Abdominal cocoon: precipitated by laparoscopic gas insufflation.

A young male in his early 30s presented to us with increasing swelling at the umbilicus, and an umbilical hernia was diagnosed. At laparoscopic intraperitoneal onlay mesh (IPOM) repair, an unexpected finding of a thin innocuous-looking fibrous film over the small bowel was noted. This finding presented a dilemma as to the probable pathology of this material, and a decision had to be made on whether laparoscopic IPOM could be continued. It was prudently decided to abandon the plan of placing a mesh intraperitoneally and an open repair of the umbilical hernia was done. In retrospect this was a wise decision, as, after 7 months he had to have a laparotomy for intestinal obstruction, when the classic thick fibrous encapsulating abdominal cocoon was seen. Hence here we have followed the evolution of the abdominal cocoon from its original asymptomatic phase to the classic encapsulating sclerosing peritonitis with probably laparoscopic gas insufflation being the precipitating factor.

Bilateral hypoglossal nerve damage due to the use of the harmonic focus scalpel.

We describe the case of a 68-year-old man who presented with an anterior floor of mouth squamous cell carcinoma and underwent bilateral neck dissection. Subsequently, the patient developed permanent bilateral hypoglossal palsies, causing significant dysphagia, dysarthria and breathing difficulties. Hypoglossal nerve damage from surgical causes is uncommon, occurring in only 0.42% of functional neck dissections. However, it is the bilateral and permanent features of this case which make it unique. This injury may have been caused by incorrect use of the Harmonic Focus scalpel. Therefore, we discuss the literature demonstrating that the Harmonic Focus scalpel causes more lateral thermal damage than alternative tools, and the widely accepted 3 mm safety limit is not enough to protect important surrounding structures. This case report aims to highlight the need for proper training and specific identification of the hypoglossal nerve to prevent this rare and debilitating complication occurring in future patients.

Sequence Analysis and Comparative Bioinformatics Study of Camelysin Gene (calY) Isolated from Bacillus thuringiensis.

Bacillus strains have been widely used for the production of fibrinolytic enzymes having role in the treatment of cardiovascular disorders. Purification and overproduction of such enzymes has increased their usage in medical fields including metalloproteinases with the ability to degrade extracellular matrix (ECM). Camelysin, a neutral metalloproteinase has been isolated from different species of bacteria like Bacillus cereus, Bacillus anthracis, and Bacillus thuringiensis with fibrinolytic, collagenolytic and actin degradation activity. This project successfully demonstrated the presence of 734-bp coding DNA sequence (CDS) encoding a 20.72331 kDa camelysin gene in local strain of Bacillus thuringiensis containing a signal peptide with cleavage site between residues 19 and 20. The sequence was submitted to GenBank (KT023597) and the sequence showed high homology with the camelysin protein of closely related Bacillus species. The alignment of related proteins through ClustalW displayed difference of four amino acids ("Q" replaced by "P" at position 169 and at position 182-184, "NQE" replaced by "HLK") in the isolated protein. Comparison including structural and functional analysis of camelysin sequences isolated from different Bacillus species was carried out using different bioinformatics tools and software. The information would help in better understanding the properties of camelysin protein and its role in pathogenicity and clinical treatments.

Regeneration of a Compromized Masticatory Unit in a Large Mandibular Defect Caused by a Huge Solitary Bone Cyst: A Case Report and Review of the Regenerative Literature.

The reconstructive options for large expansive cystic lesion affecting the jaws are many. The first stage of treatment may involve enucleation or marsupialization of the cyst. Attempted reconstruction of large osseous defects arising from the destruction of local tissue can present formidable challenges. The literature reports the use of bone grafts, free tissue transfer, bone morphogenic protein and reconstruction plates to assist in the healing and rehabilitation process. The management of huge mandibular cysts needs to take into account the preservation of existing intact structures, removal of the pathology and the reconstructive objectives which focus both on aesthetic and functional rehabilitation. The planning and execution of such treatment requires not only the compliance of the patient and family but also their assent as customers with a voice in determining their surgical destiny. The authors would like to report a unique case of a huge solitary bone cyst that had reduced the ramus, angle and part of the body of one side of the mandible to a pencil-thin-like strut of bone. A combination of decompression through marsupialization, serial packing, and the fabrication of a custom made obturator facilitated the regeneration of the myo-osseous components of the masticatory unit of this patient. Serial CT scans showed evidence of concurrent periosteal and endosteal bone formation and, quite elegantly, the regeneration of the first branchial arch components of the right myo-osseous masticatory complex. The microenvironmental factors that may have favored regeneration of these complex structures are discussed.

Pancreatic adenocarcinoma presenting as mandibular tumor: case report.

CONTEXT: Pancreatic adenocarcinoma metastasizing to the mandible is extremely rare, with only 4 previous cases reported in the literature. Here, we present a patient with a metastatic lesion in the mandible as the initial manifestation of pancreatic adenocarcinoma. We also review the incidence, diagnosis, and management of this rare occurrence. CASE REPORT: A 45-year-old man with a 5-week history of pain, following a tooth extraction, was referred to our Oral & Maxillofacial Department and presented with a nonhealing socket in the mandibular premolar region. He was investigated by use of imaging and an urgent biopsy. The diagnosis of pancreatic neoplasm was made. At this stage, the disease was fairly extensive and management was palliative. CONCLUSION: This case demonstrates the importance of a full investigation when a patient presents with a nonhealing socket and pain after tooth extraction. Mandibular metastases from distant primaries often have poor prognosis, with most patients getting palliative support. A multidisciplinary team approach is required for the management of these rare cases.

Prompt delivery of thrombolytic therapy: experience with chest pain units and emergency medical services.

OBJECTIVE: To reduce the reperfusion time with thrombolytics. METHODS: The study was done at Sheikh Zayed Hospital, Rahimyar Khan, between January and October 2009, and comprised all consecutive patients with ST segment Myocardial Infarction presenting to the hospital in emergency. In phase one, emergency medical services of Rescue 1122 were utilised to minimize transportation time and thrombolytics were instituted in the Emergency Department or the Coronary Care Unit. In Phase II, a chest pain unit was established in the Emergency Department and all patients were thrombolysed there. A proforma describing Total time, Door-to-needle time, demographics, reperfusion criteria, immediate and delayed complications was filled up for each patient. Comparative groups were analysed using Chi-square and Kruskal-Wallis tests, and p < 0.05 was considered statistically significant. RESULTS: A total of 291 patients were enrolled. Of them 15 (5.15%) were rescued by the emergency medical services, while 276 (94.84%) presented themselves or were referred. Mean age was 51 +/- 11.5 years. There were 245 (84%) males. Thirty (10.30%) patients were thrombolysed at the Chest Pain Unit; 216 (74.22%) at the Coronary Care Unit; and 45 (15.46%) in the Emergency Department. Total time was 3:52, 5:29, and 4:55 hours respectively (p = 0.003). Door-to-needle time was significantly reduced in the chest pain unit (p = 0.0001). Total time was minimum in emergency medical services (p = 0.0001). ST segment resolution > 70% was maximum in the chest pain unit (p = 0.0001). CONCLUSION: There was remarkable reduction in Total time utilising emergency medical services and door-to-needle time by establishing the chest pain unit. It is strongly recommended thatsuch units be developed in all districts and tertiary care hospitals as a cost-effective facility.

Carotid body paraganglioma manifesting as a malignant solitary mass on imaging: a case report.

A 58-year-old woman presented with a lump on the left side of the neck. Investigations by ultrasound-guided fine needle aspiration, magnetic resonance imaging, and positron emission tomography were all indicative of a diagnosis of a solitary malignant mass with no primary lesion identified. The patient underwent a level I-V leftside selective neck dissection. The histology results reported the mass as a carotid body paraganglioma. These are highly vascular lesions. Paragangliomas have characteristic features on the different imaging modalities; in this case they were atypical. This article reviews the main imaging modalities of paragangliomas and cytologic findings of the fine needle aspiration, which is not often performed for these cases owing to their high vascularity.

Alpha-synuclein and tyrosine hydroxylase expression in acute rotenone toxicity.

Chronic low-dose (2-3 mg/kg/day) rotenone infusion produces clinical features and biological markers of Parkinson's disease (PD) in some rats. A significant proportion of rats, however, die of acute rotenone toxicity. Most studies have focused on chronic rotenone-infused rats. It has not been established if the animals that die of acute low-dose rotenone toxicity manifest clinical or pathological evidence of PD. In the present study, six rats that received continuous 3 mg/kg/day subcutaneous rotenone infusion, became moribund and were euthanized after five days were compared with ten vehicle infused animals sacrificed 14, 28 or 56 days after placebo infusion. All rotenone-infused rats had significant motor function decline beginning one day after the infusion and progressive worsening in the physical condition until they became severely akinetic, at which point they were euthanized. In the substantia nigra of rotenone-treated rats, four of six had reduced numbers of tyrosine hydroxylase-positive neurons and all six had increased nigral alpha-synuclein expression. Our observations show that even a short duration of low-dose subcutaneous rotenone infusion can induce clinical and pathological markers of PD in some rats. The pathophysiology of the enhanced susceptibility to PD in some animals remains to be established.

RAEB-t in young adults--a rare entity.

Refractory anemia with excess blasts in transformation (RAEB-t) in young adults is a rare entity. RAEB-t presenting with megaloblastic erythropoiesis should be differentiated from nutritional B12 and folic acid deficiency and from acute erythroleukemia. We report two cases in the present article.

Serum immunoglobulin levels in neoplastic disorder of breast.

Serum IgG, IgA and IgM were estimated in 42 cases of carcinoma and 12 cases of fibroadenoma of breast. The results were compared with 20 healthy female controls. Results showed increased levels of serum IgA in carcinoma breast cases. This increase was statistically significant (p = 0.001) when compared with healthy controls while IgG and IgM values were found to be insignificant. Values of IgG, IgA and IgM in cases of fibroadenoma breast when compared with the controls were found to be insignificant. Statistically significant increased value of IgA was also observed in medullary carcinoma and non-metastasizing tumours when viewed separately, suggestive of good prognostic index of serum IgA level estimation in the case of carcinoma breast.