaging modalities can aid in diagnosis such as lymphoscintigraphy, retrograde pyelography, CT scan of the abdomen and pelvis, and magnetic resonance imaging. Numerous etiologies are associated with chyluria among which are surgical interventions. Partial and radical nephrectomy have been reported in a number of symptomatic and asymptomatic cases, while radiofrequency ablation of renal tumors has been very rarely reported. Herein, we report 2 cases of chyluria; one caused by trans-urethral resection of a bladder tumor and another by radiofrequency ablation of a renal oncocytoma. Fat-fluid level in the urinary bladder was seen on both precontrast and postcontrast images of CT scan of the abdomen and pelvis. Cystoscopy demonstrated no evidence of any abnormality of the urinary bladder.

Rectovaginal septum primary squamous cell cancer: Extremely rare entity.

Rectovaginal septum primary cancer is an extremely rare entity including gastrointestinal stromal tumor , adenocarcinoma (endometriosis related/unrelated) and Mullerian cell remnant cancer. These cancers are usually asymptomatic, but can grow large enough to present with pelvic discomfort or pressure symptoms (urinary retention or constipation). Imaging plays an important role in detection, characterization, staging workup and follow-up. Despite adenocarcinoma being the histology seen in most cases of primary rectovaginal septum carcinoma, 1 prior case of squamous cell cancer was reported in 2016. To the best of our knowledge, our case is the second reported case of this same extremely rare entity. We discuss a 35-year female with a rectovaginal mass which was detected by pelvic ultrasound, worked up by computed tomography (CT), positron emission tomography-CT and diagnosed by large incisional transvaginal biopsy. The patient underwent combined chemoradiotherapy, which resulted in complete resolution of the mass on follow up pelvic magnetic resonance imaging. Standard management guidelines are not available due to lack of adequate data.

Intestinal Dysbiosis and Markers of Systemic Inflammation in Viscerally and Generally Obese Persons Living With HIV.

BACKGROUND: The intestinal microbiota contributes to the pathogenesis of obesity and metabolic disorders. People living with HIV (PLWH) have a higher risk for the development of visceral adiposity with accompanying worsened cardiovascular risk. SETTING: Convenience sample from an HIV clinic and research unit. METHODS: To understand the relationship between adiposity and intestinal dysbiosis, we compared the gut microbiota and inflammatory markers in a cross-sectional study of viscerally obese, generally obese, and lean PLWH. Fecal intestinal microbiota was characterized by 16S ribosomal DNA sequencing. Abdominal CTs quantified subcutaneous adipose tissue and visceral adipose tissue (SAT; VAT). Serum high sensitivity C-reactive protein, adiponectin, leptin, IL-6, MCP-1, and sCD14 were assayed. RESULTS: We studied 15, 9, and 11 participants with visceral obesity, general obesity, and lean body type, respectively. The generally obese group were all women and 2/3 African American, whereas the visceral obesity and lean groups were predominantly white and men who have sex with men. Markers of systemic inflammation and sCD14 were higher in general obesity compared with lean. sCD14 was positively correlated with VAT, but not SAT. Bacterial diversity was significantly reduced in participants with visceral and general obesity and composition of intestinal microbiota was significantly different from lean body types. Bacterial alpha diversity was negatively correlated with VAT area, waist/hip ratio, and sCD14, but not with SAT area. CONCLUSIONS: In this exploratory study, obesity in general was associated with dysbiotic intestinal microbiota. The relationships of VAT to bacterial diversity and sCD14 suggest that dysbiosis in viscerally obese PLWH could be associated with heightened inflammatory state.

Extension of air into the right perirenal space after duodenal perforation: CT findings.

PURPOSE: To determine the extraperitoneal distribution of air following perforation of the second portion of the duodenum. MATERIALS AND METHODS: Institutional review board approval was obtained for this HIPAA-compliant study. The requirement for written informed consent was waived. Two reviewers who were aware of the presence of duodenal perforation after duodenal endoscopy retrospectively reviewed computed tomographic (CT) images in eight patients (one man, seven women; mean age, 68 years; age range, 27-88 years) to assess and categorize the location of extraluminal air. RESULTS: Extraluminal air was detected in the following locations: right anterior pararenal space (n = 8), right perirenal space (n = 7), right posterior pararenal space (n = 4), right properitoneal compartment (n = 4), bare area of the liver (n = 6), right extraperitoneal pelvis (n = 7), hepatoduodenal ligament (n = 3), mesentery (n = 2), mediastinum (n = 4), portal venous system (n = 1), and peritoneal cavity (n = 1). CONCLUSION: Air extended posteriorly into the right perirenal space in seven (88%) of eight patients following perforation of the second portion of the duodenum. Duodenal perforation introduces potential for direct communication between the right anterior pararenal space and the right perirenal space. SUPPLEMENTAL MATERIAL: http://radiology.rsnajnls.org/cgi/content/full/2503080605/DC1.

Structural and functional changes to the testis after conventional versus microdissection testicular sperm extraction.

OBJECTIVES: To compare, in a retrospective study, the ultrasound findings and hormonal changes after testicular sperm extraction (TESE) using the conventional multiple biopsy approach and the more recent microdissection technique. TESE has been performed using the conventional multiple biopsy approach and the more recent microdissection technique. METHODS: A total of 435 men with nonobstructive azoospermia who had undergone 543 TESE attempts were included in the study. The initial 83 attempts were done using the conventional open technique and the remaining 460 attempts were performed by microdissection. The sperm retrieval rates were compared, as were the complication rates as assessed by ultrasound and endocrinologic evaluations between the two groups. RESULTS: The retrieval rate by the conventional technique was 32% and by microdissection was 57% (P = 0.0002). In patients with hypospermatogenesis, the retrieval rate differed between the two approaches (P = 0.03). Ultrasound findings demonstrated fewer acute and chronic changes in the microdissection group than in the conventional group (P < 0.05). At 3 to 6 months after surgery, the testosterone levels had dropped to 80% of their pre-TESE levels in both groups (P < 0.01). The levels rose back to 85% after 12 months and to 95% after 18 months. The mean follicle-stimulating hormone levels increased from 22 +/- 2 to 30 +/- 3 IU/L (P = 0.02), and the luteinizing hormone levels increased from 12 +/- 2 to 16 +/- 2 IU/L (P = 0.2). CONCLUSIONS: TESE has effects on testicular function, but the microdissection procedure is relatively safer than the conventional technique and improves the sperm retrieval rate significantly in patients with nonobstructive azoospermia.