A rare case of squamous cell carcinoma of the scrotum with infiltration into penis

Squamous cell carcinoma of the scrotum is a tumour that is of interest for clinical and historical reasons.This is a rare case of carcinoma of scrotum invading the penis.We describe, a case of  scrotal and penile squamous cell carcinoma. An old case of balanitis xerotica obliterans for which he had undergone Johannson’s urethroplasty earlier.&nbsp

Case report: multiple gastric adenomatous polyps- a rare occurrence

Multiple gastric polyps usually occur as a part of multiple polyposis syndrome of the gut. Multiple gastric polyps are rarely encountered in general surgical practice, with an incidence of <1% including those detected incidentally. Most common multiple gastric polyps are hyperplastic polyps. Multiple adenomatous gastric polyps without polyps anywhere else in gut is a very rare occurrence. Aggressive approach with total gastrectomy should be done to all cases of multiple adenomatous gastric polyps due to the high chances of developing cancer even if it localised

Coupling of c-Src to large conductance voltage-and Ca2+-activated K+ channels as a new mechanism of agonist-induced vasoconstriction

The voltage-dependent and Ca(2+)-activated K(+) channel (MaxiK, BK) and the cellular proto-oncogene pp60(c-Src) (c-Src) are abundant proteins in vascular smooth muscle. The role of MaxiK channels as a vasorelaxing force is well established, but their role in vasoconstriction is unclear. Because Src participates in regulating vasoconstriction, we investigated whether c-Src inhibits MaxiK as a mechanism for agonist-induced vasoconstriction. Functional experiments in human and rat show that inhibitors of Src (Lavendustin A, PP2) but not inactive compounds (Lavendustin B, PP3) induce a pronounced relaxation of coronary or aortic smooth muscle precontracted with 5-hydroxytriptamine, phenylephrine, or Angiotensin II. Iberiotoxin, a MaxiK blocker, antagonizes the relaxation induced by Lavendustin A or PP2, indicating that c-Src inhibits the Iberiotoxin-sensitive component, likely MaxiK channels. In agreement, coronary muscle MaxiK currents were enhanced by Lavendustin A. To investigate the molecular mechanism of c-Src action on MaxiK channels, we transiently expressed its alpha subunit, hSlo, with or without c-Src in HEK293T cells. The voltage sensitivity of hSlo was right-shifted by approximately 16 mV. hSlo inhibition by c-Src is due to channel direct phosphorylation because: (i) excised patches exposed to protein tyrosine phosphatase (CD45) resulted in a partial reversal of the inhibitory effect by approximately 10 mV, and (ii) immunoprecipitated hSlo channels were recognized by an anti-phosphotyrosine Ab. Furthermore, coexpression of hSlo and c-Src demonstrate a striking colocalization in HEK293T cells. We propose that MaxiK channels via direct c-Src-dependent phosphorylation play a significant role supporting vasoconstriction after activation of G protein-coupled receptors by vasoactive substances and neurotransmitters

Accelerated versus standard Ponseti cast in the management of idiopathic congenital talipes equinovarus at a tertiary care centre in North India: a comparative study

Background: Congenital talipes equinovarus varus (CTEV) is one of the most common congenital anomalies of foot and ankle. With a male dominance pattern, this deformity is bilateral in around 50% cases. It is characterized across varying degrees and severity of components manifesting with: forefoot adductus, midfoot cavus, hindfoot varus and hindfoot equinus. Severity is accessed using Pirani score (0 to 6). Insights into the basic patho-anatomy of this complex 3-dimensional deformity has helped to correct it using the method given by Ignacio Ponseti, a Spanish orthopedician, in which serial manipulations of foot are done and weekly casts are applied, followed by a tendoachilles tenotomy in selected cases to correct the equinus component which is then followed by splintage of the feet in foot-ankle orthosis initially for 23 hours day for 3 months and then 12 hours a day for 3 years. Parental counselling regarding the importance of compliance with maintenance braces remains the most important component of treatment. Methods: This was a double blinded randomized prospective study including 40 patients with 61 feet of only idiopathic clubfoot, conducted in the department of orthopaedics, government medical college, Jammu over a period of 01 year. Results: The mean days of plaster duration in accelerated casting group was 18.45 days as compared to 47.25 days in standard casting group (statistically significant, p<0.05). Also, Pirani score at the end of last follow up was comparable in both the groups. Tenotomy rate was slightly higher in accelerated casting group (89.5%) as compared to standard group (85.7%) which may be attributed to higher initial Pirani score in former (5.5) as compared to later (5.0). Conclusions: The clubfoot in developing countries has social stigma, the early and the promising result of the accelerated method of Ponseti casting has a dramatic impact on both parents and the treating orthopaedician. The accelerated Ponseti casting has remarkably reduced the overall duration of the treatment of Ponseti casting without any complication

Perioperative Changes in Plasma Nitrite and IL-6 Levels Predict Postoperative Atrial Fibrillation (POAF) and Acute Kidney Injury (AKI) after Cardiac Surgery.

Background: Postoperative atrial fibrillation (POAF) and acute kidney injury (AKI) are common yet significant complications after cardiac surgery, with incidences of up to 40% for each. Here, we assessed plasma nitrite and serum interleukin-6 (IL-6) levels before and after cardiac surgery to quantify the extent to which oxidative stress and inflammation contribute to POAF and AKI occurrence. Methods: We prospectively enrolled 206 cardiac surgical patients. Plasma nitrite and serum IL-6 levels were determined preoperatively and at 24 h, 48 h and 72 h postoperatively. The patients had continuous EKG monitoring for occurrence of POAF, while daily serum creatinine was measured for determination of stage 1 + AKI. Results: Postoperatively, 78 (38%) patients experienced AF, and 47 (23%) patients experienced stage 1 + AKI. POAF analysis: Age, ACE-inhibitor use, valve surgery and percent change in baseline plasma nitrite at 24 h postoperatively were associated with POAF in multiple logistic regression analysis. The inclusion of this new biomarker significantly improved the POAF prediction model (AUC 0.77 for clinical risk factors alone, to AUC 0.81). AKI analysis: A history of diabetes mellitus was associated with AKI in multiple logistic regression analysis, and the addition of preoperative IL-6 levels improved the prediction model for AKI occurrence (AUC 0.69 to AUC 0.74). Conclusions: We previously observed selective upregulation of NADPH oxidase isoform 4 (NOX4) in patients with AF, a critical causal role of NOX4 for AF in zebrafish and a robust inhibitory effect of nitric oxide (NO) on NOX4. Our data innovatively demonstrate that a reduction in circulating nitrite levels, likely implicative of elevated NOX4-mediated oxidative stress, independently associates with POAF and improves POAF prediction, whereas the inclusion of circulating IL-6 levels improves the prediction model for AKI. Therefore, therapeutic strategies to mitigate these pathophysiological sequalae of surgical stress may reduce the incidence of severe postoperative complications of POAF and AKI

Virgin Coconut Oil Solubilised Curcumin Protects Nephropathy in Diabetic Rats

Nephropathy is considered as one of the major secondary complications in diabetic patients. The goal of the current study was to perform preclinical screening of virgin coconut oil (VCO) solubilised curcumin in diabetes-induced nephropathy. Male albino rats of the Wistar strain were injected with a single dose of streptozotocin (STZ) (60 mg/kg/i.p). Diabetic nephropathy (DN) was developed after 4 weeks of STZ injection and the treatment was continued for further 4 weeks (i.e 8 weeks). DN rats were treated with VCO (8ml), VCO solubilised curcumin at a low dose (0.66mg/4ml/kg) and high dose (1.32mh/8ml/kg). DN was assessed by evaluating biochemical parameters such as blood glucose, total protein, albumin, urea, creatinine, and total bilirubin from serum and urine sample, whereas the activity of endogenous antioxidant and membrane- bound phosphatases were studied from kidney homogenate. VCO-solubilised curcumin significantly reduced blood and urine glucose level, increased body weight and reduced kidney weight and kidney hypertrophy. It also normalized urine volume, albumin, creatinine, total protein, total bilirubin and urea levels. Treatment also significantly improved antioxidants and membrane-bound phosphatase activities. In conclusion, compared to the individual treatment group, VCO solubilized curcumin significantly modifies the altered parameters toward normal. The potent antioxidant activity of these substances may be to blame for this defense. Keywords: Virgin coconut oil, curcumin, diabetes, nephropathy, antioxidant

Spinal neuromodulation mitigates myocardial ischemia-induced sympathoexcitation by suppressing the intermediolateral nucleus hyperactivity and spinal neural synchrony

IntroductionMyocardial ischemia disrupts the cardio-spinal neural network that controls the cardiac sympathetic preganglionic neurons, leading to sympathoexcitation and ventricular tachyarrhythmias (VTs). Spinal cord stimulation (SCS) is capable of suppressing the sympathoexcitation caused by myocardial ischemia. However, how SCS modulates the spinal neural network is not fully known.MethodsIn this pre-clinical study, we investigated the impact of SCS on the spinal neural network in mitigating myocardial ischemia-induced sympathoexcitation and arrhythmogenicity. Ten Yorkshire pigs with left circumflex coronary artery (LCX) occlusion-induced chronic myocardial infarction (MI) were anesthetized and underwent laminectomy and a sternotomy at 4−5 weeks post-MI. The activation recovery interval (ARI) and dispersion of repolarization (DOR) were analyzed to evaluate the extent of sympathoexcitation and arrhythmogenicity during the left anterior descending coronary artery (LAD) ischemia. Extracellular in vivo and in situ spinal dorsal horn (DH) and intermediolateral column (IML) neural recordings were performed using a multichannel microelectrode array inserted at the T2-T3 segment of the spinal cord. SCS was performed for 30 min at 1 kHz, 0.03 ms, 90% motor threshold. LAD ischemia was induced pre- and 1 min post-SCS to investigate how SCS modulates spinal neural network processing of myocardial ischemia. DH and IML neural interactions, including neuronal synchrony as well as cardiac sympathoexcitation and arrhythmogenicity markers were evaluated during myocardial ischemia pre- vs. post-SCS.ResultsARI shortening in the ischemic region and global DOR augmentation due to LAD ischemia was mitigated by SCS. Neural firing response of ischemia-sensitive neurons during LAD ischemia and reperfusion was blunted by SCS. Further, SCS showed a similar effect in suppressing the firing response of IML and DH neurons during LAD ischemia. SCS exhibited a similar suppressive impact on the mechanical, nociceptive and multimodal ischemia sensitive neurons. The LAD ischemia and reperfusion-induced augmentation in neuronal synchrony between DH-DH and DH-IML pairs of neurons were mitigated by the SCS.DiscussionThese results suggest that SCS is decreasing the sympathoexcitation and arrhythmogenicity by suppressing the interactions between the spinal DH and IML neurons and activity of IML preganglionic sympathetic neurons