An unusual case of paravaginal sebaceous cyst posing diagnostic dilemma

The prevalence of vaginal cysts is uncertain since many go unreported but it is estimated that 1 out of 200 women have a vaginal cyst. We report a case of a 23-year-old female with secondary infertility with an incidental asymptomatic vaginal cyst, which was originally misdiagnosed as an endometriotic cyst. We performed the surgical treatment with negative hysterolaparoscopic findings, only to identify a paravaginal sebaceous cyst on vaginal exploration. Pathology results confirmed that the cyst wall was lined by stratified squamous keratinizing epithelium with a lumen containing lamellated keratin. The features were suggestive of epithelial inclusion cyst.

Role of Therapeutic endoscopy vs surgery in the management of traumatic pancreatic injury – A tertiary referral center experience

Background: Pancreatic injury remains a complicated condition requiring an individualized case by case approach to management. In this study, we aim to analyze the varied presentations and treatment outcomes of traumatic pancreatic injury in a tertiary care center. Materials and methods: All consecutive patients hospitalized at our center with traumatic pancreatic injury between 2013 and 2017 were included. The American Association for Surgery of Trauma (AAST) classification was used to stratify patients into five grades of severity. Outcome parameters were then analyzed based on the treatment modality employed. Results: Of the 35 patients analyzed, 26 had an underlying blunt trauma with the remaining 9 presenting due to penetrating injury. Overall in-hospital mortality was 28%. 19 of these patients underwent exploratory laparotomy with the remaining 16 managed non-operatively. 9 patients had severe injury (>grade 3) – of which 4 underwent endotherapy, 3 had stents placed and one underwent an endoscopic pseudocyst drainage. Among those managed non-operatively, 3 underwent a radiological drainage procedure. Conclusion: Mortality rates were clearly higher in patients managed operatively. This is likely a result of significantly higher degrees of major associated non-pancreatic injuries and not just a reflection of surgical morbidity. Despite this, surgical management remains the mainstay of therapy, especially in higher grades of pancreatic injury. However we would like to emphasize that endoscopic intervention definitely remains the preferred treatment modality when the clinical setting permits. This is especially applicable in cases of main pancreatic duct injury with ascites as well as pseudocysts.

Relationship between end-tidal carbon dioxide tension obtained from the distal ends of the tracheal tube and arterial pressure of carbon dioxide with the side stream capnometerin infants with congenital heart disease / 临床麻醉学杂志

Objective To determine the relationship between end-tidal carbon dioxide tension (PET CO 2 )obtained from the distal ends of the tracheal tube and arterial pressure of carbon dioxide (PaCO 2 ) compared with the sidestream capnometer in infants with congenital heart disease. Methods Twenty infants undergoing congenital heart disease surgery,12 males and 8 females,aged 3-48 months,ASA physical statusⅠ-Ⅲ were enrolled.Measurements of PET CO 2 were obtained from the distal ends of the tracheal tube using a sterile 22 G catheter that was inserted into the tube and from the proximal end with a sidestream capnometer in 20 intubated infants with congenital heart dis-ease.The data including PET CO 2 and the arterial PaCO 2 were obtained both after the anesthesia induc-tion and the CPB.Results The data of PET CO 2 obtained from the distal ends of the tracheal tube after the anesthesia induction [(36.8 ±2.7)mm Hg vs.(32.5 ± 1.4)mm Hg,P <0.05 ]and the CPB [(40.8±2.5)mm Hg vs.(36.5±1.6)mm Hg,P <0.05]were both higher than those from the proximal end with a sidestream capnometer.The difference between PaCO 2 and PET CO 2 obtained from the distal ends of the tracheal tube after the induction [(7.1 ±0.7)mm Hg vs.(1 1.4 ± 1.5 ) mm Hg,P <0.01]and the CPB [(9.3±1.2)mm Hg vs.(13.5±2.3)mm Hg,P <0.01]were sig-nificantly lower than that between PaCO 2 and PET CO 2 obtained from the proximal end.Distal side-stream PET CO 2 correlated with the PaCO 2 (R 2 =0.94 after induction and R 2 =0.93 after the CPB,P<0.05).However,the proximal PET CO 2 with the sidestream capnometer correlated very poorly with PaCO 2 whether after the induction (R 2 = 0.68,P < 0.05 )nor the CPB (R 2 = 0.66,P < 0.05 ). Conclusion We conclude that the PET CO 2 obtained from the distal ends of the tracheal tube provides accurate estimates of the PaCO 2 in critically ill infants with congenital heart disease.

Is It Prudent to Screen the Thyroid before Initiating Treatment for Acromegaly?.

Aim: To present a case of acromegaly with coexisting thyrotoxicosis and to emphasize the relevance of screening the screening the thyroid before initiating treatment for thyrotoxicosis. Presentation of the Case: A 55-year-old lady presented with palpitations, and weight loss of two months’ duration. She also noted her fingers and toes had swollen up, inability to incise properly since two years. Upon examination, she had morphological features clinically diagnostic of acromegaly. Her thyroid was enlarged was on investigation found to have biochemical evidence of thyrotoxicosis. Fine needle aspiration cytology of the thyroid yielded colloid goiter. Insulin like growth factor-1 was elevated. Serum growth hormone after an oral glucose tolerance test was elevated. Magnetic resonant imaging (MRI) of the brain revealed a hypo enhancing focal lesion of size 11X10X12 mm at the pituitary region with delayed contrast enhancement suggestive of pituitary adenoma. Patient was started on anti-thyroid medications and referred to higher centre, and is awaiting surgery for pituitary adenoma. Discussion: Among patients with acromegaly the incidence of thyroid diseases is around 78% and it has the most common presentation being nodular thyroid disease as the initial presentation. It is uncommon to see patients presenting with symptoms of thyrotoxicosis initially, who had florid morphological features of acromegaly. The prevalence of toxic nodular goiter to the tune of 14.3% in acromegaly. Goiters seen in acromegaly were euthyroid or autonomous, are due to the elevated growth hormone levels independent of TSH action. In about 13 to 17%, thyroidectomies were performed before acromegaly was diagnosed. When patients with acromegaly presents with a weight loss should arouse the possibilities of thyroid cancer or hyperthyroidism. Conclusion: Screening the thyroid is important, as inadvertent thyroidectomies were performed before acromegaly was diagnosed. When acromegaly co-exists with thyroid dysfunction, the burden of cardiovascular abnormality should be addressed especially, to reduce the morbidity and mortality rate.

Terminações nervosas e suprimento vascular em tendão semitendíneo de crianças com paralisia cerebral / Nerve endings and vascular supply in semitendinosus tendon of cerebral palsy children

Objetivo: Avaliar a distribuição de substância P (SP) e imunorreatividadedo peptídeo S-100, bem como o suprimento vascular de tecidoscomumente usados como enxertos na reconstrução do ligamentocruzado anterior (LCA). Um segundo objetivo foi comparar a distribuiçãoacima mencionada nos tendões do músculo semitendíneo depacientes com paralisia cerebral (PC) com os tendões do músculosemitendíneo e tendões patelares de pacientes sem PC. Métodos:O primeiro grupo era composto por 14 crianças com paralisia cerebral,com média de idade de 11,7 anos. No momento da operaçãode alongamento dos isquiotibiais, uma amostra de músculo semitendíneofoi retirada para análise. O segundo grupo era composto por20 pacientes tratados por ruptura isolada do LCA do joelho (idademédia de 32 anos). O grupo três era composto por dez pacientescom idade média de 14,3 anos tratado de recorrente luxação dapatela lateral, e de quem foi obtida uma amostra de tendão patelar.Resultado: Não houve diferenças estatisticamente significativas noque diz respeito à quantidade de fibras nervosas imunopositivas queexpressam SP ou S-100 em todos os três grupos de pacientes. Umadiferença significativa foi observada no número de vasos sanguíneosentre músculos semitendíneo do adulto e da criança, mas não entreo músculo semitendíneo e o tendão patelar das crianças. Conclusão:O número de nociceptores, bem como de fibras proprioceptivas, ésemelhante em pacientes com PC e pacientes de uma populaçãoneurologicamente saudável. Nível de Evidência IV, Série de Casos.

Objective: To evaluate the distribution of SP (substance P) andS-100 peptide immunoreactivity, as well as the vascular supplyof tissues commonly used as grafts for anterior cruciate ligament(ACL) reconstruction. A second aim was to compare the abovementioned distribution in the semitendinosus muscle tendonsof cerebral palsy (CP) patients with the semitendinosus muscletendons and patellar tendons of patients without CP. Methods:The first group consisted of 14 children with cerebral palsy witha mean age of 11.7 years old. At the time of hamstring lengtheningoperation, a sample of semitendinosus muscle was takenfor analysis. The second group comprised 20 patients treated forisolated ACL rupture of the knee (mean age 32 years old). Groupthree comprised ten patients in the mean age of 14.3 years oldtreated for recurrent lateral patellar dislocation, and from whoma sample of patellar tendon was obtained. Results: No statisticallysignificant differences were demonstrated with regard to theamount of immunopositive nerve fibers expressing SP or S-100 inall 3 groups of patients. A significant difference was noted in thenumber of blood vessels between the adult and child semitendinosusmuscles, but not between the semitendinosus musclesand patellar tendon of children. Conclusion: The number of nociceptorsas well as proprioceptive fibers is similar in patients withCP and patients from a neurologically healthy population. Levelof Evidence IV, Cases Series.

Antibiotic sensitivity pattern from pregnant women with urinary tract infection in Bangalore, India

Objective: To determine the antibacterial profile of pregnant women with urinaty tract infections and analyze the antibiotic sensitivity pattern for the effective treatment. Methods: A total of 395 urine samples from pregnant women with different gestational age were processed for the isolation of uropathogens and tested against eight groups of antibiotics namely penicillins, cephalosporins, fluoroquinolones, aminoglycosides, macrolides, lincosamides, glycopeptides and sulfonamides. Results: A positive culture percentage of 46.6% was obtained with the highest urinary tract infection in third trimester gestational age. Among the uropathogens isolated, 85.6% were Gram negative and 14.4% were Gram positive with Escherichia coli as the predominant bacteria (43.9%) followed by Klebsiella oxytoca (19.4%) and Klebsiella pneumoniae (13.3%). Antibiotic sensitivity assay revealed that amikacin had the highest overall sensitivity (n=136; 76.7%) and the subsequent highest sensitivity was observed with ciprofloxacin (n=132; 73.3%), clindamycin (n=124; 68.9%), cefotaxime (n=117; 65%) and nalidixic acid (n=115; 63.9%). Conclusions: The findings revealed that uropathogens were more resistant to penicillins, macrolides and glycopeptides which restrict their use in treating urinaty tract infections during pregnancy. In conclusion, common causative bacteria and their antibiotic sensitivity pattern are to be determined along with their safety to mother and fetus for the effective treatment of urinary tract infections during pregnancy.

In vitro antibacterial activities of Broccoli (Brassica oleracea L.var italica) against food borne bacteria.

Foodborne diseases remain substantial and safety of food is an important health, social and economical issue. Food borne illnesses caused by microbial contamination raises concerns to find alternate sources which are safe to human and environmental health. This study was investigated to determine the antibacterial activity of broccoli (Brassica oleracea L. var. italica). Various solvent extracts of broccoli were prepared and analyzed for their phytoconstituents. A total of six food borne bacteria viz., Bacillus cereus ATCC 10876, Bacillus subtilis ATCC 6633, Staphylococcus aureus ATCC 6538, Escherichia coli ATCC 8739, Salmonella typhimurium MTCC 3224 and Shigella flexneri ATCC 12022 were tested against the broccoli extracts. Minimum inhibitory concentration (MIC) values of 10 - 320 μg ml-1 were recorded against most of the pathogens with acetone and methanol as the potential extracts. B. subtilis ATCC 6633 (15.4 mm) and Bacillus cereus ATCC 10876 (16.3 mm) were found to be the most sensitive organisms among the pathogens tested.

Effect of ulinastatin on renal function during perioperative period in infants undergoing open heart surgery under CPB / 中华麻醉学杂志

Objective To investigate the effect of ulinastatin on the renal function during perioperative period in infants undergoing open heart surgery under CPB.Methods Forty ASA Ⅱ infants (25 male, 15 female)aged 3-5 months weighing 5.3-6.8 kg undergoing open heart surgery under CPB were randomly divided into 2 groups (n = 20 each): control group (group C) and ulinastatin group (group U). Ulinastatin 20 000 U/kg in normal saline 20 ml was infused iv in 3 parts (1/3 was infused via CVP line when the catheter was successfully placed in the internal jugular vein; 1/3 at the beginning of CPB and 1/3 at aortic unclamping). Blood and urine samples were collected at 30 min before incision ( T1 ), 5 min before aortic clamping (T2 ), 5 min after aortic unclamping (T3 ), at the end of operation (T4) and 24 and 48 h after operation (T5, T6 ) for determination of serum urea nitrogen (BUN) and creatinine (Cr) and urinary N-acetyl-β-D-glucosaminidase (NAG) and β2-microglubin (β2-MG) levels. Results There was no significant difference in serum BUN and Cr concentrations between the two groups. The urinary β2-MG concentration and NAG activity were significantly increased at T2-6 as compared with baseline values at T1 in both groups. The urinary β2-MG concentration and NAG activity were significantly lower in group U than in group C at T3-5 . Conclusion Ulinastatin can protect the renal function during perioperative period in infants undergoing open heart surgery under CPB.

Brucella isolated from bone marrow.

A 40 year patient presented with pyrexia of one month duration. Routine work up for fever of unknown origin (FUO) was negative. Bone marrow aspiration and culture done yielded Brucella. Bone marrow cultures are recommended for patients for FUO for whom the routine workup turns out to be negative. Serological tests for brucellosis can be false-negative in some cases of brucellosis due to prozone phenomena.

Cilazapril and Enalapril Treatment of 2 Type Diabete Mellitus Complicated with Hypertension / 中华高血压杂志

Objective To investigate the effect of cilazapril on treatment of hypertension,the microalbumin excretion,and carbohydrate netabolism in 2 type diabete mellitus complicated with hypertension. This compared with enalapril. Methods Eighty persons were divided into cilazapril group and enalapril group randomly. The treatment course is eight weeks.Results Cilazapril had more decreased in BP,urine moicroalbumin exerection,and blood creatinine than enalapril group,the side effect is more lower than enalapril group also. Conclusion Cilazapril had good effect in decreased BP,and protected the renal function in 2 type diabete mellitus.