Salvageability of kidney in Grade IV renal trauma by minimally invasive treatment methods.

CONTEXT: Renal trauma is increasingly being managed conservatively. Grade I-III injuries are managed conservatively whereas Grade V injuries may end in surgery. Managing Grade IV renal trauma is individualized and managed accordingly. AIMS: To evaluate retrospectively all Grade IV renal injuries managed in our institute over five years and to review the available literature. SETTINGS AND DESIGN: Reviewing the records of patients who sustained renal trauma and study all Grade IV renal injuries. MATERIALS AND METHODS: We retrospectively analyzed all Grade IV renal injuries (16) managed at our institute between July 2008-August 2013. All patients were treated conservatively initially by hemodynamic stabilization, strict bed rest, if required endoscopic procedures. These patients were followed up with CECT. STATISTICAL ANALYSIS: Descriptive statistics was performed using Microsoft excel spreadsheet 2007. Continuous data were described as mean and range. Categorical data was described as percentages. RESULTS: Sixteen patients with Grade IV renal injury were included in the study. All patients had gross hematuria and 15 had urinary extravasation. D-J Stenting was done in 7 patients; perinephric tube drainage with D-J stentingwas done in 2 patients. One required selective upper pole arterial embolisation. Nephrectomy was not required in any of the patients. In the follow-up period, no patient had delayed complications. CONCLUSIONS: Successful conservative management of Grade IV renal trauma requires constant monitoring both clinically and radiologically, and if properly managed, kidneys can be salvaged in all stable patients as reinforced by our study.

Herpes Zoster with disseminated lesions. What is it?

Herpes Zoster (HZ) is a Cutaneous Viral infection caused by Varicella zoster virus (VZV). Lesions of HZ are usually limited to one dermatome only but sometimes, there can be dissemination of lesions. The present case describes the role of proper examination of HZ case, which presents with disseminated lesions.

Metastatic breast carcinoma presenting as a sigmoid stricture: report of a case and review of the literature.

Metastatic spread of breast carcinoma to the colon and rectum is rare. We report the case of a patient treated for lobular breast carcinoma presenting 17 years later with metastatic breast cancer of the colon. A 63-year-old lady with a past history of right-sided invasive lobular carcinoma of the breast presented with persistent diarrhoea. Colonoscopy with biopsies revealed a benign-looking stricture at the rectosigmoid junction. A CT scan of the abdomen and pelvis revealed a benign-looking stricture in keeping with a probable diverticular stricture. A Hartmann procedure was performed and histology revealed a metastatic lobular carcinoma with oestrogen and progesterone receptor-positive status. Treatment was commenced with letrozole and the patient remains well under clinical surveillance. In a patient with a history of breast carcinoma who presents with gastrointestinal symptoms the possibility of gastrointestinal tract spread should always be considered. Endoscopic diagnosis may be misleading with pathological diagnosis only being made following surgical resection. A history of breast carcinoma must be declared to the histopathologist following surgical resection so that an accurate diagnosis is made and appropriate treatment is commenced.

Facile one-pot synthesis of novel dispirooxindole-pyrrolidine derivatives and their antimicrobial and anticancer activity against A549 human lung adenocarcinoma cancer cell line.

Novel dispirooxindole-pyrrolidine derivatives have been synthesized through 1,3-dipolar cycloaddition of an azomethine ylide generated from isatin and sarcosine with the dipolarophile 3-(1H-indol-3-yl)-3-oxo-2-(2-oxoindolin-3-ylidene)propanenitrile, and also spiro compound of acenaphthenequinone obtained by the same optimized reaction condition. Synthesized compounds were evaluated for their antimicrobial activity and all the compounds shown significant activity. Anticancer activity was evaluated against A549 human lung adenocarcinoma cancer cell lines. Compounds 7b, 7g, 7i and 7r exhibit very good anticancer activity 62.96%, 62.03%, 67.67% and 60.22%, respectively, at the dose of 200µg/mL and compound 7i shows IC50 value in 50µg/mL.

1'-Butyl-2-methyl-1',2,2',3,4,9-hexa-hydro-spiro-[benzo[f]isoindole-1,3'-indole]-2',4,9-trione.

In the title compound, C(24)H(22)N(2)O(3), the indoline and pyrrole-fused naphtho-quinone units are both essentially planar [r.m.s. deviations = 0.042 (3) and 0.133 (3) Å, respectively]. The pyrrole ring adopts a C-envelope conformation. The dihedral angle between the mean planes of the two five-membered rings is 89.94 (9)°. The O atoms deviate from the mean planes of the pyrrolidine and naphthalene rings by 0.0311 (2), 0.2570 (2) and 0.1669 (2) Å. In the crystal, C-H⋯O inter-actions generate dimers with R(2) (2)(16) and R(2) (2)(18) graph-set motifs. The carbonyl O atom is involved in bifurcated hydrogen bonding. C-H⋯π inter-actions also occur.

3-(1,2-Di-p-tolyl-vin-yl)-2-methyl-1H-indole.

In the title compound, C(25)H(23)N, the indole unit makes a dihedral angles of 79.03 (5) and 61.82 (4)° with the benzene rings. No classical hydrogen bonds are found in the crystal structure.

(E)-3-Phenyl-2-(1-tosyl-1H-indol-3-ylcarbon-yl)acrylonitrile.

In the title compound, C(25)H(18)N(2)O(3)S, the indole moiety is planar and makes a dihedral angle of 89.95 (09)° with the phenyl ring of the sulfonyl substituent. The mol-ecular conformation features a weak C-H⋯N short contact and the crystal packing reveals a weak C-H⋯O hydrogen bond.

2-Iodo-3-(4-meth-oxy-anilino)-5,5-dimethyl-cyclo-hex-2-en-1-one.

The cyclo-hexene ring in the title compound, C(15)H(18)INO(2), adopts a sofa conformation. The dihedral angle between the cyclo-hexene (through all ring atoms) and benzene rings is 63.3 (1)°. The mol-ecular conformation features an N-H⋯I short contact and the crystal packing features C-H⋯O hydrogen bonds.

1-Benzyl-3-(1,2-diphenyl-ethen-yl)-1H-indole.

In the title compound, C(29)H(23)N, the planar [maximum deviation from the least squares plane = 0.056 (1) Å] indole ring makes dihedral angles of 83.4 (4), 69.9 (1) and 59.9 (1)°, with the least-squares planes of three benzene rings. The mol-ecular packing is stabilized by weak inter-molecular C-H⋯π inter-actions.

5-Chloro-3-[(E)-1,2-diphenyl-ethen-yl]-1H-indole.

In the title compound, C(22)H(16)ClN, the pyrrole system makes a dihedral angle of 68.9 (1)° with the plane of phenyl ring at the ethenyl 1-position. An intra-molecular C-H⋯π inter-action is observed. In the crystal, inter-molecular C-H⋯π inter-actions link the mol-ecules into infinite chains running along the b axis.

3-(1,2-Diphenyl-ethen-yl)-2-phenyl-1H-indole.

In the title compound, C(28)H(21)N, the planar pyrrole ring makes dihedral angles of 1.5 (2), 42.4 (2), 65.4 (2) and 79.7 (1)°, with the least squares planes of the four phenyl rings. The mol-ecular structure and crystal packing are stabilized by weak inter- and intra-molecular C-H⋯π inter-actions.

Redox control of photoinduced electron transfer in axial terpyridoxy porphyrin complexes.

The photophysical properties of axial-bonding types (terpyridoxy)aluminum(III) porphyrin (Al(PTP)), bis(terpyridoxy)tin(IV) porphyrin (Sn(PTP) 2), and bis(terpyridoxy)phosphorus(V) porphyrin ([P(PTP) 2] (+)) are reported. Compared with their hydroxy analogues, the fluorescence quantum yields and singlet-state lifetimes were found to be lower for Sn(PTP) 2 and [P(PTP) 2] (+), whereas no difference was observed for Al(PTP). At low temperature, all of the compounds show spin-polarized transient electron paramagnetic resonance (TREPR) spectra that are assigned to the lowest excited triplet state of the porphyrin populated by intersystem crossing. In contrast, at room temperature, a triplet radical-pair spectrum that decays to the porphyrin triplet state with a lifetime of 175 ns is observed for [P(PTP) 2] (+), whereas no spin-polarized TREPR spectrum is found for Sn(PTP) 2 and only the porphyrin triplet populated by intersystem crossing is seen for Al(PTP). These results clarify the role of the internal molecular structure and the reduction potential for electron transfer from the terpyridine ligand to the excited porphyrin. It is argued that the efficiency of this process is dependent on the oxidation state of the metal/metalloid present in the porphyrin and the reorganization energy of the solvent.

Chiral discrimination of alpha-amino acids by DNA tetranucleotides under electrospray ionization conditions.

A set of DNA tetranucleotides, which are 3'- or 5'-end extended versions of GCA, was used as chiral selectors for the discrimination of enantiomers of alpha-amino acids. The [X+Y-2H](2-) ions of the 1:1 complexes were generated by electrospraying a mixture of tetranucleotide (X) and amino acid (Y) solution. Chiral discrimination was achieved by studying the collision-induced dissociation spectra of the [X+Y-2H](2-) ion and the ratio of relative abundance of precursor ion to that of the product ion was used to measure the extent of discrimination. Among the tetranucleotides used, GCAA and GGCA exhibited better discrimination, in which GCAA showed D-selectivity and GGCA showed L-selectivity for the studied amino acids. In addition, binding constants were measured for the 1:1 complexes of phenylalanine enantiomers with GCAA and GGCA. Ltd.

Differentiation of diastereomeric N-aryltetrahydropyrano/tetrahydrofuranochromenylamines under electron ionization and chemical ionization conditions.

A series of diastereomeric 4S,5S,6R/S-tetrahydropyrano- and 3S,4S,5R/S-tetrahydrofuranochromenylamine derivatives (a/b isomers; 1-26) has been studied under electron ionization (EI) and chemical ionization (CI) conditions. The EI mass spectra of all diastereomeric compounds show two characteristic fragment ions, of which one is formed by retro-Diels-Alder (RDA) reaction from the molecular ion, retaining the charge on the diene fragment, and the other [M-(HNAr)]+ ion by a simple radical loss. The RDA process is more favorable in all b isomers, whereas the radical loss is dominant in all a isomers; based on these two ions it is easy to differentiate the two diastereomers. The collision-induced dissociation (CID) spectra of all the molecular ions also show the same trend, which reflects the stereoselectivity in the formation of the two characteristic fragment ions. The results of theoretical calculations performed are in accordance with the experimental observations. The CI experiments (methane and isobutane) on all the diastereomeric compounds also enabled the differentiation of the isomers.

Matrix-assisted laser desorption/ionization studies on transition metal complexes of benzimidazole thiosemicarbazones.

The transition metal (M=Fe, Co, Ni, Cu, Zn, Cd and Hg) complexes of 2- acetylbenzimidazolethiosemicarbazone (L(1)) and 1-methyl 2-acetylbenzimidazole-thiosemicarbazone (L(2)) are analyzed by MALDI using HCCA, THP, MMNPD and DMN as the matrices. All the MALDI spectra are clean without any contribution from the complex ions resulted by multiple proton addition/removal. All the complexes, except Cu, irrespective of the matrix used, show 1:2 complex ions wherein two ligands (neutral or deprotonated) complex with the metal ion depending on the nature and stable oxidation state of the central metal ion viz., [M + 2L - 2H](+) ion for Fe and Co complexes (+3 oxidation state) and [M + 2L - H](+) ion for Ni, Zn, Cd and Hg (+2 oxidation state). The Cu complex show 1:1 complex ion corresponding to [2M + 2L - 2H](+) ions. When HCCA is used as a matrix, the complex ions due to ligand exchange by matrix are also found, and this process is relatively more if a neutral ligand is bound to the metal ion in the original complex ion. The type of complex ions found under MALDI experiments are similar to those found under ESI experiments. However, the complex ions due to reduction of Cu are found only in the MALDI analysis of Cu complexes.

Mass spectral studies of meso-dialkyl, alkyl aryl and cycloalkyl calix(4)pyrroles under positive and negative ion electrospray ionization conditions.

A series of meso-dialkyl, alkyl aryl and cycloalkyl calix(4)pyrroles (1-15) are studied under positive and negative ion electrospray ionization (ESI) conditions. The positive ion spectra show abundant [M + H](+) and [M + Na](+) ions and the negative ion spectra show the [M + Cl](-) (the Cl(-) ions from the solvent) and [M - H](-) ions. The collision induced dissociation (CID) spectra of [M + H](+), [M + Na](+), [M + Cl](-) and [M - H](-) ions are studied to understand their dissociation pathway and compared to that reported for M(+) under electron ionization (EI) conditions. The beta-cleavage process that was diagnostic to M(+) is absent in all the CID spectra of the ions studied under ESI. Dissociation of all the studied ions resulted in the fragment ions formed by sequential elimination of pyrrole (A) and/or dialkyl/alkyl aryl/cycloalkyl (B) groups involving hydrogen migration to pyrrole ring at each cleavage of A--B bond, which clearly reveals the arrangement of A and B groups in the calix(4)pyrroles. The source of hydrogen that migrates to pyrrole ring during A--B bond cleavage is investigated by the experiments on deuterated compounds and [M + D](+) ions; and confirmed that the hydrogen attached to pyrrole nitrogen, hydrogen on alpha-carbon of alkyl group and the H(+)/Na(+) ion that added during ESI process to generate [M + H](+)/[M + Na](+) ions involve in the migration. The yields of [M + Na](+) ions are found to be different for the isomeric meso-cycloalkyl compounds (cycloheptyl, and 2-, 3- and 4-methyl cyclohexyl) and for normal and N-confused calix(4)pyrroles. The isomeric methyl and 3-hydroxy/4-hydroxy phenyl calix(4)pyrroles show specific fragmentation pattern during the dissociation of their [M - H](-) ions.

Differentiation of diastereomeric conduramine derivatives under electron ionization and chemical ionization mass spectral conditions.

Diastereomeric conduramine derivatives, i.e., (1R,2S,3R/S,6S)-6-(N-carbomethoxyamino) 1,2-O-isopropylidenecyclohex-4-ene-1,2,3-triol (1 and 2) and their O-acetyl derivatives (3 and 4), were studied using gas chromatography (GC) with electron ionization (EI) and chemical ionization (CI). The EI mass spectra of diastereomeric pairs show consistent differences in the relative abundances of characteristic ions. The EI fragmentation patterns are based on precursor/product ion spectra, high-resolution mass spectrometry (HRMS) and deuterium labelling. The CI spectra show differences from the EI spectra, and the isobutane/CI spectra are much simpler than the methane/CI spectra. The differences shown in the CI spectra are similar to those shown in the product ion spectra of [M+H](+) ions generated under electrospray ionization (ESI) conditions. Theoretical calculations are performed to understand the observed differences. The differences in the relative stabilities of molecular ions, or protonated molecules at different sites, can explain the observed differences in the spectra.

Unusual complications of empyema thoracis: diaphragmatic palsy and Horner's syndrome.

We report here a 3 month old child with empyema thoracis, who developed complications of diaphragmatic palsy and Horner's syndrome. These complications of empyema thoracis have not been reported earlier. We discuss the possible mechanisms for these complications.

Griscelli syndrome.

A 4-month-old child had silvery gray hair, light-colored skin, recurrent chest infections, hepatosplenomegaly, and episodes of pancytopenia and hemophagocytosis in the liver, spleen, and bone marrow. Light microscopy of hair showed characteristic large aggregates of pigment granules distributed irregularly along the hair shaft. Peripheral blood smear examination did not show giant granules in granulocytes. Enlarged hyperpigmented basal melanocytes with sparsely pigmented adjacent keratinocytes were seen on the skin biopsy specimen. On the basis of these clinical and laboratory findings, Griscelli syndrome was diagnosed. The child succumbed to infection during an accelerated phase of the disease.