Torsion of Appendix Epiploica: A Rare Cause of Acute Right Iliac Fossa Pain

Abstract Acute appendicitis is the most common cause of right iliac fossa pain. However, if the appendix is normal at surgery, the surgeon has to search for other causes of acute abdominal pain including rare etiologies. Awareness of all causes of acute right iliac fossa pain and a high index of suspicion is essential for diagnosis of rare causes like torsion of appendix epiploica In addition, in some patients, two pathologies causing acute pain may coexist. It is to the authors' knowledge that the simultaneous occurrence of torsion of appendix epiploica and acute appendicitis in a patient has not been previously reported, and is therefore discussed in this report. From th

Data from: Ultra structural changes occurring in duct ectasia and periductal mastitits and their significance in etiopathogenesis

Introduction: Duct Ectasia (DE) and Periductal Mastitis (PDM) are the most common benign breast conditions seen in women. The etiopathogenesis of these entities is still not clear and most of the theories regarding the causation are based on the histological features as seen on light microscopy. The ultramicroscopic features associated with these conditions that may give more insight to the etiopathogenesis are unknown. Aim: To study the ultrastructural changes occurring in mammary duct cones in patients with DE and PDM using Transmission Electron Microscopic (TEM). Method: Major ducts removed by radical duct excision from 21 patients with final histopathological diagnosis of DE and PDM were subjected to TEM study with 2 normal duct samples as controls Results: The TEM features of DE were denudation of the epithelial cells with focal loss of microvilli, widening of the inter-epithelial junctions with focal disruption of the T bars, periductal collagenisation without inflammation; and features suggestive of Epithelial Mesenchymal Transition (EMT). PDM features are intact epithelial lining with proliferative epithelium and periductal collagenisation with inflammation. Conclusions: Based on the TEM findings, we suggest that DE and PDM are two different entities. EMT is a novel finding observed in DE in this study

Potential of magnetic resonance spectroscopy to detect metastasis in axillary lymph nodes in breast cancer

Focused pathological evaluation of axillary lymph nodes in breast cancer is gaining importance. Nuclear magnetic resonance (NMR) spectroscopy that assesses the whole of the specimen has the potential in evaluating micrometastases. The biochemical changes associated with breast cancer metastases in axillary nodes by in vitro NMR and its use in the detection of axillary metastases in a clinical setting in comparison with conventional histopathology is presented in this study. Eighty-eight lymph nodes obtained from 30 patients with breast cancer were investigated. Histopathology revealed metastases in 20 nodes from 11 patients, while in vitro NMR spectroscopy revealed metastases in 22 nodes. Out of these 22 nodes, 16 were the same, which showed metastases on histopathology, while 6 nodes have shown metastases only on in vitro magnetic resonance spectroscopy (MRS). These 6 nodes with suspicion of metastases on MRS were subjected to reevaluation with serial sectioning and immunohistochemistry, but no additional metastases were revealed. Forty metabolites could be identified from the MR spectrum of lymph nodes. The levels of the glycerophosphocholine-phosphocholine (GPC-PC), choline, lactate, alanine and uridine diphosphoglucose were elevated significantly in nodes with metastases. In addition, the intensity ratio of GPC-PC/threonine (Thr) was higher in nodes with metastases, and using this as marker, MRS detected the axillary metastases with a sensitivity, specificity and accuracy of 80%, 91% and 88%, respectively. Neoadjuvant chemotherapy (NACT) lowered the concentrations of GPC-PC and GPC-PC/Thr ratio. The accuracy of MRS in detecting metastases was 75% in patients who received NACT (n=9) as compared to 96% in those who did not (n=21). Our results demonstrate the potential of in vitro MRS in characterizing the metabolite profile of the axillary nodes with breast cancer metastases. It detected axillary metastases with reasonable accuracy and can be complementary to histopathological evaluation and immunohistochemistry

Ultra structural changes occurring in duct ectasia and periductal mastitis and their significance in etiopathogenesis - Fig 2

<p>B1- Low power electro micrographic view of a dilated duct with periductal tissue showing focal denudation [<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0173216#pone.0173216.ref001" target="_blank">1</a>] of lining epithelium with intraluminal secretions[S] containing epithelial fragments [F]. Around the duct there is collagen deposition. [x1100]; B2- The epithelial cells in this show large number of vacuoles [V] and dense bodies [indicated by the arrows]. E- epithelial cell. [x5000]; B3- The duct epithelial cell [E] shown in the electro micrograph has elongated nucleus, intracytoplasmic fibrils [f] and intraluminal projections [indicated by the arrows] of the cytoplasm suggestive of mesenchymal transformation of the epithelial cell. [x3200]; B4- This electro micrograph depicts focal distortion of terminal bar [indicated by the arrow] and widening of the interepithelial junction [W]. E –epithelial cells. [x8000]; B5- This electro micrograph shows lifting of the epithelium from the basal lamina [arrow] and duplication of the basal lamina[D]. [x2550]; B6- The above electro micrograph shows periductal tissue filled with thick and thin collagen fibres indicative of active collagenisation. [x2550]; B7- Dilated lymphatic vessel [Ly] with the endothelial cell [En] in the periductal tissue seen in this electro Micrograph. [x1100].</p

Prevention of burst abdominal wound by a new technique: a randomized trial comparing continuous versus interrupted X-suture

Background: Abdominal wound dehiscence is a common complication of emergency laparotomy in Indian setup. It's prevention is important to reduce post operative morbidity and mortality Research Hypothesis: The application of interrupted X-sutures reduces the risk of burst in midline laparotomy wounds. Aims: To compare the risks of burst with continuous versus interrupted suturing in midline laparotomy wounds. Setting: Surgical Wards of All India Institute of Medical Sciences (AIIMS), a tertiary care center. Design: Open randomised trial with two arms. Material and Methods: One hundred patients undergoing emergency laparotomy and 110 patients undergoing elective laparotomy through a midline vertical incision were randomized after informed consent, to either a continuous closure or an interrupted X technique. Main Outcome Variable: The risk of burst abdomen diagnosed by a consultant. Predictor Variables: intraperitoneal sepsis, abdominal distension, cough, diabetes, malignancy, anaemia, hypoxia, uraemia, hypoalbuminaemia. Statistical Analysis: The risk of burst in each group and relative risk (RR) of burst (using continuous group as the reference category) were caluculated. Results: There were one burst (out of 46) in the X suture group and 8 bursts (out of 54) in the continuous arm in the emergency group. The RR for burst (continuous group as the reference category) was 0.15 (95% C.I. : 0.02 to 1.13, P=0.028). Conclusion: The risk of burst in the emergency group is less with interrupted X method of closure. Sepsis, cough, anaemia, malnutrition and abdominal distension are significant risk factors for burst