Esophageal Liposarcoma: A rare tumor.

Esophageal liposarcoma is a rare type of tumor. This case report documents the presentation, diagnosis, and management of a 74-year-old male with a medical history including diabetes mellitus, asthma, and hypertension. The patient's primary complaint was dysphagia, accompanied by regurgitation and substantial weight loss over a six-month period. Diagnostic evaluation revealed a sizable esophageal liposarcoma, which was successfully resected through surgery. Follow-up assessments demonstrated the absence of residual mass. Esophageal liposarcomas, though rare, should be considered in patients presenting with dysphagia or chest discomfort. Surgical resection is the mainstay of treatment, with the recommendation for extended postoperative surveillance given the limited available data regarding long-term prognosis.

Chirality and length-dependent electron transmission of fullerene-capped chiral carbon nanotubes sandwiched in gold electrodes.

In order to develop high-performance CNT-based electronic and optoelectronic devices, it is crucial to establish the relationship between the electron transport properties of carbon nanotubes (CNTs) and their structures. In this work, we have investigated the transport properties of chiral (8, m) and (10, m) CNTs sandwiched between two gold electrodes by employing nonequilibrium Green's function (NEGF) combined with density functional theory (DFT). We demonstrate that with the change of chirality the transport property changes, as predicted by the (n - m) rule. The change of length is also considered. Our results show that the electrical conductance of (10, m) CNTs is larger than that of the (8, m) CNTs, due to larger diameter. Furthermore, we found that the (8, 1) chiral CNT does not follow the (n - m) rule in shorter length and it shows metallic behavior. The cohesive energy, wavefunctions of electronic states, and coupling energy calculation indicate that the devices considered in this study are stable. The transmission spectra, current vs. voltage curves, and transmission eigenchannels provide strong evidence for our findings. Among the (10, m) series, (10, 3) CNT would be the optimal choice for a semiconducting molecular junction device with a significant conductance of 20 µA at 0.8 bias voltage.

Spin-polarized electrical transport properties of organic radicals in presence of zigzag-graphene nanoribbon leads.

The present work delves into the spin-polarized transport property of organic radicals sandwiched between two zigzag-graphene nanoribbon (ZGNR) electrodes by employing density functional theory and nonequilibrium Green's function technique. We demonstrated that the magnetic center(s) of the radical can manipulate the localized edge states of the ZGNR in the scattering region, causing ferromagnetic coupling. Such manipulation of the magnetic edges results in a high spin-filter effect in molecular junctions, and even the antiferromagnetic diradicals serve as nearly perfect spin filters. We have confirmed that this is a general phenomenon of ZGNR by analyzing two antiferromagnetic diradicals and a doublet. The spin-polarized density of states, transmission spectra, and current vs voltage curves of the systems provide strong evidence for our findings. This research strongly suggests that ZGNRs attached with organic radicals could be the perfect building blocks for spintronic materials.

Abdominal Crunch Syndrome Creates a -Diagnostic Challenge in Treating a Pilot with Acute Upper -Abdominal Pain.

BACKGROUND: A diagnosis in acute abdomen may remain elusive especially when the cause is rare. We report this interesting case of a fighter pilot presenting with acute abdominal pain. The case posed significant challenges in reaching the correct diagnosis of abdominal crunch syndrome. The syndrome is rare with only seven reports in the literature so far. To the best of our knowledge, this is the first ever report of this condition in an aircrew.CASE REPORT: A 37-yr-old pilot presented with severe upper abdominal pain and sweating. During examination, he developed bradycardia and was admitted with a presumptive diagnosis of acute coronary syndrome. Investigations revealed no myocardial ischemia on ECG, transaminitis, raised CPK, CKMB, and LDH. A CECT scan of chest and abdomen was normal. A GI surgery consult was sought where we connected the transaminitis and raised CPK and considered the possibility of rhabdomyolysis. On specific inquiry, the aviator gave history of unaccustomed exercise with a vigorous session of abdominal crunches a day prior. Thus, a diagnosis of abdominal crunch syndrome was concluded.DISCUSSION: The aviator did not associate his vigorous exercise with the occurrence of pain and, therefore, did not mention it. It would have avoided unnecessary investigations and delay in treatment. From the aeromedical safety aspect, had the aviator flown on the day he developed pain, there was a possibility of developing severe pain exacerbated by the G force and G suit and sudden in-flight incapacitation. From the perspective of the aircrew, it is advisable that they avoid sudden, unaccustomed exercise.Kumar A, Kaistha S. Abdominal crunch syndrome creates a diagnostic challenge in treating a pilot with acute upper abdominal pain. Aerosp Med Hum Perform. 2023; 94(2):86-89.

Laparoscopic management of obturator hernia in the setting of intestinal obstruction: A report of two cases and review of literature.

Owing to its rarity and non-specific clinical features, a diagnosis of obturator hernia is often delayed until the patient presents with intestinal obstruction. Often the diagnosis is made on a Computed Tomography (CT) scan or during exploratory laparotomy. While a laparoscopic approach is well described in an elective scenario, open surgery through a midline laparotomy has been the preferred approach for obturator hernia with intestinal obstruction. However, a few cases of obstructed obturator hernia have been reported that have been managed laparoscopically. We present our experience of two elderly patients who presented with intestinal obstruction. A CT scan helped clinch the diagnosis of obturator hernia as the cause and both were managed laparoscopically.

Spontaneous cutaneous endometriosis in Mons Pubis: review of literature.

Cutaneous endometriosis is not a very often seen condition and is broadly classified as primary (spontaneous) and secondary. While perineal endometriosis arising in a previous scar has been reported, spontaneous cutaneous endometriosis in perineum is extremely rare and only three cases occurring in mons pubis have been reported in literature. We report a case of 34-year-old lady presented with a swelling in pubic region and associated dull aching pain of 1-year duration with no history of cyclical variation of symptoms. Investigations finally concluded a diagnosis of endometriosis and a Complete excision with clear margins. Clinicians should be aware that a spontaneous endometriosis in the perineum can occur and can have atypical presentation with no increase in size or pain during menstruation.

A Case Report of Paralysis and Respiratory Difficulty in a Patient With a Recent History of Complicated Pregnancy - An Uncommon Expression of Distal Renal Tubular Acidosis.

Renal tubular acidosis type 1 (RTA-1) is a disorder where kidneys are unable to acidify urine, which ultimately results in normal anion gap metabolic acidosis. Its initial presentations and subsequent clinical manifestations can vary depending on the underlying cause and severity of the disease. We report a case of a 26-year-old female with a recent history of complicated pregnancy. She presented to a tertiary care hospital with quadriplegia and shortness of breath and required ventilator support. The extensive workup revealed that the patient had RTA-1 in association with Sjögren's syndrome. There are only a few cases of RTA-1 reported where the diagnosis was made during the pregnancy. By reporting this case of RTA-1 with rare initial clinical presentation and a recent complicated pregnancy, we propose that further research studies should be carried out in this area to explore a possible statistically significant association between pregnancy (and its complications) and RTA-1 exacerbation.

Current practice of antibiotic prophylaxis in elective laparoscopic cholecystectomy among surgeons of the Armed Forces Medical Services of India.

Background: Laparoscopic cholecystectomy (LC) is the most common surgery done in general surgical practice worldwide. Despite clear guidelines recommending against the routine use of antibiotic prophylaxis (ABP) for elective LC by professional entities such as the Scottish Intercollegiate Guidelines Network (SIGN), Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) etc., most surgeons are not convinced about omitting ABP in low-risk LC. Thus, this study aimed at capturing the practice of administering ABP in elective LC among surgeons of Armed Forces Medical Services (AFMS). Methods: This was a survey based on an electronic, cross-sectional, self-completion questionnaire that was designed and disseminated amongst 184 surgeons of the AFMS, online, and the data was collated centrally. Results: 64% of surgeons completed the survey. The majority (85%) of surgeons used ABP routinely in elective LC. In the univariate analysis, only the number of years of surgical experience and the total number of LC done in an entire career, and in the multivariate analysis age group of the surgeon, surgical experience and designation were significant factors for avoiding routine ABP in elective LC. Amongst the surgeons administering ABP, only 30% administered a single dose, 73% chose a single agent and Cefotaxime (57%) was the commonest antibiotic used. Conclusion: This study found that there is a high prevalence of use of antibiotic prophylaxis in elective laparoscopic cholecystectomy amongst the surgeons of the AFMS. There was a wide variation in terms of choice of antibiotics, administering single or multiple doses and as a single agent or combination therapy. Registered with clinical trials registry of India: CTRI/2019/03/018092.

Correlation Of Preoperative Volume Of Oral Tongue Squamous Cell Carcinoma (SCC) On CT Scan With Postsurgical Tumour Size.

BACKGROUND: Computed tomography (CT) radiological investigation is commonly used worldwide as a reliable method for determining the existence of oral tongue squamous cell carcinoma. This research was carried out to determine the correlation between the pre-surgical results of the CT scan and the size of the post-surgical tumour. METHODS: An analytical crosssectional study was conducted at the radiology department of Jinnah Post Graduate Medical Centre (JPMC), Karachi, Pakistan from May to October 2020. All patients aged 18 years or above of either gender having malignant tumours of the tongue already proven on biopsy were consecutively enrolled. Pre-surgery CT scan images were performed. The preoperative volume on CT scan then correlated with the post-surgical tumour size findings. The tumour thickness level of anterio-posterior (AP), transverse dimension (TS) and craniocaudal (CC) on pre-surgery CT scan and post-surgery tumour size were the outcome variables. RESULTS: Of 84 patients, the mean age of the patients was 48.38 ±11.40 years. There were 56 (66.7%) males and 28 (33.3%) females. A moderate positive correlation of AP tumour size on CT scan was observed with post-surgical AP tumour size (r=0.671, p-value <0.001). Similarly, a moderate positive correlation of TS tumour size was observed with post-operative TS tumour size (r=0.692, p-value <0.001). While, a strong positive correlation of CC tumour size was observed with post-operative surgical tumour size (r=0.787, p-value <0.001). CONCLUSIONS: This study has reported a strong positive correlation of tumour thickness level on CT scan with post-surgical findings for determining the oral tongue squamous cell carcinoma.

Environmental quality: examining role of financial development, institutional capacity, and corruption.

This study aims to investigate the influence of institutional capacity on the relationship between financial development and environmental quality and also examines the moderating role of corruption on the link between institutional quality and environmental quality. By using yearly data from 33 developing countries for 7 years from 2011 to 2017, this paper applies a dynamic technique system GMM. The results suggest that financial development increases environmental degradation due to possible higher energy-intensive investment. However, institutional capacity moderates its impact on environmental quality by channelizing the funds to energy-efficient investment. The findings of this study suggest that financial development improves the environmental quality when institutional capacity is higher than 3.5 on the scale of 0 to 6. Interestingly, institutional capacity is unable to control environmental degradation in the presence of corruption. The results propose that financial development has a positive relation with environmental degradation in the presence of corruption. Nevertheless, relationship between institutional capacity and environmental degradation turns to negative when corruption improves in the economies. Furthermore, the findings show that institutional capacity may only control environmental degradation when corruption improves to 40 or higher on a scale of 0 to 100. The policy implications of this study are useful for policy departments, environmental regulatory bodies, and financial institutions.

Frequency of Hyponatremia in Patients of Tuberculosis Bacterial Meningitis in a Tertiary Care Hospital.

Introduction Tuberculous meningitis (TBM) brings significant morbidity and mortality worldwide. Hyponatremia has long been documented as a potentially grave metabolic result of TBM. The syndrome of inappropriate antidiuretic hormone (SIADH) secretion has been supposed to be accountable for the majority of cases of hyponatremia in TBM. Cerebral salt wasting syndrome (CSWS) is being progressively reported as a basis of hyponatremia in some of these cases. Differentiating CSWS from SIADH can be challenging but is vital because treatment of these two conditions is profoundly different. Objective The rationale of our study is to determine the frequency of hyponatremia and etiology in patients presenting with TBM in a tertiary care hospital in order to establish the local perspective as there is paucity of local data. Methods A total of 160 hospitalized patients at a tertiary care hospital in Pakistan who fulfilled the inclusion criteria were enrolled in this study after informed consent. The study was conducted for six months at the department of neurology, Jinnah Postgraduate Medical Centre (JPMC), Karachi, Pakistan. Brief history was taken and demographic information was entered in the performa by researchers. The data was collected and analyzed on Statistical Package for Social Sciences (SPSS) version 18.0 (IBM Corp., Armonk NY, USA). Demographic data were presented as simple descriptive statistics giving mean and standard deviation for age, height, weight, GCS (Glasgow Coma Scale), serum sodium and duration of symptoms. Frequencies and percentages were calculated for categorical variables like gender, hypertension, smoking status, T2DM (Type 2 Diabetes Mellitus), BMRC (British Medical Research Council Contemporary Clinical Criteria for TBM) stage, hyponatremia, SIADH and CSWS. Effect modifiers were controlled through stratification of age, gender, hypertension, smoking status, T2DM, BMRC stage and duration of symptoms to see the effect of these on the outcome variable (hyponatremia). Quantitative data were presented as simple descriptive statistics giving mean and standard deviation and qualitative variables were presented as frequency and percentages. Post stratification chi-square test was applied with a p-value of ≤0.05 taken as significant. Results In our study, out of 160 patients with TBM, 40% (64) had hyponatremia. Moreover, 14.4% and 25.6% had SIADH and CSWS, respectively with 60% (96) of patients were male and 40% (64) were female. Mean age of patients in our study was 46.78±2.81 years. Whereas, mean duration of symptoms, serum sodium, GCS, height and weight in our study was 1.2±0.78 weeks, 128.65±7.52 mmol/L and 11.21±3.14%, 158±7.28 cm and 78.7±9.87 kg, respectively. Conclusion This study concluded that the frequency of hyponatremia among patients of TBM was significant, consistent with previous studies. Privation of proper assessment and management can lead to grave and permanent neurological consequences, as well as death. Healthcare providers should be aware of the implication of sodium deregulation among patients of TBM and differentiate between the numerous therapeutic preferences in order to advocate safe and effective treatment.

A potential intraoperative disaster averted: Preduodenal portal vein compressing a preduodenal common bile duct.

Familiarity with the anatomy is paramount for conduct of safe surgery for a surgeon. Anomalies with the biliary and hepatic arterial system are common but portal vein anomalies are least common. A preduodenal portal vein has been reported in about 100 cases but a combination of preduodenal portal vein with preduodenal common bile duct is extremely rare with only 9 cases being reported. We report a one such case and discuss the embryological basis for the peculiar anatomy observed in our case which has never been reported earlier. We also reviewed the reported cases in literature.

Bannwarth's syndrome and a surgical dilemma: An uncommon zoonosis with a rare presentation.

Lyme's disease also known as Erythema chronicum Migrans, is a multisystem infectious disease caused by the spirochete "Borrelia burgdorferi" which is transmitted by "Ixodes" tick, with both specific and nonspecific manifestations. Nervous system involvement occurs in 10%-15% of untreated patients and typically involves lymphocytic meningitis, cranial neuritis, and/or polyradiculitis. Here, we are reporting an interesting and challenging case of Neuro-Borreliosis in a young officer cadet, meeting the description for Bannwarth's syndrome and presenting initially as a surgical emergency followed by paraparesis. The diagnosis was finally clinched based on clinical profile of Chronic Myeloradiculopathy with focal myositis in the setting of recent outdoor camping, and confirmed by demonstrating high IgG antibody titres in serum and Cerebro spinal fluid (CSF). The officer cadet was treated successfully with a 6 week course of Ceftriaxone and Doxycycline, and went back to full training.

Fabrication of Pt-Pd@ITO grown heterogeneous nanocatalyst as efficient remediator for toxic methyl parathion in aqueous media.

In this study, nano-sized ITO supported Pt-Pd bimetallic catalyst was synthesized for the degradation of methyl parathion pesticide, a common extremely toxic contaminant in aqueous solution. On the characterization with different techniques, a beautiful scenario of honeycomb architecture composed of ultra-small nanoneedles or fine hairs was found. Average size of nanocatalyst also confirmed which was in the range of 3-5 nm. High percent degradation (94%) was obtained in 30 s using 1.5 × 10- 1 mg of synthesized nanocatalyst, 0.5 mM NaBH4, and 110 W microwave radiations power. Recyclability of nanocatalyst was efficient till 4th cycle observed during study of reusability. The supported Pt-Pd bimetallic nanocatalyst on ITO displayed many advantages over conventional methods for degradation of methyl parathion pesticide, such as high percent degradation, short reaction time, small amount of nanocatalyst, and multitime reusability. Graphical abstract Schematic illustration of reaction for degradation of methyl parathion.

Laparoscopic surgery in pancreatic diseases: Pushing the boundaries.

BACKGROUND: Laparoscopic surgery has expanded exponentially in the last two decades but, somehow it is limited in pancreatic surgery by virtue of the pancreas being a friable, retroperitoneal organ with difficult access and adjacent major vessels risking torrential bleed. It is thought to be unforgiving if not handled well. However, improvements in technology and surgeon's expertise have pushed the boundaries of minimal access surgery (MAS) to include pancreas in its domain. We present our series of laparoscopic pancreatic surgery (LPS) with an aim to look at the feasibility and outcomes. METHODS: This is a retrospective review of all LPS done at the Gastrointestinal Surgery (GIS) centre of a tertiary care Armed Forces Hospital over a period of 3 years. RESULTS: A total of 24 LPS were done during this period. The median age of the patients was 46 years (range; 13-81). There were 14 male and 10 female patients. Nine patients had at least one co-morbidity. Three patients underwent laparoscopic lateral pancreaticojejunostomy, 4 distal pancreatectomy, 4 laparoscopic Whipples pancreaticoduodenectomy, 6 laparoscopic pancreatic necrosectomy, 6 laparoscopic cystogastrostomy and 1 roux en y cystojejunostomy. CONCLUSION: LPS can be performed for almost all open pancreatic surgeries and can be done with reasonable outcomes. However, it has a steep learning curve and therefore, a hybrid approach leading to a totally laparoscopic approach may be the way forward.

Spontaneous idiopathic pulmonary vein thrombosis successfully treated with Warfarin: A case report and review of the literature.

Pulmonary veins (PVs) are the most proximal source of arterial thromboembolism. Pulmonary vein thrombosis (PVT) is an uncommon clinical condition that can be fatal. Its incidence or prevalence is unclear as existing cases are case reports. It is often seen as a complication of malignancy, lobectomy, atrial fibrillation and less commonly idiopathic. It can be diagnosed using different types of non-invasive imaging studies. We present a 68-year-old woman who was undergoing treatment for recurrent urinary tract infection (UTI) but was incidentally noted to be dyspneic and intermittently hypoxic. She was found to have idiopathic pulmonary vein thrombosis that was successfully managed with systemic anticoagulation.

Laparoscopic Access: Direct Trocar Insertion Versus Open Technique.

INTRODUCTION: Creation of pneumoperitoneum and laparoscopic entry into the abdominal cavity are crucial initial steps of laparoscopic surgery and associated with bowel and major vessel injuries. Various methods have been described in literature such as Veress needle, open access technique (OAT), direct trocar insertion (DTI), and optical port. There is no consensus on the safest method of gaining access to the peritoneal cavity to create a pneumoperitoneum. DTI technique appears to be not well accepted by many due to the fear of causing injuries as it is a blind procedure. OBJECTIVE: To compare the outcome of DTI in terms of feasibility and complications with a well-established and widely practiced OAT for a laparoscopic procedure. MATERIALS AND METHODS: Nine hundred fifty-five participants were randomized to be in either of the two groups, that is, Group "A" for DTI and Group "B" for OAT. The primary endpoint was major complications (bowel, major vessel, and solid organ injury) and the secondary endpoint was port access time and minor complications directly related to access. Patients were assessed on the first postoperative day, at the time of discharge, 3 months, 6 months, and a year after discharge, for complications. RESULTS: There was no statistical difference in major complications between DTI and OAT groups, however, DTI was found to be superior to OAT in terms of port access time (P = .01), umbilical port-site hernia, port-site infection, and port-site pain (P = .01). CONCLUSION: This study further strengthens the literature on DTI being a good and safe technique of laparoscopic access. The technique of DTI is still underutilized and needs to be adopted by surgeons without fear.

Non-fixation Versus Fixation of Mesh in Totally Extraperitoneal Repair of Inguinal Hernia: a Comparative Study.

Two major issues with laparoscopic inguinal hernia (IH) repair are recurrences and chronic groin pain (CGP). The procedure involves fixing the mesh with the tackers which is believed to increase the rate of CGP due to nerve injuries. Thus, non-fixation of mesh is being proposed but concerns remain regarding increased recurrences. We sought to look at our outcomes after we switched over to non-fixation of mesh in totally extraperitoneal repair (TEP). Retrospective review of prospectively maintained database of 171 repairs was done on 122 patients (fixation 59 and non-fixation 112) during a period of 4 years with an endeavor to complete a minimum of 1 year of clinical follow-up. The primary objective was to assess the recurrence rates and CGP and the secondary objective was to assess operative times, immediate post-op pain, incidence of urinary retention, duration of hospital stay, days taken to return to activity, and cost. The mean operative times for unilateral IH for the fixation and non-fixation groups were 41.8 ± 11.4 and 35.9 ± 9.7 min, respectively (p = 0.021), whereas for bilateral were 66.2 ± 15.6 and 55.3 ± 14.2 min, respectively (p = 0.018). The mean pain score was 3.44 ± 1.2 versus 3.01 ± 1.0; (p = 0.037) in the two groups, respectively. At a mean follow-up of 33.2 ± 17.0 and 18.7 ± 6.2 months, the incidence of CGP was 02 (3.4%) and 3 (2.7%) (p = 1.000) and recurrences were 02 (3.4%) in the two groups, respectively (p = 0.118). Non-fixation of mesh in TEP does not lead to increased recurrence though it does not decrease the incidence of chronic groin pain. Collateral advantage would be decreased operative times, lesser post-operative pain, and decreased costs.