EUS-FNA for the Diagnosis of Retroperitoneal Primitive Neuroectodermal Tumor

Primitive neuroectodermal tumor (PNET) is a rare “small round blue cell tumor” that is diagnosed by open biopsy or percutaneous biopsy of the lesion under radiologic guidance. In this case report, we present a novel approach to the diagnosis of a retroperitoneal PNET by endoscopic ultrasound- (EUS-) guided fine needle aspiration (FNA). A 35-year-old man presented with the history of left-sided flank pain and swelling of 3-weeks duration. Computerized tomography (CT) scan of his abdomen revealed a 12.8 × 13 × 12.5 cm cystic and solid mass arising from the retroperitoneum and displacing the third and fourth portions of the duodenum. He underwent EUS which revealed a well-circumscribed heterogeneous mass abutting the inferior portion of the stomach. EUS-FNA of the mass revealed malignant cells consistent with primitive neuroectodermal tumor (PNET)/Ewing's sarcoma. EUS-guided FNA is an appropriate technique for diagnosing retroperitoneal PNET/Ewing's sarcoma

Aberrant Right Hepatic Duct Draining into the Cystic Duct: Clinical Outcomes and Management

Background. Aberrant right hepatic duct (ARHD) draining into cystic duct (CD) is relatively rare but clinically important because of its susceptibility to injuries during cholecystectomy. These injuries are often-times missed or diagnosed late and as a result can develop serious complications. Methods. Four consecutive patients diagnosed with ARHD draining into CD were identified for inclusion. Results. The mean age of patients was 42.5 years. The diagnosis in one of the patient was incidental during a routine endoscopic retrograde cholangiopancreatography (ERCP). Other three patients were diagnosed post-cholecystectomy- one presented with suspected intra-operative biliary injury, one with persistent bile leak and another with recurrent cholangitis. Inadequate filling of the segment of liver on ERCP with dilation of intrahepatic ducts in the corresponding segment on imaging was present in two patients with complete obstruction of ARHD which was managed surgically. In another patient, the partially obstructed ARHD was managed by endoscopic therapy. Conclusion. ARHD draining into the CD can have varied clinical manifestations. In appropriate clinical settings, it should be suspected in patients with persistence of bile leak early after cholecystectomy, segmental dilation of intrahepatic-bile ducts on imaging and paucity of intrahepatic filling in a segment of liver on ERCP

Incidence and frequency of desynapsis in Eremurus persicus (Jaub. & Spach) Boiss.(Asphodelaceae) – A native and important medicinal plant species of Western Himalaya

Eremurus persicus (Jaub. & Spach) Boiss. (Asphodelaceae); a little known species of genus Eremurus grows in arid and semi-arid regions, on rocky mountains in Central Asia and Middle East. The species is native and an important medicinal plant used to treat various diseases. In the current study, we examined male meiosis, karyotypic variability, pollen viability and reproductive output of three populations of the target species. All the studied populations have diploid chromosome count of 2n = 2x =14. Meiotic course in majority of the pollen mother cells (PMCs) in all the three populations is not normal due to the presence of desynapsis at diplotene and metaphase-I. Instead of 7IIs most of the PMCs examined reveal varying number of bivalents and univalents. Anaphasic segregation is also affected in few PMCs. Present study also revealed that the species has asymmetric karyotype of 10 long and 4 short chromosomes. Species exhibits fruit abortion that results in extremely low fruit/seed set. The meiotic abnormalities and low fruit/seed set may be attributed to restricted distribution of this important plant species. Present study may prove helpful in devising the conservation and management strategies for this prized plant species

Meiotic behavior and its implications on the reproductive success of Arnebia euchroma (Royle ex Benth.) I.M.Johnst. (Boraginaceae), an important medicinal plant of Trans-Himalaya

The present study reports the chromosome number, meiotic behavior and its relation with pollen fertility and seed set of Arnebia euchroma (Royle ex Benth.) I.M.Johnst. The species shows a chromosome count of 2n = 2x = 14. The meiotic abnormalities such as chromatin stickiness, cytomixis, laggard formation, chromosomal bridges, were also observed in the Pollen Mother Cells (PMCs) of the target plant species. The linear model of regression showed a significant reduction of seed set with increasing meiotic abnormality and correlation analysis highlighted positive relationship between pollen viability and seed set. Meiotic abnormalities within the species hinder its reproductive process, causing a decline in reproductive efficiency. This study highlights the importance of addressing these intrinsic factors in future conservation programs to prevent a decline in the species population in nature

Lubiprostone plus PEG electrolytes versus placebo plus PEG electrolytes for outpatient colonoscopy preparation: a randomized, double-blind placebo-controlled trial

Bowel preparation using large volume of polyethylene glycol (PEG) solutions is often poorly tolerated. Therefore, there are ongoing efforts to develop an alternative bowel cleansing regimen that should be equally effective and better tolerated. The aim of this study was to assess the efficacy of lubiprostone (versus placebo) plus PEG as a bowel cleansing preparation for colonoscopy. Our study was a randomized, double-blind placebo-controlled design. Patients scheduled for screening colonoscopy were randomized 1:1 to lubiprostone (group 1) or placebo (group 2) plus 1 gallon of PEG. The primary endpoints were patient\u27s tolerability and endoscopist\u27s evaluation of the preparation quality. The secondary endpoint was to determine any reduction in the amount of PEG consumed in the lubiprostone group compared with the placebo group. One hundred twenty-three patients completed the study and were included in the analysis. There was no difference in overall cleanliness. The volume of PEG was similar in both the groups. The volume of PEG approached significance as a predictor of improved score for both the groups (P = 0.054). Lubiprostone plus PEG was similar to placebo plus PEG in colon cleansing and volume of PEG consumed. The volume of PEG consumed showed a trend toward improving the quality of the colon cleansing