A Case Report of Type B Aortic Dissection With Ruptured False Lumen.

Aortic dissection is a critical condition characterized by an intimal tear in the aortic wall, leading to the formation of a false lumen. We present a case of a 54-year-old male with chronic type B aortic dissection and hypertension who presented with acute tearing left back pain. Initial evaluation revealed elevated blood pressure and subtle laboratory abnormalities. Imaging confirmed a Stanford type B aortic dissection with an intramural hematoma and contained rupture of the false lumen. Despite initial stabilization efforts, the patient deteriorated rapidly and succumbed. This case highlights the critical importance of early diagnosis.

Atypical Choroid Plexus Tumor of the Cauda Equina With Metastases to the Spinal Cord and Brain.

We report a case of a 57-year-old man with a tumor arising from the cauda equina with spinal cord and intracranial metastases in the basal cisterns and along the cranial nerves. He presented with severe lower back pain and mild gait imbalance. His imaging revealed a large mass in the lumbosacral region with involvement of the cauda equina, intradural extramedullary enhancing metastases in the thoracic spinal canal, and intracranial metastases in the suprasellar cistern and along both trigeminal and facial/vestibulocochlear nerve complexes. Pathological examination of the resected thoracic spinal cord mass showed an atypical papillary proliferation with moderate nuclear pleomorphism and rare mitotic figures. While the morphologic and immunophenotypic features were consistent with the diagnosis of a choroid plexus tumor, the atypical location for this entity required the exclusion of other epithelioid tumors with papillary architecture. Additional immunohistochemical markers were used to exclude a metastatic adenocarcinoma, a papillary variant of a meningioma, and a papillary variant of an ependymoma. Ultimately, methylation-based tumor profiling determined that the methylation class was a match for "plexus tumor" resulting in the integrated diagnosis of the tumor with features of choroid plexus papilloma. This is a unique presentation for both the location and the metastatic spread. The methylation profile was instrumental in establishing this diagnosis.

Slow-Flow Venous Vascular Malformation in the Carotid Sheath.

Slow-flow venous vascular malformation is a benign lesion characterized by an abnormal but non-cancerous growth of capillaries. In the carotid space, a slow-flow venous vascular malformation is an exceptionally uncommon occurrence. Here, we present the case of a 58-year-old man who had been experiencing a slow-growing lump on the left side of his neck for the past four years. Upon conducting magnetic resonance imaging (MRI) of the neck soft tissues and computed tomography angiography (CTA) of the neck, imaging findings revealed a venous vascular malformation within the carotid sheath. Venous vascular malformation in the carotid space is rarely reported in the medical literature. The unique imaging findings for venous vascular malformation make our case distinct, which deviates from the more common entities usually encountered in this area, such as schwannoma or carotid body tumor. The atypical presentation of this case has brought about greater awareness among the medical community and readers alike.

Merkel Cell Carcinoma of the Left Cheek With Testicular Metastasis: An Uncommon Occurrence.

Merkel cell carcinoma (MCC) is an infrequent and aggressive neuroendocrine tumor of the skin. 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) is an effective imaging technique with good diagnostic accuracy that may be used to help stage MCC and for detecting unexpected recurrences and distant metastatic disease. Other causes of testicular neoplasms, such as primary testicular tumors, lymphomas, or anaplastic small cell melanomas, are difficult to differentiate from MCC testicular metastases on imaging, and tumor markers and histopathology will help confirm it. The current case is a 65-year-old non-immunocompromised male with Merkel cell carcinoma who was incidentally identified with testicular metastases on PET/CT and confirmed on histopathology.

Quantification of hematoma and perihematomal edema volumes in intracerebral hemorrhage study: Design considerations in an artificial intelligence validation (QUANTUM) study.

BACKGROUND: Hematoma and perihematomal edema volumes are important radiographic markers in spontaneous intracerebral hemorrhage. Accurate, reliable, and efficient quantification of these volumes will be paramount to their utility as measures of treatment effect in future clinical studies. Both manual and semi-automated quantification methods of hematoma and perihematomal edema volumetry are time-consuming and susceptible to inter-rater variability. Efforts are now underway to develop a fully automated algorithm that can replace them. A (QUANTUM) study to establish inter-quantification method measurement equivalency, which deviates from the traditional use of measures of agreement and a comparison hypothesis testing paradigm to indirectly infer quantification method measurement equivalence, is described in this article. The Quantification of Hematoma and Perihematomal Edema Volumes in Intracerebral Hemorrhage study aims to determine whether a fully automated quantification method and a semi-automated quantification method for quantification of hematoma and perihematomal edema volumes are equivalent to the hematoma and perihematomal edema volumes of the manual quantification method. METHODS/DESIGN: Hematoma and perihematomal edema volumes of supratentorial intracerebral hemorrhage on 252 computed tomography scans will be prospectively quantified in random order by six raters using the fully automated, semi-automated, and manual quantification methods. Primary outcome measures for hematoma and perihematomal edema volumes will be quantified via computed tomography scan on admission (<24 h from symptom onset) and on day 3 (72 ± 12 h from symptom onset), respectively. Equivalence hypothesis testing will be conducted to determine if the hematoma and perihematomal edema volume measurements of the fully automated and semi-automated quantification methods are within 7.5% of the hematoma and perihematomal edema volume measurements of the manual quantification reference method. DISCUSSION: By allowing direct equivalence hypothesis testing, the Quantification of Hematoma and Perihematomal Edema Volumes in Intracerebral Hemorrhage study offers advantages over radiology validation studies which utilize measures of agreement to indirectly infer measurement equivalence and studies which mistakenly try to infer measurement equivalence based on the failure of a comparison two-sided null hypothesis test to reach the significance level for rejection. The equivalence hypothesis testing paradigm applied to artificial intelligence application validation is relatively uncharted and warrants further investigation. The challenges encountered in the design of this study may influence future studies seeking to translate artificial intelligence medical technology into clinical practice.

Synthesis and Antimicrobial Activity of Some New Thiadiazoles, Thioamides, 5-Arylazothiazoles and Pyrimido[4,5-d][1,2,4]triazolo[4,3-a]pyrimidines.

A novel series of 1,3,4-thiadiazoles, 5-arylazothiazoles and hexahydropyrimido-[4,5-d][1,2,4]triazolo[4,3-a]pyrimidines were synthesized via reaction of hydrazonoyl halides with each of alkyl carbothioates, carbothioamides and 7-thioxo-5,6,7,8-tetrahydropyrimido-[4,5-d]pyrimidine-2,4(1H,3H)-diones in the presence of triethylamine. The structures of the newly synthesized compounds were established based on their spectral data, elemental analyses and alternative synthetic routes whenever possible. Also, the newly synthesized compounds were screened for their antimicrobial activity against various microorganisms.

Efficacy of microencapsulated lactic acid bacteria in Helicobater pylori eradication therapy.

BACKGROUND: Probiotic delivery systems are widely used nutraceutical products for the supplementation of natural intestinal flora. These delivery systems vary greatly in the effectiveness to exert health benefits for a patient. This study focuses on providing probiotic living cells with a physical barrier against adverse environmental conditions. MATERIALS AND METHODS: Microencapsulation of the selected lactic acid bacteria (LAB) using chitosan and alginate was performed. Physical examination of the formulated LAB microcapsules was observed using phase contrast inverted microscope and scanning electron microscope (SEM). Finally, the survival of microencapsulated and noncapsulated bacteria was cheeked in the simulated human gastric tract (GT). The potential antimicrobial activity of the most potent microencapsulated LAB strain was in vivo evaluated in rabbit models. RESULTS: Microencapsulated L. plantarum, L. acidophilus, and L. bulgaricus DSMZ 20080 were loaded with 1.03 × 10(10) CFU viable bacteria/g, 1.9 × 10(10) CFU viable bacteria/g, and 5.5 × 10(9) CFU viable bacteria/g, respectively. The survival of microencapsulated cells was significantly higher than that of the free cells after exposure to simulated gastric juice (SGJ) at pH 2. Additionally, in simulated small intestine juice (SSJ), larger amounts of the selected LAB cells were found, whereas in simulated colon juice (SCJ), the released LAB reached the maximum counts. In vivo results pointed out that an 8-week supplementation with a triple therapy of a microencapsulated L. plantarum, L. acidophilus, and L. bulgaricus DSMZ 20080 might be able to reduce H. pylori. CONCLUSION: Microencapsulated probiotics could possibly compete with and downregulate H. pylori infection in humans.

Case-by-case study using antibiotic-EDTA combination to control pseudomonas aeruginosa.

Ps. aeruginosa a well-known opportunistic bacterium infects various tissues and organs causing sever problems. In tropical and semitropical countries and because of environmental and sanitizations reasons Ps. aeruginosa acquiring more virulent factors, gained multi-resistant genes, adapt resistant mechanisms for antibiotics, drugs, disinfectants and in general for any toxic compound. Six multidrugs resistant strains out of 260 different bacteria isolated from patients at Tanta University hospital, Tanta, Egypt, used in this study. To evaluate the role of divalent cations in antibiotic resistance we used a medium containing Ca(2+) and Mg(2+). Various antibiotics tested with or without the LC(10) and LC(50) equivalent amount of EDTA against each strain. We found that after adding EDTA, 70% of the strains turned from resistant to sensitive, especially considering those antibiotics, which inhibit protein synthesis, such, as tetracycline. Simple experiment for testing the effect of Antibiotic-EDTA combination on Rabbits skin artificial ulcer(s) infected by Ps. aeruginosa significantly improve the efficiency of using such combination in superficial treatment. We propose using media other than Muller-Hinton agar in antibiotic sensitivity test to select the best antibiotics could be used in vivo or in superficial treatment. A combination between a proper amount of EDTA and antibiotics especially protein inhibitors will improve the control of Ps. aeruginosa.

Production of proinflammatory cytokines: granulocyte-macrophage colony stimulating factor, interleukin-8 and interleukin-6 by peripheral blood mononuclear cells of protein energy malnourished children.

Protein-energy malnutrition (PEM) is a serious disease responsible for the high morbidity and mortality rates among children in developing countries. The damaging effects of PEM on their immune system may persist for long throughout their lives. In this study, the levels of the proinflammatory cytokines; Granulocyte-Macrophage colony stimulating factor (GM-CSF), interleukin-8 (IL-8) and interleukin-6 (IL-6) were measured in culture supernates of peripheral blood mononuclear cells (PBMCs) isolated from 46 PEM children before and after stimulation with lipopolysaccharide (LPS). The PEM children were classified into four groups; under weight (u.wt= 15), marasmus (M= 11), marasmic kwashiorkor (MK=10), and kwashiorkor (K=10). Results were compared with those of a control group composed of ten healthy well-nourished age-matching children (C=10). Before LPS stimulation, GM-CSF levels of M, MK and K groups were lower than those of the control group, while IL-8 and IL-6 levels were higher in all PEM groups than in the controls. After LPS stimulation, GM-CSF, IL-8 and IL-6 levels were lower in all PEM groups than controls. The three cytokines' levels were elevated in control and PEM groups after LPS stimulation than before. Before and after LPS stimulation, the highest level of the GM-CSF, IL-8 and IL-6 within PEM children were detected in the u.wt group followed by M, MK and K groups respectively. The disturbance in the production of GM-CSF, IL-8 and IL-6 by PBMCs of PEM children under study and the decreased stimulatory responses of these cells denoted to severely impaired inflammatory response associated with PEM status in addition to several immunological processes in which these cytokines are involved.

Serum IL-6 and IL-12 levels in breast cancer patients.

Previous studies indicated that interleukins 6 & 12 are multifunctional cytokines which regulate of immune response and cancer cell proliferation. We measured serum levels of these cytokines in 40 females with breast cancer and examined their correlation with clinicopathological variables including stages of the disease and estrogen and progesterone receptor expression on tumor cells. Serum levels of IL-6 (mean =111.38 pg/ml) as well as IL-12 (mean=1142.75 pg/ml) were significantly increased in breast cancer patients as compared to controls (mean 1.75 pg/ml &19.90 pg/ml respectively). A statistically significant correlation was found between levels of IL-6 as well as IL-12 and progression of the tumor (P < 0.05). However, no statistical difference was found in serum levels of these cytokines between metastatic and non-metastatic cases. Both cytokines negatively correlated with estrogen and progesterone receptor expression on tumor cells. In conclusion, serum levels of IL-6 and IL-12 are highly elevated in breast cancer patients and correlate with tumor progression. Assays for serum levels of IL-6 and IL-12 can be used as predictive non-invasive tests for tumor progression in breast cancer patients.