Obstructive Jaundice Due to Tuberculosis of Distal CBD and Periampullary Region Mimickcholangiocarcinoma

Abdominal tuberculosis (TB) commonly affects the intestinal tract, lymph nodes, peritoneum, and solid organs in varying combinations. Hepatobiliary or pancreatic TB is rare and the preoperative diagnosis is difficult. Though rare, there have been a few citations of intrahepatic tuberculosis, but isolated bile duct tuberculosis is extremely rare. Here we report a case of obstructive jaundice which was initially thought to be due to lower-end cholangiocarcinoma but postoperatively it was found to be tuberculosis.Keywords: Bile ducts, obstructive jaundice, tuberculosisNigerian Journal of Surgery, Jan-Jun 2012 | Volume 18 | Issue

Murine Dishevelled 3 Functions in Redundant Pathways with Dishevelled 1 and 2 in Normal Cardiac Outflow Tract, Cochlea, and Neural Tube Development

Dishevelled (Dvl) proteins are important signaling components of both the canonical β-catenin/Wnt pathway, which controls cell proliferation and patterning, and the planar cell polarity (PCP) pathway, which coordinates cell polarity within a sheet of cells and also directs convergent extension cell (CE) movements that produce narrowing and elongation of the tissue. Three mammalian Dvl genes have been identified and the developmental roles of Dvl1 and Dvl2 were previously determined. Here, we identify the functions of Dvl3 in development and provide evidence of functional redundancy among the three murine Dvls. Dvl3−/− mice died perinatally with cardiac outflow tract abnormalities, including double outlet right ventricle and persistent truncus arteriosis. These mutants also displayed a misorientated stereocilia in the organ of Corti, a phenotype that was enhanced with the additional loss of a single allele of the PCP component Vangl2/Ltap (LtapLp/+). Although neurulation appeared normal in both Dvl3−/− and LtapLp/+ mutants, Dvl3+/−;LtapLp/+ combined mutants displayed incomplete neural tube closure. Importantly, we show that many of the roles of Dvl3 are also shared by Dvl1 and Dvl2. More severe phenotypes were observed in Dvl3 mutants with the deficiency of another Dvl, and increasing Dvl dosage genetically with Dvl transgenes demonstrated the ability of Dvls to compensate for each other to enable normal development. Interestingly, global canonical Wnt signaling appeared largely unaffected in the double Dvl mutants, suggesting that low Dvl levels are sufficient for functional canonical Wnt signals. In summary, we demonstrate that Dvl3 is required for cardiac outflow tract development and describe its importance in the PCP pathway during neurulation and cochlea development. Finally, we establish several developmental processes in which the three Dvls are functionally redundant

Regulation of new telomere synthesis in Euplotes

Telomeres are the special DNA-protein complexes which cap the ends of linear eukaryotic chromosomes. The telomeric DNA consists of tandem repeats with one G-rich strand and one C-rich strand. Studies from yeast and ciliates have shown that there is a mechanistic link between synthesis of the G-strand by telomerase and synthesis of the C-strand by DNA polα-primase, which results in coordinated regulation of G- and C-strand synthesis. Until recently the mechanism by which this coordinate regulation is achieved was unclear. However, insight into this aspect of telomere synthesis has come to light in the last six months both from studies with the budding yeast, S. cerevisiae and from my work with the ciliate Euplotes . I have investigated the mechanism of new telomere synthesis in Euplotes by studying the role of the lagging strand replication machinery in C-strand synthesis, and how it contributes to telomere length regulation. In Euplotes, extensive new telomere synthesis occurs during macronuclear development. This is a highly efficient, developmentally regulated process, where an entire telomere is added onto the end of a fragmented chromosome. Prior to new telomere synthesis, telomerase undergoes a programmed developmental switch and assembles into three higher order complexes with the properties required for telomere addition. The large size of the telomerase complexes together with the requirement for DNA polymerase in telomere synthesis, suggested that polα-primase might be a component of the telomerase holoenzyme. I have now shown that in Euplotes there is a direct biochemical interaction between telomerase and the lagging strand synthesis machinery. This interaction is developmentally regulated as it occurs only during the sexual stage of the Euplotes life cycle. My results show that primase is present in all three higher order telomerase complexes but absent from the vegetative telomerase complex. I also show that PCNA is present in the largest of the higher order telomerase complexes. The association of telomerase and lagging strand replication machinery within a complex explains the coordination of G- and C-strand synthesis during new telomere addition in Euplotes

Extranodal involvement in lymphoma – A Pictorial Essay and Retrospective Analysis of 281 PET/CT studies

Objective(s): The aim of this study is to evaluate the role of PET-CT in identification of different patterns of extranodal involvement in Hodgkin’s disease (HD) and Non-Hodgkin’s Lymphoma (NHL) and to enlist the common sites of extranodal involvement in each histological type and compare our results with the existing literature. Methods: In this retrospective study of 281 cases of lymphomas of various histologies, we illustrate the spectrum of PET/CT features of extranodal lymphoma (ENL) of commonly involved organs and compare our result with the literature. Result: Extranodal appearance in lymphoma is strikingly varied. Diffuse large B cell lymphoma (DLBCL) is the commonest histological subtype and gastrointestinal tract is the commonest anatomical subsite in NHL. Skeletal system is the commonest site for involvement in HD. Conclusion: A broad spectrum of extranodal organs is involved in various subtype of lymphoma which can be depicted in PET-CT in the most appropriate manner. Familiarity with the pattern of involvement is essential for comprehensive management

Surgical management of peptic perforation in a tertiary care center: A retrospective study

Background: The purpose of this study is to estimate disease burden, clinical features, and outcome in the emergency surgical management of peptic perforation in a rural government tertiary care center where patients are socioeconomically very poor and also impacted by lack of good quality health‑care facility. Materials and Methods: The study had retrospectively analyzed 121 patients with peptic perforation who had undergone emergency laparotomy at Midnapore medical college, West Bengal, India, from June 2018 to December 2019. All patients >12 years were included in this study. Exclusion criteria were other traumatic and nontraumatic gastrointestinal perforations. Results: The study population had 112 males and 9 females with a mean age of 44.80 ± 15.29 years and maximum incidence in the 6th decade (P = 0.001). Smoking and alcohol were associated with 54.5% and 49.6%, respectively. The symptoms were pain abdomen (100%) with vomiting (38.8%) and fever (33.9%). The signs of hypotension, peritonitis, distension, and pneumoperitoneum were observed in 34.7%, 64.5%, 39.7%, and 83.5%, respectively. Only 20.7% of patients were admitted within the first 24 h. The mean duration of symptoms was 2.3 days. Most perforations were located on the duodenum (74.4%) with duodenal to gastric perforation ratio 2.9:1. The mean size was 1.02 cm. Chest infection (19%) was the most common complication. The mortality rate was 9.1%. The mean length of hospital stay was 11.1 days. Conclusion: Peptic perforation remains a major disease burden in our environment predominantly due to late presentation, leading to high morbidity and mortality

Surgical site infection in emergency and elective patients and it’s major risk factor in resource limited tertiary care center: A multicentric study

Postoperative surgical site infection (SSI) is major threat for surgeons. In this study, we measure the incidence of SSI in emergency and elective surgical patients and evaluation of any significant relation to anemia, hypoalbuminemia, Diabetes mellites, alcohol and tobacco user. This study was a prospective comparative study of 200 patients, studied during a twelve-month duration who were admitted and operated in our departments. Data collected including demographic profile and presence of SSI up to 30 postoperative days. In this prospective study of 200 patients (100 patients in each emergency and elective surgical case) surgical site infection was present in 17% (n=34) of patients, out of 34 SSI patients 64.7% (22 Patients) were male and 35.3% (12 Patients) were female. SSI was present in 73.5% and 26.5% of emergency and elective surgical cases respectively. Emergency and elective surgical cases were compared in SSI and non SSI cases and data showed a statistically significant difference (X2= 9.0716, P value .00256). Patients having SSI were compared with non SSI for anemia, hypoalbuminemia and diabetes mellites data showed statistically significant difference (X2=66.6, P value< 0.00001, X2=78.5, P value< 0.00001 and X2 =61.7, P value< 0.00001 respectively).&nbsp

Construction of a three-dimensional supramolecular network of manganese(II) with an encapsulated croconate dianion

A three-dimensional supramolecular polymer of manganese(II), [{Mn(4,4′-bipy)(H2O)4}(C5O5)(H2O)2] n has been prepared and characterized by X-ray single crystal analysis. The polymer results from the mutual relationship of each coordination unit, [Mn(4,4′-bipy)(H2O)4]2+ through H-bonding between crystalline water and the encapsulated croconate dianion. Solid state thermal investigation shows stepwise elimination of water molecules and the 4,4′-bipyridine ligand

Interactions between Telomerase and Primase Physically Link the Telomere and Chromosome Replication Machinery

In the ciliate Euplotes crassus, millions of new telomeres are synthesized by telomerase and polymerase α-primase during macronuclear development in mated cells. Concomitant with de novo telomere formation, telomerase assembles into higher-order complexes of 550 kDa, 1,600 kDa, and 5 MDa. We show here that telomerase is physically associated with the lagging-strand replication machinery in these complexes. Antibodies against DNA primase precipitated telomerase activity from all three complexes from mated cells but not the 280-kDa telomerase complex from vegetatively growing cells. Moreover, when telomerase was affinity purified, primase copurified with enzyme from mated cells but not with the 280-kDa vegetative complex. Thus, the association of telomerase and primase is developmentally regulated. Intriguingly, PCNA (proliferating cell nuclear antigen) was also found in the 5-MDa complex from mated cells. We therefore speculate that this complex is a complete telomere synthesis machine, while the smaller complexes are assembly intermediates. The physical association of telomerase and primase explains the coordinate regulation of telomeric G- and C-strand synthesis and the efficiency of telomere addition in E. crassus

Tri-filial presentation of familial tuberous sclerosis with renal tumors

Tuberous sclerosis is a rare neuro-cutaneous syndrome with autosomal dominant penetrance. Only some organs are involved, e.g., skin (earthy skin thickenings, ash leaf patches), cerebral cortex (hamartomatous nodules) and kidneys, (angiolipoma, adenocarcinoma). These hamar-tomatous swellings resemble potatoes and hence, referred to as tubers. We herein report on three patients (all familial), father, son and granddaughter, with this rare involvement, from the eastern part of India. The father and son had involvement of only the skin (i.e. nose) and kidneys while the disease penetrated further in the subsequent filial generations with son and granddaughter having skin, brain and bilateral kidney involvement. This kind of tri-filial progression has not till date, been reported from this region, making it an interesting case presentation

Two new supramolecular malonato complexes of manganese(II): synthesis, crystal structure and magnetic property

A mononuclear [Mn(mal)(bipy)(H2O)2] (1) and a dinuclear [Mn2(mal)(phen)3(H2O)2(Cl)]Cl (2) (mal=malonate dianion; bipy=2,2′-bipyridine and phen=1,10-phenanthroline) have been synthesised and structurally characterized by X-ray crystallography. The structure of complex 1 shows that each Mn(II) is linked with one bipy, two water molecules and a malonate ligand forming distorted octahedral environment and each mononuclear fragment through H-bonding interactions form 2D supramolecular network. The structure of complex 2 comprises to an asymmetric dinuclear cation which is bridged by a single anti–anti malonate ligand and chloride anions. The two distorted Mn(II) centres are separated by large distance 6.256(3) Å due to the anti–anti bridging mode. The magnetic behavior of complex 2 studied in the temperature range 300–2 K corresponds to a weak antiferromagnetic coupling through the MnOCOMn anti–anti conformation. The magnetic data were fitted based on H=−2JS1·S2, yielding the intramolecular coupling constant J=−0.35 cm-1 with g=1.92 and R=1.255×10-4. A mononuclear [Mn(mal)(bipy)(H2O)2] (1) and a dinuclear [Mn2(mal)(phen)3(H2O)2(Cl)]Cl (2) (mal=malonate dianion; bipy=2,2′-bipyridine and phen=1,10-phenanthroline) have been synthesised and structurally characterized by X-ray crystallography. The structure of complex 1 shows that each mononuclear fragment through H-bonding interactions forms 2D supramolecular network. The structure of complex 2 comprises to an asymmetric dinuclear cation which is bridged by a single anti–anti malonate ligand and chloride anions. The magnetic behavior of complex 2 studied in the temperature range 300–2 K and it corresponds to a weak antiferromagnetic coupling through the MnOCOMn anti–anti conformation