Tf2O-Promoted Regioselective Heteronucleophilic Ring-Opening Approaches of Tetrahydrofuran.

The ring-opening functionalization strategy in tetrahydrofuran (THF) represents an ideal approach to access different valuable structures. Herein, we report different operationally simple, efficient, unique, and practical regioselective heteronucleophilic ring-opening strategies for the THF system. Tf2O, which is a strong electrophilic activator, was found to generate a THF triflate intermediate that triggers the nucleophilicity of nitriles (Nu1) and led to regioselective ring opening in the presence of different nucleophiles (Nu2). Furthermore, the synthesis of different heteronucleophilic ring-opening dimerization products was attributed to the nucleophilicity of Nu2. We also demonstrated that use of borane-tetrahydrofuran (BTHF) can achieve challenging hydride addition in a similar manner.

Small Cell Type Undifferentiated Carcinoma of Gall Bladder with Pas Positive Hyaline Globule Masquerading as Liver Mass: A Case Report and Literature Review.

An undifferentiated carcinoma (UC) of the gall bladder behaves aggressively and has a grave prognosis. Small cell type undifferentiated carcinoma of the gall bladder is a rare variant. This paper reports a case of UC of gall bladder with PAS-positive diastase- resistant eosinophilic hyaline globules present as liver mass (on imaging) in a male patient. The microscopic findings of the liver and gall bladder after a right tri-segmentectomy showed an un-differentiated malignant neoplasm composed of cells with round to oval nuclei, prominent nucleoli, and scanty neoplasm. No definite cell pattern was identified with these neoplastic cells. A section from the gall bladder revealed a tumor arising from the lining epithelium and infiltrating through the muscularis. This tumor was infiltrating the adherent liver tissue directly and forming a mass of undifferentiated malignant cells. The focal area within the tumor mass showed the presence of PAS-positive, diastase-resistant, eosinophilic hyaline globules within the neoplastic cells. The immunohistochemistry test was diffusely positive for perinuclear anti-neutrophil cytoplasmic antibodies and negative for chromogranin, vimentin, Desmin, alpha-fetoprotein, leukocyte common antigen, CD34, and bcl2. When the clinical and radiological data are inconclusive, careful analysis of the histological and immunophenotypic features is needed to make the final diagnosis of UC of the gall bladder. The biological behavior and prognosis of this tumor remain unclear because of its rarity. Further studies will be needed to understand the characteristics of this deadly tumor and to establish an effective therapy for it.

DABCO- and DBU-promoted one-pot reaction of N-sulfonyl ketimines with Morita-Baylis-Hillman carbonates: a sequential approach to (2-hydroxyaryl)nicotinate derivatives.

An intriguing DABCO-catalyzed and DBU-promoted one-pot synthesis of an important class of (2-hydroxyaryl)pyridine derivatives bearing a carboxylate or a nitrile group suitably placed at C3 position of the aza-ring has been achieved in acceptable chemical yields with a broad functional group tolerance. This sequential C-C/C-N bond making process proceeds through a regioselective allylic alkylation/aza-Michael reaction between MBH carbonates derived from an acrylate/acrylonitrile and N-sulfonyl ketimines as C,N-binucleophiles catalyzed by DABCO, followed by elimination of SO2 under the influence of base and subsequent aromatization in an open atmosphere.

Dengue Virus Transmission from Living Donor to Recipient in Liver Transplantation: A Case Report.

Many infections are transmitted from a donor to a recipient through organ transplantations. The transmission of dengue virus from a donor to a recipient in liver transplantation is a rare entity, and currently, there is no recommendation for screening this virus prior to transplantation. We report a case of transmission of dengue virus from donor to recipient after liver transplantation. The recipient had a history of multiple admissions for hepatic encephalopathy and ascites. He was admitted in the ICU for 15 days for chronic liver disease, ascites, and acute kidney injury before transplantation. The donor was admitted 1 day before transplantation. The donor spiked fever on postoperative day 2 followed by thrombocytopenia and elevated liver enzymes. The donor blood test was positive for dengue NS1 antigen. The recipient also had a similar clinical picture on postoperative day 5 and his blood test was also positive for dengue NS1 antigen. Hence, the diagnosis for posttransplant donor-derived allograft-related transmission of dengue infection was made. Both recipient and donor were treated with supportive measures and discharged after their full recovery on postoperative days 9 and 18, respectively. The effect of immunosuppression on dengue presentation is still unclear and there is lack of literature available. In our case, the recipient developed dengue fever similar to general population without showing any feature of severe graft dysfunction. We have concluded that dengue virus can also be transmitted from donor to recipient, and immunosuppression did not have any adverse effect on the evolution of dengue fever within the recipient. Delhi being a hyperendemic zone, screening for donors (especially in season time) for dengue virus seems to be the best preventive method to control donor-derived transmission of dengue to recipient.

Variations of gonadal veins: embryological prospective and clinical significance.

INTRODUCTION: An adequate knowledge of anomalies of gonadal veins will help the radiologists and surgeons in recognition and protection of these veins which play major roles in thermo-regulation that is essential for the efficient functioning of testis on which the survival of the human species depends. AIM: The aim of this work is to present an analysis of the anatomical variations of gonadal veins. An effort has also been made to explicate the possible embryological model of development of such variants and to present the variable clinical aspects concerning them. MATERIALS AND METHODS: Gonadal veins in 60 dissection room cadavers were examined for variations from the classic anatomic description. RESULT: In the present study, out of 60 cases, male: female ratio was 2:1(40:20) in which no variation was found in ovarian veins. In the 18 (45%) cases, testicular veins showed variations which consist of duplication and atypical drainage. DISCUSSION: Variations of drainage of gonadal vein are due to error of embryological development in venous shift and alteration in anastomotic channel of post-cardinal, supra-cardinal and sub cardinal veins. CONCLUSION: The gonadal veins present numeric variations as well as variations in its site of drainage, which attributed to the various pathological conditions as varicocele and pelvic congestion syndrome, leading to infertility in patients. Hence, in -depth knowledge of these developmental anomalies of gonadal veins is important.

Delayed presentation of the traumatic abdominal wall hernia; dilemma in the management - review of literature.

Traumatic abdominal wall hernia is a rare entity, and an uncommon type of abdominal wall hernia as far as the etiology is concerned. It is caused by blunt trauma and disrupts the fascial layers, but does not disrupt the elastic skin. In this study, we report the case of a 60-year-old female, diagnosed with traumatic abdominal wall hernia with delayed presentation. In this case, herniation of the bowels was present through the defect in the left iliac region. She was surgically well-managed. During the follow-up of 1 year, there was no recurrence. In the Western medical literature, only a few cases have been reported, especially with intra-abdominal injuries. Confusion still exists in the management of such a disease as to whether to treat the condition at an early or later stage.

Traumatic anterior abdominal wall hernia: A report of three rare cases.

Traumatic abdominal wall hernia is a rare condition that can follow any blunt trauma. Associated intra-abdominal injuries are infrequent. In this study, we are reporting three cases, diagnosed as abdominal wall hernia associated with herniation of bowel loops due to blunt trauma. In one case, injury of the herniated bowel was seen. In western medical literature, only few cases have been reported especially with intra-abdominal injuries.

Report of two cases of non-union of clavicle treated with nonsurgical management.

CONTEXT: Fractures of the clavicle usually occur at the junction of the medial two third with the lateral one third and usually heal by nonsurgical measures. Radiographs and MRI of the shoulder provide helpful investigations for diagnosis and treatment. In the following cases, an anterior-posterior view revealed non-union of the clavicle on the right side, which is atypical in children. CASE REPORT: Non-union of a clavicular fracture is an extremely rare condition, especially in children. We are reporting two cases in this paper; in the first case; an 8-year-old male child visited the hospital with a history of fracture of the right clavicle one year ago. In the second case, a 26-year-old male patient presented with a history of fracture of the right clavicle six years ago. CONCLUSION: Careful attention should be paid when obtaining a detailed history and physical examinations, as traumatic arthritis at either clavicular joint may mimic non-union. The explicable evidence of osseous non-union on radiographs may be minor and may not correlate with the clinical symptoms.

Intramuscular cysticercosis diagnosed on ultrasonography in thigh: A rare case report.

CONTEXT: Cysticercosis is an infection with the larval (cysticercus) stage of Taenia solium. It is difficult to diagnose cysticercosis on ultrasonography. Ultrasonography was done on Logiq 500 Pro machine with convex probe at 3.5 MHz frequency and diagnosed as cysticercosis with surrounding inflammation in the right vastus medialis muscle of thigh with a linear probe at 9.6 MHz frequency. In this case, we are discussing the role of high resolution sonography which helped in non-invasive diagnosis and treatment. CASE REPORT: A 12 years old male patient presented with a swelling on the medial aspect of the right thigh. There was complaint of pain in the right thigh for the last one week with history of fever since three days. On local examination, a single swelling of size approximately 4x5 cm in the right medial aspect of thigh was present. On ultrasonography there was a well defined isolated cystic lesion of size 3.3 × 2.5 cm intermuscular area. We have successfully managed the patient conservatively with albendazole and steroids only. CONCLUSION: We conclude that intermuscular cystic swelling in thigh can be diagnosed on high resolution sonography with a great confidence to manage it conservatively. Cost of investigations also reduced. Ultrasonography plays an important role. Child is doing well in follow-up.

Superior mesenteric artery syndrome: A case report.

CONTEXT: Superior mesenteric artery syndrome is a life- threatening upper gastrointestinal disorder due to compression of duodenum as it poses a difficult diagnostic dilemma. Third part of duodenum is in fixed compartment bounded anteriorly by the root of mesentery and superior mesentery artery and posteriorly by the aorta and lumbar spine. On barium contrast study and abdominal computerized tomography (CT) showed the dilatation of second part of duodenum and compression of the third part of duodenum between aorta and superior mesentery artery. CASE REPORT: A 22 year young asthenic man admitted with the complaint of recurrent abdominal pain, epigastric fullness, and vomiting and weight loss. Abdominal examination revealed epigastric fullness and hyper peristaltic bowel sounds. Upper gastrointestinal barium study showed a dilated stomach with dilated second part of the duodenum and cut off at the third part of duodenum with no intrinsic mucosal abnormalities. There was no relief of obstruction in the left lateral decubitus or prone position. Conservative treatment was tried for one month but failed. Intra-operative findings confirmed the extrinsic obstruction of third part of duodenum with distension of 2(nd) part. A retrocolic duodenojejunostomy, side to side anastomosis done. In post-operative follow up, patient was symptom free. CONCLUSION: Superior mesentery artery syndrome is a life threatening disease. It should be treated as soon as possible. Conservative trial can be given but Surgery is the treatment of the choice.