Median arcuate ligament syndrome: A case report of a rare disease.

INTRODUCTION: Median arcuate ligament syndrome (MALS) is a rare condition caused by the compression of the celiac trunk by the median arcuate ligament, which may trigger a typical symptom triad: postprandial abdominal pain, weight loss, nausea and vomiting. CLINICAL CASE: A 58-year-old male was admitted to the emergency department due to abdominal pain, vomiting, fever and diarrhea. On admission, the patient was tachycardic, had abdominal distension, no peritoneal irritation signs, and a serum lactate level of 5 mmol/L. The computed tomography (CT) scan showed gastric and intestinal pneumatosis associated with pneumoportia. Conservative treatment with intravenous fluids, antibiotics and low molecular weight heparin, was initiated. The reassessment CT scan showed resolution of the gastric and intestinal pneumatosis and a severe stenosis of the initial portion of the celiac trunk with associated angulation. After recovery from the acute episode, an abdominal duplex ultrasound and an aortoiliac arteriography in forced inspiration and expiration was performed, corroborating the diagnosis of MALS. A laparoscopic decompression of the celiac trunk was performed. DISCUSSION: Symptoms of MALS closely mimic other abdominal disorders, and it should be considered in the differential diagnosis. Currently, there are no international guidelines on MALS diagnostic criteria. Treatment is focused on decompression of the median arcuate ligament constriction of the celiac artery, with or without celiac lymph node removal. CONCLUSION: MALS diagnostic and therapeutic approach must be patient focused. Laparoscopic decompression is an effective treatment and can provide immediate symptomatic relief, associated with the benefits of the less invasive nature of the procedure.

Spontaneous hemoperitoneum as a rare presentation of gastric lesions: Two case reports.

INTRODUCTION: Spontaneous hemoperitoneum is a rare but life-threatening condition. Clinical presentation is usually nonspecific. The aim of this report is to document a rare clinical presentation of two different intramural stomach tumors. CLINICAL CASES: A 40-year-old patient with 24 h epigastric pain was admitted to the emergency, pale, with signs of peritoneal irritation. Computed tomography showed an hemoperitoneum with active bleeding in the posterior wall of the stomach. A wedge resection was performed. Histological report revealed a plexiform fibromyxoma (PF). The second case presents a 79-year-old patient with 24 h abdominal pain, fullness and dizziness, pale and with signs of peritoneal irritation. A voluminous exophytic lesion on gastric wall with active bleeding was diagnosed. Wedge resection was performed and histological report demonstrated a gastrointestinal stromal tumor (GIST). DISCUSSION: Imaging plays a role in the diagnosis of spontaneous hemoperitoneum, in elucidating a cause and detecting active hemorrhage. Tumor hemorrhage may be the first presentation of an underlying mass. The presence of a bleeding gastric mass of uncertain nature may result in a challenging situation for the surgeon, who is forced to perform a gastric resection without knowing the exact nature of the tumor and hence the extent of gastric resection required. To our knowledge, our case is the first of PF presenting as hemoperitoneum. Hemoperitoneum is rare as first presentation of GIST, with few cases reported in literature. CONCLUSION: We report two extremely rare cases of spontaneous hemoperitoneum as first presentation of gastric tumor. For the diagnosis a high level of suspicion is required.

Isolating an active and inactive CACTA transposon from lettuce color mutants and characterizing their family.

Dietary flavonoids play an important role in human nutrition and health. Flavonoid biosynthesis genes have recently been identified in lettuce (Lactuca sativa); however, few mutants have been characterized. We now report the causative mutations in Green Super Lettuce (GSL), a natural light green mutant derived from red cultivar NAR; and GSL-Dark Green (GSL-DG), an olive-green natural derivative of GSL. GSL harbors CACTA 1 (LsC1), a 3.9-kb active nonautonomous CACTA superfamily transposon inserted in the 5' untranslated region of anthocyanidin synthase (ANS), a gene coding for a key enzyme in anthocyanin biosynthesis. Both terminal inverted repeats (TIRs) of this transposon were intact, enabling somatic excision of the mobile element, which led to the restoration of ANS expression and the accumulation of red anthocyanins in sectors on otherwise green leaves. GSL-DG harbors CACTA 2 (LsC2), a 1.1-kb truncated copy of LsC1 that lacks one of the TIRs, rendering the transposon inactive. RNA-sequencing and reverse transcription quantitative PCR of NAR, GSL, and GSL-DG indicated the relative expression level of ANS was strongly influenced by the transposon insertions. Analysis of flavonoid content indicated leaf cyanidin levels correlated positively with ANS expression. Bioinformatic analysis of the cv Salinas lettuce reference genome led to the discovery and characterization of an LsC1 transposon family with a putative transposon copy number greater than 1,700. Homologs of tnpA and tnpD, the genes encoding two proteins necessary for activation of transposition of CACTA elements, were also identified in the lettuce genome.

Epithelioid Hemangioendothelioma Of The Internal Jugular Vein.

Ephitelioid Hemangioendothelioma (EHE) is a rare type of tumor with vascular and sarcomatous components. There's only another case published of an internal jugular vein (IJV) EHE. A case of a 50 years-old woman with a palpable and pulsatile mass on the left cervical area is reported. Doppler ultrasound and magnetic resonance imaging showed an IVJ' 4 cm mass. Cytology was inconclusive. Surgical treatment was therefore decided and during surgery a mass inside the left IJV, with local nonsuspicious lymph nodes, was confirmed. The mass was resected including a segmental resection of the IJV and one affected tributary vessel. Lymphadenectomy of the adjacent cervical levels was performed. Histologic examination depicted an EHE without metastatic lymph nodes. Tumor was staged as pT1bN0M0 and a multidisciplinary sarcoma group proposed surveillance. Patient remained well, without evidence of disease and without complications in a twenty-four months follow-up period.

Genetic and Phytochemical Characterization of Lettuce Flavonoid Biosynthesis Mutants.

We previously developed red lettuce (Lactuca sativa L.) cultivars with high flavonoid and phenolic acid content and demonstrated their anti-diabetic effect. Here we report on developing three fertile and true-breeding lettuce lines enriched with flavonoids with reported beneficial health effects. These lines were identified in a segregating population of EMS-mutagenized red lettuce and characterized biochemically and genetically. Change in red coloration was used as a visual indicator of a mutation in a flavonoid pathway gene, leading to accumulation of flavonoid precursors of red anthocyanins. Pink-green kaempferol overproducing kfoA and kfoB mutants accumulated kaempferol to 0.6-1% of their dry weight, higher than in any vegetable reported. The yellow-green naringenin chalcone overproducing mutant (nco) accumulated naringenin chalcone, not previously reported in lettuce, to 1% dry weight, a level only observed in tomato peel. Kfo plants carried a mutation in the FLAVONOID-3' HYDROXYLASE (F3'H) gene, nco in CHALCONE ISOMERASE (CHI). This work demonstrates how non-GMO approaches can transform a common crop plant into a functional food with possible health benefits.

Incidental diagnosis of breast cancer in the pursuit of the treatment of intestinal obstruction.

Intestinal lipomatosis is rare and often asymptomatic but can present with intestinal obstruction. Occasionally, metastatic breast cancer is identified in the ovary before a breast primary is discovered. We report the case of a 50-year-old woman diagnosed with synchronous intestinal obstruction due to lipomatosis, and incidental ovarian metastases from breast cancer. The patient presented with a 12-day history of nausea, diffuse abdominal pain, and constipation. An abdominal x-ray showed air-fluid levels, and computed tomography documented small bowel distention. An explorative laparotomy was performed, which revealed small bowel distention, an obstructive lesion of the ileocecal valve, three terminal ileum lesions, ascites, and heterogeneous ovaries. Right ileocolic resection and left oophorectomy were performed. The pathological diagnosis revealed lipomatous submucosal lesion of the ileocecal valve and ileum, and 17 lymph nodes, which were all negative for malignant cells. The oophorectomy revealed ovarian metastasis from breast carcinoma. Ascitic fluid was positive for malignant cells. Mammography and breast/axillary ultrasonography showed a solid nodule of the left breast, ductal carcinoma, and multiple enlarged left axillary lymph nodes, which were positive for neoplastic cells. Immunohistochemical evaluation showed hormonal receptor positivity and C-erb2 negativity. Breast magnetic resonance imaging showed a 14 mm left nodule and a positron emission tomography scan revealed 18F-FDG uptake in the left breast, left axillary lymph nodes, right ovary, and peritoneum. The tumor was staged as stage IV ductal breast carcinoma, cT1N1M1, Grade 2, Luminal B-like. The multidisciplinary oncological meeting proposed chemotherapy, and a re-staging breast MRI after chemotherapy, which showed a complete response. The patient started treatment with letrozole and remains disease-free 22 months after finishing chemotherapy.

Incidental diagnosis of breast cancer in the pursuit of the treatment of intestinal obstruction

Intestinal lipomatosis is rare and often asymptomatic but can present with intestinal obstruction. Occasionally, metastatic breast cancer is identified in the ovary before a breast primary is discovered. We report the case of a 50-year-old woman diagnosed with synchronous intestinal obstruction due to lipomatosis, and incidental ovarian metastases from breast cancer. The patient presented with a 12-day history of nausea, diffuse abdominal pain, and constipation. An abdominal x-ray showed air-fluid levels, and computed tomography documented small bowel distention. An explorative laparotomy was performed, which revealed small bowel distention, an obstructive lesion of the ileocecal valve, three terminal ileum lesions, ascites, and heterogeneous ovaries. Right ileocolic resection and left oophorectomy were performed. The pathological diagnosis revealed lipomatous submucosal lesion of the ileocecal valve and ileum, and 17 lymph nodes, which were all negative for malignant cells. The oophorectomy revealed ovarian metastasis from breast carcinoma. Ascitic fluid was positive for malignant cells. Mammography and breast/axillary ultrasonography showed a solid nodule of the left breast, ductal carcinoma, and multiple enlarged left axillary lymph nodes, which were positive for neoplastic cells. Immunohistochemical evaluation showed hormonal receptor positivity and C-erb2 negativity. Breast magnetic resonance imaging showed a 14 mm left nodule and a positron emission tomography scan revealed 18F-FDG uptake in the left breast, left axillary lymph nodes, right ovary, and peritoneum. The tumor was staged as stage IV ductal breast carcinoma, cT1N1M1, Grade 2, Luminal B-like. The multidisciplinary oncological meeting proposed chemotherapy, and a re-staging breast MRI after chemotherapy, which showed a complete response. The patient started treatment with letrozole and remains disease-free 22 months after finishing chemotherapy.

Potencial terapéutico de plantas utilizadas en herboristería por el Gallego Otero / Therapeutic potential of plants used in herbal medicine by Gallego Otero

Introducción: la estrecha relación entre los grupos humanos y las plantas ha permitido la aparición y el desarrollo de la herboristería tradicional. En Cuba, la vasta experiencia del científico popular Enrique Otero, conocido popularmente como "Gallego Otero" en el uso de herboristería medicinal para la sanación de la población ha tenido un alcance nacional e internacional, por lo que resulta muy necesario evaluar técnicamente algunas propiedades de las especies más comunes utilizadas en sus prácticas habituales. Objetivo: investigar el potencial antioxidante y antifúngico de especies de plantas recomendadas como medicinales, a partir de los saberes populares del Gallego Otero. Métodos: se aplicaron los procedimientos establecidos para la elaboración de los extractos vegetales y los análisis antioxidantes y antifúngicos. Los resultados de cada ensayo fueron puntuados cualitativamente de 0 a 3, indicando "0" la ausencia de actividad visible en comparación con el control negativo y representando "3" el nivel de actividad más alto. Finalmente se compararon los resultados obtenidos para cada parte de la planta analizada. Resultados: el 51% de las especies analizadas demostró actividad antifúngica y el 100% antioxidante. A nivel de hojas y tallos, un 88 y 98% respectivamente revelaron respuesta antioxidante, mientras el 47 y 37% demostraron efecto antifúngico. Conclusiones: los "Ensayos en la naturaleza", utilizados para detectar actividades bioquímicas de interés en plantas identificaron actividad antioxidante y antifúngica en hojas y tallos de 51 especies entre las plantas seleccionadas en el "Complejo Integral de Investigación y Desarrollo de plantas medicinales "Gallego Otero".

Introduction: from the very origins of humankind, the close relationship between humans and plants led to the emergence and development of traditional herbal medicine. In Cuba, Enrique Otero, the botanical healer commonly known as "Gallego Otero", has become renowned domestically and internationally for his vast knowledge and experience in herbal medicine. For this reason, there is a pressing need for the technical evaluation of the properties of the species deployed most often as part of his treatments. Objective: to investigate the antioxidant and antifungal potential of plant species recommended for medicinal treatment by Gallego Otero. Methods: established procedures were applied for the preparation of plant extracts and for the antioxidant and antifungal assays. The results of each test were qualitatively scored from 0 to 3, with "0" indicating the absence of visible activity compared to the negative control, and "3" denoting the highest level of activity. Finally, the results were compared for all different plant parts tested. Results: 51% of the species tested displayed antifungal activity, while 100% resulted in antioxidant activity. At the leaf and stem level, 88% and 98% respectively showed antioxidant activity, whereas 47% and 37% indicated antifungal activity. Conclusions: "Screens-to-Nature" technology, used for the primary detection of biochemical activities of interest in traditional herbal medicine plants, identified antioxidant and antifungal activity in leaves and stems of 51 plant species out of all the plants selected for testing at the "Gallego Otero" Medicinal Plant Research and Development Center.

A rapid and efficient in vitro regeneration system for lettuce (Lactuca sativa L.).

BACKGROUND: Successful biotechnological improvement of crop plants requires a reliable and efficient in vitro regeneration system. Lettuce (Lactuca sativa L.), one the most important vegetable crops worldwide, is strongly genotype-dependent in terms of regeneration capacity, limiting the potential for biotechnological improvement of cultivars which show recalcitrance under currently available protocols. The effect of different nutrient sources, plant hormone combinations and activated charcoal supplementation on shoot induction efficiency was evaluated on the cultivar 'RSL NFR', which had previously shown poor regeneration efficiency. RESULTS: Multiple shoot organogenesis from cotyledon explants was recorded at the highest frequency and speed on Murashige and Skoog regeneration medium supplemented with 200 mg/l of activated charcoal, 3% sucrose, 10 mg/l benzylaminopurine and 0.5 mg/l naphthaleneacetic acid, which induced shoots through direct regeneration in 90.8 ± 7.9% of explants. High shoot induction efficiency was also observed, albeit not quantified, when using this medium on some other cultivars. CONCLUSIONS: This activated charcoal-containing regeneration medium might offer a rapid and efficient option for direct shoot induction in some lettuce genotypes that do not respond well to common lettuce regeneration protocols. This is also the first report of the effect of activated charcoal in lettuce tissue culture.

High phenolics Rutgers Scarlet Lettuce improves glucose metabolism in high fat diet-induced obese mice.

SCOPE: The ability of high phenolic Rutgers Scarlet Lettuce (RSL) to attenuate metabolic syndrome and gut dysbiosis was studied in very high fat diet (VHFD)-fed mice. Phenolic absorption was assessed in vivo and in a gastrointestinal tract model. METHODS AND RESULTS: Mice were fed VHFD, VHFD supplemented with RSL (RSL-VHFD) or store-purchased green lettuce (GL-VHFD), or low-fat diet (LFD) for 13 weeks. Compared to VHFD or GL-VHFD-fed groups, RSL-VHFD group showed significantly improved oral glucose tolerance (p<0.05). Comparison of VHFD, RSL-VHFD, and GL-VHFD groups revealed no significant differences with respect to insulin tolerance, hepatic lipids, body weight gain, fat mass, plasma glucose, triglycerides, free fatty acid, and lipopolysaccharide levels, as well as relative abundances of major bacterial phyla from 16S rDNA amplicon data sequences (from fecal and cecal samples). However, RSL and GL-supplementation increased abundance of several taxa involved in plant polysaccharide degradation/fermentation. RSL phenolics chlorogenic acid, quercetin-3-glucoside, and quercetin-malonyl-glucoside were bioaccessible in the TIM-1 digestion model, but had relatively low recovery. CONCLUSIONS: RSL phenolics contributed to attenuation of post-prandial hyperglycemia. Changes in gut microbiota were likely due to microbiota accessible carbohydrates in RSL and GL rather than RSL phenolics, which may be metabolized, absorbed, or degraded before reaching the colon.