Huge Bartholin’s cyst managed by primary marsupialization:A case report

BACKGROUND We report on the case of a 21-year-old female who could not walk due to a huge Bartholin's cyst occupying the right vulvar region.The patient was treated by marsupialization of the Bartholin’s cyst and postoperative antibiotic therapy.CASE SUMMARY A 21-year-old female without a medical history of sexually transmitted diseases presented to our outpatient clinic with complaints of a painful vulvar lump and a green-yellowish discharge for 4 d.A large Bartholin’s cyst,10 cm in diameter,was suspected over the right side of the vulva.She was advised to be admitted to the ward for intravenous antibiotic treatment and to perform marsupialization several days later.However,the patient requested immediate surgery because of time limitations.The patient underwent marsupialization under local anesthesia.The procedure was well-tolerated.After making the incision,a significant amount of malodorous pus(approximately 30 mL)was removed from the abscess.The patient was followed up for 1 wk postoperatively.The Bartholin’s cyst regressed,and the surgical wound healed well.CONCLUSION Our case shows that an initial marsupialization followed by oral antibiotic therapy can be an appropriate treatment option for a large Bartholin’s cyst.However,depending on the patient’s condition,a suitable treatment,either cystectomy or marsupialization,can be considered.

Hemorrhagic Bartholin’s cyst in a woman using anti-platelet medication:A case report and review of the literature

BACKGROUND We report the case of a postmenopausal female with a hemorrhagic Bartholin’s cyst who has been using an antiplatelet medication.CASE SUMMARY A postmenopausal woman,84 years of age,had a medical history of hypertension,diabetes mellitus,coronary artery disease(three-vessel disease),chronic kidney disease(stage 3),and dementia.The patient has been taking clopidogrel,an antiplatelet medication,for several years.She presented at our outpatient clinic complaining of painful swelling over her left vulva for several days.A Bartholin’s cyst over the left vulva was suspected,and the patient underwent marsupialization under local anesthesia,which was well-tolerated.During the incision procedure,bright-red blood with some blood clots was discharged,and a hemorrhagic Bartholin’s cyst was observed.There was no recurrence of the hemorrhagic Bartholin’s cyst during the 6-mo subsequent follow-up period.CONCLUSION Hemorrhagic Bartholin’s cysts rarely occur.We report the case of a postmenopausal female with a hemorrhagic Bartholin’s cyst who had been on antiplatelets and was successfully treated with marsupialization.No recurrence was noted during the 6-mo follow-up period.Older females taking antiplatelets should be cautious of bleeding when presenting with a Bartholin’s cyst.

揭盖造袋技术在鼻前庭囊肿中的应用

近年来,随着内镜的广泛使用,揭盖造袋技术在腔镜技术领域得到广泛开展,特别是对一些开放性腔道表浅囊肿的治疗。在耳鼻咽喉科,揭盖造袋技术较早应用于鼻窦黏液囊肿[1]、会厌囊肿和咽囊囊肿等治疗。

鼻内镜下低温等离子造袋术治疗腭正中囊肿临床分析

目的探讨鼻内镜下低温等离子造袋术治疗腭正中囊肿的临床疗效。方法分析暨南大学附属祈福医院2019年9月~2021年8月收治的5例腭正中囊肿患者,行鼻内镜下低温等离子腭正中囊肿造袋术,术后定期随访,观察患者术后症状改善、术腔恢复、术后并发症以及囊肿复发情况。结果术后1个月鼻内镜检查囊肿壁黏膜上皮化良好,鼻塞症状消失;术后第6~24个月随访均未见囊肿复发。结论鼻内镜下低温等离子腭正中囊肿造袋术创伤小,术后并发症少,囊肿未见复发,值得临床推广。

Combined Single Step Definitive Treatment in Acute Pilonidal Sinus Abscess Running Head: Single Step Treatment of Pilonidal Abscess

Backgrounds: The treatment of choice has been drainage and definitive surgical treatment after an interval for acute pilonidal sinus abscess till now. Because of the high incidence of chronic pilonidal sinus disease following drainage and aiming the cure in one step, synchronous treatment choices to drainage have been attempted recently. We analyzed retrospectively 20 patients with pilonidal sinus abscess on whom we carried out drainage+ marsupialization as singlestep treatment. Methods: Drainage+ synchronous marsupialization results of 20 patients (17 male, 3 female) between 20 to 37 years of age (mean 28) were analyzed retrospectively on the parameters of operation time, recovery period, time to workreturn and recurrence ratios. Results Operation times were between 15 to 25 minutes. Mean recovery period was 45 days (3050 days), the mean period from operation to workreturn was 24 (2230) days. There were full recovery in 18 patients (90%) and recurrence in 2 patients (10%). Silver nitrate ablation treatment achieved cure in recurrences. Conclusion: Drainage+ Marsupialization is an applicable and successful combined choice in the treatment of Pilonidal sinus abscess.

“Management of Bartholin Cysts and Abscess” in a Tertiary Care Centre, Jeddah, Saudi Arabia

Objective: To analyse all cases of Bartholin glands pathology (cysts and abscess), and identify the different variable affecting the method of management with Marsupialization or excision. Methods: This study is a cross-sectional retrospective analysis of all cases of Bartholin cysts and abscess admitted and managed at KAUH, from January 2017 to December 2017. Results: 48 patients were analysed: age (32.60 ± 9.9), parity, BMI (26.9 ± 4.98). Out of 48 patients, 25 (52.1%) were diagnosed as Bartholin cysts and 23 (47.9%) as Bartholin abscess. 72.9% (35) patients were managed with Marsupialization, and only 27.1% ended with excision. Comparing age in years, parity and BMI in the cases managed by Marsupialization with those with excision, the only statically significant difference was found in the parity. When comparing the important factors collected, younger subjects less than 35 years old, never being pregnant and BMI less than 30 had more Marsupialization than excision. But age . Abscess and non-recurrent had more Marsupialization but were statistically not significant. Other factors, past medical and surgical history and type of anaesthesia were the same in both groups. Logistic regression performed using the dependent variable for Marsupialization rather than excision with different covariant categorised variable, age less than 35, single, abscess, non-recurrent, and BMI less than 30 (Table 2). Age less than 35 and BMI less than 30

A Loculated Pyocele of Maxillary Sinus—A Rare Case Report

Pyocele of maxillary sinus occurs unusually, when its mucocele content gets secondarily infected. Most of the pyocele occupies the frontal and anterior ethmoid sinus involving the frontal-ethmoidal complex expanding into the orbit leading to ocular disorders. Maxillary sinus presentation is rare, and our patient had a well defined loculated pyocele in her right maxillary sinus that we suspected with radiological images and was confirmed by needle aspiration under endoscopic guidance to the pyocele sac. Here we would like to describe more in detail about the nature of the mucopyocele in paranasal sinuses, its presentation and various surgical modalities of treating the pyocele.

Incidence, Presentation and Management of Bartholin’s Gland Cysts/Abscesses: A Four-Year Review in Federal Teaching Hospital, Abakaliki, South-East Nigeria

Background: The Bartholin’s gland cysts and abscesses are one of the most common vulva cyst or abscesses in gynaecological practice. Symptomatic cases give significant discomfort to sufferers and have a negative impact on their quality of life. Objective: To investigate the incidence, pattern of presentation and management of Barthholin’s gland cysts and abscesses in the Federal Teaching Hospital Abakaliki (FETHA) Ebonyi State, Nigeria. Methodology: This was a four-year retrospective study of cases of Bartholin’s gland cysts and abscesses in FETHA. We studied all cases of Bartholin’s gland cysts and abscesses that were managed at the Federal Teaching Hospital Abakaliki from 1st January 2012 to 31st December 2015. Results: During the study period, there were 1015 gynaecological surgical cases of which 18 were for Bartholin’s gland cysts or abscess giving an incidence of 1.78%. The mean age of the patients was 28.8 ± 5.6 years with 61% of the patients within the age range of 21 to 30 years. The commonest risk factor that was found for the occurrence of Bartholin’s gland cyst or abscess was previous history of the disease in 14 (77.8%) followed by previous history of sexually transmitted diseases 8 (44.4%). Pain was the commonest presenting symptom in 14 (77.8%) of cases. The left vulva was the commonest site of disease as noted in 15 (83.3%) of patients. Escherichia coli and Staphylococcus aureus were the commonest isolates on swabs with 16 (88.9%) and 14 (77.8%) prevalence respectively. The disease presented commonly in form of abscess as observed in 10 (55.6%) of patients. All the patients had Marsupialization as the modality of treatment. Conclusion: Symptomatic Bartholin’s gland cyst and abscess cause significant morbidity for the sufferers and decreased quality of life. Accurate diagnosis and treatment is advocated to prevent chronicity and complications. Although options of treatment abound, Marsupialization remains the mainstay of treatment in low resource setting like ours.

The Endonasal Endoscopic Management of Paranasal Sinuses Mucoceles

Introduction: Paranasal sinuses mucoceles are benign, epithelial lined, mucus filled lesions, causing destruction of the adjacent sinus walls, and with further gradual extension to adjacent structures, serious morbidities and mortalities may occur. Objective: To emphasize on the efficacy of endonasal endoscopic marsupialization in the treatment of paranasal sinus mucoceles. Method: Retrospective descriptive study on paranasal sinus mucocele cases operated on endoscopically by the author (AAM), in the 10-year-period from to 2009-2019. Result: Total of 23 cases were included, 16 were males and 7 females, age ranging between 14 - 76 years, with a mean age of 45 years Location of mucoceles varied between: Frontal 7 cases (30%), Fronto-ethmoidal 6 cases (26%), Isolated Ethmoidal accounted for 3 cases (13%), sphenoidal 4 cases (17%), maxillary were 3 cases (13%) all of the 23 cases underwent endonasal endoscopic complete marsupialization, none of them required combination with external approach in-spite of different locations and complications, with no recurrence in a mean follow up period of 2.4 years. Conclusion: Endonasal endoscopic approach is a safe, efficient approach in the treatment of most paranasal sinus mucocele case in their different presentations and locations.

Leishmania in Marsupials—An Overview of Infection Records in the Americas and Australia

Marsupials have been the subjects of studies of both experimental and natural infections with different species of Leishmania in the Americas as well as Australia. Over a century has passed since the first description of a mammal being infected with Leishmania and since then several reviews have been published on the systematics of the parasites as well as their hosts. Consequently, an update of this information is needed in order to assure correct identification of the species involved in each case. A comprehensive review was undertaken and included most of the records of marsupials being infected with Leishmania sp. Emphasis was placed on parasitological, eco epidemiological and taxonomic information of both the parasites and mammalian hosts. The clinical profiles of the infections varied from severe, which principally occurred in experimentally infected animals, to asymptomatic, which was typical of natural infections. Marsupials must be considered one of the most important groups of mammalian hosts of Leishmania sp. Important factors, such as their ancient origin, wide geographical distribution and susceptibility to infections by different species of Leishmania, but with considerable resistance to the disease, could indicate that didelphids play a key role in the evolution of Leishmania in the New World.

Tropical cyclogenesis:Controlling factors and physical mechanisms

In this review,advances in the understanding of the controlling factors and physical mechanisms of tropical cyclogenesis(TCG)are summarized from recent(2018–2022)research on TCG,as presented in the Tenth International Workshop on Tropical Cyclones(IWTC-10).Observational,theoretical,and numerical modeling studies published in recent years have advanced our knowledge on the influence of large-scale environmental factors on TCG.Furthermore,studies have shown clearly that appropriate convective coupling with tropical equatorial waves enhances the development chances of TCG.More recently,illuminating research has been carried out on analyzing the mechanisms by which oscillations and teleconnections(El Ni˜no Southern Oscillation(ENSO)in particular)modulate TCG globally,in association with changes in the sea surface temperature(SST).In addition to this,recent research has diligently addressed different aspects of TCG.Multiple studies have reported the applicability of unified theories and physical mechanisms of TCG in different ocean basins.Recently,research has been carried out on TCG under different flow pattern regimes,dry air intrusion,importance of marsupial pouch,genesis of Medicanes,wind shear,convection and vertical structure.Furthermore,studies have discussed the possibility of near equatorial TCG provided that there is enough supply of background vertical vorticity and relatively low vertical wind shear.Progress has been made to understand the role of climate change on global and regional TCG.However,there are still significant gaps which need to be addressed in order to better understand TCG prediction.

A marsupial robotic fish team: Design, motion and cooperation

A bio-inspired marsupial robotic fish system composed of heterogeneous robotic fish is proposed in this paper. A miniature robotic fish, as the daughter robotic fish, can adapt to some narrow space, while the mother robotic fish, with a cabin to transport the daughter, possesses a powerful movement ability to improve the mobility and endurance of the team. The structures for mimicking bio-motion and the method for fishlike-motion are presented. A typical task of daughter-mother following is given to show the cooperation of the team. A motion model of free swimming is built based on the Lagrangian function, and the coupled dynamic and kinematic functions are calculated based on the relation between the generalized force and fluid force. Then, a neural network is trained through the data generated from this model to get a predictive yaw controller, which can control the orientation by a different offset of each link. The daughter robotic fish adopts a dynamic light source tracking approach to follow the mother, and a heterogeneous communication-based finite state machine is presented for task modeling. Experiments are carried out to verify the system.

Responding to the weather:energy budgeting by a small mammal in the wild

Energy conservation is paramount for small mammals because of their small size,large surface area to volume ratio,and the resultant high heat loss to the environment.To survive on limited food resources and to fuel their expensive metabolism during activity,many small mammals employ daily torpor to reduce energy expenditure during the rest phase.We hypothesized that a small terrestrial semelparous marsupial,the brown antechinus Antechinus stuartii,would maximize activity when foraging conditions were favorable to gain fat reserves before their intense breeding period,but would increase torpor use when conditions were poor to conserve these fat reserves.Female antechinus were trapped and implanted with small temperature-sensitive radio transmitters to record body temperature and to quantify torpor expression and activity patterns in the wild.Most antechinus used torpor at least once per day over the entire study period.Total daily torpor use increased and mean daily body temperature decreased significantly with a reduction in minimum ambient temperature.Interestingly,antechinus employed less torpor on days with more rain and decreasing barometric pressure.In contrast to torpor expression,activity was directly related to ambient temperature and inversely related to barometric pressure.Our results reveal that antechinus use a flexible combination of physiology and behavior that can be adjusted to manage their energy budget according to weather variables.

Exploiting a readily available but hard to digest resource:A review of exudativorous mammals identified thus far and how they cope in captivity

Gum is a widely available carbohydrate,composed mainly of non-digestible structural carbohydrates.No mammalian enzymes can digest gum;therefore,a mammal ingesting gum must rely on microbial fermentation to access the energy it possesses.Gums are relatively nutrient poor.Despite this,some mammals have evolved to exploit this food resource.We aim to review the literature for all mammal species which have been recorded to ingest gum,whether quantified or not,and discuss this in the context of their evolutionary adaptations.We also investigated the recommended captive diets for these species to look at whether gum is recommended.We conducted a literature search on ISI Web of Knowledge to tabulate all mammal species observed ingesting gum and classified them as obligate,facultative or opportunistic feeders.We encountered 94 mammal species that eat gum in the wild(27 obligate feeders,34 facultative feeders and 33 opportunistic feeders).Obligate feeders have entirely evolved to exploit this resource but were found to not be given gum in captivity,which may explain why they are failing to thrive,as opposed to facultative feeders,which have fewer issues.Gum may be necessary for the health of obligate feeders in captivity.Future research should focus on the physiological effects that gum ingestion poses on different digestive systems.

Keeping an ear out:size relationship of the tympanic bullae and pinnae in bandicoots and bilbies(Marsupialia:Peramelemorphia)

Bandicoots and bilbies(Order Peramelemorphia)occupy a broad range of habitats across Australia and New Guinea,from open,arid deserts to dense forests.This once diverse group has been particularly vulnerable to habitat loss and introduced eutherian predators,and numerous species extinctions and range retractions have occurred.Understanding reasons for this loss requires greater understanding of their biology.Morphology of the pinnae and tympanic bullae varies markedly among species.As hearing is important for both predator avoidance and prey location,the variability in ear morphology could reflect specialization and adaptation to specific environments,and therefore be of conservation relevance.We measured 798 museum specimens representing 29 species of Peramelemorphia.Controlling for phylogenetic relatedness and head length,pinna surface area was weakly negatively correlated with average precipitation(rainfall being our surrogate measure of vegetation productivity/complexity),and there were no environmental correlates with effective diameter(pinna width).Controlling for phylogenetic relatedness and skull length,tympanic bulla volume was negatively correlated with precipitation.Species that inhabited drier habitats,which would be open and allow sound to carry further with less obstruction,had relatively larger pinnae and tympanic bullae.In contrast,species from higher rainfall habitats,where sounds would be attenuated and diffused by dense vegetation,had the smallest pinnae and bullae,suggesting that low-frequency hearing is not as important in these habitats.Associations with temperature did not reach statistical significance.These findings highlight linkages between hearing traits and habitat that can inform conservation and management strategies for threatened species.