Clinical progression of renal vein leiomyoma: A case report.

INTRODUCTION: Vascular leiomyoma originating in the renal vein is a rare entity. Our case allowed us charting of progression of renal vein leiomyoma for 8-years' duration. Apart from intraluminous growth causing displacement of viscera, the leiomyoma did not show any aggressive behaviour. Eventually, removal of the tumour through nephrectomy provided complete symptomatic relief to our patient. CASE PRESENTATION: A 75-year old female presented with an eight-year long history of severe pain in right flank. CT imaging revealed a mass arising from the right renal vein and a few hepatic tumours. The differentials included leiomyosarcoma, in view of hepatic lesions. Excision of the tumour was performed with radical nephrectomy. Immunohistopathological examination confirmed it to be a case of leiomyoma. Three months post-op, the patient reported complete pain relief and no adverse events, and there were no signs of recurrence. DISCUSSION AND CONCLUSION: Vascular leiomyomas do not show any aggressive behaviour. However, their growth tends to displace the normal viscera, causing pressure effects that may give rise to intractable pain. Vascular obstruction affects GFR and renal function. In our patient, despite a long period of growth, the tumour did not show any malignant changes. Tumour excision through radical nephrectomy resulted in symptomatic improvement in our patient. Since imaging alone does not distinguish a leiomyoma from its malignant counterpart with certainty, surgical excision may be warranted in all the cases.

Role of micro-structure and interfacial properties in the higher photocatalytic activity of TiO2-supported nanogold for methanol-assisted visible-light-induced splitting of water.

This paper deals with the textural, microstructural and interfacial properties of Au/TiO(2) nanocomposites, in relation to their photocatalytic activity for splitting of water. TiO(2) samples of two different morphologies were employed for dispersing different cocatalysts, such as: Au, Pt, Ag or Cu, for the sake of comparison. The samples were characterized using powder XRD, XPS, UV-visible, thermoluminescence, SEM, HRTEM and SAED techniques. Compared to other metal/TiO(2) photocatalysts, Au/TiO(2) with an optimum gold loading of 1 wt% was found to exhibit considerably higher activity for visible light induced production of H(2) from splitting water in the presence of methanol. Further, the sol-gel prepared TiO(2) (s.TiO(2)), having spherical grains of 10-15 nm size, displayed better photoactivity than a Degussa P25 catalyst. The electron microscopy investigations on s.TiO(2) revealed significant heterogeneity in grain morphology of individual TiO(2) particles, exposure of the lattice planes, metal dispersion, and the interfacial metal/TiO(2) contacts. The gold particles were found to be in a better dispersed state. O(2) TPD experiments revealed that the gold nanoparticles and Au/TiO(2) interfaces may serve as distinct binding sites for adsorbate molecules. At the same time, our thermoluminescence measurements provide an insight into Au-induced new defect states that may facilitate the semiconductor-to-metal charge transfer transition. In conclusion, the superior photocatalytic activity of Au/TiO(2) may relate to the grain morphology of TiO(2), dispersion of gold particles, and the peculiar architecture of metal/oxide heterojunctions; giving rise in turn to augmented adsorption of reactant molecules and their interaction with the photo-generated e(-)/h(+) pair. The role played by methanol as a sacrificial reagent in photocatalytic splitting of water is discussed.

Changes in antioxidant defense status in response to cisplatin and 5-FU in esophageal carcinoma.

The ability of reactive oxygen species to induce cellular damage and to cause cell death opens the possibility of exploiting this property in the treatment of esophageal cancer through a free radical mediated mechanism. The present study was carried out with the aim of evaluating the changes in the antioxidant defense status in esophageal cancer patients treated without and with neoadjuvant therapy (NAT). Forty surgically resected tissue specimens from tumors, tissue adjoining the tumors and paired macroscopically normal mucosa were obtained from esophageal cancer patients treated with or without chemo-radiotherapy. An evaluation of antioxidant defense system in the normal, adjoining and tumor esophageal tissues in response to NAT revealed decreased catalase activity in tumor and adjoining tissues as compared to their respective normal tissue levels. Similarly, decreased superoxide dismutase activity was observed in tumor tissue in response to NAT. In both the treatment groups (with and without NAT), no significant change was observed in the enzyme activity of glutathione reductase in the normal, adjoining and tumor tissues. Enhanced glutathione peroxidase activity was found in tumor tissue, as compared to the adjoining and paired normal tissue of patients after NAT. Estimation of reduced glutathione (GSH) levels showed a significant decline in GSH levels in esophageal tumors after NAT. Depletion of GSH, an endogenous antioxidant, would elevate drug sensitivity and might predispose neoplastic cells to apoptosis in response to NAT. The antioxidant enzymes in the esophageal carcinoma thus may play an important role in influencing the final outcome upon NAT course.

Interplay between oncoproteins and antioxidant enzymes in esophageal carcinoma treated without and with chemoradiotherapy: a prospective study.

PURPOSE: To analyze p53, bcl-2, c-myc, and cyclooxygenase-2 protein expression changes and examine their relationship with various antioxidant enzymes in esophageal carcinoma patients. METHODS AND MATERIALS: Patients in Group 1 underwent transhiatal esophagectomy and those in Group 2 were administered chemoradiotherapy followed by surgery after 4 weeks of neoadjuvant therapy. RESULTS: The relationship analysis among the various protein markers and antioxidant enzymes showed an inverse correlation between bcl-2 and superoxide dismutase/catalase in tumor tissues, irrespective of the treatment arm followed. An important positive association was observed between bcl-2 and reduced glutathione levels in the tumor tissue of patients receiving neoadjuvant therapy. Another apoptosis-modulating marker, c-myc, in the tumor tissue of Group 2 patients showed similar pattern levels (high and low) as that of superoxide dismutase/catalase. The association of cyclooxygenase-2 and p53 with various antioxidant enzymes showed a significant positive correlation between cyclooxygenase-2 expression and catalase activity and an inverse trend between p53 expression and superoxide dismutase and catalase activity in the tumor tissue of patients given neoadjuvant therapy. In addition, patients with overexpressed p53 protein levels had lower glutathione peroxidase enzyme levels and vice versa in the tumor tissue of patients who had undergone surgery as their main mode of treatment. CONCLUSION: The results of this study broaden the insight into the relationships shared among oncoproteins and the antioxidant defense system, and this could be helpful in the clinical management of esophageal carcinoma.

P53, COX-2, iNOS protein expression changes and their relationship with anti-oxidant enzymes in surgically and multi-modality treated esophageal carcinoma patients.

Esophageal carcinoma has a high incidence in India but its etiology remains unknown. In the present study the correlation between apoptosis regulatory proteins and anti-oxidant enzymes in 40 esophageal carcinoma patients was examined. Patients in one group were operated by transhiatal esophagectomy and in the second group were administered cisplatin (30 mg/m2/day) and 5-fluorouracil (5-FU) (750 mg/m2/day) daily for three days followed by surgery after four weeks of neo-adjuvant therapy (NAT). Complete pathological response was achieved in 15% of patients. Results obtained by Western blot analysis showed over-expressed p53 and COX-2 protein levels in the tumor tissues as compared to the adjoining tissue and its paired normal mucosa in both groups of patients. Immunohistochemical studies showed heterogenous p53 staining pattern with sections showing both nuclear and cytoplasmic staining with 36.8% mild, 10.5% moderate and 52.6% intense p53 immunoreactivity. Both COX-2 and iNOS immunostaining revealed 25% negative and 75% mild to strongly positive immunoreactivity. Correlation studies demonstrated a positive relationship between p53 and COX-2 (P=0.030; r = +0.70) in surgically treated patients. The association of COX-2 and p53 with various anti-oxidant enzymes showed a significantly positive correlation between COX-2 expression and catalase activity and an inverse correlation between p53 expression and superoxide dismutase and catalase activity in the tumor tissue of patients given NAT. In addition, we observed a negative trend between p53 expression levels and GPx enzyme levels in both the adjoining and tumor tissue of patients having undergone surgery as main mode of treatment.

Vapor-phase photo-oxidation of methanol over nanosize titanium dioxide clusters dispersed in MCM-41 host material part 1: synthesis and characterization.

Nanosize clusters of titania were dispersed in mesoporous MCM-41 silica matrix with the help of the incipient wet-impregnation route, using an isopropanol solution of titanium isopropoxide as precursor. The clusters thus formed were of pure anatase phase and their size depended upon the titania loading. In the case of low (< 15 wt %) loadings, the TiO2 particles were X-ray and laser-Raman amorphous, confirming very high dispersion. These particles were mostly of < or = 2 nm size. On the other hand, larger size clusters (2-15 nm) were present in a sample with a higher loading of approximately 21 wt %. These particles of titania, irrespective of their size, exhibited an absorbance behavior similar to that of bulk TiO2. Powder X-ray diffraction, N2-adsorption and transmission electron microscopy results showed that while smaller size particles were confined mostly inside the pore system, the larger size particles occupied the external surface of the host matrix. At the same time, the structural integrity of the host was maintained even though some deformation in the pore system was noticed in the case of the sample having highest loading. The core level X-ray photoelectron spectroscopy results revealed a + 4 valence state of Ti in all the samples. A positive binding energy shift and the increase of the width of Ti 2p peaks were observed, however, with the decrease in the particle size of supported titania crystallites, indicative of a microenvironment for surface sites that is different from that of the bulk.

Vapor-phase photo-oxidation of methanol over nano-size titanium dioxide clusters dispersed in MCM-41 host material part 2: catalytic properties and surface transient species.

We report in this paper on the ultraviolet-assisted vapor-phase oxidation of methanol at room temperature, with the help of nano-size clusters of titanium dioxide dispersed in an MCM-41 silicate matrix. The surface species formed during the adsorption/oxidation of methanol and the transformation that they undergo as a result of ultraviolet irradiation were monitored using in-situ Fourier transform infrared and thermal desorption spectroscopy techniques. Parallel experiments conducted on TiO2/MCM, bulk titania, and pristine MCM-41 samples helped in identifying the individual role of titanium dioxide and host matrix in these processes. The photo-catalytic oxidation of methanol, at concentrations of 0.1 to 1.1 mol% in air, gave rise to formation of CO2 and H2O as products, for both the TiO2/MCM and bulk TiO2 samples. No such reaction occurred on titania-free MCM. Furthermore, the rate of reaction depended upon the TiO2 content of a sample and also on the concentration of methanol in reaction mixture. Thus, the rate of conversion increased progressively with the increase in TiO2 loading from 5 to 21 wt% in TiO2/MCM samples, particularly for the experiments with high concentration of methanol. For low methanol concentration (0.1 mol%) in air, the effect of titania content in MCM was very small. The specific activity (per g of titania) of a sample, on the other hand, showed an inverse relationship with the loading of titanium dioxide in a sample. Infrared and temperature-programmed desorption results revealed that the mode of CH3OH adsorption and the reactivity of the transient species formed during the oxidation process were independent of the size of dispersed titania particles. Thus, the particles of approximately 2-6 nm size, present in TiO2/MCM, exhibited a chemisorption behavior similar to that of the bulk titania. The results of the present study provide strong evidence that the hydroxyl groups, both on the host matrix and at the titania sites, participate independently in the formation of methoxyl groups and at the same time promote the heterogeneous photo-catalytic oxidation of methanol molecules via formation of transient formate groups. Our results also show that the effect of titania crystallite size in the photo-catalytic properties relate mainly to the larger surface area and hence to the enhanced number of chemisorption sites, rather than to the changes in electronic properties.

Bronchoendoscopic involvement in patients with carcinoma of middle third of esophagus in absence of respiratory symptoms.

BACKGROUND: Bronchoscopic examination has been advocated as an essential part of evaluation of patients with newly diagnosed esophageal malignancy. The present study describes the role of routine preoperative fibreoptic bronchoscopy in staging disease and assessing resectibility in patients with malignancy involving the middle third of esophagus. METHODS: Preoperative fibreoptic bronchoscopy was performed in 125 patients with carcinoma of the middle third of esophagus. None of the patients had clinical or chest radiographic evidence of extension of disease outside the esophagus. RESULTS: Abnormalities were detected in 33 patients (25.6%), the commonest being external compression over the posterior wall of trachea in 17 (13.6%). Other abnormalities noted were left vocal cord paresis in seven (5.6%); compression over one or both major bronchi in seven (5.6%) and over the left lower lobe bronchus in one (0.8%); infiltration of the left main bronchus in two (1.6%); and growth in trachea in four (3.2%), in left main bronchus in two (1.6%) and over cricoarytenoid area in one (0.8%) patient. CONCLUSIONS: Tracheobronchial involvement, even in the absence of clinical or radiological features, is not uncommon in esophageal cancer. Preoperative bronchoscopy is useful to assess the extent of disease and resectibility in these patients.

Xanthogranulomatous cholecystitis.

Twelve cases of xanthogranulomatous cholecystitis are reported. The clinical presentation was similar to chronic cholecystitis. All patients had associated gallstones. The diagnosis was achieved at histopathological examination of the resected gall bladders and none had any focus of malignancy. Cholecystectomy was curative.

Imaging features of esophageal leiomyomatosis: a case report.

Leiomyomas are the most common benign tumors of the esophagus. However, esophageal leiomyomatosis is a rare pathologic entity that has received little attention in the radiologic literature. We present a case of esophageal leiomyomatosis with imaging features on barium swallow and computed tomography (CT).

Exacerbation of ulcerative colitis by cytomegalovirus infection in an immunocompetent Indian patient.

A patient with typical features of idiopathic ulcerative colitis, in remission, developed an attack of severe colitis. Sigmoidoscopy showed submucosal black nodules in the sigmoid colon. Mucosal biopsies from the involved areas showed evidence of acute on chronic colitis with cytomegalic cells and intra-nuclear inclusions suggestive of cytomegalovirus (CMV) disease. The patient attained remission following subtotal colectomy and intravenous ganciclovir therapy for 3 weeks. The patient had another relapse five months later. The colonic biopsies during this relapse showed evidence only of idiopathic ulcerative colitis, with no CMV infection. The patient responded well to steroid therapy.

Effect of erythromycin and cisapride on emptying of the vagally denervated intrathoracic stomach.

BACKGROUND: Subsequent to esophagectomy and reconstruction among patients with esophageal cancers, the intrathoracic denervated stomach acts as a passive conduit without peristalsis. OBJECTIVE: The study was designed to assess the impact of two prokinetic drugs viz. erythromycin and cisapride on the emptying of vagally denervated intrathoracic stomach. METHODS: Twenty consecutive patients of carcinoma esophagus, who had undergone one stage transhiatal oesophagectomy with cervical esophagogastrostomy and were disease free at three months postoperative follow-up, were included in the study. These patients were randomised into two groups of ten each. The patients in group A received erythromycin, while patients in group B received cisapride. The gastric emptying was studied by scintigraphy, using a standard test meal containing 99m Tc sulphur colloid labelled 'IDLIS' [rice based radio labelled food] before and after the drug treatment. RESULTS: The pre and post treatment mean gastric half emptying time of the patients in the erythromycin group was 52.6 min and 49.7 min (p > 0.1) and in cisapride group it was 53.76 and 26.4 min respectively (p < 0.05). Intergroup comparison of the difference was not statistically significant. CONCLUSION: Cisapride is an effective prokinetic agent in the treatment of gastric stasis of the vagally denervated intrathoracic stomach.

Minimizing cervical esophageal anastomotic complications by a modified technique.

BACKGROUND: The anastomotic leak and stricture formation after esophagectomy and cervical esophagogastric anastomosis deny patients with esophageal carcinoma the benefits of surgery. The present study was designed to ascertain whether a wide cross-sectional area at the site of anastomosis leads to lesser anastomotic complications. METHODS: One hundred patients with resectable carcinoma of the esophagus were randomly distributed into two groups of 50 each. All patients underwent one-stage transhiatal esophagectomy. In group A, 3 x 2 cm gastric crescent was excised from the anterior wall of the gastric tube before constructing the cervical esophagogastric anastomosis. No such intervention was done in group B, which acted as control. All patients were followed up for at least 3 months for detection of anastomotic complications. RESULTS: The incidence of anastomotic leak in the study group was significantly less in comparison with the control group (4.3% versus 20.8%; P = 0.03). Similarly, anastomotic stricture formation was significantly lower in the study group (8.5% versus 29.2%; P = 0.02). CONCLUSIONS: A wide cross-sectional area achieved at the anastomotic site by removal of gastric crescent resulted in significantly lower anastomotic complications.

Comparison of the clinical profile and outcome for squamous cell carcinoma and adenocarcinoma of the distal esophagus and cardia in India.

This retrospective review aimed to assess the clinical profile and outcome of squamous cell carcinoma as compared with adenocarcinoma of the lower third of esophagus and cardia following a transhiatal esophagectomy. A total of 169 patients were analyzed retrospectively in this series from 1989 to 1994. There were 100 patients with squamous cell carcinoma (SCC) and 69 patients with adenocarcinoma (ADC). All tumors were assessed by an esophagogram, upper gastrointestinal endoscopy, and abdominal ultrasonography. The surgical procedure performed in all cases was a transhiatal esophagectomy (THE). The mean age of the patients with SCC and ADC was comparable (48 +/- 14 vs 54 +/- 12 years). Male/female ratio was 1.0:1.4 in the SCC group while in the ADC group it was 8.8:1.0. The main symptom in both the groups was grade II dysphagia (62% in SCC and 60% in ADC). The mean length of the tumor was 6.6 +/- 4.5 cm in the SCC group and 4.2 +/- 3.3 cm in the ADC group. The resectability rate of the SCC group was significantly higher (76%) than in the ADC group (55%). The 6-month and 1-year survival for the SCC patients was not significantly different from the ADC patients (83.7% and 49.3% vs 85.0% and 54.0%). The 5-year survival achieved in SCC was higher than in the ADC group (11.6% vs 7.2%) but the difference was not statistically significant. Adenocarcinoma arising from the distal esophagus and cardia was more common in males, and also occurred in a higher age group and had a lower resectability rate than squamous cell carcinoma. No case of Barrett's esophagus was encountered. The short- and long-term survival in both tumors were similar.

Gastrointestinal stromal tumors the assessment of malignant potential.

GISTS are the largest category of non-epithelial neoplasms of stomach and small bowel. Numerous immunohistochemical, ultrastructural and flow cytometry studies have been carried out for evaluation of prognostic factors which could predict malignant behaviour of these neoplasms. Tumor size of 5 cm and mitosis of 2/10 hpf were suggested as two important parameters which could predict the chances of recurrence and clinically aggressive course. The aim of this study is to examine predictive value of these two important parameters in assigning the tumors as high, intermediate and low risk groups. Using these two parameters we categorized 30 cases of GIST over a period of 6 years (1990-95) into low, intermediate and high risk groups and examined other features of these cases. Based on these two parameters alone we found that 4 cases each in low and intermediate group could be assigned to a higher risk group clinically as there were presence of adjacent organ infiltration, lymphatic emboli, serosal nodules, lymph node metastasis and transmural infiltration. Hence, other features like hemorrhage, necrosis and anaplasia should also be included in risk assessment. Metaplastic tissues like bone, cartilage and adipose tissues were seen only in high-risk categories.