Trematodes Lecture Flashcards
1
Q
Largest trematode infecting humans.
A
Fasciolopsis buski
2
Q
Terminal spined eggs are seen in
A
Schistosoma haematobium
3
Q
The ova of this parasite resembles an old-fashioned electric bulb and contains a small knob.
A
Clonorchis sinensis
4
Q
A term that refers to the parasites that reproduce via separate sexes
A
Dioecious
5
Q
General term for (human) infection with flukes
A
Distosomiasis
6
Q
Common name of Fasciolopsis buski
A
Giant Intestinal Fluke
7
Q
Common name of Fasciola hepatica
A
Sheep Liver Fluke
8
Q
All flukes are organ-dwelling except _
A
Schistosomes
9
Q
Consumption of infected crab causes human infection with which trematode?
A
Paragonimus westermani
10
Q
Which blood fluke is characterized by an egg with lateral spine?
A
Schistosoma mansoni
11
Q
T or F. S. japonicum inhabits the superior veins of the small intestine
A
TRUE
12
Q
T or F. S. haematobium inhabits the portal vein of urinary bladder.
A
TRUE
13
Q
T or F. The male schistosome is more slender than the female.
A
FALSE
The female schistosome is more slender than the male.
14
Q
Some Heterophyids have a gonotyl or a genital sucker.
A
TRUE
15
Q
Heterophyid adults release embryonated eggs each with a fully-developed miracidium
A
TRUE
16
Q
Intestinal Flukes
A
Fasciolopsis buski
Heterophyes heterophyes
Metagonimus yokogawai
17
Q
Liver Flukes
A
Fasciola hepatica
Clonorchis sinensis
18
Q
Lung Fluke
A
Paragonimus westermani
19
Q
Blook Flukes
A
Schistosoma mansoni
Schistosoma japonicum
Schistosoma haematobium
20
Q
Heterophyid Flukes
A
Heterophyes heterophyes, Metagonimus yokogawai
21
Q
It contains a third sucker (genital or gonotyl sucker)
A
Heterophyes heterophyes
22
Q
Common Name for Fasciola hepatica
A
Sheep Liver Fluke
23
Q
It has cephalic comb in the anterior end or near the oral socket
A
Fasciola hepatica
24
Q
CN for Clonorchis sinensis
A
Chinese or Oriental Liver Fluke
25
CN for Paragonium westermani
Oriental Lung Fluke
26
Most common lung infection in humans
Paragonimus westermani
27
CN for Schistosoma mansoni
Manson’s Blood Fluke
28
Schistosoma mansoni inhabits in the ___.
large intestine
29
CN for Schistosoma japonicum
Blood Fluke
30
Schistosoma japonicum inhabits in the ___.
small intestine
31
CN for Schistosoma haematobium
Bladder Fluke
32
Schistosoma haematobium inhabits the __.
portal vein of urinary bladder
33
Adult form of trematodes are primarily ___, ___, and ___.
non-segmented
flattened
leaf-shaped
34
What form of trematodes is the most causing Mostly causing damage or possible irritation and
other pathophysiological mechanisms?
Adult form
35
Another name for the trematodes
Digenea
36
Dioecious is specific for what species?
Schistosoma spp.
37
What trematodes that have presence and location of spines in eggs?
Schistosoma spp.
38
All trematode eggs are embryonated except?
Fasciola hepatica
Fasciolopsis buski
Echinostoma ilocanum
Paragonimus westermani
39
They require certain embryonation or developmental period once they are laid.
Underdeveloped eggs
40
They are capable of developing into another stage of parasite once laid
Embryonated eggs
41
Infective stage of schistosome
Cercaria
42
Infective stage of all trematodes except schistosomes
Metacercaria
43
Stages of Trematodes
Eggs >> Miracidia >> Sporocyst >> Redia >> Cercaria >> Metacercaria
44
Characteristics of Trematodes except Schistosome
leaf-like
hermaphroditic
typically food-borne
45
Characteristics of Schistosomes
long and slender
dioecious
direct penetration of infective stage
46
What are the specific canals found in Schistosomes males (larger) utilized for copulation with females where they attach themselves until death?
Gynecophoral canal
47
T or F. All trematode life cycles require a snail as the 1st and/or 2nd intermediate host.
True
48
T or F. All trematodes are organ-dwelling except schistosomes.
True
49
Blood-dwelling trematodes
Schistosomes
50
young form of schistosoma
Schistosomule
51
T or F. There is no 2nd intermediate host for Schistosoma sp.
True
52
Specimen of Choice for Trematodes
Feces
Duodenal drainage
Rectal biopsy
Sputum
Urine
53
It is the most important fluke infecting man
Clonorchis sinensis
54
Specimen of Choice for Paragonimus westermani
Sputum
55
Clonorchis sinensis infection is diagnosed through?
EnteroTest
56
Specimen of Choice for Schistosoma haematobium
Urine
57
DH of Fasciola hepatica
Sheep, cattle, and other herbivores (humans infected occasionally)
58
1st IH of Fasciola hepatica
Amphibious snails
59
2nd IH of Fasciola hepatica
Kangkong (Ipomea obscura), Nasturtium officinale (watercress)
60
Reservoir Host of Fasciola hepatica
Hares and rabbits, sheep
61
IS of Fasciola hepatica to DH
Metacercaria
62
Habitat of Fasciola hepatica
Billiary passages of liver
63
MOT of Fasciola hepatica
Ingestion of undercooked or raw aquatic plants containing the metacercaria
64
DH of Fasciolopsis buski
Humans and pigs
65
1st IH of Fasciolopsis buski
Segmentina or Hippeutis (Segmentina coenosus
Hippeutis cantori)
66
IS of Fasciolopsis buski
Metacercaria
67
2nd IH of Fasciolopsis buski
Freshwater vegetation:
Trapa bicornis (water caltrop)
Eliocharis tuberosa (water chestnut)
Ipomea obscura (morning glory or kangkong)
Nymphaea lotus (lotus)
68
Habitat of Fasciolopsis buski
Duodenum and jejunum (small intestine)
69
MOT of Fasciolopsis buski
Ingestion of encysted metacercariae from aquatic plants
70
T or F. Fasciolopsis buski and Fasciola sp. are almost similar under the microscope that is why it is difficult to differentiate
True
71
T or F. Fasciolopsis buski and Fasciola sp. are almost similar under the microscope that is why it is difficult to differentiate
True
72
Fasciolopsis buski is commonly found in the ___.
Oriental areas or Far East
73
Its egg is also described as “Hen’s egg appearance”
Fasciolopsis buski
74
T or F. F hepatica egg is larger than F. buski egg.
True
75
Egg contents of F. buski and F. hepatica
Undeveloped miracidium
76
Eggs of these species have distinct operculum
F. buski and F. hepatica
77
Adult worm of this trematode is equipped with so-called shoulders (cephalic cone)
Fasciola hepatica
78
Adult worm of this trematode have large oral sucker
Fasciola hepatica
79
T or F. Adult worm of Fasciolopsis buski is larger than adult worm of Fasciola hepatica.
True
80
Adult worm of this trematode has no prominent shoulders (cephalic cone).
Fasciolopsis buski
81
Adult worm of this trematode has an intestinal ceca that is unbranched or lacks its side branches.
Fasciolopsis buski
82
Adult worm of this trematode has ventral sucker that is much larger than its oral sucker.
Fasciolopsis buski
83
Reservoir hosts of F. buski
rabbits, pigs, dogs
84
F. hepatica has a worldwide epidemiology
True
85
Adult worm of F. buski and F. hepatica inhabits where?
Small intestine
86
Metacercariae of F. hepatica and F. buski excyst where?
duodenum
87
What trematode has clinical manifestations in which the stools are profuse, light yellow in color, and contain much undigested food if there is an heavy infection?
Fasciolopsis buski
88
T or F. In F. hepatica even light infections may produce signs and symptoms of biliary obstruction and cholangitis due to its size.
True
89
It is the obstruction or accumulation of adult forms of F. hepatica in the pharynx
Halzoun
90
DOC for F. buski
Praziquantel
Bithionol (sometimes used)
91
DOC for F. hepatica
Dichlorophenol (Bithionol)
Triclabendazole
92
DH of Clonorchis sinensis
Humans and other vertebrates (Cattle)
93
1st IH of C. sinensis
Snails:
Parafossarulus (P. manchouricus, P. anomalospiralis, and P. stratulus)
Bulinus (B. striatulus)
Semisulcospira Alocinma (A. longicornis)
Thiara (T. granifera)
Melanoides (M. tuberculatus)
94
2nd IH of C. sinensis
Ctenopharyngodon idellus (Freshwater fish/ Cyprinidae fish)
Freshwater shrimp
95
IS of C. sinensis
Metacercaria
96
Habitat of C. sinensis
Liver, bile ducts
97
MOT of C. sinensis
Ingestion of raw undercooked fish containing the metacercaria
98
Reservoir hosts of C. sinensis
Sheep, cats, dogs, pigs, other mammals (fish eating animals)
99
It has old-fashioned bulb in the eggs
Clonorchis sinensis
100
It has the smallest trematode egg.
Clonorchis sinensis
101
Egg contents of C. sinensis
Developed miracidium
102
T or F. C. sinensis egg has operculum.
True
103
Other features of C. sinensis egg
distinct shoulders
small knob opposite of operculum
104
It is called as the thickened rim around the operculum in C. sinensis egg.
shoulder
105
Heterophyes heterophyes and Metagonimus yokogawai eggs resemble what trematode egg?
Clonorchis sinensis egg
106
What features differentiate C. sinensis egg from H. heterophyes and M. yokogawai eggs?
Small comma shaped process at the abopercular end
Thickened rim around the operculum
Small knob on the opposite end
107
T or F. Each end of the C. sinensis adult worm is narrower than the midportion of the body.
True
108
What adult trematode has a spatula-like appearance?
Clonorchis sinensis
109
What trematode has a ventral sucker that is smaller than the oral sucker?
Clonorchis sinensis
110
T or F. Clonorchis sinensis has a short intestinal ceca.
False. Clonorchis sinensis has a long intestinal ceca.
111
Testes of Clonorchis sinensis are what?
dendritic or branching
112
What trematode has minute vitellaria at the sides?
Clonorchis sinensis
113
What are located anterior to the testes of Clonorchis sinensis?
A small slightly lobated ovary positioned in the midline and loosely coiled uterus ending at the common genital core
114
It is responsible for the production of egg shell in C. sinensis.
minute vitellaria
115
How many flukes should there be to be considered as asymptomatic in C. sinensis?
less than 100
116
What clinical manifestation results from heavy infections of C. sinensis?
Clonorchiasis
117
How many phases of pathological changes does clonorchiasis?
4
118
It results in liver dysfunction in person severely infected over a long period of time by C. sinensis
Cholangiocarcinoma
119
It is the inflammation of the gall bladder due to C. sinensis.
Cholecystitis
120
It refers to the gallstone formation due to C. sinensis.
Cholelithiasis
121
What trematode is sometimes aggravated by the intrahepatic stone formation, cholangitis, and multiple liver abscesses?
Clonorchis sinensis
122
Cirrhosis is also a possible complication of what trematode?
Clonorchis sinensis
123
DOC of C. sinensis
Praziquantel
Others:
Albendazole
Artemisinins
synthetic peroxides
124
What trematode is almost identical to M. yokogawai?
Heterophyes heterophyes
125
It is considered as the minute flukes.
Heterophyids
126
CN of Heterophyes heterophyes
Von Siebold’s fluke
127
DH of Heterophyes heterophyes/ Metagonimus yokogawai
Man, birds, various fish-eating mammals
128
1st IH of Heterophyids
Brackish water or marine species snails
Pironella
129
Common 1st IH of Heterophyids in the Philippines
H. taichui
Procerovum calderoni
Melania juncea
Thiara riquetti
130
2nd DH of Heterophyids
Brackish and salt water fish
tilapia
Mugil cephalus (mullet for H. heterophyes)
131
IS of Heterophyids
Metacercaria
132
IS of Heterophyids
Metacercaria
133
Habitat of Heterophyids
small intestine
134
MOT of Heterophyids
Ingestion of metacercariae encysted in fish
135
Egg contents of Heterophyids
Developed miracidium
136
T or F. Operculum is not present in Heterophyids eggs
False. Operculum is present in Heterophyids eggs.
137
T or F. Shoulders are present but discrete in Heterophyids eggs.
True
138
T or F. Small knob is always present in Heterophyids eggs.
False. Small know may be absent in Heterophyids eggs.
139
Shell thickness of H. heterophyes eggs
Thick
140
Shell thickness of H. heterophyes eggs
Thick
141
Shell thickness of M. Yokogawai
Thin
142
What features differentiate Heterophyids from C. sinensis?
Shoulders are less distinct
Eggs may lack small terminal knob
143
What trematode have eggs that do not have an abopercular protuberance in contrast to Clonorchis and Opisthorchis eggs?
Heterophyids
144
T or F. Heterophyid eggs are slightly larger than Metagonimus eggs.
True
145
Shape of H. heterophyes and M. yokogawai
Pyriform
146
Adult of this trematode is grayish in color
Heterophyes heterophyes
147
Adult of this trematode is protected by outer layer of fine scaly spines
Heterophyes heterophyes
148
Adult of this trematode has tapers at anterior end and round posterior end.
Metagonimus yokogawai
149
What end of M. yokogawai has a tiny layer of scaly spines?
anterior end
150
What trematode has avocado or pear shaped with three suckers, having a third sucker which is the gonotyl?
Heterophyids adult
151
Where is the gonotyl of Heterophyids adults located?
left posterior border of the ventral sucker
152
T or F. Heterophyids adults have two ovoid testes, variously arranged, are in the posterior end of the body
True
153
Where is the globular or slightly lobed ovary of Heterophyids located?
submedian, pre- or post testicular area
154
T or F. Only following anti-helminthic treatments can the adult forms be seen in the feces
True
155
Heterophyids may escape the intestinal tract and migrate to other areas.
True
156
Chronic mucous diarrhea and granulomas is a clinical symptom of what trematode?
Heterophyids
157
What trematode may be encapsulated in the cardiac muscle and may lead to myocarditis or cardiomegaly, resulting in the death of the host due to cardiac arrest?
Heterophyids
158
A case in Hawaii referred to _______ myocarditis as “mystery death” among Filipino descent due to aberrant ____.
heterophyid; heterophyid eggs
159
DOC of Heterophyids
Praziquantel
160
DH of Paragonimus westermani
Dogs, cats, field rats, humans
161
1st IH of P. westermani
Antemelania asperata (Brotia asperata)
Antemelania dactylus (snail)
162
2nd IH of P. westermani
Sundathelphusa philippina (Parathelphusa grapsoides; mountain crab or talangka)
163
Reservoir host of P. westermani
Dogs, cats, field rats, humans, pigs, monkeys
164
IS of P. westermani
Metacercaria
165
Habitat of P. westermani
Lungs (encysted in lung tissue)
166
MOT of P. westermani
Ingestion of uncooked or undercooked crabs
(crustaceans) or crayfish with metacercariae
167
It is the lung flukes affecting humans in the oriental or Oriental lung fluke.
Paragonimus westermani
168
What trematode is a zoonotic parasite, meaning humans and animals can serve as definitive and reservoir hosts?
Paragonimus westermani
169
How many species of the lung fluke belong to the genus Paragonimus?
at least 8
170
What trematodes are primarily the parasite of wild felines such as canines (dogs, cats, and wolves), civet cats, leopards, lions, tigers, and other mammals?
Paragonimus westermani
171
T or F. Egg of P. westermani is embryonated at oviposition.
False. Egg of westermani is umebryonated at oviposition.
172
Egg of this trematode has flattened but prominent operculum.
Paragonimus westermani
173
Shape of P. westermani egg
somewhat oval
174
Egg contents of P. westermani
Undeveloped miracidium surrounded by a thin, smooth shell
175
Other features of P. westermani egg
Prominent operculum with shoulders; obvious terminal shell opposite operculum
176
What is the color of adult lung fluke?
reddish brown and thick
177
What adult trematode resembles a coffee bean?
P. westermani
178
Eggs of P. westermani is discharged into where and they may be expectorated or if swallowed, they may appear in our feces.
bronchioles
179
T or F. Adult lung fluke is slightly tapered anteriorly.
False. Adult lung fluke is slightly tapered posteriorly
180
T or F. Tegument of P. westermani adult is covered with single-spaced spines
True
180
T or F. Tegument of P. westermani adult is covered with single-spaced spines
True
181
Specimen of Choice for P. westermani
Sputum
182
T or F. Recovery of eggs in stool is common in P. westermani
False. Recovery of eggs in stool is rare in P. westermani
183
T or F. Patients with tuberculosis who undergo a sputum exam have a positive result on acid-fast staining, while patients with P. westermani will have eggs on the sputum.
True
184
Symptoms often mimic those seen in tuberculosis-infected individuals.
Paragonimiasis (pulmonary distomiasis)
185
It is when P. westermani enters the brain and cause seizures, visual difficulties, and decreased precision of motor skills.
Cerebral paragonimiasis
186
Sputum of patients with P. westermani is frequently __ and may contain numerous ___.
blood-tinged; dark brown eggs and Charcot-Leyden crystals
187
Bronchiectasis may result and pleural effusion is
sometimes seen in this trematode?
Paragonimus westermani
188
It is the most serious consequence of P. westermani in which the flukes enters the cranial cavity through the jugular foramen and invades the brain tissue.
cerebral paragonimiasis
189
Where does P. westermani enter the cranial cavity?
Jugular foramen
190
Cutaneous paragonimiasis is a characteristic of what Paragonimus specie?
Paragonimus skrjabini (Paragonimus szechuanensis)
191
DOC of Paragonimus westermani
Praziquantel
192
Alternative drug for P. westermani
Bithionol
193
It is a genus of parasitic blood flukes that infect birds and mammals, including humans
Schistosoma
194
Fiver medically important blood flukes
S. japonicum
S. mansoni
S. haematobium
S. mekongi
S. intercalatum
195
Predominant Schistosoma spp in the Philippines
Schistosoma japonicum
196
Eggs of what Schistosoma spp are found in the feces
S. mansoni
S. japonicum
S. intercalatum
S. mekongi
197
Eggs of what Schistosoma spp are found in the urine
S. haematobium
198
T or F. Female worms of Schistosoma spp are shorter than male worms.
False. Female worms of Schistosoma spp are longer
199
T or F. Male worms of Schistosomes looks cylindrical and have gynecophoral canal where female reposes.
True
200
T or F. Body structure of schistosomes are particularly long, thick, and seems to clearly have an adaptation to an intravascular existence.
False. Body structure of schistosomes are particularly long, THIN, and seems to clearly have an adaptation to an intravascular existence.
201
Where do female Schistosomes deposit their eggs after leaving the male worms?
small venules close to the lumen of the
intestine or bladder
202
What Schistosomes have sharp spines on the eggs that assist in their retention in the blood vessels?
S. mansoni
S. haematobium
203
T or F. Schistosome eggs are operculated.
False. Schistosome eggs (ova) are not operculated compared to other trematodes and hatch by rupture if liberated into the freshwater.
204
DH of Schistosoma spp.
Humans
has a wide range of definitive hosts (domestic mammals such as dogs, pigs, cats, carabaos, and cows)
some may be permissive and become infected over an extended period of time and some may be non-permissive wherein schistosomes are stunted or mature but die prematurely
205
IH of Schistosoma spp.
Snails
require one IH
206
IS of Schistosoma
Fork-tailed cercariae
207
Habitat of Schistosoma spp
Mesenteric veins, blood, urinary tract (Schistosoma haematobium)
208
MOT of Schistosoma spp.
Skin penetration
209
Redia and metacercaria are not included in its life cycle
Schistosoma spp.
210
T or F. Only one host is involved in Schistosoma spp.
True
211
T or F. Adult worms are the cause of Schistosoma spp pathology.
False. Eggs are the cause of its pathology, not adult worms.
212
Smallest egg among Schistosoma spp.
Schistosoma japonicum
213
Largest egg among Schistosoma spp.
Schistosoma mansoni
214
Shape of S. mansoni egg
Oblong
215
Shape of S. japonicum
Somewhat roundish
216
Shape of S. haematobium
Somewhat oblong
217
Egg contents of Schistosoma spp.
Developed miracidium
218
Appearance and Location of Spine of S. mansoni
Large; lateral
219
Appearance and Location of Spine of S. japonicum
Small; lateral (difficult to see)
220
Appearance and Location of Spine of S. haematobium
Large; terminal
221
What Schistosoma spp egg has a small, knoblike protuberance?
S. japonicum
222
T or F. Male Schistosomes are shorter but sturdier.
True
223
What sex of Schistosome has a gynecophoral canal where the longer and more slender sex is held?
Male
224
What trematode has testes are arranged in one row above the ventral sucker?
Schistosomes
225
T or F. Female Schistosome has a single pyramidal ovary is located in the midline.
True
226
Reservoir hosts of Schistosomes
Monkeys, cattle and other livestock, rodents, dogs, cats
227
It is also called as bilharziasis, swamp fever.
Schistosomiasis
228
Acute symptoms of Schistosomiasis is more likely to be seen in __.
S.mansoni infections
229
Petechial hemorrhages may occur at site of penetration of this trematodes
Schistosoma
230
What stage occurs when Schistosomes reach the mesenteric or vesicular venules and egg laying commences?
Acute stage
231
T or F. The degree of reaction in Schistosomes is not necessarily proportional to the number of parasites involved.
True
232
What Schistosomes cause diarrhea or dysentery at acute stage?
S. mansoni
S. japonicum
233
What Schistosomes cause hematuria (blood in the urine) at the end of micturition and sometimes dysuria (frequent urination)?
S. haematobium
234
Early symptoms tend to be quite severe in heavily infected persons in this Schistosome spp.
S. japonicum
235
It is a very common symptom for S. japonicum and often significant mortality rate of the particular stage of the disease.
Katayama fever
236
Where was Katayama fever first described?
Japan
237
What eggs of Schistosomes produce most of the pathologic changes seen in chronic schistosomiasis?
eggs in the circulation
238
It is the most common form of chronic infection in
patients with S.mansoni or S.japonicum.
Hepatosplenic schistosomiasis
239
Hepatosplenic schistosomiasis also occurs regularly in ___ infections but tends to be subclinical or mild in ___.
S. haematobium; S. japonicum
240
T or F. In Hepatosplenic schistosomiasis, the chronically enlarged liver is not tender and the spleen may be barely palpable or massively enlarged.
True
241
Intestinal schistosomiasis is more common in __ and __ infections.
S. mansoni
S. japonicum
242
It may present a picture suggestive of granulomatous colitis, with abdominal cramps and tenderness, and intermittent bloody mucoid stools.
Intestinal schistosomiasis
243
Intestinal polyposis is not uncommon in what Schistosome?
Schistosomiasis mansoni
244
What is the most successful means of
diagnosing this intestinal schistosomiasis?
Colonoscopy
245
What type of schistosomiasis is seen with S. haematobium infections?
Urinary Schistosomiasis
246
It is so common among adolescent boys in the Nile River valley as to have been widely considered a phenomenon analogous to the menarche in girls
Hematuria
247
It is usually the first sign of infection for hematuria.
Terminal hematuria
248
Squamous cell carcinoma may be found in patients with heavy burden of what Schistosoma spp?
S. haematobium
249
Nephrotic syndrome is occasionally seen in both what type of Schistosoma spp. ?
S. mansoni
S. haematobium
250
Pulmonary involvement may be seen in all forms of schistosomiasis but is more common with __ infections.
S. haematobium
251
It is the coughing of blood due to pulmonary involvement in Schistosoma infections.
Hemoptysis
252
What trematode has resultant cor pulmonale due to pulmonary involvement of the parasite?
Schistosomes
253
Cerebral manifestations of schistosomiasis are most
commonly seen in ___ infection.
S. japonicum
254
What schistosomes affect the spinal cord more than the cerebral?
S. mansoni
S. haematobium
255
What area of the spine does Schistosome spp usually affect?
Lumbar area
256
What schistosome has been associated with bladder cancer?
S. haematobium
257
What schistosome may be associated with repeated Salmonella infections?
S. mansoni
S. japonicum
258
DOC of Schistosome spp
Praziquantel
259
It has been used to treat S. mansoni
Oxamniquine
260
T or F. Antimalarial medications has been proven effective for schistosomes
True
261
T or F. S. haematobium may damage the
tissues of the bladder causing considerable loss of blood.
True
262
Drug of choice for treating fascioliasis
Triclabendazole
263
T or F. Fasciolopsis buski / Fasciola hepatica egg contains undeveloped miracidium.
True
264
Clonorchis sinensis egg contains undeveloped miracidium.
False
265
T or F. Heterophyid eggs differ from Clonorchis due to the absence of abopercular protruberance.
True
266
When the cercaria of S. japonicum shed its forked tail, it becomes a ____.
Schistosomule
267
This structure in the adult schistosome is where the longer and more slender female is held.
Gynecophoral Canal
