Acute Pulmonary Embolism Following Baker’s Cyst Excision – A Life Threatening Complication: A Case Report

@#A 55-year-old women was diagnosed with Baker’s cyst and underwent open Baker’s cyst excision. She had developed acute pulmonary embolism in the post-operative period. Our case report is to emphasise the sub-clinical concomitant deep vein thrombosis with Baker’s cyst. Such a fatal complication has not been reported in literature and preventive measures of pre-operative venous Doppler and post-operative thrombo-prophylaxis can prevent them.

Stability of hydroalcoholic extracts of two species of guaco; Mikania glomerata SPRENG. and Mikania laevigata SCHULTZ. (Asteraceae), by UHPLC-MS

It is important to study the stability of plant extracts used as active ingredients in phytotherapic medicine, as degradation of the active principles directly affects the efficacy and safety of these products. Therefore, a stability study of the hydroalcoholic extract of the species: Mikania glomerata and Mikania laevigata was conducted in order to determine the speed of degradation and shelf life of these extracts, which are incorporated in cough syrup in Brazil. Leaves of both species were dried in an oven or by lyophilization (freeze-dried). Hydroalcoholic extracts underwent both accelerated stability study of six months and long-term stability study for 12 months. Samples were stored at different temperatures and every three months were analysed by ultra-high performance liquid chromatography-mass spectrometry (UHPLC-MS) to monitor their chemical profile, quantifying coumarin and chlorogenic acid. For all conditions of the study, a reduction of the content of the chemical marker of this species, coumarin, greater than 5% was observed, so a shelf life of two years cannot be assigned to the hydroalcoholic extracts of these species as observed in commercial extracts.

Calf “Arch Sign” Seen on a Tc-99m-MDP Bone Scan Is Indicative of Synovial Fluid Leak in Ruptured Baker's Cysts: Case Reports and Analysis of Literature / 대한핵의학회잡지

The authors present two cases in which the ruptured popliteal (Baker's) cysts remained undetected and were diagnosed only during an isotope investigation. The aim was to describe a specific imaging sign, the “arch sign”, that is indicative of ruptured Baker's cysts. In both cases, the whole-body imaging was performed 2 hours after injection of 706.7 MBq of Tc-99m-MDP. Single-photon emission computed tomography (SPECT) imaging was performed to localize an accumulation of the radiopharmaceutical. An analysis of literature was performed to connect these cases with previously reported data and to detect the pathognomonic radio image sign of ruptured popliteal cysts. The arch-shaped distribution of the radiopharmaceutical below the knee joints was seen already on the whole-body bone scan image in both cases. An anterior view of SPECT MIP images showed the arched accumulation of the Tc-99m-MDP bone tracer along the postero-medial aspect of the right calf secondary to synovial fluid leak from a ruptured Baker's cyst. The similar arthroscintigrams were published since 1971 without recognizing this sign as pathognomonic. Tc-99m-MDP bone scanning is sensitive for a Baker's cyst with synovial effusion, and distribution of a radiopharmaceutical in the medial posterior calf in a shape of an arch, the arch sign, may serve as an indicator of a ruptured popliteal cyst.

Evaluation of the analgesic and antipyretic properties of African Cleome viscosa

Background: Cleome viscosa Linn a plant from the family Capparaceae has been used in traditional medicine in Asia and Africa for the treatment of various diseases including diarrhea, cardiac stimulant, anthelmintic, carminative, anti-inflammatory and antiseptic. Decoction of the whole plant has been used for the treatment of inflammation and as a stimulant while the leaves have been applied externally on wounds and ulcers. The objective of this study is to investigate and evaluate the antipyretic and analgesic properties, toxicity profile and the phytochemical study of the methanolic leaf extract of African Cleome viscosa.Methods: The antipyretic study was performed by adopting the Baker’s yeast induced pyrexia in rats while the analgesic study was performed adopting the tail immersion or tail flick technique. Data generated was analyzed as appropriate using the analysis of variance (ANOVA).Results: The methanolic extract of the leaves of the African Cleome viscosa had a significant (P<0.05) antipyretic and analgesic effects at different time intervals and varying doses when compared with the negative control groups in the respective studies. The preliminary phytochemical study showed the presence of alkaloids, tannins, steroids, glycosides and flavonoids. The extract also proved to be non-toxic in the acute toxicity study carried out at the highest dose of 5000mg/kg body weight administered to the albino rats.Conclusions: The methanolic leaf extract of the plant showed significant antipyretic and analgesic activity in albino rats thus supporting its use in traditional medicine.

Steroidal components from rhizome of Smilacina henryi / 中草药

Objective To study the chemical components from the roots of Smilacina henryi. Methods Silica gel, Sephadex LH-20, and preparation of thin layer chromatography techniques were used for isolation, and 1D, 2D-NMR, IR, and HR-ESI-MS data were used for structure identification. Results Seven steroidal components were obtained and its chemical structures were elucidated as (25S)-5α-spirostan-9(11)-en-3β,17α-diol 3-O-β-D-glucopyranosyl-(1→2)-β-D-galactopyranoside (1), (25S)-5α-spirostan-9(11)-en- 3β,17α-diol (2), (25S)-5α-spirostan-9(11)-en-3β,17α-diol 3-O-β-D-glucopyranoside (3), diosgenin (4), aspidistrin (5), henryioside A (6), and henryioside B (7). Conclusion Compound 1 is a new steroidal saponin named henryioside D, and compounds 2-5 are isolated from the plant for the first time.

Association of MBL With Work-Related Respiratory Symptoms in Bakery Workers

Baker's asthma is the most prevalent occupational asthma, and IgE-mediated response is known as a major pathogenesis. However, recent studies have suggested the involvement of innate immune response because wheat flour contains bacterial endotoxins or lipopolysaccharides. To further understand a role of innate immune response in the development of work-related respiratory symptoms (WRS) in bakery workers, we investigated mannose-binding lectin (MBL), one of the initiating components of the complement cascade in a single cohort of bakery workers. A total of 373 bakery workers completed a questionnaire regarding WRS. The bakery workers were divided into 2 groups according to previous history of allergic rhinitis (AR)/bronchial asthma (BA): those with history of AR/BA (group I) and those without (group II). We measured serum MBL levels by using enzyme-linked immunosorbant assay and genotyped 4 single nucleotide polymorphisms of the MBL2 gene (226G>A in exon 1, -554G>C, -431A>C, and -225G>C in the promoter) by using TaqMan assays. Fifty-nine subjects (15.5%) were previously diagnosed with AR/BA, and 64 subjects (16.8%) complained of WRS. No significant differences were found in serum MBL levels between groups I and II. However, in group II subjects, but not in group I subjects, the serum MBL levels were significantly higher in bakery workers with WRS than in those without. In addition, the serum MBL levels were significantly different according to genetic polymorphisms of the MBL2 gene and its haplotypes. In conclusion, serum MBL, affected by genetic polymorphisms, may be associated with WRS in bakery workers with no previous history of AR/BA.

Surgical Treatment of Gouty Tophi in Bilateral Popliteal Cysts / 대한정형외과학회잡지

Gout often occurs in the first metatarsophalyngeal joint, and also in the ankle joint and posterior foot. Knee joint gouty arthritis is commonly reported, but gouty tophi in bilateral popliteal cysts, such as this case, are rare. We report on a case treated by cystectomy of gouty tophi in bilateral popliteal cysts and review.

Growth and reproductive characteristics of different grades of Tulipa edulis bulb / 中草药

Objective: To explore the growth and reproductive characteristics of different grades of Tulipa edulis bulb. Methods: T. edulis bulbs were divided into four grades based on weight, e.g. the 1st grade, m > 2.0 g; the 2nd grade, m 1.0-2.0 g; the 3rd grade, m 0.5-1.0 g, and the 4th grade, m < 0.5 g. The growth indexes, flowering and fruiting percentage, and photosynthetic characteristics were measured at vigorous growth period. And the yield, reproduction coefficient, and net yield-increasing percentage were calculated at harvest period. Results: The growth indexes increased with the increasing weight of bulbs. In comparison with the 3rd and 4th grades bulbs, the 1st and 2nd grades bulbs showed higher photosynthetic efficiency, and net yield-increasing percentage. The bulbs, weight of which were higher than 1 g, showed high flowering and fruiting percentage. Conclusion: The 1st and 2nd grades bulbs are suitable to be reproductive materials for bulbs, while the 3rd and 4th grades bulbs are more applicable as materials for producing seeds.

Bud stem tissue culture of Tulipa edulis / 中草药

Objective: To establish the tissue culture system of callus induction and cluster shoot proliferation with bud stems of Tulipa edulis. Methods: Bud stems were isolated from cooled T. edulis bulbs as explants. The calli were inducted on MS media with different concentration of 6-BA and NAA, and the cultural conditions of shoot differentiation and multiplication were optimized. Results: The optimal medium for callus induction was MS + 6-BA 0.5 mg/L + NAA 2.0 mg/L with a callus inducation rate of 78.54%. After subcultured in original medium, the callus was turned into differentiation medium. The optimal medium for callus differentiation was MS + 6-BA 2.0 mg/L + NAA 0.2 mg/L with a shoot differentiation rate of 66.21%. The optimal medium for the shoot multiplication was MS + 6-BA 0.5 mg/L + NAA 0.2 mg/L, and the proliferation coefficient was 2.48. Conclusion: The media for callus induction, adventitious bud differentiation, and cluster shoot proliferation are optimized. The optimal medium for the culture of T. edulis bud stems is preliminarily established.

Baker's Cyst Filled with Hematoma at the Lower Calf

Baker's cyst is a distension of the gastrocnemius-semimembranosus bursa of the knee, which communicates with the posterior portion of the joint capsule. Baker's cyst is commonly located in the inferomedial or superficial layers of the knee joint and rarely extends laterally or proximally. Complications of Baker's cysts are dissection, rupture, pseudothrombophlebitis, leg ischemia, nerve entrapment, and compartment syndrome. However, hematomas in the Baker's cyst have not been reported in Korea. We report a rare case of hematoma in the Baker's cyst with subfascial extension into the calf. The hematoma was demonstrated by magnetic resonance imaging and removed by mass excision.

Effect of Dichloromethane-Ethanol Extract of Morinda Morindoides (Backer) Milne-Redhead (Rubiaceae) (Etde) on Rabbit Carotid Blood Pressure.

Morinda morindoides (Backer) Milne-Redhead (Rubiaceae) is used by the people of west and central Africa for the treatment of diarrhea. The dichloromethane/ethanol extract of M. morindoides (Back) (ETDE) known to be used orally, will be in direct contact with the nobles organs. This study is conduced to see if this extract has effects on the body more precisely on blood pressure. ETDE injected intravenously (10.40 mg/kg b.w to 31.19 mg/kg b.w) provoked a decrease in the arterial blood pressure (hypotension) in a dose-dependent manner (ED50 = 7.08 mg/kg b.w). ETDE at 41.58 mg/kg b.w induce a maximum and irreversible hypotension which leads to the death of the animal. The effects induced by ETDE were inhibited in the presence of atropine at a concentration of 4.46 ×10-4 mg/kg b.w. Our observations, regarding the effects of ETDE on the high blood pressure initiated by adrenaline, showed that the hypertensive effects induced by adrenalin were totally inhibited by ETDE. ETDE induced a dose-dependent hypotension and reversible and his antihypertensive effect could militate for its use in the treatment of hypertension.

Baccharis rufescens Spreng. var. tenuifolia (DC. ) Baker: contribuição ao estudo farmacognóstico / Baccharis rufescens Spreng. var. tenuifolia (DC. ) Baker: contribution to the pharmacognostic study

Baccharis rufescens Spreng. var. tenuifolia (DC.) Baker pertence à família Asteraceae e é usada na medicina tradicional como estomáquico e hepatoprotetor. Um estudo fitoquímico mostrou a presença de flavonoides e triterpenos, sendo que os extratos clorofórmico e metanólico de folhas apresentaram-se ativos no bioensaio de toxicidade sobre Artemia salina Leach. Além disso, extratos clorofórmicos evidenciaram a presença de peróxidos, sugerindo sua aplicação no tratamento da malária (Schenkel at al., 2002; Montanher et al., 2002; Moreira et al., 2003). Considerando a importância farmacológica de B. rufescens var. tenuifolia, o presente trabalho objetivou o estudo morfoanatômico e histoquímico do caule e da folha dessa espécie, a fim de fornecer subsídios farmacognósticos para o controle de qualidade. O material botânico foi submetido às técnicas usuais empregadas na microscopia de luz e microscopia eletrônica de varredura. Folha anfiestomática, presença de estômatos anomocíticos, tricomas glandulares capitados bisseriados, tricomas tectores flageliformes simples unisseriados, dutos secretores associados ao floema, calota de fibras perivasculares e cristais de oxalato de cálcio do tipo estiloide e prismático na região medular do caule foram as principais características observadas que auxiliam na identificação do táxon.

Baccharis rufescens Spreng. var. tenuifolia (DC.) Baker belongs to the Asteraceae family. It is used for liver and stomach problems in traditional medicine. Previous phytochemical data reported flavonoid and triterpene contents. Chloroform and methanol extracts of the leaves showed activity in the bioassay of brine shrimp. Chloroform extracts showed the presence of peroxides that can be used to treat malaria (Schenkel et al., 2002; Montanher et al., 2002; Moreira et al., 2003). Considering the pharmacological importance of B. rufescens var. tenuifolia, the purpose of this paper was to perform the anatomical analysis of aerial vegetative parts of Baccharis rufescens var. tenuifolia in order to provide pharmacognostic data for quality control. The plant material was studied by the usual methods of light and scanning electron microscopy. Amphistomatic leaves, anomocytic stomata, biseriate capitate glandular trichomes, uniseriate simple flagelliform non-glandular trichomes, secretory ducts associated to the phloem, perivascular fiber cap, calcium oxalate as prismatic and styloid crystals in the pith of the stem were reported as the mainly anatomical data for B. rufescens var. tenuifolia.Ouvir Ler foneticamente.

Comparison of Specific IgE Antibodies to Wheat Component Allergens in Two Phenotypes of Wheat Allergy

Specific IgE to gliadin was proposed as a marker for wheat dependent exercise induced anaphylaxis, while Tri a 14 was found to induce IgE response in baker's asthma. We evaluated whether these components could be used for discriminating phenotypes of wheat allergy. Twenty-nine patients who were wheat-induced anaphylaxis and/or urticaria (n=21, group I) and baker's asthma (n=8, group II) were enrolled. The prevalence of serum specific IgE to Tri a 14 was higher in group II (25%) than in group I (4.8%), while the serum specific IgE to gliadin was significantly higher in group I (70%) than in group II (12.5%). The cutoff value for predicting the baker's asthma using the ratio of serum specific IgE to Tri a 14 to gliadin was 742.8 optical densityx1,000/(kU/L) with high sensitivity and specificity. These findings suggest that Tri a 14/gliadin may be a potential marker for predicting baker's asthma.

Diagnosis and Management of Grain-Induced Asthma

Grain-induced asthma is a frequent occupational allergic disease mainly caused by inhalation of cereal flour or powder. The main professions affected are bakers, confectioners, pastry factory workers, millers, farmers, and cereal handlers. This disorder is usually due to an IgE-mediated allergic response to inhalation of cereal flour proteins. The major causative allergens of grain-related asthma are proteins derived from wheat, rye and barley flour, although baking additives, such as fungal alpha-amylase are also important. This review deals with the current diagnosis and treatment of grain-induced asthma, emphasizing the role of cereal allergens as molecular tools to enhance diagnosis and management of this disorder. Asthma-like symptoms caused by endotoxin exposure among grain workers are beyond the scope of this review. Progress is being made in the characterization of grain and bakery allergens, particularly cereal-derived allergens, as well as in the standardization of allergy tests. Salt-soluble proteins (albumins plus globulins), particularly members of the alpha-amylase/trypsin inhibitor family, thioredoxins, peroxidase, lipid transfer protein and other soluble enzymes show the strongest IgE reactivities in wheat flour. In addition, prolamins (not extractable by salt solutions) have also been claimed as potential allergens. However, the large variability of IgE-binding patterns of cereal proteins among patients with grain-induced asthma, together with the great differences in the concentrations of potential allergens observed in commercial cereal extracts used for diagnosis, highlight the necessity to standardize and improve the diagnostic tools. Removal from exposure to the offending agents is the cornerstone of the management of grain-induced asthma. The availability of purified allergens should be very helpful for a more refined diagnosis, and new immunomodulatory treatments, including allergen immunotherapy and biological drugs, should aid in the management of patients with this disorder.

Diagnosis and Management of Grain-Induced Asthma

Grain-induced asthma is a frequent occupational allergic disease mainly caused by inhalation of cereal flour or powder. The main professions affected are bakers, confectioners, pastry factory workers, millers, farmers, and cereal handlers. This disorder is usually due to an IgE-mediated allergic response to inhalation of cereal flour proteins. The major causative allergens of grain-related asthma are proteins derived from wheat, rye and barley flour, although baking additives, such as fungal alpha-amylase are also important. This review deals with the current diagnosis and treatment of grain-induced asthma, emphasizing the role of cereal allergens as molecular tools to enhance diagnosis and management of this disorder. Asthma-like symptoms caused by endotoxin exposure among grain workers are beyond the scope of this review. Progress is being made in the characterization of grain and bakery allergens, particularly cereal-derived allergens, as well as in the standardization of allergy tests. Salt-soluble proteins (albumins plus globulins), particularly members of the alpha-amylase/trypsin inhibitor family, thioredoxins, peroxidase, lipid transfer protein and other soluble enzymes show the strongest IgE reactivities in wheat flour. In addition, prolamins (not extractable by salt solutions) have also been claimed as potential allergens. However, the large variability of IgE-binding patterns of cereal proteins among patients with grain-induced asthma, together with the great differences in the concentrations of potential allergens observed in commercial cereal extracts used for diagnosis, highlight the necessity to standardize and improve the diagnostic tools. Removal from exposure to the offending agents is the cornerstone of the management of grain-induced asthma. The availability of purified allergens should be very helpful for a more refined diagnosis, and new immunomodulatory treatments, including allergen immunotherapy and biological drugs, should aid in the management of patients with this disorder.

IL-4 Receptor alpha Polymorphisms May Be a Susceptible Factor for Work-Related Respiratory Symptoms in Bakery Workers

PURPOSE: The IL-4 and IL-4 receptor alpha (IL-4Ralpha) genes are the key candidate genes for atopy and asthma susceptibility. Exposure to wheat flour can cause IgE sensitization and respiratory symptoms in bakery workers. Therefore, we hypothesized that IL-4 and IL-4Ralpha single nucleotide polymorphisms (SNPs) may be involved in the pathogenic mechanism of baker's asthma. METHODS: Clinical and genetic data from 373 bakery workers were analyzed. A survey questionnaire, spirometry, and skin prick tests with wheat flour were performed. Serum-specific IgE, IgG1, and IgG4 to wheat flour were determined using ELISA. Five candidate IL-4 (-729 T>G, 589 T>C, and 33 T>C) and IL-4Ralpha (Ile75Val A>G and Gln576Arg A>G) SNPs were genotyped and analyzed. RESULTS: Workers with the G allele of IL-4Ralpha Ile75Val A>G had a significantly higher prevalence of work-related lower respiratory symptoms than those with the AA genotype (P=0.004, 16.0% vs. 2.9%). In the skin prick test, workers with the AA genotype of IL-4Ralpha Gln576Arg A>G had a significantly higher positive rate to wheat flour (P=0.015, 8.2% vs. 1.1%) than those with AG/GG genotype. No significant associations were found in the three genetic polymorphisms of IL-4. For the predicted probabilities, workers with the AA genotype of Gln576Arg A>G had a higher prevalence of IgG1 and IgG4 in response to wheat flour, according to increased exposure intensity (P=0.001 for IgG1 and P=0.003 for IgG4). CONCLUSIONS: These findings suggest that the IL-4Ralpha Ile75Val and Gln576Arg polymorphisms may be associated with work-related respiratory symptom development.

IL-4 Receptor alpha Polymorphisms May Be a Susceptible Factor for Work-Related Respiratory Symptoms in Bakery Workers

PURPOSE: The IL-4 and IL-4 receptor alpha (IL-4Ralpha) genes are the key candidate genes for atopy and asthma susceptibility. Exposure to wheat flour can cause IgE sensitization and respiratory symptoms in bakery workers. Therefore, we hypothesized that IL-4 and IL-4Ralpha single nucleotide polymorphisms (SNPs) may be involved in the pathogenic mechanism of baker's asthma. METHODS: Clinical and genetic data from 373 bakery workers were analyzed. A survey questionnaire, spirometry, and skin prick tests with wheat flour were performed. Serum-specific IgE, IgG1, and IgG4 to wheat flour were determined using ELISA. Five candidate IL-4 (-729 T>G, 589 T>C, and 33 T>C) and IL-4Ralpha (Ile75Val A>G and Gln576Arg A>G) SNPs were genotyped and analyzed. RESULTS: Workers with the G allele of IL-4Ralpha Ile75Val A>G had a significantly higher prevalence of work-related lower respiratory symptoms than those with the AA genotype (P=0.004, 16.0% vs. 2.9%). In the skin prick test, workers with the AA genotype of IL-4Ralpha Gln576Arg A>G had a significantly higher positive rate to wheat flour (P=0.015, 8.2% vs. 1.1%) than those with AG/GG genotype. No significant associations were found in the three genetic polymorphisms of IL-4. For the predicted probabilities, workers with the AA genotype of Gln576Arg A>G had a higher prevalence of IgG1 and IgG4 in response to wheat flour, according to increased exposure intensity (P=0.001 for IgG1 and P=0.003 for IgG4). CONCLUSIONS: These findings suggest that the IL-4Ralpha Ile75Val and Gln576Arg polymorphisms may be associated with work-related respiratory symptom development.

Baker's Cyst with Intramuscular Extension into Vastus Medialis Muscle

Baker's cysts are one of the most common cystic lesions around the knee joint and mainly caused by fluid distension of the gastrocnemius-semimembranous bursa that is situated along the medial side of the popliteal fossa. Typically, a Baker's cyst extends along the intermuscular planes around the knee joint and may enlarge any direction. However, it is mostly located in the inferomedial or superficial layers of the knee joint and less commonly extends laterally or proximally. Expansion of the cyst tends to respect the intermuscular planes, and Baker's cysts along the intramuscular route have been rarely reported. Thus, we report a case of Baker's cyst with intramuscular extension into the vastus medialis muscle.

Intramuscular Baker's Cyst in Plantaris: A Case Report / 대한골관절종양학회지

Baker's cyst is found as most frequent cystic mass around the knee occurring between medial head of gastrocnemius muscle and semimembranosus muscle. The proximal or posterolateral extension of the cyst had been rarely reported and the cyst into the surrounding muscular tissue extremely rare. Intramuscular Baker's cyst that we report was found between lateral head of gastrocnemius muscle and popliteus tendon, and then extended into the plantaris muscle. With review of the literature, we here report a very rare case of plantaris muscular extension of Baker's cyst.

Determination of the Factors Influencing Rupture of Baker's Cysts in the Knee on Plain Radiographs and MRI

PURPOSE: We retrospectively compared plain radiographic and MR imaging findings of acutely ruptured and unruptured Baker's cysts to determine which factors cause rupture of BCs. MATERIALS AND METHODS: The MR findings for 44 Baker's cysts (non-ruptured Baker's cysts in 30 patients and ruptured Baker's cysts in 14 patients) were evaluated. On the MR images, the characteristics of the Baker's cysts, meniscal tears, and the quantity of joint effusions were evaluated. On plain radiographs, the grade of osteoarthritis of the affected knee was evaluated. RESULTS: There was no statistically significant difference with respect to the size of Baker's cysts, meniscal tears, and the grade of osteoarthritis between ruptured and unruptured Baker's cysts. The wall thicknesses, inner signal intensities, inner septations, and the quantity of joint effusions were statistically different between the ruptured and unruptured Baker's cysts. CONCLUSION: The most significant imaging finding which influences the rupture of a Baker's cyst is the quantity of the joint effusion of the affected knee. In management of the patients with Baker's cysts, the quantity of joint effusions should be kept in mind for preventative or treatment trials involving ruptured Baker's cysts.