Temporal Vascular Endothelial Growth Factor Sub-type gene Switching in SARS-CoV Pathogenesis. Interpretation through in vivo Murine C57BL Models

IntroductionIncreased Vascular Endothelial Growth Factor A (VEGF-A) levels are associated with Severe Acute Respiratory (SARS) infection. The aim was to investigate in vivo VEGF-A and VEGF-B (VEGF-A/B) gene expression (GE) in severe pulmonary disease pathogenesis. MethodTwelve temporal Mus musculus Wildtype (WT) C57BL/6 SARS-CoV MA15 lung studies were selected from the NCBI GEO database for GE profiling. ResultsIn murine dataset (GSE68820) Day 2 was compared to Day 7 demonstrating a downregulation trend in VEGF-A GE, with an opposite effect on VEGF-B GE (p=4.147e-03, p=7.580e-07, respectively). A v-shaped VEGF-B gene expression trajectory was noteworthy across certain datasets and after dORF6 stimulation. In addition, MA15 dose stimulation studies showed that a higher antigenic load caused more profound effects on VEGF-A resulting in a steeper fall in GE compared to other antigens. ConclusionsDistinct temporal trajectory patterns of VEGF-A and VEGF-B gene expression were associated with SARS-CoV MA15 stimulation. Unraveling the importance of VEG-A/B dynamics offers exciting prospects for improved bio-marking and therapeutic precision.

Synchronous Multicentric Giant Cell Tumour of Distal Radius and Sacrum with Pulmonary Metastases.

Giant cell tumour (GCT) is an uncommon primary bone tumour, and its multicentric presentation is exceedingly rare. We report a case of a 45-year-old female who presented to us with GCT of left distal radius. On the skeletal survey, osteolytic lesion was noted in her right sacral ala. Biopsy confirmed both lesions as GCT. Pulmonary metastasis was also present. Resection-reconstruction arthroplasty for distal radius and thorough curettage and bone grafting of the sacral lesion were done. Multicentric GCT involving distal radius and sacrum with primary sacral involvement is not reported so far to our knowledge.

Tibialis anterior partial rupture mimicking muscle hernia: a rare case report.

Rupture of tibialis anterior tendons is infrequently described in literature, and those described were around the ankle, either at the origin or in the tendon substance. To our known knowledge only very few cases of rupture of the tibialis anterior at musculotendinous junction were reported. We highlight the occurrence of rupture at the musculotendinous junction in tibialis anterior muscle after trauma, presenting as a soft tissue mass, the need to differentiate it from traumatic muscle hernia, mechanism of injury and its ultrasound and MRI findings.

Glued Angiocatheter: A Rare Complication of Intrarenal Pseudoaneurysm Glue Angioembolization

Endovascular management of intraparenchymal renal artery pseudoaneurysms is a reasonable and effective therapeutic technique. Endovascular management preserves the maximum amount of renal tissue and reduces the potential risk of nephrectomy. We present the case of an angiocatheter that became stuck in the renal artery following the injection of cyanoacrylate glue for angioembolization of an intrarenal pseudoaneurysm.

Fragmented Pigtail Percutaneous Nephrostomy Tubes: Etiology and Management

PURPOSE: To review our experience with the management of fragmented and retained pigtail percutaneous nephrostomy (PCN) tubes and to explore the reasons for the fragmentation. MATERIALS AND METHODS: We retrospectively reviewed our institute database from January 2006 to December 2011 for patients who had undergone retrieval of fragmented PCN tubes. We assessed the preoperative factors, operative technique, and post-operative outcomes. RESULTS: A total of seven patients (4 males and 3 females) had been diagnosed with fragmented PCN tubes. The mean age of the patients was 41.5 years. Of the seven patients, five required antegrade instrumentation by way of a percutaneous tract to remove the foreign body, mostly along with stone retrieval. One patient underwent ureterorenoscopy and pneumolithotripsy for a ureteric stone along with ureteroscopic removal of the PCN fragment. Another patient underwent nephrectomy of the kidney containing the PCN fragment because it had become nonfunctioning. All patients were free of stones and symptoms on follow-up. CONCLUSIONS: A prolonged waiting period for definitive surgery, urinary infection, and associated stone disease are significant factors causing fragmentation of PCN tubes. Proper insertion techniques, regular timed changes of the PCN tube, appropriate care of the PCN tube, and early surgery for underlying stone disease are required to avoid this complication. Patients with retained PCN tubes can be managed effectively with antegrade or retrograde endoscopic techniques while definitive management of the primary pathology is carried out, without any additional morbidity.

Efficacy of Holmium Laser Urethrotomy in Combination with Intralesional Triamcinolone in the Treatment of Anterior Urethral Stricture

PURPOSE: To evaluate the outcome of visual internal urethrotomy with a holmium:yttrium-aluminum-garnet laser along with intralesional triamcinolone injection. MATERIALS AND METHODS: Patients with an anterior urethral stricture less than 3 cm in length were evaluated by clinical history, physical examination, uroflowmetry, and retrograde urethrogram preoperatively. All patients were treated with holmium laser urethrotomy and intralesional triamcinolone (80 mg) injection under general or regional anesthesia. An 18 F urethral catheter was placed for 5 days. All patients were followed up for 12 months postoperatively by history, uroflowmetry, and if required, retrograde urethrogram or urethroscopy every 3 months. RESULTS: The mean age of the patients was 42.9 years (range, 14 to 70 years). The overall recurrence rate was 24%. The success rate in patients with strictures less than 1 cm in length was 95.8%, whereas that in patients with strictures of 1 to 3 cm in length was 57.7% (p=0.002). The outcome did not depend on age, duration of symptoms, etiology, or location of stricture. CONCLUSIONS: Holmium laser urethrotomy with intralesional triamcinolone is a safe and effective minimally invasive therapeutic modality for urethral strictures. This procedure has an encouraging success rate, especially in those with stricture segments of less than 1 cm in length.