Formation of Pancreatoduodenal Fistula in Intraductal Papillary Mucinous Neoplasm of the Pancreas Decreased the Frequency of Recurrent Pancreatitis

Intraductal papillary mucinous neoplasms (IPMN) of the pancreas are characterized by proliferation of mucin-secreting cells in the main pancreatic duct (PD) or its branches. The secreted thick mucin usually leads to PD obstruction and dilation. A common complication of IPMN is recurrent acute pancreatitis secondary to poor pancreatic fluid drainage, and rarely, pancreatobiliary and pancreatointestinal fistulae. We describe a unique case of IPMN in a 57-year-old male who was referred to our institution for evaluation of recurrent acute pancreatitis. After extensive evaluation, he was diagnosed with main duct IPMN. Intraductal PD biopsy revealed intestinal type IPMN with intermediate grade dysplasia. Patient was managed clinically by large caliber (10 French) PD stenting which eliminated his recurrent acute pancreatitis. The patient was initially referred for pancreatic resection; however, surgery was aborted and evaluated to be high risk with high morbidity secondary to the extensive adhesions between the pancreas and surrounding structures. Patient remained clinically stable for a few years except for an episode of acute pancreatitis that happened after a trial of stent removal. Subsequently, the patient did well after the PD stent was replaced. Recently, repeat abdominal imaging revealed a large pancreatoduodenal fistula which was confirmed on repeat endoscopic retrograde cholangiopancreatography. We were able to perform pancreatoscopy by advancing a regular upper scope through the fistula and into the PD. Interestingly, the fistula relieved the symptoms of obstruction and subsequently decreased the frequency of recurrent pancreatitis episodes with no further episodes at 6 months follow-up. This case highlights the importance of providing adequate PD drainage to reduce the frequency of recurrent acute pancreatitis in the setting of main duct IPMN, especially if the patient is not a surgical candidate. Also, physicians need to monitor for complications such as fistula formation between the pancreas and surrounding structures in the setting of chronic inflammation due to recurrent episodes of pancreatitis. Early identification of a fistula is important for surgical planning. Furthermore, since recent studies suggested a higher incidence of additional primary malignancies in patients with IPMN of the pancreas compared to the general population, patients may be considered for screening for other primary malignancies

Photon temporal modes: a complete framework for quantum information science

Field-orthogonal temporal modes of photonic quantum states provide a new framework for quantum information science (QIS). They intrinsically span a high-dimensional Hilbert space and lend themselves to integration into existing single-mode fiber communication networks. We show that the three main requirements to construct a valid framework for QIS -- the controlled generation of resource states, the targeted and highly efficient manipulation of temporal modes and their efficient detection -- can be fulfilled with current technology. We suggest implementations of diverse QIS applications based on this complete set of building blocks.Comment: 17 pages, 13 figure

The Arabidopsis JAGGED gene encodes a zinc finger protein that promotes leaf tissue development

Important goals in understanding leaf development are to identify genes involved in pattern specification, and also genes that translate this information into cell types and tissue structure. Loss-of-function mutations at the JAGGED (JAG) locus result in Arabidopsis plants with abnormally shaped lateral organs including serrated leaves, narrow floral organs, and petals that contain fewer but more elongate cells. jag mutations also suppress bract formation in leafy, apetala1 and apetala2 mutant backgrounds. The JAG gene was identified by map-based cloning to be a member of the zinc finger family of plant transcription factors and encodes a protein similar in structure to SUPERMAN with a single C2H2-type zinc finger, a proline-rich motif and a short leucine-rich repressor motif. JAG mRNA is localized to lateral organ primordia throughout the plant but is not found in the shoot apical meristem. Misexpression of JAG results in leaf fusion and the development of ectopic leaf-like outgrowth from both vegetative and floral tissues. Thus, JAG is necessary for proper lateral organ shape and is sufficient to induce the proliferation of lateral organ tissue

Aortic arch tortuosity with PHACE syndrome : a rare case scenario

PHACE syndrome is a rare neurocutaneous disorder characterised by an association of infantile haemangiomas with structural anomalies of brain, cerebral vasculature, eye, aorta and chest wall.1 Coarctation of aorta (COA) is most the common cardiac anomaly reported in PHACE syndrome. COA or interrupted aortic arch in PHACE is unique and complex both in location and character compared to the typical coarctation anatomy. Arterial tortuosity of the cerebral vasculature has been well described in literature in PHACE syndrome. We present a rare case of tortuous aortic arch continuing as descending aorta in an infant with PHACE syndrome.peer-reviewe

INSIGHT OF METHANOLIC EXTRACT OF VENTILAGO MADERASPATANA LEAVES ON HEPATOPROTECTIVE ACTIVITY UNDER STREPTOZOTOCIN-INDUCED DIABETIC RATS

Objective: The methanolic leaf extract of Ventilago maderaspatana (MEVML, 200 mg/kg body weight [b.w.]) was investigate to hepatoprotective activity under streptozotocin-induced (45 mg/kg b.w.) diabetic (Di) rats. Methods: In the present study, we determined the blood glucose levels, b.w., insulin, creatinine, and bilirubin levels in normal, Di, Di treated with MEVML and positive control rats. Results: The Di rats shown adverse changes in blood glucose levels, b.w., insulin, creatinine, and bilirubin levels when compared to other group rats. Reverse the adverse changes in the above parameters when treated the Di rats with MEVML Conclusion: The MEVML shown anti-diabetic activity and reverse the adverse changes in the above parameters in liver so that the MEVML supported the traditional claim of the hepatoprotective activity under Di condition