Liver Resection for Giant Hepatic Cavernous Hemangioma.

Liver hemangiomas are common. Giant liver hemangiomas are rare and symptomatic patients require treatment. Surgery is the curative procedure. Other options such as intra-arterial embolization may be used to decrease the volume and bleeding of these lesions. Three cases of giant liver hemangioma were treated with liver resection, one with left lateral hepatectomy and two with right lateral hepatectomy. All patients had made an uneventful recovery with no recurrence at 3-year follow-up. Most hemangiomas are small, asymptomatic, and do not require any treatment. Liver resection is a safe and effective treatment for giant hemangiomas.

Using the STOP-BANG questionnaire to predict hypoxaemia in patients recovering from noncardiac surgery: a prospective cohort analysis.

BACKGROUND: The STOP-BANG questionnaire is a validated, eight-point dichotomized scale used to screen preoperative patients for obstructive sleep apnoea. Sleep apnoea causes hypoxaemia, and nocturnal oxygen desaturation is diagnostic in these patients. We tested the hypothesis that STOP-BANG score is associated with hypoxaemia after noncardiac surgery. METHODS: This analysis was a sub-study of VISION, a prospective cohort study of perioperative cardiovascular events. With institutional review board approval, we included 630 patients in the final analysis. We assessed the association between the STOP-BANG score and postoperative hypoxaemia, defined as integrated area under the curve of [Formula: see text] saturation of 90% per h using median quantile regression. Secondarily, we selected a subset of STOP-BANG questions that best predicts postoperative hypoxaemia using 'Least Absolute Shrinkage and Selection Operator' method, and then assessed the association between the new score based on the selected questions and the primary outcome using quantile regression. RESULTS: The median [q1, q3] area under [Formula: see text] of 90% per h was 0.09 [0.02, 0.39] %-h. The STOP-BANG score was not associated with hypoxaemia, with a multivariable slope coefficient of 0.002 (95% CI: -0.01, 0.01) %-h for a unit increase in the score (P=0.76). Secondarily, no association was found between the new score based on the two retained STOP-BANG questions, treatment for hypertension and neck circumference >40 cm, and the primary outcome with a multivariable slope coefficient of 0.03 (98.3% CI: -0.01, 0.06) %-h/score (P=0.07). CONCLUSIONS: The STOP-BANG score does not predict hypoxaemia in adults recovering from noncardiac surgery. CLINICAL TRIAL REGISTRATION: NCT00512109.

Discovery of amide based fibrates as possible antidyslipidemic and antioxidant agents.

A novel series of amide based fibrates were synthesized and evaluated for antidyslipidemic activity in triton induced hyperlipidemic rats. Interestingly, the compound 13 produced striking reduction in serum levels of total cholesterol (TC), phospholipids (PL) and triglycerides (TG). In addition, it exhibited improved lipoprotein lipase activity and found to possess moderate radical scavenging potential. The results of the above studies shows that the compounds synthesized on fibrate based pharmacophores might result in identification of new lead for dyslipidemia.

Antidyslipidemic and antioxidant activity of the constituents isolated from the leaves of Calophyllum inophyllum.

In continuation of our drug discovery program on Indian medicinal plants, we isolated bioactive compounds (1-5) from the leaves of Calophyllum inophyllum and evaluated their antidyslipidemic activity in triton induced hyperlipidemia model. The calophyllic acid (1A) and isocalophyllic acid (1B) mixture, canophyllic acid (4) and amentoflavone (5) showed dose dependent lipid lowering activity in in vivo experiments. The compounds 1A+1B mixture and 3 also showed good in vitro antioxidant activity.

Bilateral synchronous testicular germ cell tumours in a patient with bilateral cryptorchidism.

Bilateral testicular tumours are rare, and 80% of bilateral tumours are metachronous. The incidence of testicular tumours is high in cryptorchidism. Synchronous bilateral testicular tumours are rare, and bilateral synchronous testicular tumours in bilateral cryptorchidism extremely rare, probably not reported previously.

Pancreatic pseudocyst: therapeutic dilemma.

Pancreatic pseudocyst develops in both acute and chronic pancreatitis. It is an entity likely to either remain asymptomatic or develop devastating complications. Despite being diagnosed easily, treatment exercise is still at crossroads whether in the form of internal or external drainage or endoscopic, laparoscopic, or open intervention with a good radiological guidance. The therapeutic dilemma whether to treat a patient with a pancreatic pseudocyst, as well as when and with what technique, is a difficult one. This paper is intended to get information about diagnostic and therapeutic exercises most appropriate for acute and chronic pancreatic pseudocyst.

Indole-based fibrates as potential hypolipidemic and antiobesity agents.

Hypolipidemic and antiobesity effects of the newly synthesized indole-based fibrates were evaluated in Triton WR-1339 and high fat diet (HFD)-induced hyperlipidemic rats. Preliminary screening of all the synthesized compounds was done by using an acute model (Triton model), in which compounds 3f and 3l showed significant antidyslipidemic activity. Furthermore, these compounds 3f and 3l were found to induce significant weight loss in the visceral fat mass of HFD-fed hyperlipidemic rats without affecting the normal feeding behavior. Histological examination of the liver of rats supplemented with 3f and 3l revealed a significant decrease in steatosis when compared to the effect of the standard drug fenofibrate. Additional effects such as an increase in lecithin cholesterol acyl-transferase (LCAT) enzyme level and increased receptor mediated catabolism of I(131)-low density lipoproteins (LDL) confirm and reinforce the efficacy of both of these compounds as a new class of dual-acting hypolipidemic and antiobesity agents.

Synthesis of 5-aryl-6-cinnamoyl-7-methyl-flavanones as novel antioxidants and antihyperlipidemics.

An economical and efficient one-pot synthesis of a series of novel 5-aryl-6-cinnamoyl-7-methyl-flavanones has been developed by simple refluxing of cinnamoyl chalcones with NaOAc in aqueous ethanol in quantitative yields. These flavanones were screened for their in vitro antioxidant and in vivo antidyslipidemic activities. Among 24 compounds screened, four compounds 28, 29, 30, and 48 showed significant antidyslipidemic activities. However, out of all the compounds, only compound 28 exhibited significant antioxidant activity and other compounds showed moderate antioxidant activities.

Thyroid incidentaloma.

Because of emerging investigation modalities many of the thyroid lesions are picked up and that poses a big dilemma about management of such lesions. Majority of these lesions especially in iodine-deficient regions, are not significant and may be only followed up without any active treatment but, sometimes the small lesions may be microcarcinoma. This article discusses about the reliability of clinical examination of neck for detection of such lesions, the controversy of such lesion being benign or malignant, and how to evaluate these lesions and the recommendation as per American Thyroid Association guidelines.

Synthesis of novel N-(2-hydroxy-2-p-tolylethyl)-amide and N-(2-oxo-2-p-tolylethyl)-amide derivatives and their antidyslipidemic and antioxidant activity.

In continuation of our drug discovery program on metabolic diseases, we identified an alkaloidal amide, that is, Aegeline (V) from the plant Aegle marmelos leaves as a dual acting agent (antihyperlipidemic and antihyperglycemic). We therefore synthesized a series of alkaloidal amides [N-(2-hydroxy-2-p-tolylethyl)-amides and N-(2-oxo-2-p-tolylethyl)-amide derivatives] related to Aegeline and screened for their in vivo antihyperlipidemic activity in Triton induced hyperlipidemia model. The synthetic compounds 4, 17 and 20 showed equipotent activity to the natural product, that is, Aegeline (V). These compounds also showed strong antioxidant activity, which support their antihyperlipidemic activity. Compound 12 showed better antihyperlipidemic and antioxidant profile than the natural product V.

Recurrent Rapunzel syndrome.

Rapunzel syndrome is a rare condition that occurs when gastric trichobezoar extends beyond the pylorus and into the bowel. Recurrent Rapunzel syndrome is an extremely rare entity, with only two cases reported in the literature so far. Here, we present a case of recurrent Rapunzel syndrome in a 15-year-old girl. She underwent laparotomy twice in five years to extract trichobezoars measuring 58 cm and 62 cm. In both stances when Rapunzel syndrome was diagnosed, a tuft of hair extending from the stomach toward the jejunum was observed. The patient underwent psychiatric consultation and supervision after the first laparotomy; however, a lack of follow-up resulted in recurrence. We conclude that complete removal of trichobezoar and psychiatric consultation, coupled with long-term follow-up, are essential to prevent recurrence.

Synthesis and anti-inflammatory activity of novel biscoumarin-chalcone hybrids.

A series of synthesized novel biscoumarin-chalcone hybrids were evaluated for their anti-inflammatory and antioxidant activity. The tested compounds significantly inhibit the carrageenin induced paw oedema in albino rats and also exhibit important scavenging activities. These compounds thus constitute an interesting template for the design of new therapeutic tools against inflammation.

Novel coumarin derivatives as potential antidyslipidemic agents.

A series of novel benzocoumarin derivatives were synthesized and evaluated for their in vivo antidyslipidemic and in vitro antioxidant activities. Among 11 compounds tested, 2 compounds showed potent antidyslipidemic activity and 3 compounds showed potent antioxidant activity.

Synthesis of novel benzocoumarin derivatives as lipid lowering agents.

A series of novel benzocoumarin derivatives were synthesized and evaluated for their in vivo anti-dyslipidemic and in vitro antioxidant activities. Preliminary screening indicates compound 4 as potential lead with significant lipid lowering and antioxidant activities. The study revealed that such attempts on benzocoumarin-based pharmacophores which is a biologically important scaffold might result in identification of new lead for anti-dyslipidemia.

Pregnane glycoside from Hemidesmus indicus as a potential anti-oxidant and anti-dyslipidemic agent.

A new pregnane glycoside hindicusine (1) was isolated from the CHCl(3)-EtOH (3 : 2) extract of Hemidesmus indicus, whose structure was established on the basis of spectroscopic studies. The glycoside (1) and its acetylated derivative (5) were evaluated for their anti-oxidant and anti-dyslipidemic activities.

Extragonadal germ cell tumour.

We report a rare case of extragonadal germ cell tumour in a 55-year-old man. He presented with a painless mass in right inguinal region, a few days after hernioplasty for right direct inguinal hernia, which caused diagnostic difficulties and treatment problems.

An accessory tongue.

An accessory tongue is a rare anomaly. In the literature, only a few case reports have been cited. We report a 28-year-man with this anomaly. The patient was treated with a simple surgical excision.

A case series describing 118 patients with lower limb necrotizing fasciitis.

Necrotizing fasciitis of the lower limb is not uncommon, with poor outcome. This study reviewed 118 cases (78 males and 40 females) with mean age of 45 + 16.5 years (range 12-95 years) of lower limb necrotizing fasciitis admitted to the Department of Surgery, BHU in India between 1995 and 2007. Most patients (n = 97) presented with fever. Other presenting symptoms included painful swelling, bullae, erythema, ulcer, and necrosis. Comorbid conditions such as diabetes, tuberculosis, malignancy, and immunosuppressive therapy were associated in 72 (61%) cases. Amputations were done in 24 patients. Thirty one patients developed septic shock. Renal dialysis was done in 16 patients and ventilatory support was needed in 12 patients. The most common organism identified was beta-hemolytic streptococci (n = 42). Eighteen patients died, a mortality of 15%. The authors consider early diagnosis and aggressive surgical intervention to be crucial for the successful treatment of disease.

Desmoid tumors: experience of 32 cases and review of the literature.

BACKGROUND: Desmoids are infiltrative, locally destructive, soft tissue tumors. Although they do not metastasize, the incidence of local recurrence is quite high. AIM: Present study aimed at reporting the 10-year experience of 32 desmoid cases and reviewing some facts with symptoms, investigation, and treatment of the disease. MATERIALS AND METHODS: Thirty two cases of desmoid tumors were reviewed over a 10-year span. Surgical resection and adjuvant radiotherapy were the treatments of choice whenever histological margins were positive. RESULTS: Multiparous women in reproductive age were the most commonly afflicted. The commonest site of presentation was the abdominal wall. Ninety one percent (20/22) were infraumbilical. The tumors were found in the rectus sheath in 14 patients (64%) and were laterally situated in 8 patients (36%). Local infiltration was found in six patients and the urinary bladder was most commonly involved (3/6). Locally recurrent desmoids were seen in eight patients (25%). CONCLUSIONS: In our experience, 25% of the desmoid tumors (8/32) were recurrent and postoperative radiotherapy did not seem to influence the local recurrence rate. The most important predictor for recurrence was tumors of > 5 cm.