Atypical leiomyoma: unusual locations and findings coupled with uncommon presentation

Extrauterine leiomyomas are a rare phenomenon, and they present a great diagnostic challenge. Retroperitoneal leiomyomas remain asymptomatic for a variable period and usually present with wide variety of signs and symptoms. A 51 years old female was multiparous and had undergone a total laparoscopic hysterectomy along with a bilateral salpingo-oophorectomy about four years ago. She visited the outpatient department of a tertiary care hospital complaining of something coming out per vaginum and expressed difficulty in passing urine and also complained of stress urinary incontinence. Bimanual pelvic examination, ultrasonography (USG) and Magnetic resonance imaging (MRI) revealed a large oval shaped well defined solid mass completely filling the vaginal canal while compressing urinary bladder. Tumor marker levels were normal. Laparotomy with adhesiolysis and complete excision of retroperitoneal mass was performed. Frozen section followed by histopathology and immunohistochemistry confirmed that the mass was a leiomyoma. After surgical intervention and removal of mass, the symptoms dissipated and patient had a complete recovery. Despite hysterectomy the manifestation of leiomyoma appears to be apparent. Surgical excision of the mass appeared to be the correct move forward after the leiomyoma was diagnosed with the help of the MRI and the USG

Use of intrauterine balloon tamponade in successful conservative management of life threatening menorrhagia in a patient with idiopathic thrombocytopenic purpura and severe anemia

A 45-year-old woman was brought into the emergency ward of a tertiary care hospital. The patient gave a history of excess bleeding and passage of clots per vaginum since the past 15 days. The patient had a history of severe headaches, body ache, giddiness and vomiting. She was diagnosed with idiopathic thrombocytopenic purpura (ITP) and severe anemia six months before this incidence. The authors performed a diagnostic pelvic and transvaginal ultrasound and reported the presence of uterine fibroids. They determined that these fibroids had aggravated the bleeding which was caused by ITP. The diagnosis of ITP coupled with severe anemia prevented the authors from using the traditional approach of a hysterectomy in such a case. She was administered tranexamic acid, testosterone enanthate, blood, intravenous immunoglobulins, steroids and platelets transfusion. Uterine artery embolization (UAE) was tried for arresting menorrhagia, but was unsuccessful. Finally, a Bakri® balloon, normally used for management of post-partum hemorrhage (PPH), was inserted and retained for 48 hrs.. The bleeding gradually ceased and significant improvements in hematocrit and platelet count were observed. However, the patient then suffered from a deep vein thrombosis (DVT) in the lower extremity, which was treated with low molecular weight heparin (LMWH), a thrombectomy and an Inferior vena cava Filter. Patient was advised a hysterectomy to curb her symptoms, however, she was too exhausted of surgical procedures and refused. Therefore, the authors decided to employ the use of Selective Estrogen Receptor Molecule Therapy (SERM). 3-months post-intervention, patient is thriving and stable

The role of dendritic cells in the sepsis-induced immunosuppression

The present study comprises of two parts. The first part deals with studies on the role of DCs during polymicrobial sepsis and the second part includes the exploitation of BMDCs as therapeutic agents to prevent the sepsis-induced immunosuppression. The data obtained from the first part indicated that the sepsis induced altered phenotypic and functional changes in the splenic and the lymph node DCs. There was marked maturation of DCs in the spleen and in the lymph nodes but this process of maturation occurred later in lymph nodes than in the spleen. The splenic DCs developed an altered cytokine secretion pattern, which was associated with the inability of splenic DCs to produce Th1-type cytokines such as IL-12 but released high levels of IL-10. This impairment of IL-12 synthesis was independent from endogenously produced IL-10 as neutralization of IL-10 did not restore the IL-12 secretion by DCs. But IFN-g treatment restored in part the IL-12 production by splenic DCs only during early sepsis. In addition, the splenic CD4+CD8- and CD4-CD8+ subpopulations were lost during sepsis, and the remaining DCs showed a reduced capacity for allogeneic T cell activation associated with decreased IL-2 synthesis. Thus, during sepsis DCs acquire a phenotype that might favor the development of Th2 and/or Treg cells and might inhibit effective immunity against the bacterial infection through Th1 cell polarization. The data obtained from the second part highlighted that the administration of competent BMDCs into septic mice changed the cytokine milieu in the spleen, representing a main secondary lymphoid organ situated near to the site of infection. The instillation of competent BMDCs resulted in the diminished loss of splenocytes and in reduced IL-10 production by these cells. The diminished loss of splenocytes was associated with an increased total T cell number in the spleen. In addition to the reduced IL-10 production by splenocytes mediated by the administration of BMDCs, a reduced secretion of TNF-a and IFN-g was also observed. Moreover, the reduced IL-10 production by splenocytes was not dependent on the IL-12 secreted by injected BMDCs. These changes in the spleen cytokine environment might favor the development of a Th1 response, which is required for the effective immunity against the bacterial infection. The present findings reinforce the idea that DCs are affected by sepsis and their replacement has some potentially beneficial contributions to the host’s response to infectious challenge. The present data are also in accord with an emerging understanding of the critical role played by DCs in the development of the proper Th1/Th2 cytokine balance during sepsis syndrome in order to ward off the invading bacteria. Thus, these data suggest that DCs are critical cells at the boundary between the innate and adaptive immune response and play an important role in bacterial responses

Effect of Drip Irrigation and Polythene Mulch on the Fruit Yield and Quality Parameters of Mango (Mangifera indica L.)

A field experiment was carried out at Horticultural Research Farm, Precision Farming Development Centre, Department of Horticulture, Indira Gandhi Krishi Vishwavidyalaya, Raipur, Chhattisgarh during the year 2009- 2010 in Randomized Block Design with three replications and ten treatment combinations ( 100%, 80%, 60%, and 40% water through drip irrigation system with and without polythene mulch + Basin irrigation with and without mulch). Fruits characters, yield and yield attributing parameter were higher under drip irrigation with 0.6 V volume of water + polythene mulch (T8) and the same characters were lowest under control (Basin irrigation with V- volume of water). Application of black plastic mulch with drip irrigation system can conserve moisture, check the growth of weeds and improve the fruit yield and quality. Water use efficiency was higher under drip irrigation with 0.6 V volume of water + polythene mulch and low under basin irrigation with V volume of water. The net income and benefit cost ratio was also higher under the treatment T8 as compared to surface method of irrigation

Rapid and even spreading of complex fluids over a large area in porous substrates

Rapid and even spreading of complex fluids over a large area on substrates like paper is required for chemical and biological sensing applications. Non-Newtonian flow behavior and the presence of multi-phase components pose a significant challenge to uniform flow in porous media. Specifically in the case of blood, for biosensing applications, fast spread on a large area is required to avoid coagulation and non-uniform component spread. In this work, we have developed a filter paper-based device to resolve this spreading challenge. We sandwich the filter paper between a matrix of nanofibrous membrane backed by polyethylene terephthalate (PET) sheets, forming a multi-scale porous network: one within the filter paper and the other between the PET sheet and the filter paper. By doing so, we decrease the overall resistance to flow while maintaining the same capillary suction pressure to obtain a quick, uniform spread of dyed liquids, milk solutions, and whole blood. The device design and concepts used here can be used in paper microfluidic applications and to develop devices for dried blood spot analysis, which utilize this fast flow while maintaining even spreading over a large area

Unusual metastatic sex cord stromal tumor - staging and response assessment

Metastatic sex cord stromal tumor (SCST) is rare and contributing <1% of ovarian tumors. A 42-year-old female presented with lower abdominal pain for 2 months. Ultrasonography revealed masses in the abdominal and pelvic. USG guided biopsy from the pelvic mass revealed SCST. For staging, whole body F-18 fluorodeoxyglucose positron emission tomography-computed tomography was performed and revealed heterogenous mildly FDG avid retroperitoneal and bilateral pelvic masses with lung nodules. To confirm the nature of the lung nodule; PET-CT guided biopsy performed and revealed metastatic SCST. After three cycle of chemotherapy, clinical, biochemical and imaging show partial response to treatment

Atrial myxoma causing cerebral embolic ischemic stroke as the first presentation in an apparently asymptomatic young male with birth asphyxial injury: a case report

A myxoma is the most common primary tumor of the heart. It has been reported as the source of a cardiogenic embolism. Therefore, it is important for clinicians to detect the myxoma early to prevent complications like cerebral embolic stroke. This report presents the case of a 40-year-old male with birth asphyxial injury whose first clinical manifestation of atrial myxoma was an ischemic stroke. Atrial myxoma was later confirmed as the cause of his symptoms by echocardiography and cardiac CT scan along with Doppler studies

Imaging resemblance but diagnostic disparity in cervix cancer: a rare case report

F-18 FDG PET-CT is an establish modality for staging of cervical cancer. The high uptake value in PET with no evidence of necrosis in CECT is generally understood malignant pathology in known cancer patients. A 47 year-old-female with cervix carcinoma underwent staging FDG PET-CT. It showed FDG avid primary lesion in cervix with FDG avid pelvic, retroperitoneal, mediastinal and supraclavicular lymph nodes. USG guided FNA from the supraclavicular lymph node revealed tuberculosis. Now patient scheduled for ATT and chemotherapy

RESEARCH ON FORMULATION AND EVALUATION OF INSITU MUCOADHESIVE NASAL GELS OF METOCLOPRAMIDE HYDROCHLORIDE

ABSTRACT The prolonged residence of drug formulation in the nasal cavity is of utmost importance for intranasal drug delivery. The objective of the present investigation was to develop a mucoadhesive in situ gel with reduced nasal mucocilliary clearance in order to improve the bioavailability of the antiemetic drug, Metoclopramide Hydrochloride. The in situ gelation upon contact with nasal mucosa was conferred via the use of the thermogelling Methyl cellulose whereas mucoadhesion and drug release enhancement were modulated via the use of sodium alginate and polyethylene glycol polymers respectively. The results revealed that the mucoadhesive polymer increased the gel viscosity but reduced its sol gel transition temperatures and the drug release. The inclusion of polyethylene glycol polymer counteracted the effect of mucoadhesive polymer where by it decreased the gel consistency and increased the sol gel transition as well as in vitro drug diffusion. The in vitro tests performed for mucoadhesive strength and drug diffusion showed that nasal in situ gelling formulations prepared are having good mucoadhesive strength with nearly100percente drug diffusion within four hours. So this study points to the potential of mucoadhesive in situ nasal gel in terms of ease of administration, accuracy of dosing, prolonged nasal residence and improved nasal bioavailability.  Keywords: Nasal Gel, Metoclopramide Hydrochloride, Methyl Cellulose, Mucocilliary Clearance