Value of Drains in Soft-Tissue Tumour Surgery: A Specialist Regional Centre Experience.

Background The mainstay of therapy in most soft-tissue tumours (STTs) is excision. However, this often results in blood/extracellular fluid collection within large dead spaces necessitating the use of surgical drains. Whether meticulous attention to haemostasis, careful closure of dead space, and use of compression bandage obviates the need for drains was investigated. This study aimed to compare postoperative outcomes in patients undergoing surgery for STTs with and without the use of drains. Methodology A retrospective analysis of patients undergoing STT surgery over five years was undertaken using a regional STT specialist service database. Patients were stratified into the following two groups: compression bandage alone (CB) versus compression bandage with drain (CBD). The chi-square test was used to examine associations with infection, seroma, and haematoma, while the unpaired t-test was used for associations with hospital stay and time to wound healing. The unpaired t-test with Bonferroni correction was used to account for tumour dimensions across both groups. Results A total of 81 CB and 25 CBD patients were included. The mean hospital stay was significantly lower in CB compared to CBD (4.9 days, SD = 8.574 vs. 9.8 days, SD = 7.647, p = 0.0125). None of the other variables was significantly different between the two groups, including infection (21.3% vs. 24.0%, p = 0.7804), seroma (25.0% vs. 36.0%, p = 0.2865), haematoma (0.026% vs. 2.0%, p = 0.2325), and time to wound healing (55.8 days, SD = 63.59 vs. 42.3 days, SD = 58.88, p = 0.3648). Conclusions Our findings suggest that the use of drains in patients undergoing STT tumour surgery lengthens hospital stay without reducing the incidence of postoperative complications/time to wound healing. A larger, prospective trial is needed.

Organophosphate hydrolase conjugated UiO-66-NH2 MOF based highly sensitive optical detection of methyl parathion.

The hexahistidine-tagged organophosphorus hydrolase (OPH6His) has been immobilized on a Zr-MOF, namely UiO-66-NH2. The resulting enzyme-MOF composite was used as a carrier to facilitate the hydrolysis of an organophosphate pesticide, i.e., methyl parathion in to p-nitrophenol (PNP). The formation of PNP took place in direct proportion to the added pesticide concentration. Coumarin1 (7-diethylamino-4-methylcoumarin) was then introduced in the reaction mixture as a reporter fluorescent molecule. As PNP acted to quench the fluorescence of coumarin1, it became possible to detect methyl parathion over a wide concentration range of 10-106 ng/mL with an achievable limit of quantification as 10 ng/mL. The immobilization of OPH6His on the surface of UiO-66-NH2 was found to endow an improvement in the enzymatic activity by about 37%. The OPH6His/UiO-66-NH2 conjugate was reusable for at least up to eight times and also found stable toward long-term storage (minimum 60 days). The potential practical utility of the above proposed sensing method has been demonstrated by employing it for an accurate analysis of pesticide-spiked food samples.

Fluorescent Sensing Assay for Trinitrotoluene Using Fluorescein Isothiocyanate Conjugated Mesoporous MCM-41 Particles.

In the present study, Trinitrotoluene (TNT) has been detected by the formation of Meisenheimer complex using Fluorescein isothiocyanate (FITC) dye loaded Mesoporous silica particles (MCM-41). FITC dye loaded mesoporous silica particles (MCM-41/FITC) have been synthesized using (3-Aminopropyl)trimethoxysilane, APTMS (λex = 490 nm and λem = 512 nm). TNT forms Meisenheimer complex with the amine group of APTMS present on MCM-41 particles. The loading of FITC in the pores of MCM-41 particles has been confirmed by different advanced characterization techniques. The average diameter of mesoporous MCM-41 particles was found about 130 nm. Pore volume is observed to decrease from 1.06 cm3/g to 0.49 cm3/g after FITC loading. The selective detection of TNT up to 0.1 ppb level makes MCM-41/FITC particles a potential sensing material for TNT detection.

A label-free electrochemical immunosensor for the detection of cardiac marker using graphene quantum dots (GQDs).

A label-free immunosensor based on electrochemical impedance spectroscopy has been developed for the sensitive detection of a cardiac biomarker myoglobin (cMyo). Hydrothermally synthesized graphene quantum dots (GQDs) have been used as an immobilized template on screen printed electrodes for the construction of an impedimetric sensor platform. The GQDs-modified electrode was conjugated with highly specific anti-myoglobin antibodies to develop the desired immunosensor. The values of charge transfer resistance (Rct) were monitored as a function of varying antigen concentration. The Rct value of the immunosensor showed a linear increase (from 0.20 to 0.31kΩ) in the range of 0.01-100ng/mL cMyo. The specific detection of cMyo was also made in the presence of other competing proteins. The limit of detection for the proposed immunosensor was estimated as 0.01ng/mL which is comparable to the standard ELISA techniques.

A New Electrolytic Synthesis Method for Few-Layered MoS2 Nanosheets and Their Robust Biointerfacing with Reduced Antibodies.

We report an efficient method for the synthesis of few-layered MoS2 nanosheets and demonstrate their application in the label-free detection of the prostate-specific antigen (PSA) cancer marker. As a novel strategy, the electro-dissolution of molybdenum metal sheets in the presence of Na(+) and S(2-) ions led to the formation of Na(+) intercalated MoS2. Further exfoliation by ultrasonication yielded the desired formation of few-layered MoS2 nanosheets. After comprehensive characterization, the synthesized MoS2 nanosheets were channeled in a field-effect transistor (FET) microdevice. Chemically reduced anti-PSA antibodies were immobilized on the MoS2 channel above the FET microdevice to construct a specific PSA immunosensor. The antibodies were deliberately reduced to expose the hinge-region disulfide bonds. This approach offered a robust and site-directed immunosensing device through biointerfacing of the sulfhydryl groups (-SH) in the reduced antibody with the surface S atoms of MoS2. This device was validated as an effective immunosensor with a low detection limit (10(-5) ng/mL) over a wide linear detection range (10(-5) to 75 ng/mL).

Intrapiriformis lipoma: an unusual cause of piriformis syndrome.

INTRODUCTION: We report on a patient with an unusual cause of non-discogenic sciatica. MATERIAL AND METHODS: A 48-year-old woman presented with a 10-day history of gradually worsening left buttock pain radiating to the ipsilateral posterior thigh and calf. She had a similar episode of less intense pain 8 months before which lasted about 2 months. She denied any history of antecedent trauma or back pain. MRI scan revealed a well-defined, fat-containing lesion of the left piriformis muscle similar to a lipoma displacing the sciatic nerve but not invading it. The sciatica was relieved after excision of the lesion. The patient remained asymptomatic after the operation. CONCLUSION: The present case suggested that an intrapiriformis lipoma can cause secondary piriformis syndrome and medical practitioners should be aware of this condition and consider lipomas and other occupying lesions of the pelvic muscles as a differential diagnosis in patients presenting with radicular pain.

Biofunctionalized rebar graphene (f-RG) for label-free detection of cardiac marker troponin I.

One-step microwave-assisted unscrolling of carbon nanotubes to form functionalized rebar graphene (f-RG) is reported. The well-characterized f-RG on an interdigitated electrode biochip in a FET configuration showed enhanced electronic properties, as demonstrated with I-V characteristics. The developed device was biofunctionalized with specific anti-cTnI antibodies exhibiting a shift of threshold voltage from -2.15 V to -0.5 V and decrease in electron mobility from 3.609 × 10(4) to 8.877 × 10(3) cm(2) V(-1) s(-1). The new sensing strategy holds great promise for its applicability in diagnostics exhibiting high sensitivity (∼ 1 pg/mL) and specificity toward cardiac marker (cTnI).

Liposarcoma of the great toe: a case report.

Soft tissue sarcomas are rare malignancies, of which liposarcomas are the most common. Pleomorphic liposarcoma accounts for 5% of liposarcoma diagnoses and most commonly presents in the thigh. A 57-year-old female presented with a 5-year history of a persistent, painless swelling of the left great toe that had been previously diagnosed and treated as an in-grown toenail. After magnetic resonance imaging and core biopsy, a grade 2 pleomorphic liposarcoma was diagnosed. Treatment consisted of neoadjuvant radiotherapy and amputation of the great toe and proximal half of the first metatarsal with primary closure. The patient had no evidence of local recurrence or metastatic disease after 1 year of follow-up and, with the use of a prosthesis, had a good functional outcome. This is the first documented presentation of a high-grade pleomorphic liposarcoma of the great toe to our knowledge. Although soft tissue sarcomas are rare, a high index of suspicion is required by clinicians when presented with a soft tissue mass to promptly diagnose and treat these potentially fatal lesions.

Painful swollen leg--think beyond deep vein thrombosis or Baker's cyst.

BACKGROUND: The diagnosis of deep vein thrombosis of leg is very common in clinical practice. Not infrequently a range of pathologies are diagnosed after excluding a thrombosis, often after a period of anticoagulation. CASE PRESENTATION: This is a report of three patients who presented with a painful swollen leg and were initially treated as a deep vein thrombosis or a baker's cyst, but later diagnosed as a pleomorphic sarcoma, a malignant giant cell tumor of the muscle and a myxoid liposarcoma. A brief review of such similar reports and the relevant literature is presented. CONCLUSION: A painful swollen leg is a common clinical scenario and though rare, tumors must be thought of without any delay, in a duplex negative, low risk deep vein thrombosis situation.

A groin mass caused by metal particle debris after hip resurfacing.

We present the case of a benign groin mass associated with metal particle debris after hip resurfacing. We discuss the histological diagnosis of 'aseptic lymphocytic vasculitis associated lesions' (ALVAL).

Pretibial Full Thickness Skin Burn following Indirect Contact from Bone-Cement Use in a Giant Cell Tumour.

Bone cement reaches significant temperatures and is known to cause thermal and chemical damage to various tissues. All the reports of such damage occurred following a direct contact of the tissue or structure with cement. We report the case of a patient with a giant cell tumour of the proximal tibia who underwent curettage and bone cement application through a posterior approach and subsequently developed full thickness pretibial skin damage despite showing no evidence of any direct contact of the involved skin with bone cement. This is the first report of its kind and though anecdotal is a serious complication that surgeons should be aware of.

Proximal tibiofibular synostosis as a source of ankle pain: a case report.

We report the case of a 61-year-old man who presented with ankle pain of unknown etiology. The actual cause for his pain was missed during his two initial visits when only ankle radiographs were taken. During his third visit, a full-length tibia film revealed a proximal tibiofibular synostosis. He successfully underwent a fibular osteotomy with complete symptomatic relief. A literature review of this topic is presented.

Rhabdomyosarcoma of the extremities in adults.

Rhabdomyosarcomas are uncommon in adults and literature regarding their management is limited. Eight patients with an average age of 32.6 years (range: 21 to 75) who were treated for rhabdomyosarcomas on the extremities between 1991 and 2002 in a regional centre for the treatment of soft tissue sarcomas were studied retrospectively. Treatment consisted of en bloc resection of the primary tumour in all the patients, combined with radiotherapy or chemotherapy or both. The tumour size ranged from 5.5 cm to 15 cm (average 9.3 cm). Histologically there were four alveolar, two pleomorphic, one embryonal and one anaplastic subtype. Seven of the eight patients developed metastasis and died after an average period of 15.3 months (range 4-28 months). At the final follow-up, only one patient was disease free and alive 48 months after surgery. Extremity rhabdomyosarcoma is a highly malignant tumour and our results are poor compared to the reported results in children. Metastatic recurrence is high in adult rhabdomyosarcomas even with local control of the disease and therefore development of effective systemic therapy is an urgent priority.

Soft tissue osteosarcoma: a case report.

Osteosarcomas arising from extraskeletal locations are extremely rare and their true prevalence is unknown. We describe a case of soft tissue-origin-osteosarcoma arising from the vastus medialis muscle in a 58-year old woman. The possibility of a malignant tumour was not suspected initially and she was referred to a specialist unit only one year after the onset of the swelling. She was successfully treated with a surgical resection, chemotherapy and radiotherapy. Because of the rarity of the tumour, a high degree of suspicion is required to make an early diagnosis. The differential diagnosis of a soft tissue mass located in the thigh in a patient over the age of 40 years, should include extraskeletal osteosarcoma.

A simple K-wire cap.

The authors describe a simple technique to cap sticking K-wires using plastic syringes readily available in the hospitals, that has not been described before.

Potent inhibition of human cardiac potassium (HERG) channels by the anti-estrogen agent clomiphene-without QT interval prolongation.

The acquired form of the long-QT syndrome (LQTS) is a major safety consideration for the development and subsequent use of both cardiac and non-cardiac drugs; it is usually associated with pharmacological inhibition of cardiac HERG-encoded potassium channels. Clomiphene is an anti-estrogen agent used extensively in the treatment of infertility and is not associated with a risk of QT interval prolongation, in contrast to a structurally related compound tamoxifen. We describe here a potent inhibitory effect (IC(50) = 0.18 microM) of clomiphene on HERG ionic current (I(HERG)) recorded from a mammalian cell line expressing HERG channels. Inhibition of I(HERG) by clomiphene showed voltage-dependence and developed quickly following membrane depolarisation, indicating contingency of block on HERG channel gating. At 100 nM, clomiphene and the related anti-estrogen tamoxifen produced similar levels of I(HERG) blockade (p > 0.05). Experiments on guinea-pig isolated perfused hearts revealed that, despite its inhibitory action on I(HERG), clomiphene produced no significant effect at 1 microM on uncorrected QT interval (p > 0.1) nor on rate-corrected QT interval (QT(c); p > 0.1 for QT(c) determined using Van de Water's formula). The disparity between clomiphene's potent I(HERG) inhibition and its lack of effect on the QT interval underscores the notion that I(HERG) pharmacology may best be used alongside other screening methods when investigating the QT-prolonging tendency and related cardiotoxicity of non-cardiac drugs.

Inhibition of the current of heterologously expressed HERG potassium channels by flecainide and comparison with quinidine, propafenone and lignocaine.

1. The inhibition of the cardiac 'rapid' delayed rectifier current (I(Kr)) and its cloned equivalent HERG mediate QT interval prolonging effects of a wide range of clinically used drugs. In this study, we investigated the effects of the Class Ic antiarrhythmic agent flecainide (FLEC) on ionic current (I(HERG)) mediated by cloned HERG channels at 37 degrees C. We also compared the inhibitory potency of FLEC with other Class I agents: quinidine (QUIN, Class Ia); lignocaine (LIG, Class Ib) and propafenone (PROPAF, Class Ic). 2. Whole cell voltage clamp recordings of I(HERG) were made from an HEK293 cell line stably expressing HERG. FLEC inhibited I(HERG) 'tails' following test pulses to +30 mV with an IC(50) of 3.91+/-0.68 microM (mean+/-s.e.mean) and a Hill co-efficient close to 1 (0.76+/-0.09). 3. In experiments in which I(HERG) tails were monitored following voltage commands to a range of test potentials, I(HERG) inhibition by FLEC was observed to be voltage-dependent and to be associated with a approximately -5 mV shift of the activation curve for the current. Voltage-dependence of inhibition was greatest over the range of potentials corresponding to the steep portion of the I(HERG) activation curve. The time-course of I(HERG) tail deactivation was not significantly altered by FLEC. 4. In experiments in which 10 s depolarizing pulses were applied from -80 to 0 mV, the level of current inhibition by FLEC did not increase between 1 and 10 s. Some time-dependence of inhibition was observed during the first 200 - 300 ms of depolarization. This observation and the voltage-dependence of inhibition are collectively consistent with FLEC exerting a rapid open channel state inhibition of I(HERG). 5. Under similar recording conditions QUIN inhibited I(HERG) with an IC(50) of 0.41+/-0.04 microM and PROPAF inhibited I(HERG) with an IC(50) of 0.44+/-0.07 microM. Similar to FLEC, both QUIN and PROPAF showed voltage-dependence of inhibition and blockade developed rapidly during a sustained depolarization. 6. LIG showed little effect on I(HERG) at low micromolar concentrations, but could inhibit the current at higher concentrations; the observed IC(50) was 262.90+/-22.40 microM. 7. Our data are consistent with FLEC, PROPAF and QUIN exerting I(HERG) blockade at clinically relevant concentrations. The rank potency as HERG blockers of the Class I drugs tested in this study was QUIN=PROPAF>FLEC>>LIG.

'Leaving a mark'.

Biopsies by various means do have a risk of seeding tumour cells into the biopsy track. Even with fine needle and trocar techniques this has been proven to occur. By excising the biopsy track at the time of surgery this risk can be reduced. With needle and trocar techniques there might be little evidence of the puncture when the time of surgery takes place. We advocate using Indian ink to mark the biopsy site.