Extraosseous Ewing Sarcoma With Upper Gastrointestinal Bleeding.

Ewing sarcoma/primitive neuroectodermal tumor (ES/PNET) is a type of malignancy that usually appears as a tumor in the bone. However, in a few patients with ES/PNET, it can occur outside of the bone. Although extraosseous ES/PNET can appear in various parts of the body, involvement of small bowel is rare. If it does, it can present with vague abdominal pain and gastrointestinal bleeding. This case report presents a 28-year-old gentleman with extraosseous ES/PNET in the duodenum who experienced gastrointestinal bleeding as a presenting symptom.

Intestinal obstruction induced by portal vein thrombosis in a female undergoing oral contraceptive therapy: a case report with comprehensive review.

Introduction: Portal vein thrombosis (PVT) is a rare medical condition that obstructs blood flow in the portal vein, with cirrhosis as a common predisposing factor. However, its association with oral contraceptive pills (OCPs), particularly with progestins, remains inadequately explored. This case report aims to contribute to this understanding, focusing on the rare presentation of PVT-induced intestinal obstruction in a female on prolonged OCP therapy. Case presentation: A 45-year-old female presented with severe abdominal pain, vomiting, and constipation. Diagnosis revealed PVT-induced intestinal obstruction, an exceptionally rare occurrence in the context of prolonged OCP therapy. The patient's symptoms improved with conservative management, including rivaroxaban, highlighting the crucial role of early intervention. Discussion: This case brings attention to the limited literature exploring the link between OCPs and PVT. Despite the generally safe reputation of OCPs, they can induce pro-thrombotic conditions, emphasizing the need for heightened clinical awareness. In this case, the rarity of intestinal obstruction in PVT, compounded by the absence of common risk factors, underscores the diagnostic challenges associated with such presentations. Conclusion: PVT-induced intestinal obstruction in a patient on prolonged OCP therapy is exceptionally rare, emphasizing the necessity for multidisciplinary management. It provides crucial insights into suspecting, identifying, and treating this uncommon complication in non-cirrhotic individuals, contributing to the limited existing literature on the subject.

Synovial Chondromatosis of Hip Joint in a Patient with Ankylosing Spondylitis: A Case Report.

Synovial chondromatosis in association with ankylosing spondylitis is extremely rare and has been reported only once before and this case report is presenting a similar case. The knee is the preferential site of involvement with involvement of the hip being reported sparsely. We herein report a case of a 52-year-old male who came with complaints of the lower back pain for 5 years and left hip pain for 1.5 years who was diagnosed with synovial chondromatosis of the hip joint with axial ankylosing spondylitis and was managed operatively. We here review briefly the clinical manifestations, pathogenesis, diagnosis, previously reported cases as well as treatment of synovial chondromatosis in patients with immune-mediated inflammatory arthritides. There should be a high index of suspicion to diagnose synovial chondromatosis in association with inflammatory arthritides. We also believe that surgical management is an effective method of treatment of an established synovial chondromatosis of the hip joint. Keywords: ankylosing spondylitis; case reports; hip joint; synovial chondromatosis.

Foraminal Stenosis at L5-S1 as an Overlooked Pathology of Bilateral Radiculopathy: A Case Series.

Introduction: The classical symptom of foraminal stenosis is unilateral radiculopathy. Bilateral radiculopathy caused purely by foraminal stenosis is rare. Here, we report five cases of bilateral L5 radiculopathy caused purely by L5-S1 foraminal stenosis and describe the clinical and radiological features of these patients in detail. Case Presentation: Among the five patients, two were men and three were women with an average age of 69 years. Four patients had undergone surgeries at L4-5 level, previously. All the patients showed an improvement in symptoms in the post-operative period. After a certain period, the patients complained of bilateral leg pain and numbness. An additional surgery was performed in two patients; however, there was no improvement in symptoms. One patient, who did not undergo surgery, was treated conservatively for 3 years. All the patients had been suffering from bilateral leg symptoms before their first visit to our hospital. The neurological findings in these patients were consistent with bilateral L5 radiculopathy. The average pre-operative Japanese Orthopedic Association (JOA) score was 13 out of 29 points. Bilateral foraminal stenosis at L5-S1 level was confirmed using a three-dimensional magnetic resonance imaging or computed tomography. Posterior lumbar interbody fusion was performed in one patient and bilateral lateral fenestration using Wiltse's approach was performed in four patients. The neurological symptoms recovered immediately after surgery. The average JOA score at 2-year follow-up was 25 points. Conclusions: Spine surgeons may overlook the pathology of foraminal stenosis, particularly in patients with bilateral radiculopathy. Familiarity with the clinical and radiological features of symptomatic lumbar foraminal stenosis is necessary to properly diagnose bilateral foraminal stenosis at L5-S1 level.

TLR22-mediated activation of TNF-α-caspase-1/IL-1ß inflammatory axis leads to apoptosis of Aeromonas hydrophila-infected macrophages.

Toll-like receptors (TLRs) represent first line of host defence against microbes. Amongst different TLRs, TLR22 is exclusively expressed in non-mammalian vertebrates, including fish. The precise role of TLR22 in fish-immunity remains abstruse. Herein, we used headkidney macrophages (HKM) from Clarias gariepinus and deciphered its role in fish-immunity. Highest tlr22 expression was observed in the immunocompetent organ - headkidney; nonetheless expression in other tissues suggests its possible involvement in non-immune sites also. Aeromonas hydrophila infection up-regulates tlr22 expression in HKM. Our RNAi based study suggested TLR22 restricts intracellular survival of A. hydrophila. Inhibitor and RNAi studies further implicated TLR22 induces pro-inflammatory cytokines TNF-α and IL-1ß. We observed heightened caspase-1 activity and our results suggest the role of TLR22 in activating TNF-α/caspase-1/IL-1ß cascade leading to caspase-3 mediated apoptosis of A. hydrophila-infected HKM. We conclude, TLR22 plays critical role in immune-surveillance and triggers pro-inflammatory cytokines leading to caspase mediated HKM apoptosis and pathogen clearance.

Clinical and oncological outcomes of surgery in Anorectal melanoma in Asian population: A 15 year analysis at a tertiary cancer institute.

INTRODUCTION: Anorectal malignant melanoma (ARMM) is an aggressive malignancy with dismal prognosis and a 5-year survival rate less than 20% in most of the previous studies. The ideal surgical treatment has still remained controversial. This retrospective study aims at analysing the outcome in patients with ARMM treated with curative surgical resection. PATIENTS AND METHODS: This is a retrospective study of 38 patients of stage I anorectal malignant melanoma treated with curative surgical resection at our tertiary cancer institute. RESULTS: WLE (Wide Local Excision) was carried out in 12 patients and APR (abdominoperineal resection) was done in 26 patients. The median overall survival of the entire group in this study was 20 months. Although the median overall survival of WLE patients was higher than those with APR (37 months versus 16 months, respectively), this was not a statistically significant event (P=0.317). The 1-, 2-, 3-, 5-year survival rates were similar with both APR and WLE with no significant difference in the 5-year survival rate (P=0.816); overall 5-year survival rate of just 13%. There were 3 long-term survivors in this study group who survived for more than 10 years. CONCLUSION: Most patients ultimately succumb to the disease regardless of the management. Both APR and WLE have significant roles in the management depending on the subset of patients selected. Local treatment should be preferred wherever possible. Abdominoperineal resection should be offered in nodal disease or in a recurrent setting.

Soft tissue aneurysmal bone cyst of left hemithorax with review of literature.

Soft tissue aneurysmal bone cysts (STABCs) are extremely rare extraosseous counterpart of aneurysmal bone cyst (ABC), with close resemblance to histo-morphologic characteristics of ABC. Here we would like to report a 13-year-old female patient, who presented with a large mass, occupying the entire left hemithorax. Patient underwent resection of the thoracic mass. On histopathological examination, it was found to be a soft tissue ABC. It is a very rare tumor and until date 28 cases have been reported in English literature, to the best of our knowledge. On review of the literature, we found this to be the first case of STABC reported in thoracic cavity. The objective of this case presentation is to provide information regarding clinical presentation, radiological and pathological features, and course of management for this rare disease. Soft tissue ABCs are a new class of tumors, so more extensive research is required to establish standard guidelines for their diagnosis and management, to yield better prognosis.

Advancement of nanoscience in development of conjugated drugs for enhanced disease prevention.

Nanoscience and nanotechnology is a recently emerging and rapid developing field of science and has also been explored in the fields of Biotechnology and Medicine. Nanoparticles are being used as tools for diagnostic purposes and as a medium for the delivery of therapeutic agents to the specific targeted sites under controlled conditions. The physicochemical properties of these nanoparticles give them the ability to treat various chronic human diseases by site specific drug delivery and to use in diagnosis, biosensing and bioimaging devices, and implants. According to the type of materials used nanoparticles can be classified as organic (micelles, liposomes, nanogels and dendrimers) and inorganic (including gold nanoparticles (GNPs), super-paramagnetic iron oxide nanomaterials (SPIONs), quantum dots (QDs), and paramagnetic lanthanide ions). Different types of nanoparticle are being used in conjugation with various types of biomoities (such as peptide, lipids, antibodies, nucleotides, plasmids, ligands and polysaccharides) to form nanoparticle-drug conjugates which has enhanced capacity of drug delivery at targeted sites and hence improved disease treatment and diagnosis. In this study, the summary of various types of nanoparticle-drug conjugates that are being used along with their mechanism and applications are included. In addition, the various nanoparticle-drug conjugates which are being used and which are under clinical studies along with their future opportunities and challenges are also discussed in this review.

Reporting of Medical Errors in Autopsied Cases.

This report describes the cases autopsied at B. P. Koirala Institute of Health Sciences- Nepal, during the period of two years in which the treatment provided falls below the accepted standard practice causing the death of the patient. Postmortem examination provides an opportunity to find out the actual cause of death in which the cause of death is suspicious. Sometimes the cause of death found through postmortem examination is different from the clinical cause of death. The autopsy finding on the cause of death will help doctors even to think about unusual conditions that lead to death and hence apply preventive measures for those unusual conditions. The cause of medical error is not always due to the doctor's mistake, but sometimes also due to the obsolete hospital protocol. The autopsy reporting of medical errors can be used to identify lacunae in hospital protocols, problem-prone clinical processes and suggest interventions that may reduce negligence.

Performance, emission, and combustion characteristics of twin-cylinder common rail diesel engine fuelled with butanol-diesel blends.

Nitrogen oxides and smoke are the substantial emissions for the diesel engines. Fuels comprising high-level oxygen content can have low smoke emission due to better oxidation of soot. The objective of the paper is to assess the potential to employ oxygenated fuel, i.e., n-butanol and its blends with the neat diesel from 0 to 30% by volume. The experimental and computational fluid dynamic (CFD) simulation is carried out to estimate the performance, combustion, and exhaust emission characteristics of n-butanol-diesel blends for various injection timings (9°, 12°, 15°, and 18°) using modern twin-cylinder, four-stroke, common rail direct injection (CRDI) engine. Experimental results reveal the increase in brake thermal efficiency (BTE) by ~ 4.5, 6, and 8% for butanol-diesel blends of 10% (Bu10), 20% (Bu20), and 30% (Bu30), respectively, compared to neat diesel (Bu0). Maximum BTE for Bu0 is 38.4%, which is obtained at 12° BTDC; however, for Bu10, Bu20 and Bu30 are 40.19, 40.9, and 41.7%, which are obtained at 15° BTDC, respectively. Higher flame speed of n-butanol-diesel blends burn a large amount of fuel in the premixed phase, which improves the combustion as well as emission characteristics. CFD and experimental results are compared and validated for all fuel blends for in-cylinder pressure and nitrogen oxides (NOx), and found to be in good agreement. Both experimental and simulation results witnessed in reduction of smoke opacity, NOx, and carbon monoxide emissions with the increasing n-butanol percentage in diesel fuel.

Influence of low-temperature combustion and dimethyl ether-diesel blends on performance, combustion, and emission characteristics of common rail diesel engine: a CFD study.

Due to presence of more oxygen, absence of carbon-carbon (C-C) bond in chemical structure, and high cetane number of dimethyl ether (DME), pollution from DME operated engine is less compared to diesel engine. Hence, the DME can be a promising alternative fuel for diesel engine. The present study emphasizes the effect of various exhaust gas recirculation (EGR) rates (0-20%) and DME/Diesel blends (0-20%) on combustion characteristics and exhaust emissions of common rail direct injection (CRDI) engine using three-dimensional computational fluid dynamics (CFD) simulation. Extended coherent flame model-3 zone (ECFM-3Z) is implemented to carry out combustion analysis, and k-ξ-f model is employed for turbulence modeling. Results show that in-cylinder pressure marginally decreases with employing EGR compared to without EGR case. As EGR rate increases, nitrogen oxide (NO) formation decreases, whereas soot increases marginally. Due to better combustion characteristics of DME, indicated thermal efficiency (ITE) increases with the increases in DME/diesel blend ratio. Adverse effect of EGR on efficiency for blends is less compared to neat diesel, because the anoxygenated region created due to EGR is compensated by extra oxygen present in DME. The trade-off among NO, soot, carbon monoxide (CO) formation, and efficiency is studied by normalizing the parameters. Optimum operating condition is found at 10% EGR rate and 20% DME/diesel blend. The maximum indicated thermal efficiency was observed for DME/diesel ratio of 20% in the present range of study. Obtained results are validated with published experimental data and found good agreement.

Perfusion CT - Can it resolve the pancreatic carcinoma versus mass forming chronic pancreatitis conundrum?

OBJECTIVES: To evaluate the utility of perfusion CT (PCT) in differentiating pancreatic adenocarcinoma from mass forming chronic pancreatitis (MFCP). METHODS: In this ethically approved study, PCT was performed in 122 patients with pancreatic masses of which 42 patients had pancreatic adenocarcinoma and 13 had MFCP on histopathology. Perfusion parameters studied included blood flow (BF), blood volume (BV), permeability surface area product (PS), time to peak (TTP), peak enhancement intensity (PEI) and mean transit time (MTT). Twenty five controls with no pancreatic pathology were also studied. RESULTS: Amongst the perfusion parameters BF and BV were found to be the most reliable for differentiating between adenocarcinoma and mass forming pancreatitis. Although they were reduced in both pancreatic adenocarcinoma (BF- 16.6 ± 13.1 ml/100 ml/min and BV- 5 ± 3.5 ml/100 ml) and MFCP (BF- 30.4 ± 8.7 ml/100 ml/min and BV- 8.9 ± 3.1 ml/100 ml) as compared to normal controls (BF- 94.1 ± 24 ml/100 ml/min and BV- 36 ± 10.7 ml/100 ml) but the extent of reduction was greater in pancreatic adenocarcinoma than in MFCP. Based on ROC analysis cut off values of 19.1 ml/100 ml/min for BF and 5 ml/100 ml for BV yielded optimal sensitivity and specificity for differentiating pancreatic adenocarcinoma from MFCP. CONCLUSIONS: PCT may serve as an additional paradigm for differentiating pancreatic adenocarcinoma from mass forming chronic pancreatitis and a useful tool for detecting masses which are isodense on conventional CT.

Jejunal perforation due to ingested buffalo bone mimicking acute appendicitis.

BACKGROUND: Foreign body ingestion is seen quite frequently in clinical practice, intestinal perforation due to this is rare. The foreign body often mimics another cause of acute abdomen and requires an emergency surgical intervention. The majority of patients do not recall ingesting sharp foreign bodies. CASE PRESENTATION: We report an interesting case of a fifty five year-old man who presented with pain in the right iliac fossa with localised tenderness which was clinically diagnosed as acute appendicitis. During the operation, the presence of purulent collection and the inflamed bowel with flakes raised suspicion of bowel perforation. The assessment of the proximal small bowel revealed two small perforations in the jejunum. A hard, bony and sharp object was extracted and the perforations were closed. Post-operative recovery was uneventful. Detailed food history was taken following the recovery of the patient from surgery. It revealed the history ingestion of home prepared buffalo meat. The extracted object was identified as 'buffalo bone' by the patient and the care taker of the patient. The jejunum was perforated by the ingested buffalo bone causing local peritonitis in right iliac fossa. CONCLUSION: Intestinal perforation by ingested foreign bodies should be suspected in acute abdomen. It requires a high degree of suspicion and awareness on the part of the clinician.

MR imaging of cavernous sinus lesions: Pictorial review.

The main purpose of this pictorial review is to highlight the important MR imaging findings of various conditions involving the cavernous sinus in addition to brief description of normal anatomy. The pathological conditions that can involve the cavernous sinus can be categorized into infective, inflammatory, granulomatous, vascular and neoplastic causes. Imaging, especially with MRI, plays an important role not only in detection but also in definition of disease extent and in characterization of the pathology. Currently, high-resolution MR images clearly show various components of cavernous sinus which help in making a proper diagnosis and thus appropriate further management.

A rare Case Report of Sigmoid Colon Perforation Due to Accidental Swallowing of Partial Denture.

Perforation peritonitis is an important cause of generalized peritonitis and pneumoperitoneum. Large bowel perforation due to swallowed artificial denture is extremely rare. Foreign body can be ingested accidentally or in a suicidal attempt. However, ingested foreign body causing sigmoid colon perforation is extremely rare. Complications caused by ingestion of foreign body in gastrointestinal tract include obstruction, perforation, bleeding, or impaction at the sites of physiological narrowing or acute angulation in gastrointestinal tract. We hereby report a case of sigmoid colon perforation due to swallowed partial denture.

Traumatic pseudoaneurysm of bulbourethral artery managed by coil embolization.

Urethral injury is a common form of urogenital trauma in males. Urethral injuries can be diagnosed with ease in emergency due to the presence of blood clot at external urethral meatus or inability to catheterize the urethra. Stricture formation is usual sequelae of such injuries. Uncontrolled urethral hemorrhage is a relatively rare complication which can present either as immediate or delayed. Such injuries can be managed conservatively in majority; however, if uncontrolled may require interventional management. Such patients usually have underlying pseudoaneurysm formation or arteriovenous fistula. Here, we are reporting a case of bulbar urethral injury which presented with delayed uncontrolled urethral hemorrhage. On angiography, pseudoaneurysm arising from left bulbourethral artery with active urethral extravasation was noted and was managed with coil embolization.

Myoepithelioma of the soft palate: a case report.

Myoepitheliomas are rare benign tumors of myoepithelial cell origin, most commonly seen in parotid gland. These tumors are also reported in oral cavity, soft palate being the most common site of involvement. Imaging findings are nonspecific, and histopathology is necessary to differentiate from other tumors. Our case showed mildly enhancing well-circumscribed mass in soft palate with histological findings consistent with myoepithelioma. The aim of this case report is to increase the awareness about this rare benign tumor regarding its morphological, histopathological, and radiological features along with its possible differential diagnosis.