High Grade Dysplastic Villous Adenoma Arising from a Giant Hamartomatous Polyp- A Rare Case Presentation

Adenomatous polyps can be found throughout the colon, most commonly in right colon. Microscopically they are classified as tubular, villous or tubulovillous subtypes. Tubular adenomas are the most common subtype with villous component less than 25%. Tubulovillous adenomas have a villous component that accounts for 25-75%, while villous adenomas have a villous component that accounts for more than 75% of the polyp. Peutz-Jeghers syndrome which is an autosomal dominant condition is characterised by gastrointestinal hamartomatous polyp with distinctive arborization of smooth muscle within the lamina propria. Peutz-Jeghers type polyp is a hamartomatous polyp without associated mucocutaneous pigmentation or a family history of Peutz-Jeghers syndrome. In the present case study, a 82-year-old male presented with the chief complaint of constipation and abdominal distension since six months. A polypoidal rectal growth was identified on sigmoidoscopy. The clinical diagnosis of mid rectal growth with acute colonic obstruction was made. Positron Emission Tomography and Computed Tomography (PET CT) was done which was suggestive of malignancy and therefore, Hartmann’s procedure was performed and lesion was excised. On gross examination, a portion of large intestine including sigmoid colon and rectum was received and a pedunculated polypoidal lesion measuring 4.5×3.5×3 cm along with stalk measuring 2.5 cm was seen. On microscopy, the polyp with extensive arborization of muscularis mucosa into the lamina propria was seen with one area showing features of villous adenoma with high-grade dysplasia. Hence, a final diagnosis was given as villous adenoma with high grade dysplasia arising from a hamartomatous polyp consistent with Peutz-Jeghers polyp. The identification of a villous adenoma with high-grade dysplasia in a Peutz-Jegher type polyp is essential in such situations since it is a precursor of invasive malignancy

Experimental Investigation on Aerodynamic Characteristics for 3D Bluff Bodies: Pentagon, T, C and L-Shape Buildings

Tall buildings are mostly sensitive to wind loads and the effect of wind varies in accordance with the location, shape and height of the building. It is of utmost importance to have an aerodynamically modified building in order to reduce the wind loads on tall buildings. For the present study, a sequence of wind tunnel tests was carried out for the different building of various forms such as Pentagon, T, C and L. This paper focuses on finding the aerodynamic coefficient which includes drag, lift and torsional moment coefficients. The wind tunnel is operated at a wind velocity of 10 m/s and the building models are tested for different wind angles 0˚, 45˚, 90˚, 135˚ and 180˚. From the test results, it is concluded that pentagon plan shape building performs better than other shapes against aerodynamics forces

Efficient Concurrency Control for Broadcast Environments

A crucial consideration in environments where data is broadcast to clients is the low bandwidth available for clients to communicate with servers. Advanced applications in such environments do need to read data that is mutually consistent as well as current. However, given the asymmetric communication capabilities and the needs of clients in mobile environments, traditional serializability-based approaches are too restrictive, unnecessary, and impractical. We thus propose the use of a weaker correctness criterion called update consistency and outline mechanisms based on this criterion that ensure (1) the mutual consistency of data maintained by the server and read by clients, and (2) the currency of data read by clients. Using these mechanisms, clients can obtain data that is current and mutually consistent "off the air", i.e., without contacting the server to, say, obtain locks. Experimental results show a substantial reduction in response times as compared to existing (serializabilit..

Abstract Efficient Concurrency Control for Broadcast Environments

A crucial consideration in environments where data is broad-cast to clients is the low bandwidth available for clients to communicate with servers. Advanced applications in such environments do need to read data that is mutually consis-tent as well as current. However, given the asymmetric com-munication capabilities and the needs of clients in mobile en-vironments, traditional serializability-based approaches are too restrictive, unnecessary, and impractical. We thus pro-pose the use of a weaker correctness criterion called update consistency and outline mechanisms based on this criterion that ensure (1) the mutual consistency of data maintained by the server and read by clients, and (2) the currency of data read by clients. Using these mechanisms, clients can obtain data that is current and mutually consistent “off the air”, i.e., without contacting the server to, say, obtain locks. Experimental results show a substantial reduction in re-sponse times as compared to existing (serializability-based) approaches. A further attractive feature of the approach is that if caching is possible at a client, weaker forms of currency can be obtained while still satisfying the mutual consistency of data.

Management of Choledochal Cysts at a Tertiary Care Centre: A Nine-Year Experience from India

Background. Although choledochal cyst disease is seen predominantly in childhood, it is becomingly increasingly diagnosed in adult patients. Methods. Data of 36 patients with choledochal cysts managed in our institute between January 2010 and December 2018 were retrospectively analyzed. Results. Median age at presentation was 37 years (range: 13–72 years). Female-to-male ratio was 3.5 : 1. All patients were symptomatic, and abdominal pain was the most common symptom. 72.2% had other associated conditions. There was a considerable delay from the onset of symptoms to referral, median duration being 348 days. There were 28 cases of type I (77.8%), 5 cases of type IVA (13.9%), and 3 cases of type IVB (8.3%). Cyst excision with Roux-en-Y hepaticojejunostomy was performed in 29 (80.55%) cases. This procedure was combined with a left lateral sectionectomy, left hepatectomy, and radical cholecystectomy in 1, 2, and 1 cases, respectively. Lilly’s technique was used in 2 cases, and cyst excision with hepaticoduodenostomy was performed in 1 case. Early complications were seen in 21 patients (58.3%), and late complications were seen in 5 patients (13.8%). 2 patients were found to have associated malignancies. One patient was detected to have cholangiocarcinoma in the resected liver incidentally, and another patient was diagnosed to have gall bladder cancer intraoperatively. Conclusion. Choledochal cysts should be considered in the differential diagnosis of adults presenting with epigastric or right hypochondrium pain or jaundice. A thorough preoperative evaluation is required. Cyst excision with Roux-en-Y hepaticojejunostomy forms the standard treatment in most cases. Long-term follow-up is essential for management of complications and early detection of malignant change

Formulation of Sodium Alginate Nanospheres Containing Amphotericin B for the Treatment of Systemic Candidiasis

Purpose: The aim of this work was to formulate sodium alginate nanospheres of amphotericin B by controlled gellification method and to evaluate the role of the nanospheres as a "passive carrier" in targeted antifungal therapy. Methods: Sodium alginate nanospheres of amphotericin B were prepared by controlled gellification method, and the particle size analysis was carried out by scanning electron microscopy. The carrier capacity of sodium alginate was evaluated in terms of drug to polymer ratio. In vitro release study was carried out on all drug loaded nanospheres by the dialysis method. Release kinetics of drug from different drug loaded nanospheres was also determined. The in vivo antifungal efficacy of nanospheres bound drug vis-à-vis the free drug was evaluated in candidiasis- induced mice models. Results: Preparation of nanospheres through controlled gellification method yielded particles with a size range of 419.6 ± 0.28 nm. Studies on drug to polymer ratio showed a linear relationship between concentration of drug and drug loading capacity. In vitro release kinetic study revealed that the release of drug from the nanospheres followed Fickian diffusion. In vivo studies showed that the nanospherebound drug produced a higher antifungal efficacy than the free drug. Conclusion: The formulated sodium alginate nanospheres containing amphotericin B was found to have better antifungal activity when compared to the free drug and also yielded sustained in vitro release