Invasive rhinosinusitis due to Penicillium chrysogenum in an adolescent man with new-onset leukaemia: a diagnostic dilemma.

An adolescent boy with newly diagnosed T-cell acute lymphoblastic leukaemia developed right eye and facial pain, and a 1 cm × 2 cm area of black eschar over his hard palate. Initial differential diagnosis included rhinocerebral mucormycosis and aspergillosis, and he was started on liposomal amphotericin B. Later, he underwent nine surgical debridements of his sinus cavities, resection of a third of his palate and right orbital exenteration. While histological specimens exhibited features of both Aspergillus and Mucor, a PCR assay detected Penicillium chrysogenum He was successfully treated with amphotericin B and Posaconazole. P. chrysogenum has been reported in a rare case of endocarditis, a case of post-traumatic endophthalmitis, disseminated infection in a child with Henoch-Schonlein syndrome, and one fatal adult case of invasive rhinosinusitis. While infection from Penicillium species is rare, it should be considered as a cause of invasive rhinosinusitis in cases of unclear histopathology.

Terrestrial Locomotion in American Eels (Anguilla rostrata): How Substrate and Incline Affect Movement Patterns.

Fishes overcome a variety of challenges in order to invade the terrestrial environment. Terrestrial invasions by fish occur over a variety of environmental contexts. In order to advance their bodies on land, fishes capable of terrestrial excursions tend to use one of three different types of locomotor modes: axial-based, appendage-based, or axial-appendage-based. Elongate species with reduced appendages, such as the American eel, Anguilla rostrata, rely on axial based locomotion in water and on land. When eels move from water to land as part of their complex life cycle, they inevitably encounter a variety of substrates and must traverse variable degrees of incline. The aim of this study was to determine the effect of substrate and incline on the terrestrial locomotion of the American eel. In order to do this, eels were filmed from a dorsal view on three substrates and four inclines: sand, loose pebbles, and fixed (glued) pebbles at 0°, 5°, 10°, and 15°. We digitized 20 evenly spaced points along the body to examine the following characteristics of locomotion: velocity, distance ratio (DR), and wave parameters such as wave amplitude, frequency, and length and assessed whether substrate, incline, or body position affected these parameters. DR, our metric of movement efficiency, was highest on the flat sand condition and lowest on 15° pebble conditions. Efficiency also varied across the body. Velocity followed a similar pattern being highest on sand at 0° and lowest at the steepest inclines. Wave amplitude generally increased toward the tail but was similar across substrates and inclines. Wave frequency was relatively consistent across the body on both pebble substrates, but on sand, frequency was higher toward the head but decreased toward the tail. Wavelengths on sand were the longest at 0° near the head and shorter wavelengths were observed on steeper inclines. Both pebble substrates elicited lower wavelengths that were more similar across the body. Overall, A. rostrata were more effective in navigating compliant substrates but struggled at steeper inclines. Our findings provide insight into locomotor challenges that American eels may encounter as they move from and between bodies of water.

Implication of foam sclerosant inactivation by human whole blood in a laboratory setting.

Background During sclerotherapy, it has been recommended to confirm intravenous placement of the needle by aspirating blood into the sclerosant syringe. This may inactivate some, or all of the sclerosant. Aims To quantify the volume of human blood needed to completely inactivate 1 ml of sodium tetradecyl sulphate, and comparing fresh blood and blood that has been stored in an ethylenediaminetetraacetic acid tube. Methods A series of manual titrations were carried out following a procedure developed at STD Pharmaceutical Products Ltd (Hereford, UK) and listed in the British Pharmacopeia. Three percent of sodium tetradecyl sulphate stock solutions were made with increasing volumes of blood and titrated against benzethonium chloride to determine the active concentration (% w/v) of sodium tetradecyl sulphate remaining in the solution. Results A calculated approximation showed 0.3 ml of blood is required to fully inactivate 1 ml of 3% sodium tetradecyl sulphate when made into a foam. A comparison was made between the use of fresh blood and blood stored in ethylenediaminetetraacetic acid tubes. Blood stored in ethylenediaminetetraacetic acid tubes showed more inactivation of sodium tetradecyl sulphate, but this was not significant at the P ≤ 0.05 level. Conclusion The data from our study have shown that a minimum of 0.3 ml of fresh blood is required to inactivate 1 ml of 3% sodium tetradecyl sulphate as a foam and it is not significantly affected by storing blood in an ethylenediaminetetraacetic acid tube. Our methodology suggests that during foam sclerotherapy treatment, blood should not be aspirated into the syringe to confirm position, and that ultrasound guidance is more appropriate for needle placement.

Diagnosis of stenosis within the popliteal-femoral venous segment upon clinical presentation with a venous ulcer and subsequent successful treatment with venoplasty.

This case study reports the diagnosis and treatment of a lower limb venous ulcer with abnormal underlying venous pathology. One male patient presented with bilateral varicose veins and a right lower limb ulcer. Upon investigation, full-leg duplex ultrasonography revealed total incompetence of the great saphenous vein in the left leg. In the right leg, duplex ultrasonography showed proximal incompetence of the small saphenous vein, and dilation of the anterior accessory saphenous vein, which remained competent. Incidentally, two venous collaterals connected onto the distal region of both these segments, emerging from a scarred, atrophic popliteal-femoral segment. An interventional radiologist performed venoplasty to this popliteal-femoral venous segment. Intervention was successful and 10 weeks post procedure ulceration healed. Popliteal-femoral venous stenosis may be associated with venous ulceration in some cases and may be successfully treated with balloon venoplasty intervention.

Lack of p16 gene mutations in gastric cancers in Kashmir.

BACKGROUND AND AIM: The focus of the study was to investigate the frequencies of homozygous deletions and mutations of p16 gene in gastric carcinomas in the Kashmiri population. METHODS: A total of 84 gastric carcinoma patients were screened by the single strand conformation polymorphism (SSCP) technique and later by DNA sequencing to detect mutations of the p16 gene. Also PCR was applied further to further detect any homozygous deletions. RESULTS: SSCP and DNA sequencing performed encompassing all the three exons of p16 gene could not detect any mutations in any ofl 84 cases. Though we could observe mobility shifts in SSCP of two samples, subsequent DNA sequencing did not show any mutation. Further PCR could not detect any homozygous deletion in P16 in any case. CONCLUSION: Though Kashmir is a high incidence area of gastric carcinomas, p16gene mutations /or deletions do not appear to be involved.