Laparoscopic totally extraperitoneal exploration of intra-abdominal testis, orchidectomy and inguinal hernia repair in an adult patient.

The presence of undescended testis predisposes to the development of an inguinal hernia due to the persistent processus vaginalis. This coexistence is not very rare in the paediatric population. Here, we report an adult man who presented with inguinal hernia and an intra-abdominal testis and successfully underwent an extended totally extraperitoneal (e-TEP) approach for extraperitoneal exploration of the testis in the left iliac fossa, and orchidectomy along with inguinal hernia repair. Review of the literature revealed only two case reports in which TEP has been used in the treatment of undescended testis in adults, and in both cases, the testes were intracanalicular. This case, as per our extensive bibliographical research, is the first reported case of an intra-abdominal testis, with descent arrested at the iliac fossa, explored using e-TEP along with inguinal hernia repair. Such minimally invasive procedures may be offered to the patients without the risks of intraperitoneal entry.

MicroRNA-27b Impairs Nrf2-Mediated Angiogenesis in the Progression of Diabetic Foot Ulcer.

Nuclear factor erythroid-2-related factor 2 (Nrf2) is a stress-activated transcription factor regulating antioxidant genes, and a deficiency thereof, slowing lymphangiogenesis, has been reported in diabetic foot ulcer (DFU). The mode of Nrf2 regulation in DFU has been less explored. Emerging studies on miRNA-mediated target regulation show miRNA to be the leading player in the pathogenesis of the disease. In the present study, we demonstrated the role of miR-27b in regulating Nrf2-mediated angiogenesis in DFU. A lower expression of mRNA targets, such as Nrf2, HO-1, SDF-1α, and VEGF, was observed in tissue biopsied from chronic DFU subjects, which was in line with miR-27b, signifying a positive correlation with Nrf2. Similarly, we found significantly reduced expression of miR-27b and target mRNAs Nrf2, HO-1, SDF-1α, and VEGF in endothelial cells under a hyperglycemic microenvironment (HGM). To confirm the association of miR-27b on regulating Nrf2-mediated angiogenesis, we inhibited its expression through RNA interference-mediated knockdown and observed disturbances in angiogenic signaling with reduced endothelial cell migration. In addition, to explore the role of miR-27b and angiogenesis in the activation of Nrf2, we pretreated the endothelial cells with two well-known pharmacological compounds-pterostilbene and resveratrol. We observed that activation of Nrf2 through these compounds ameliorates impaired angiogenesis on HGM-induced endothelial cells. This study suggests a positive role of miR-27b in regulating Nrf2, which seems to be decreased in DFU and improves on treatment with pterostilbene and resveratrol.

Triple Assessment in Diagnosis of Thyroid Nodules and Its Comparison With Histopathology.

BACKGROUND:  Thyroid nodules are more common than previously realised, and the rate of prevalence is hugely impacted by the method of detection and their easy access. No single test is sufficient to access the thyroid nodule at any given time. Hence this necessitates the need for clinicians to use an evidence-based protocol for their assessment and diagnosis. AIMS AND OBJECTIVE:  To determine the likelihood of malignancy in individuals who have thyroid nodules of any size, by a) performing a triple assessment, including a history and physical examination, an ultrasound of the neck and fine needle aspiration and cytology (FNAC) b) predicting the percentage of correlation between findings of malignancy on FNAC and final histopathological diagnosis c) identifying and validate individual risk factors in the clinical examination and ultrasound imaging that point towards a nodule being malignant Methods: Patients presenting with thyroid nodules in a clinically euthyroid state were studied over a time period of 18 months. Seventy-five patients were included in this study. Patients having external cytology and ultrasonography reports were reassessed if they consented to the study. If the pathologists thought the smears were sufficient, slide reviews were accepted. A senior consultant conducted the clinical evaluation. Prior to doing the FNACs, the designated radiologist performed the majority of the ultrasonograms. If the physicians believed it was necessary, ultrasound-guided FNACs were performed. According to Bethesda criteria, the cytology was reported. The outcome of the histopathological analysis was used as the gold standard for diagnosis in this investigation. RESULT: Out of 75 patients included in the study, the older age group (50-70) patients had mostly malignant lesions (92%). In the younger age group (20-39), about 77% had benign lesions. Benign lesions were more common in females than males according to the histopathology study. Seventy-three percent of fixed swellings turned out to be malignant. About 86% of patients who had extrathyroidal extension ended up being found to have malignant lesions but even 41% of patients who didn't have any extrathyroidal extension also turned out to be having malignant lesions. However, the presence of pressure symptoms didn't necessarily translate to being an indicator of malignancy. Ninety-seven percent of patients who had punctate microcalcifications turned out to have malignant lesions. Hypoechogenicity on imaging also is an important marker of malignancy, with about 87% of patients who had hypoechogenicity having malignant lesions proven on histopathology. All the patients who had solid lesions on imaging were proven to have malignant lesions. About 77% of patients who had cystic features ended up having benign lesions. Hence, it is a very significant marker. Intranodular vascularity, taller than wider lesions and positive lymph nodes on imaging were proven to have malignant lesions. FNAC is an important diagnostic tool. It is made out that the reporting of FNAC more or less matched the histopathological diagnosis in almost all categories. CONCLUSION:  There are definite correlations in the role of triple assessment as a standard protocol in the diagnosis of thyroid nodules and guiding its management.