Terminal ileum gangrene secondary to a type IV paraesophageal hernia.

Type IV paraesophageal hernia (PEH) is very rare, and is characterized by the intrathoracic herniation of the abdominal viscera other than the stomach into the chest. We describe a 78-year-old woman who presented at our emergency department because of epigastric pain that she had experienced over the past 24 h. On the day after admission, her pain became severe and was accompanied by right chest pain and dyspnea. Chest radiography revealed an intrathoracic intestinal gas bubble occupying the right lower lung field. Emergency explorative laparotomy identified a type IV PEH with herniation of only the terminal ileum through a hiatal defect into the right thoracic cavity. In this report, we also present a review of similar cases in the literature published between 1980 and 2015 in PubMed. There were four published cases of small bowel herniation into the thoracic cavity during this period. Our patient represents a rare case of an individual diagnosed with type IV PEH with incarceration of only the terminal ileum.

Depletion of albumin and immunoglobulin G from human serum using epitope-imprinted polymers as artificial antibodies.

Serum is a readily available source for noninvasive studies in clinical research, but it contains abundant proteins such as albumin and immunoglobulin G that can hinder the presence of low-abundant proteins as well as decrease sample loading capacity of analytical methods. Therefore, depletion of these two proteins is required to observe low-abundance serum proteins. Molecularly imprinted polymers are template-induced artificial antibodies with the ability to recognize and selectively bind the target molecule. In this study, artificial albumin and immunoglobulin G antibodies were developed by using two epitopes of human serum albumin and immunoglobulin G as templates. Acrylic acid, acrylamide, and N-acryl tyramine were the corresponding monomers; N,N'-ethylene bisacrylamide served as a cross-linker, and cellulosic fibers were used as a supporting matrix. The adsorption capacity of these artificial antibodies was 15.2 mg, 10 mg, and 15 µL per gram for human serum albumin, immunoglobulin G, and human serum, respectively. The dissociation constant (Kd ) of these artificial antibodies toward the human serum albumin and immunoglobulin G was 1 µM and 0.6 µM, respectively. The biomimetic properties of these artificial antibodies, coupled with their economical and rapid production, high specificity and their reusability, make them attractive for protein separation and analysis.

Interhemispheric lipoma masquerading as pneumocranium in a patient with head injury.

Head injury is very commonly seen in the emergency department (ED) worldwide, and almost, an unenhanced computed tomography scan of the brain suffices for patients seen in the ED presenting after trauma or with a new neurologic deficit. Intracranial lipomas are usually asymptomatic, and they are often an occasional finding. In head injury cases, lipomas are easily to be misdiagnosed as pneumocranium on brain computed tomography with low-density attenuation image. We presented an extremely rare case of interhemispheric lipoma presenting to an ED as a lesion of acute brain insult. The aim of this report is to emphasize the importance of clinical thinking in the differential diagnosis of markedly hypodense lesion on computed tomography imaging of a patient with head injury.

Molecularly imprinted cavities template the macrocyclization of tetrapeptides.

Cavities formed using cyclic tetrapeptides (CTPs) or heat-induced conformers act as templates for cyclization; the cavities bind to linear tetrapeptides and enforce turn conformations to enhance cyclization to constrained CTPs.