Cystic lesions of the adrenal gland.

Cystic lesions of the adrenal glands are relatively uncommon and most of them are clinically silent. Though rarely associated with malignant changes, they may carry clinically detrimental consequences if misdiagnosed. Cystic adrenal lesions exhibit a broad histomorphological spectrum, ranging from pseudocysts, endothelial cysts, epithelial cysts and parasitic cysts. Here we present the case of a young woman with left-sided abdominal pain and contrast-enhanced CT showing a 10.4×7.7×7.8 cm fluid-filled left suprarenal lesion. The patient underwent exploratory laparotomy with cyst excision, and the histopathological examination of the specimen revealed a pseudocyst of the left adrenal gland. Despite being rare, usually benign and asymptomatic, the diagnosis and management of these cystic lesions of the adrenal glands are often unclear. Any functional lesion, potentially malignant lesion or lesion more than 5 cm deserves surgical management, whereas others can be managed conservatively.

Isolated ectopic jejunal varices in a patient with extrahepatic portal vein obstruction - A case report.

INTRODUCTION AND IMPORTANCE: Among the various causes for lower gastrointestinal bleeding, ectopic varices constitute a small chunk. Though rare, these can pose a diagnostic challenge with recurrent bleed leading to multiple admission and blood transfusions. CASE PRESENTATION: A 41-year-old male presented to our department with multiple episodes of melena. On further evaluation with CT angiography, a diagnosis of extrahepatic portal vein obstruction with moderate splenomegaly and ectopic jejunal varix was made. He underwent splenectomy with resection of involved jejunal segment with side to side anastomosis. CLINICAL DISCUSSION: The diagnosis of ectopic varices remains elusive in a large number of cases in view of the varied etiology. Various newer endoscopic and imaging modalities can play a diagnostic as well as therapeutic role but this also further complicates the management as there is a lack of substantial guidelines directing the treatment protocol. As a result, we have to resort to a case by case approach for the optimal management in these cases. CONCLUSION: The main modality of management for bleeding ectopic varices is percutaneous or endoscopic. Surgery is reserved for refractory cases, with decompressive shunts combined with segmental resection of involved intestine being at the forefront of surgical options.

Multifunctional alginate microspheres for biosensing, drug delivery and magnetic resonance imaging.

This research aims to develop and investigate a multifunctional implantable system capable of biosensing, drug delivery and magnetic resonance imaging (MRI) for continuous monitoring, controlled anti-inflammatory drug delivery and imaging, respectively. A glucose biosensor, diclofenac sodium (Diclo) and magnetic nanoparticles (MNP) were used as the biosensor component, anti-inflammatory agent and MRI contrast agent, respectively. MNP were synthesized by the co-precipitation technique and loaded with the sensor and drug components into alginate microspheres using a commercial droplet generator. The multifunctional system was then characterized using optical microscopy, scanning electron microscopy, transmission electron microscopy, X-ray diffraction, vibrating sample magnetometry (VSM) and MRI. The MNP were found to be in the size range of 5-15 nm. The final system, comprising the biosensor, drug and MNP loaded inside alginate microspheres, was found to be in the size range of 10-60 µm. Biosensing studies indicated an excellent glucose response curve, with a regression coefficient of 0.974 (0-10mM of glucose, response time: 4 min). In vitro Diclo release shows that MNP loading in alginate microspheres increases the burst release percentage by 11-12% in both 60 and 10 µm particles. However, the duration of release for 85% drug release decreases with MNP loading by 7 and 6 days for 39 the 60 and 10 µm particles, respectively. Super-paramagnetism was confirmed by VSM, with 2.09 and 1.368 emu g(-1), respectively, for the 60 and 10 µm particles, with no hysteresis. MRI showed significant contrast for both sizes. The particles showed an excellent biocompatibility (>80%) for all combinations of formulations. The system shows a great potential for biosensing with concurrent drug delivery and visualization for biomedical applications.