An uncommon case of fibrolipoma.

Lipoma is a common benign soft-tissue neoplasm derived from mature adipose tissue neoplasm, but its presence in the oral and pharyngeal region is relatively uncommon. Oral lipoma was first described by Roux in 1848 as "yellow epulis." It has an incidence rate of about 1%-4% of all benign oral lesions, with a prevalence rate of about 0.0002%. Fibrolipoma is an extremely rare subtype of lipoma which accounts for 1.6% of all facial lipomas. Specific anatomic locations of occurrence within the oral and maxillofacial region include the parotid region, buccal mucosa, lips, submandibular region, tongue, floor of mouth, and palate. Here, we present fibrolipoma, a very rare subtype of lipoma involving the left retromolar region in a 50-year-old female patient.

Budd-Chiari syndrome: outcomes of endovascular intervention-A single-center experience.

AIM: Outcomes of endovascular intervention in Budd-Chiari syndrome (BCS) have been reported with varied results. Clinical outcomes of endovascular interventions in BCS and role of various prognostic scores were critically evaluated in this study. METHODS: This study retrospectively analyzed consecutive patients of BCS who underwent endovascular intervention between January 2007 and May 2016 at our center. Technical, clinical successes and complications were documented. The role of the prognostic scores such as Child-Turcotte-Pugh (CTP), model for end-stage liver disease (MELD), Rotterdam index, and original Clichy score in predicting mortality, clinical success, and need for re-interventions were also assessed. RESULTS: A total of 88 patients were analyzed. The median follow up was 12 months (range 1-96 months). Thirteen (14.8%) patients had combined inferior vena cava (IVC) and hepatic vein (HV) obstruction; HV obstruction in 33 (37.5%) and inferior vena cava IVC obstruction in 42 (47.7%) patients. The following interventions were done: IVC angioplasty alone (n = 11), IVC angioplasty with stenting (n = 36), HV angioplasty with stenting (n = 26), combined HV and IVC stent (n = 2), and direct intrahepatic porto-systemic shunt (DIPS) (n = 13). Overall technical success was 87/88 (98.86%), and clinical success was 76/88 (86.36%). Immediate complications were noted in 8 patients (10%). The 1-, 2-, 3-, and 4-year stent patency rates were 90.91%, 81.08%, 74.59%, and 70.45%, respectively. Re-interventions were required in 15 (17%). Overall mortality was 6 (6.8%). Apart from MELD >14, none of the other prognostic score could predict mortality, clinical success, and need for re-interventions. CONCLUSION: Endovascular interventions play an important role in the management of BCS, in properly selected patients, even if prognostic score is unfavorable.

Synovial sarcoma of the buccal mucosa: a rare case report.

Synovial sarcoma (SS) is a rare malignant neoplasm that arises most commonly in joint capsules and articular tendons, but its relationship to the synovium is not always obvious. Synovial sarcoma is a malignant soft tissue tumor representing 5.6% to 10% of all soft tissue sarcomas. They are termed SS because of their histologic resemblance to the synovium, but they rarely involve a synovial structure and are thought to arise from pluripotential mesenchymal cells. The tumor usually occurs in close association with tendon sheaths, bursae, and joint capsules, primarily in the para-articular regions of the extremities, with approximately 9% occurring in the head and neck region. Synovial sarcoma has been reported rarely in the oral cavity. We report a very rare case of Synovial sarcoma of the buccal mucosa in a 24-year-old male patient.

Formulation and evaluation of insulin dry powder for inhalation.

PURPOSE: Dry powder formulation of insulin for pulmonary administration was prepared to obtain increased drug deposition in the alveolar absorptive region. The deposition was studied by investigating the dispersion and deaggregation of insulin from the carrier lactose using an Andersen cascade impactor and twin stage impinger. The subsequent absorption following the deposition was studied by in vivo method. METHODS: Insulin in solution with absorption promoters was lyophilized. The powder was incorporated with lactose of different grades and their combinations as carriers to deliver using an inhaler device. Solid-state characteristics of the carrier as well as the drug powder were assessed by particle size and distribution measurement. The flow properties such as moisture content, powder density, angle of repose, and carr's compressibility index of the powder mixture were determined. The aerosol behavior of the powder was studied by dispersion using rotahaler(c) connected to a twin-stage impinger (TSI) and an eight-stage Andersen cascade impactor (ACI) operating at different flow rates of 30-90 l/min. The in vivo performance was studied by deliverance to the respiratory tract of guinea pigs. The intratracheal bioavailability with respective to intravenous route was calculated by measuring the blood glucose reduction. RESULTS: The coarser particles of lactose in fractions of carrier containing a wide particle size distribution impacted in the preseperator of cascade impactor, and only the particle less than 10 microm size entered stage 0-stage 7. Formulation containing 1:1 mixture of Respitose ML006 (62%<50 microm) and Respitose ML003 (37.8%<50 microm) as carrier imparts well deaggregation of insulin, and higher deposition leads to 52.3% of fine particle fraction at 60 Lit/min and in vivo bioavailability of 82%. CONCLUSIONS: Insulin formulations containing 1:1 mixture of Respitose ML006 and Respitose ML003 as carrier can impart deeper deposition of drug particles and cause higher bioavailability. This suggests that carrier used in the formulation influenced the amount of insulin deposition in the alveolar region of the lung. Hence, it was concluded that the availability of insulin for systemic absorption depends on the particle size of the drug as well as the carrier lactose.

Pulmonary absorption enhancement of salmon calcitonin.

The aim of this work was to develop formulations of calcitonin for pulmonary delivery to enhance the absorption and study the comparative pharmacodynamic behavior of developed formulations in rats. Formulations with different pH, absorption promoters of different classes and combination thereof at three concentration levels were prepared and instilled intratracheally in anesthetized rats. The absorption of calcitonin was measured by its hypocalcemic effect in blood collected at specific time points. The formulations having least concentration of absorption promoter with significant blood calcium reduction were selected out from three concentration levels of absorption promoters used. The relative pulmonary bioactivity of calcitonin in acetate buffer pH 6.0 and pH 3.9 was 21.0+/-1.5% and 53.9+/-2.8%, respectively, compared to subcutaneously administered calcitonin in equivalent dose. When sodium tauroglycocholate, dimethyl beta-cyclodextrin, chymostatin, and bacitracin were co-administered in acetate buffer pH 3.9 solution, the relative bioactivity of 139.1+/-7.3% was obtained. Only 72.0+/-2.7%, 79.2+/-3.9%, 83.0+/-2.1% and 87.0+/-3.9% were obtained, respectively, upon incorporation of these absorption promoters individually. It was concluded that absorption promoters in combination significantly increase the pulmonary bioactivity of calcitonin. These studies proves that calcitonin administered through the pulmonary route can yield higher systemic absorption for enhanced bioactivity.