SummaryBackgroundThe classical theory of Müllerian origin of upper vagina fails to explain complex urogenital malformations like OHVIRA syndrome; the Acien’s hypothesis, however, unravels the hidden embryopathogenesis. As per Acien, Wolffian (mesonephric) ducts instead of Müllerian ducts and sinovaginal bulbs, give rise to the vagina. The new hypothesis, however, retains the concept of origin of the ureters (with ureters inducing renal development) by the former and the uterus by Müllerian ducts. Thus, a failure of development of mesonephros/mesonephric duct gives rise to absent ureters and hence absent homolateral kidney; blind ending (obstructed) ipsilateral hemivagina and cessation of support to paramesonephric ducts which leads to unfused uterus (uterus didelphys). Hence, the new hypothesis explains all components of OHVIRA syndrome. On a parallel track, unilateral anomalous development of the mesonephros in males causes atresia of the homolateral ejaculatory duct that results in obstruction of the proximally placed seminal vesicle. Besides, there is absence of the ipsilateral kidney (Zinner syndrome).Case ReportIn this manuscript, we describe four cases of OHVIRA syndrome. Case 1 was a 34-year-old nulligravida, married since fourteen years, who presented with a 5-month history of pelvic inflammatory disease and dyspareunia. Regular menses in the patient and azoospermia in her husband delayed the diagnosis. Case 2 was a 14-year-old girl who presented with dysmenorrhea and lower abdominal pain since a few months. Case 3 was a 27-year-old female who presented with infertility and dysmenorrhea. Case 4 was a 15-year-old female who presented with a one-year history of dysmenorrhea and cyclic pelvic pain. In all cases, one of the uterine horns revealed collection due to a hemivaginal septum and an absent ipsilateral kidney; thus, establishing the diagnosis of OHVIRA syndrome. The case 4 additionally revealed homolateral vaginal agenesis.ConclusionsOn the basis of our 4 cases, we support the Acien’s hypothesis of Wolffian origin of vagina which explains the development of OHVIRA syndrome. Besides, we emphasize the need to suspect this syndrome in a female with a pelvic mass and absence of homolateral kidney. Finally, we believe that OHVIRA due to its Wolffian origin is a female equivalent of Zinner syndrome in males. Therefore, we propose OSVIRA (Obstructed Seminal Vesicle and Ipsilateral Renal Agenesis) as an acronym for Zinner syndrome analogous to OHVIRA.
Intracranial aneurysm in paediatric age group is rare and association of the aneurysm with congenital vertebral artery anomaly is further rarer. We describe such a case in an 11-year-old male patient who consulted a paediatrician about headache and vertigo, and a noncontrast CT (NCCT) head revealed peripherally calcified hyperdense mass in prepontine and basal cisterns. Magnetic resonance imaging (MRI) including contrast enhanced magnetic resonance angiography (MRA) revealed partially thrombosed giant serpentine aneurysm of right vertebrobasilar artery and contralateral hypoplastic vertebral artery with fenestration. The nondominant left vertebral artery gave off the posterior inferior cerebellar artery, then became hypoplastic and joined with its counterpart to form the basilar artery. This pattern is called as type 9. The patient was kept on conservative management. The role of MRI in this congenital anomaly and its association with vertigo and aneurysm of vertebro-basilar artery is discussed.
Coke reactivity index (CRI) and coke strength after reaction (CSR) are the most important parameters used to assess the blastfurnace coke quality. The present work describes the possibility of estimating CSR for coke from ash chemistry of coal blends. For development and validation of the regression model, data obtained from the Tata Steel's coke oven battery numbers 8 and 9 were utilized. It was found that CSR is greatly influenced by coal ash chemistry.
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