Minimally Jointed Symmetrical Pygopagus Twins - Successful Surgical Separation.

Conjoined pygopagus accounts for about 17% of all conjoined twins and commonly share the gluteal region, terminal spine, lower gastrointestinal, urological, and reproductive tracts. This makes their separation a very challenging task. We report herein pygopagus twins who had minimal fusion in coccygeal region and could be separated without a complicated procedure. The case is being reported to add to the literature and emphasize that simple fusion in conjoined twins can be relatively easy to manage.

T1 and T2 mapping of articular cartilage and menisci in early osteoarthritis of the knee using 3-Tesla magnetic resonance imaging.

PURPOSE: 3-Tesla magnetic resonance imaging (MRI) T1 and T2 mapping to detect and quantify cartilage matrix and meniscal degeneration between normal healthy volunteers and early osteoarthritis patients. MATERIAL AND METHODS: A prospective study including 25 patients and 10 healthy volunteers was done. Patients with symptoms of early osteoarthritis and Kellgren-Lawrence grade I-II on plain radiograph were included for MRI knee. Patients with inflammatory arthritis, infection, trauma, and history of knee surgery were excluded. Healthy, normal adult volunteers (preferably age and sex matched) without symptoms of osteoarthritis of the knee were drawn from patient's relatives/hospital employees/colleagues for MRI knee. RESULTS: T1 and T2 relaxation time values of articular cartilage and menisci were significantly higher in osteoarthritis patients as compared to healthy volunteers. No significant difference was found in morphological thickness of articular cartilage and menisci in early osteoarthritis patients and healthy volunteers. CONCLUSIONS: T1 and T2 mapping are noninvasive MRI techniques reflecting changes in the biochemical composition of cartilage and menisci. T1 values reflect changes in proteoglycan content, and T2 values are sensitive to interaction between water molecules and collagen network. Mapping techniques assess early cartilage and meniscal matrix degeneration in osteoarthritis of the knee, and help in initiating treatment and monitoring disease progression. MRI is a sensitive modality for assessment of pathological changes in articular cartilage. With use of T1 and T2 mapping techniques, it is possible to evaluate the collagen network and proteoglycan content in articular cartilage and meniscal matrix.

Polyphenols in combination with ß-cyclodextrin can inhibit and disaggregate α-synuclein amyloids under cell mimicking conditions: A promising therapeutic alternative.

Parkinson's disease is characterized by the presence of insoluble and neurotoxic aggregates (amyloid fibrils) of an intrinsically disordered protein α-synuclein. In this study we have examined the effects of four naturally occurring polyphenols in combination with ß-cyclodextrin (ß-CD) on the aggregation of α-synuclein in the presence of macromolecular crowding agents. Our results reveal that even at sub-stoichiometric concentrations of the individual components, the polyphenol-ß-CD combination(s) not only inhibited the aggregation of the proteins but was also effective in disaggregating preformed fibrils. Curcumin was found to be the most efficient, followed by baicalein with (-)-epigallocatechin gallate and resveratrol coming in next, the latter two exhibiting very similar effects. Our results suggest that the efficiency of curcumin results from a balanced composition of the phenolic OH groups, benzene rings and flexibility. The latter ensures proper positioning of the functional groups to maximize the underlying interactions with both the monomeric form of α-synuclein and its aggregates. The uniqueness of ß-CD was reinforced by the observation that none of the other cyclodextrin variants [α-CD and HP-ß-CD] used was as effective, in spite of these possessing better water solubility. Moreover, the fact that the combinations remained effective under conditions of macromolecular crowding suggests that these have the potential to be developed into viable drug compositions in the near future. MTT assays on cell viability independently confirmed this hypothesis wherein these combinations (and the polyphenols alone too) appreciably impeded the toxicity of the prefibrillar α-synuclein aggregates on the mouse neuroblastoma cell lines (N2a cells).

Robotic assisted laparoscopic adrenalectomy: Initial experience from a tertiary care centre in India.

INTRODUCTION: Laparoscopic adrenalectomy (LA) is now considered the standard for treatment of surgically correctable adrenal disorders. Robotic adrenalectomy has been performed worldwide and has established itself as safe, feasible and effective approach. We hereby present the first study in robotic transperitoneal LA from Indian subcontinent. MATERIALS AND METHODS: We conducted a retrospective evaluation of 25 patients who had undergone robotic assisted LA at a tertiary health centre by a single surgeon. Demographic, clinical, histopathological and perioperative outcome data were collected and analysed. RESULTS: Mean age of the patients was 45 years (range: 27-65 years). Eleven male and 14 female patients were operated. Mean operative time was 139 min ± 30 min (range: 110-232 min) and mean blood loss was 85 ml ± 12 ml (range: 34-313 ml). Mean hospital stay was 2.5 ± 1.05 days (range: 2-6 days). Mean visual analogue scale score was 3.2 (range: 1-6) mean analgesic requirement was 50 mg diclofenac daily (range: 0-150 mg). Histopathological evaluation revealed 11 adenomas, eight phaeochromocytomas, two adrenocortical carcinomas, and four myelolipomas. According to Clavien-Dindo classification, three patients developed Grade I post-operative complications namely hypotension and pleural effusion. CONCLUSION: Robotic adrenalectomy is safe, technically feasible and comfortable to the surgeon. It is easier to perform with a short learning curve.

Spinal Chloroma - Herald of blast crisis in a patient with chronic myeloid leukaemia: A case report.

Myeloid sarcoma or chloroma is a localised tumour characterised by extramedullary proliferation of precursor myeloid cells. Commonly occurring in association with acute myeloid leukaemia, chloroma can occasionally be seen in myeloproliferative disorders with subsequent blastic transformation. Imaging plays an important role in the diagnosis and evaluation of this entity. A case of chloroma involving the dorso-lumbar vertebral region is presented in a patient with chronic myeloid leukaemia with subsequent blastic transformation.