Peritoneal blastomycosis: a hidden mystery unfolds itself.

Blastomycosis is a disease caused by the fungus Blastomyces dermatitidis. Pulmonary blastomycosis is the most common form of blastomycosis. Disseminated blastomycosis is the fulminant form of the disease, with rare reports of peritoneal cavity involvement. We report a case of extensive form of the disease presenting initially as abdominal pain and mimicking peritoneal carcinomatosis.

Structure of TeO2 Glass and Melt by Reverse Monte Carlo Simulations of High-Energy X-Ray Diffraction Data Sets.

The short-range and medium-range structures of TeO2 glass and melt are elucidated by Reverse Monte Carlo (RMC) simulations of High-Energy X-ray Diffraction data sets published in an earlier study by Alderman et al. (J. Phys. Chem. Lett.11(1) (2020)427-431). The RMC analysis reveals that there exists a wide range of Te-O bond lengths in both TeO2 glass and melt short-range structures. The Te-O pair distribution function (PDF) of the melt has peaks centered at 1.87, 2.06, 2.35, 2.65, and 3.00 (±0.01) Å, whereas the corresponding peaks in the glass are at 1.91, 2.07, 2.28, 2.54, 2.77, and 3.00 (±0.01) Å. The Te-O partial PDF of the melt shows a peak at 2.35 Å, which is not present in the glass structure; therefore, the same co-ordination sphere radius of 2.36 Å cannot be used for calculating the Te-O co-ordination numbers in the TeO2 melt and glass, as done in the earlier study by Alderman et al. Using a more appropriate radius of 2.41 Å for glass and 2.22 Å for the melt, the corresponding Te-O co-ordination numbers are found to be 3.99 and 3.33, respectively. The RMC analysis successfully determined the O-O pair distributions, which show the first peaks at 2.31-2.33 (±0.01) Å. Finally, Te-Te pair distributions show peaks at slightly longer distances in the melt compared to those in glass, and the melt is found to have greater medium-range disorder.

Avoiding unfavourable outcomes in liposuction.

The origin of liposuction can be traced to an adverse event by Dujarrier in 1921 when he used a uterine curette to remove fat from the knees of a ballerina ending in an amputation secondary to damage of the femoral artery. The history of liposuction since then has been one of avoiding complications and optimising outcome. After this adverse event, liposuction was abandoned until the 1960's when Schrudde revived the practice using small stab incisions and sharp curettage with the secondary suction to aspirate the freed tissue. This technique was associated with a high incidence of complications especially seroma and skin necrosis. Illouz then replaced the curette with a blunt cannula connected to vacuum pump thus avoiding the complications of a sharp curette. Despite the presence of various techniques for liposuction, suction assisted liposuction (SAL) is still the standard technique of liposuction. This article aims to discuss literature regarding the various aspects of liposuction (SAL) and to highlight the salient points in the literature and in the senior author's experience in order to avoid unfavourable outcomes in liposuction. A literature review on avoiding complication is in liposuction including some of the seminal papers on liposuction. Liposuction is generally a safe procedure with reproducible outcome. Just like any surgical procedure it should be treated with the utmost care. Illouz published 10 commandments for liposuction in 1989 and we review these commandments to demonstrate how liposuction has evolved.

Referral and Management of Pretibial Lacerations in Two District General Hospitals.

Background Pretibial lacerations are common injuries that have a significant yet underestimated association with morbidity and mortality. Although they may occur in any age group, they are commonly followed by an often relatively minor trauma in elderly and frail patients. The six-month mortality among such patients may be more than double the age group average. Currently, 5.2 in 1000 patients per year present to the emergency departments in UK hospitals due to pretibial lacerations. The associated acute admissions have a high financial cost. Despite the significant disease burden, there is a paucity of evidence on the optimal management of such injuries. This study aimed to describe the typical demographic and injury factors of individuals presenting to two district general hospitals, as well as their subsequent management and referral. Methodology Relevant patients were identified through NHS coding searches. Subsequently, it was found that 99 patients presented to an NHS trust with pretibial lacerations throughout 2020. A retrospective manual evaluation of clinical documentation was performed to identify the details of the patients' injury, management, referral, and demographics. Results The patients had a mean age of 55.4 (SD 28.3), and 56.6% were female. The most commonly presenting mechanism of injury was direct blunt trauma. The majority of cases were solely managed and discharged directly by the emergency department (74.8%). Of the 99 patients, 25 (25.3%) were referred to specialist services, 12 (12.1%) were managed conservatively, and 13 (13.1%) underwent operative intervention. The mean length of stay for those referred was 5.9 days, and the mean for the same was greater for those managed conservatively compared to those managed operatively (9.0 vs. 2.6 days). Among patients discharged by the emergency department, the most common method of wound closure was steristrips (n = 40; 54.1%), followed by conservative management with dressings (n = 22; 29.7%), sutures (n = 10, 13.5%) and glue (n = 5; 6.8%). Conclusions Overall, this study showed that the majority of patients presenting with pretibial lacerations have minor wounds that can be effectively managed in the emergency department. However, those with considerably more injuries should be provided an early referral to specialist services, where they would ideally receive early surgery and comprehensive follow-up.

Comparative study of the short-range structure of α-V2O5, α-TeO2 and xV2O5-(100 - x)TeO2 glasses using X-ray diffraction, Rietveld analysis and reverse Monte Carlo simulations.

Vanadium-tellurite glasses, tetragonal TeO2 and orthorhombic V2O5 crystalline samples were characterized for their atomic structure properties by synchrotron X-ray diffraction, pair distribution function analysis, reverse Monte Carlo simulations (RMC) and Rietveld analysis. The pair correlation function, G(r), of V2O5 shows the first peak at 1.61 Å. G(r) of TeO2 shows three peaks at 1.57, 2.13 and 2.88 Šdue to Te-O linkages of three different lengths, whereas the Te-Te atomic pair correlation shows a peak at 3.85 Å. The average coordination number of V with O in crystalline V2O5 is 4.39 while that of Te with O in crystalline TeO2 is 3.71. G(r) of the vanadium tellurite glass shows the first peak at 1.90 Šdue to overlapping Te-O and V-O atomic pair correlations. The RMC analysis on diffraction data of glasses found that the V-O coordination number is in the range 5.27-5.59 and the Te-O coordination number is 5.39-5.67. However, it is found that these coordination numbers cannot be clearly defined due to short-range disorder.

Should the 'normal' and 'ideal' nipple position in a male influence the surgeon when planning severe gynaecomastia correction?

BACKGROUND: The ideal nipple areolar complex (NAC) position of the male chest following gynaecomastia surgery is well documented; however, with increased development of the chest muscles, the NAC placement can change, leading to the medial displacement of the nipple giving a poor aesthetic outcome. Therefore, we believe that these measurements need to be applied to the patients' build and take into consideration the future fitness goals of the patients. METHOD: We have analysed the photographs of three groups of men: super athletes, athletes and individuals with severe gynaecomastia. We have assessed the proportions of the chest in relation to the NAC, degree of ptosis and TAP index. RESULTS: There was a wide variation between the athlete and the super athlete group, with minor variations within each group. The range of measurement in the severe gynaecomastia group was significantly larger than those in the other groups. We feel that based on this research study, surgeons should however be somewhat circumspect in their choice of nipple position as there is a wide variation in what can be considered as normal, and positioning of the NAC too early in the recovery process may lead to an abnormal aesthetic appearance following muscle development. CONCLUSION: Despite the multitude of techniques available in the literature to determine the position of nipple, there is a lack of understanding on how the NAC position changes with muscle development. Adopting a dogmatic approach may result in a very aesthetically displeasing outcome, which can be very difficult to correct in men.

Structure of lithium tellurite and vanadium lithium tellurite glasses by high-energy X-ray and neutron diffraction.

xLi2O-(100 - x)TeO2 (x = 20 and 25 mol%) and xV2O5-(25 - x)Li2O-75TeO2 (x = 1, 2, 3, 4 and 5 mol%) glasses were prepared by melt-quenching and their thermal and structural properties were characterized by differential scanning calorimetry, Raman spectroscopy, high-energy X-ray diffraction and neutron diffraction and reverse Monte Carlo (RMC) simulations. The glass transition temperature increases steadily with an increase in V2O5 mol% in lithium tellurite glasses due to an increase in the average single bond energy of the glass network. The X-ray and neutron diffraction structure factors were modelled by RMC technique and the Te-O distributions show the first peak in the range 1.85-1.90 Å, with V-O = 1.75-1.95 Å, Li-O = 1.85-2.15 Šand O-O = 2.70-2.80 Å. The average Te-O coordination number decreases with an increase in Li2O mol% in lithium tellurite glasses, and the V-O coordination decreases from 5.12 to 3.81 with an increase in V2O5 concentration in vanadium lithium tellurite glasses. The O-Te-O, O-V-O, O-Li-O and O-O-O linkages have maxima in the ranges 86°-89°, 82°-87°, 80°-85° and at 59o, respectively. The structural analysis of tellurite glasses reveal significant short-range and medium-range disorder due to the existence of a wide range of Te-O and Te-Te distances in the first coordination shell.

Structural and optical characterization of Er-doped CaMoO4 down-converting phosphors.

xEr2O3-(1-x)CaMoO4 (x = 1, 3, 5, 7 and 10 mol%) nanoparticles were synthesized by solid-state sintering at 800°C. X-ray diffraction studies confirmed the tetragonal crystal structure of CaMoO4, while the doped samples show the co-existence of cubic Er2O3 and tetragonal CaMoO4 and rule out the replacement of Ca2+ by Er3+ in the structure. The crystal unit-cell dimensions, phase concentration and atomic position coordinates were determined by Rietveld refinement. The short-range structure of CaMoO4 consists of tetrahedral MoO4 and snub disphenoid deltahedral CaO8 units, while the unit cell of Er2O3 consists of two types of ErO6 octahedral units. All MoO4 units contain Mo-O bonds of equal lengths, whereas two types of slightly different Ca-O bond lengths exist in CaO8. Raman spectra of the doped samples show only Mo-O vibrational modes and the Raman peaks of Er2O3 are masked by Mo-O bond vibrations. CaMoO4 shows bluish-green emission at 500 nm, while Er-doped samples show strong green emission under UV excitation. UV irradiation (380 nm) induces down-conversion green emission at 531 nm and 552 nm and good color purity in 1 mol% Er2O3-CaMoO4 sample which makes it a potential candidate for applications in optical devices.

Structure of bismuth tellurite and bismuth niobium tellurite glasses and Bi2Te4O11 anti-glass by high energy X-ray diffraction.

Glass and anti-glass samples of bismuth tellurite (xBi2O3-(100 - x)TeO2) and bismuth niobium tellurite (xBi2O3-xNb2O5-(100 - 2x)TeO2) systems were prepared by melt-quenching. The bismuth tellurite system forms glasses at low Bi2O3 concentration of 3 to 7 mol%. At 20 mol% Bi2O3, the glass forming ability of the Bi2O3-TeO2 system decreases drastically and the anti-glass phase of monoclinic Bi2Te4O11 is produced. Structures of glass and the anti-glass Bi2Te4O11 samples were studied by high-energy X-ray diffraction, reverse Monte Carlo simulations and Rietveld Fullprof refinement. All glasses have short short-range disorder due to the existence of at least three types of Te-O bonds of lengths: 1.90, 2.25 and 2.59 Å, besides a variety of Bi-O and Nb-O bond-lengths. The medium-range order in glasses is also disturbed due to the distribution of Te-Te pair distances. The average Te-O co-ordination (N Te-O) in the glass network decreases with an increase in Bi2O3 and Nb2O5 mol% and is in the range: 4.17 to 3.56. The anti-glass Bi2Te4O11 has a long-range order of cations but it has vibrational disorder and it exhibits sharp X-ray reflections but broad vibrational bands similar to that in glasses. Anti-glass Bi2Te4O11 has an N Te-O of 2.96 and is significantly lower than in glass samples.

In situ high pressure neutron diffraction and Raman spectroscopy of 20BaO-80TeO2 glass.

The short-range structure of 20BaO-80TeO2 glass was studied in situ by high pressure neutron diffraction and high pressure Raman spectroscopy. Neutron diffraction measurements were performed at the PEARL instrument of the ISIS spallation neutron source up to a maximum pressure of 9.0 ± 0.5 GPa. The diffraction data was analysed via reverse Monte Carlo simulations and the changes in the glass short-range structural properties, Ba-O, Te-O and O-O bond lengths and speciation were studied as a function of pressure. Te-O co-ordination increases from 3.51 ± 0.05 to 3.73 ± 0.05, Ba-O coordination from 6.24 ± 0.19 to 6.99 ± 0.34 and O-O coordination from 6.00 ± 0.05 to 6.69 ± 0.06 with an increase in pressure from ambient to 9.0 GPa. In situ high pressure Raman studies found that the ratio of intensities of the two bands at 668 cm-1 and 724 cm-1 increases from 0.99 to 1.18 on applying pressure up to 19.28 ± 0.01 GPa, and that these changes are due to the conversion of TeO3 into TeO4 structural units in the tellurite network. It is found that pressure causes densification of the tellurite network by the enhancement of co-ordination of cations, and an increase in distribution of Te-O and Ba-O bond lengths. The original glass structure is restored upon the release of pressure.

Structure of strontium tellurite glass, anti-glass and crystalline phases by high-energy X-ray diffraction, reverse Monte Carlo and Rietveld analysis.

The structures of xSrO-(100 - x)TeO2 (x = 5, 7.5, 8.5 and 10 mol.%) glass, anti-glass and crystalline samples were studied by high-energy X-ray diffraction (HEXRD), reverse Monte Carlo (RMC) simulations, atomic pair distribution function analysis and Fullprof Rietveld refinement. The atomic pair distributions show the first peak at 1.90 Šdue to the Te-O equatorial bonds and the Te-O peak is asymmetrical due to the range of Te-O bond lengths in glass, anti-glass and crystalline samples. The short-range structural properties of glasses such as Te-O bond lengths, Te-O speciation, Te-Te distances and O-Te-O bond angle distributions were determined by RMC simulations. The average Te-O coordination number (NTe-O) for 5SrO-95TeO2 glass is 3.93 which decreases to 3.59 on increasing the SrO concentration to 10 mol.%. The changes in NTe-O revealed that the glass network predominantly contains TeO4 units with a small amount of TeO3 units and there is a structural transformation TeO4 → TeO3 with an increase in SrO concentration. The O-Te-O bond angle distributions have a peak at 79° and reveal that the Oequatorial-Te-Oequatorial bonds are the most abundant linkages in the tellurite network. Two glass samples containing 7.5 and 8.5 mol.% of SrO were annealed at 350°C for 1 h to produce anti-glass phases; they were further annealed at 450°C for 4 h to transform them into crystalline phases. The anti-glass samples are disordered cubic SrTe5O11 and the disordered monoclinic SrTeO3 phases, whereas the crystalline samples contain monoclinic SrTeO3 and the orthorhombic TeO2 phases. The unit-cell parameters of the anti-glass and crystalline structures were determined by Fullprof Rietveld refinement. Thermal studies found that the glass transition temperature increases with an increase in SrO mol.% and the results on the short-range structure of glasses from Raman spectroscopy are in agreement with the RMC findings.

Crystallization of bismuth borate glasses.

Bismuth borate glasses with Bi(2)O(3) concentration of 20-66 mol% were prepared by melt quenching and devitrified by heat treatment above their glass transition temperatures. All glasses show a strong tendency towards crystallization on annealing that increases with Bi(2)O(3) concentration. The crystalline phases formed on devitrification were characterized by FTIR absorption spectroscopy and DSC measurements. Our studies reveal that phases produced in glasses are strongly determined by initial glass composition and the two most stable crystalline phases are: Bi(3)B(5)O(12) and Bi(4)B(2)O(9). The metastable BiBO(3) phase can also be formed by devitrification of glass with 50 mol% of Bi(2)O(3). This phase is, however, unstable and decomposes into Bi(3)B(5)O(12) and Bi(4)B(2)O(9) on prolonged heat treatment.

An idiosyncratic reaction to clopidogrel.

Clopidogrel is an irreversible antiplatelet agent belonging to the thienopyridine group that acts to antagonize the adenosine diphosphate P2Y12 receptor on platelets. It thus inhibits the activation of platelet glycoprotein GPIIb/IIIa complex, which is essential for fibrinogen­platelet complex formation. Clopidogrel has widely replaced ticlopidine because of a much better clinical safety profile. Clopidogrel is a prodrug that requires hepatic activation to exert its antiplatelet effect. Hepatotoxicity with use of clopidogrel is a rare but clinically significant phenomenon. We report a case of clopidogrel-induced hepatotoxicity in an elderly white woman.