Portal Vein Thrombosis in Patients With Cirrhosis of the Liver: Prevalence and Risk Factors.

INTRODUCTION: Chronic liver disease very often culminates into cirrhosis and its associated complications. One of the serious complications is portal venous thrombosis, which can occur due to a variety of risk factors. One significant factor contributing to portal hypertension is portal vein thrombosis (PVT). In this study, we aimed to investigate the prevalence of PVT among patients with liver cirrhosis in a tertiary hospital and identify the factors associated with this complication. METHODOLOGY: This was a cross-sectional observational study of 93 diagnosed liver cirrhosis patients treated at Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER) hospital in southern India between June 2020 and January 2021. A thorough evaluation of the clinical condition of the patients and associated comorbidities was done. The patients then underwent Doppler ultrasound/CECT/MRI to look for PVT and its extent. The collected data were analyzed using Statistical Product and Service Solutions (SPSS, version 24) (IBM SPSS Statistics for Windows, Armonk, NY). Comparison between two proportions was done using two two-tailed Z-test/Fisher's exact tests. RESULTS: Our study found a PVT prevalence of 17.2% in cirrhotic patients, with a higher prevalence of acute PVT than chronic PVT. Ascitic fluid infection, longer duration of cirrhosis, and increased cirrhosis severity were significantly associated with PVT development. We found no significant associations between PVT and gender, hypertension, smoking, diabetes, or the duration of alcohol intake. CONCLUSION: This study highlights the importance of early screening for PVT using Doppler USG in all patients diagnosed with cirrhosis. Additionally, anticoagulation therapy for acute PVT may be considered in patients without bleeding risks.

Outcomes After Sphincter-Sparing Local Therapy for Anorectal Melanoma: 1989 to 2020.

PURPOSE: The treatment paradigm for patients with anorectal melanoma eligible for sphincter-sparing excision has evolved over time. This study examines outcomes across a 30-year era in this rare disease with poor prognosis. METHODS AND MATERIALS: This retrospective cohort study included all patients with pelvis-confined anorectal melanoma undergoing sphincter-sparing local excision and adjuvant radiation therapy (RT) at our institution between 1989 and 2020. Patterns of care and predictors of outcome were evaluated. RESULTS: Of the 108 patients included, 92 (85%) presented with clinically uninvolved nodes. For clinically node-negative patients, the sentinel lymph node biopsy rate increased from 18/43 (42%) before 2008 to 38/49 (78%) subsequently and the use of inguinal nodal RT decreased from 33/35 (94%) before 2003 to 1/57 (2%) subsequently. All clinically node-positive patients treated before 2003 received inguinal nodal RT, whereas no node-positive patient treated subsequently received this treatment. Patients treated before 2016 mostly received biochemotherapy, and those treated since 2017 mostly received immune checkpoint inhibitors. With median follow-up of 32 months, 77 patients (71%) recurred. Three-year actuarial outcomes were 84% local control, 64% nodal control, 38% distant metastasis-free survival, 30% disease-free survival, and 51% melanoma-specific survival. Ostomy-free survival at last follow-up was 95%. Factors contributing to outcome were identified. Outcomes for patients treated in the contemporary era (2017+) were not significantly better than those treated earlier. CONCLUSIONS: Sphincter-sparing surgery followed by adjuvant RT results in excellent local control and ostomy-free survival for locally resectable anorectal melanoma. Overall oncologic outcomes continue to be poor, reinforcing the need to identify more effective therapies.

Computed Tomography and Cephalometric Evaluation of Obstructive Sleep Apnea Syndrome.

To examine the changes of upper airway cross sectional area in each phase of respiration in different degrees of severity of OSAS with computed tomography and cephalometry to decide on further treatment. A Prospective study was done in the Department of Radiology and Imaging, Kasturba Medical College, Mangalore, spanning over a period from March 2017 to December 2019. 50 patients were included in the study including control group. Patients who had at least 2-3 major symptoms of sleep apnea such as snoring, daytime somnolence, and apnea were included in this study. All patients were examined and then subjected to polysomnography(PSG) and upper airway CT. Patients with apnea-hypopnea index (AHI) of < 5 on Polysomnography were included in the control group and those with AHI of > 5 were categorized in to the study group Cross-sectional area of the airway at the level of the nasopharynx, oropharynx and the hypopharynx were obtained. Standard cephalometric measurements were made on a lateral radiograph of skull/ CT scanogram. Of the 36 patients in the study group, 31 patients were males and 5 were females. In the control group of 12 patients, 8 were males and 4 females. The cross sectional area at the lower border of the nasopharynx which is also the level of the nasopharyngeal sphincter was the most affected level in OSAS (p value of < 0.0001). Mean uvular diameter in the control group was 9.6 mm and in the OSAS group it was 11.2 mm. The mean length of the soft palate was 36.4 mm in the controls, 39.5 mm in the mild/moderate OSAS and 41.2 mm in the severe OSAS group. Obstructive sleep apnea is a complex disorder characterized by apneic episodes during sleep. In this study the most common site of obstruction is nasopharyngeal sphincter and the oropharynx. Although PSG is the diagnostic test of choice, imaging plays an important role in planning surgical and conventional treatment.

Eosinophilic gastroenteritis: Clinical characteristics and management.

There is paucity of published data related to eosinophilic gastroenteritis (EGE). We aimed to study the clinical characteristics, management, and follow-up of EGE. From March 2014 to December 2018, patients with gastrointestinal (GI) symptoms suspected to have EGE were investigated. This is a retrospective study. Complete blood count, upper GI endoscopy (UGIE), and biopsy were done. Contrast-enhanced computed tomography (CECT) abdomen was done when intestinal obstruction was suspected. Laparoscopic small bowel resection or stricturoplasty and full-thickness biopsy were obtained. EGE was diagnosed if the biopsies showed eosinophilic infiltration of one or more regions of the GI tract (> 30 eosinophils per high power field [HPF]). Patients were treated with immunosuppressive therapy and if indicated surgery. Clinical response to therapy was assessed and patients were followed up for 1 year. Forty-one patients (mean age 34.8 years, median age 32, range 25-70 years, 29 males) had EGE. Upper abdominal pain was the most common symptom. Peripheral eosinophilia was present in 82.9% patients. On UGIE, duodenal lesions were observed in 75% patients. EGE was confirmed in 37 patients by endoscopic duodenal biopsies, in 2 patients by jejunal mucosal biopsies using enteroscopy, and in 2 patients by full thickness surgical biopsies. Forty-one patients were treated with oral corticosteroids inclusive of 4 patients who underwent surgery. Of the 37 patients, 6 were lost to follow-up; 31 patients were followed up for a period of 1 year. All the patients who were treated with corticosteroids responded to initial therapy. Over a follow-up period one case had frequent relapses. EGE should be suspected in patients with upper abdominal pain. Peripheral eosinophilia occurs in the majority. Tissue diagnosis showing eosinophilic infiltration is diagnostic. Oral corticosteroid therapy is highly effective and relapse is rare.

Fluoresceinated Aminohexanol Tethered Inositol Hexakisphosphate: Studies on Arabidopsis thaliana and Drosophila melanogaster and Docking with 2P1M Receptor.

Inositol hexakisphosphate (InsP6; phytic acid) is considered as the second messenger and plays a very important role in plants, animals, and human beings. It is the principal storage form of phosphorus in many plant tissues, especially in dry fruits, bran, and seeds. The resulting anion is a colorless species that plays a critical role in nutrition and is believed to cure many diseases. A fluoresceinated aminohexanol tethered inositol hexakisphosphate (III) had been synthesized earlier involving many complicated steps. We describe here a simple two-step synthesis of (III) and its characterization using different techniques such as matrix-assisted laser desorption ionization mass spectrometry, tandem mass spectrometry, and Fourier transform infrared, ultraviolet-visible, ultraviolet-fluorescence, 1H nuclear magnetic resonance (NMR), and two-dimensional NMR spectroscopies. The effect of (III) has been investigated in the model systems, Arabidopsis thaliana and Drosophila melanogaster. Using Schrodinger software, computational studies on the binding of (III) with the protein 2P1M (Auxin-receptor TIR1-adaptor ASK1 complex) has revealed strong binding propensity with this compound. These studies on the fluoresceinated tethered phytic acid could have far reaching implications on its efficacy for human health and treatment of diseases (cancer/tumor and glioblastoma) and for understanding phosphorous recycling in the environment, especially for plant systems.

Ampullary carcinosarcoma with osteosarcomatous, small cell neuroendocrine carcinoma and conventional adenocarcinoma components; First report.

Caracinosarcomas are tumours with diverse epithelial and mesenchymal differentiation. They most commonly occur in the female reproductive organs and upper aero digestive tract. They are relatively rare in the gastrointestinal tract and affect the oesophagus most commonly. Ampullary carcinosarcomas are exceptionally rare. We report a case of ampullary carcinosarcoma in a 67-year-old male, with osteosarcomatous, small cell carcinoma and conventional adenocarcinoma components. To the best of our knowledge, this is the first reported case of its kind.

Cryopreservation of extracted corneal lenticules after small incision lenticule extraction for potential use in human subjects.

PURPOSE: To describe the technique of cryopreservation of corneal lenticules extracted after small incision refractive lenticule extraction (ReLEx SMILE) and initial results of femtosecond laser intrastromal lenticular implantation for hyperopia. METHODS: Lenticules were collected from patients undergoing ReLEx SMILE for the correction of myopia and subjected to a tissue processing technique and cryopreservation. These lenticules were subsequently used to treat 8 hyperopic eyes and 1 aphakic eye. A femtosecond laser was used to create a pocket into each patient's cornea, followed by implantation of a cryopreserved lenticule. The patients were monitored through follow-up examinations for a mean 155.4 days (38-310 days). RESULTS: The mean interval from storage of lenticules to removal from liquid nitrogen was 96 days (range, 19-178 days). Mean spherical equivalent of hyperopic eyes treated was +4.50 ± 1.1 diopter (D). Mean keratometry and pachymetry changed from preoperative 43.9 D and 531.6 µm to 47.4 D and 605.2 µm, respectively, postoperatively. Mean residual spherical equivalent for hyperopic eyes was +0.6 D and +4.1 D for the aphakic eye. None of the eyes showed evidence of rejection or loss of best-corrected visual acuity at the end of the follow-up period. CONCLUSIONS: The cryopreservation technique seems to be a safe method of long-term storage of refractive lenticules extracted after ReLEx SMILE for use in allogeneic human subjects. It may potentially be a safe and effective alternative to excimer laser ablation for hyperopia because of the low risks of regression, haze, flap-related complications, postoperative dry eye, and higher-order aberrations.Clinical Trial Registration-URL: http://www.clinicaltrials.gov. Unique identifier: CTRI/2014/01/004331.

Osteomyelitis of the temporal bone: terminology, diagnosis, and management.

Objectives To review the terminology, clinical features, and management of temporal bone osteomyelitis. Design and Setting Prospective study in a tertiary care center from 2001 to 2008. Participants Twenty patients visiting the outpatient department diagnosed with osteomyelitis of the temporal bone. Main Outcome Measures The age, sex, clinical features, cultured organisms, surgical interventions, and classification were analyzed. Results Of the 20 cases, 2 (10%) were diagnosed as acute otitis media. Eighteen (90%) had chronic otitis media. Nineteen (95%) were classified as medial temporal bone osteomyelitis and one (5%) as lateral temporal osteomyelitis. The most common clinical features were ear discharge (100%), pain (83%), and granulations (100%). Facial nerve palsy was seen in seven cases (35%) and parotid involvement in one case. Ten patients (56%) had diabetes mellitus. The organisms isolated were Pseudomonas aeruginosa (80%) and Staphylococcus aureus (13.33%). Histopathology revealed chronic inflammation in 20 patients (100%) and osteomyelitic bony changes in 14 (70%). Surgical debridement was the most preferred modality of treatment (87%). Conclusion A new classification of temporal bone osteomyelitis has been proposed. Bacterial cultures must be performed in all patients. Antibiotic therapy is the treatment of choice. Surgical intervention is necessary in the presence of severe pain, complications, refractory cases, or the presence of bony sequestra on radiology.

Branchial anomalies: diagnosis and management.

Objective. To find out the incidence of involvement of individual arches, anatomical types of lesions, the age and sex incidence, the site and side of predilection, the common clinical features, the common investigations, treatment, and complications of the different anomalies. Setting. Academic Department of Otolaryngology, Head and Neck Surgery. Design. A 10 year retrospective study. Participants. 30 patients with clinically proven branchial anomalies including patients with bilateral disease totaling 34 lesions. Main Outcome Measures. The demographical data, clinical features, type of branchial anomalies, and the management details were recorded and analyzed. Results and Observations. The mean age of presentation was 18.67 years. Male to female sex ratio was 1.27 : 1 with a male preponderance. Of the 34 lesions, maximum incidence was of second arch anomalies (50%) followed by first arch. We had two cases each of third and fourth arch anomalies. Only 1 (3.3%) patients of the 30 presented with lesion at birth. The most common pathological type of lesions was fistula (58.82%) followed by cyst. 41.18% of the lesions occurred on the right side. All the patients underwent surgical excision. None of our patients had involvement of facial nerve in first branchial anomaly. All patients had tracts going superficial to the facial nerve. Conclusion. Confirming the extent of the tract is mandatory before any surgery as these lesions pass in relation to some of the most vital structures of the neck. Surgery should always be the treatment option. injection of dye, microscopic removal and inclusion of surrounding tissue while excising the tract leads to a decreased incidence of recurrence.

InCl3-catalysed synthesis of 2-aryl quinazolin-4(3H)-ones and 5-aryl pyrazolo[4,3-d]pyrimidin-7(6H)-ones and their evaluation as potential anticancer agents.

A convenient and practical methodology for the synthesis of 2-aryl quinazolin-4(3H)-ones by the condensation of o-aminobenzamides with aromatic aldehydes under mild conditions using catalytic InCl(3) with good yields and high selectivities. This method has been extended for the synthesis of 5-aryl pyrazolo[4,3-d]pyrimidin-7(6H)-ones which have potential applications in medicinal chemistry. Many of these compounds were evaluated for their anti-proliferative properties in vitro against four cancer cell lines and several compounds were found to be active. Further in vitro studies indicated that inhibition of sirtuins could be the possible mechanism of action of these molecules.

Upper gastrointestinal bleeding revealing the stomach metastases of renal cell carcinoma.

INTRODUCTION: Renal cell carcinoma (RCC) constitutes 3% of all adult malignancies and often presents insidiously. Consequently, 25-30% of patients have metastases at the time of diagnosis. DISCUSSION: Gastrointestinal (GI) bleeding from RCC metastases is an uncommon and underrecognized manifestation of this disease. We hereby report a rare case of RCC with stomach metastasis which heralded the primary manifestation of the disease. This case highlights the importance of maintaining vigilance for unusual causes during endoscopy in cases of upper GI hemorrhage.

Pituitary tuberculosis mimicking idiopathic granulomatous hypophysitis.

An unusual case of tubercular granulomatous hypophysitis is reported. A sellar mass diagnosed as pituitary adenoma in MRI, showed non-caseating granulomas, glandular destruction and fibrosis in histology. Stain for acid-fast bacilli (AFB) were negative and the case was misdiagnosed as Idiopathic Granulomatous hypophysitis. The patient came back 2 weeks after trans-sphenoidal endoscopic resection with meningitis. CSF showed mixed pleocytosis. PCR for Mycobacterium tuberculosis was positive. The case is reported to highlight the need to maintain a high degree of suspicion for tuberculosis in any form of granulomatous hypophysitis, with or without caseous necrosis, in regions endemic for tuberculosis to prevent subsequent complications.