Inflammatory fibroid polyp of the ileum presenting with small bowel obstruction in an adult patient: a case report

<p>Abstract</p> <p>Introduction</p> <p>Inflammatory fibroid polyps are rare benign tumors of the gastrointestinal tract with the gastric antrum being the most common site, followed by the ileum. Histogenesis is still unknown and controversial. Inflammatory fibroid polyps are one of the rare benign conditions leading to intestinal obstruction in adults.</p> <p>Case presentation</p> <p>A 54-year-old Caucasian man presented with acute abdomen pain and a two month history of intermittent cramping and lower abdominal pain. Computed tomography imaging demonstrated a partial intestinal obstruction in the location of the terminal ileum. An ileo-ileal intussusception due to a mass lesion 15 cm proximal to the caecum was found on exploratory laparotomy. Intussusception was spontaneously reduced during exploration and a wedge resection was performed to the affected bowel segment. Histopathologic examination showed the mass to be an inflammatory fibroid polyp.</p> <p>Conclusion</p> <p>Although inflammatory fibroid polyps are rare and benign, in the case of intestinal obstruction the only solution is a surgical approach.</p

Clinical, genetic, and structural basis of apparent mineralocorticoid excess due to 11β-hydroxysteroid dehydrogenase type 2 deficiency

Mutations in 11β-hydroxysteroid dehydrogenase type 2 gene (HSD11B2) cause an extraordinarily rare autosomal recessive disorder, apparent mineralocorticoid excess (AME). AME is a form of low renin hypertension that is potentially fatal if untreated. Mutations in the HSD11B2 gene result either in severe AME or a milder phenotype (type 2 AME). To date, ∼40 causative mutations have been identified. As part of the International Consortium for Rare Steroid Disorders, we have diagnosed and followed the largest single worldwide cohort of 36 AME patients. Here, we present the genotype and clinical phenotype of these patients, prominently from consanguineous marriages in the Middle East, who display profound hypertension and hypokalemic alkalosis. To correlate mutations with phenotypic severity, we constructed a computational model of the HSD11B2 protein. Having used a similar strategy for the in silico evaluation of 150 mutations of CYP21A2, the disease-causing gene in congenital adrenal hyperplasia, we now provide a full structural explanation for the clinical severity of AME resulting from each known HSD11B2 missense mutation. We find that mutations that allow the formation of an inactive dimer, alter substrate/coenzyme binding, or impair structural stability of HSD11B2 yield severe AME. In contrast, mutations that cause an indirect disruption of substrate binding or mildly alter intramolecular interactions result in type 2 AME. A simple in silico evaluation of novel missense mutations could help predict the often-diverse phenotypes of an extremely rare monogenic disorder

Factors affecting the attitudes of nursing students toward ageism

Background & Aim: The world's older adult population is increasing and is expected to increase in the future. Ageism is one of the difficulties older adults experienced. Nursing students as a candidate for the nursing profession will frequent contact with older adults. Ageism attitudes among nursing students are essential for this reason. This study aims to determine the attitudes of nursing students toward ageism and the factors affecting it. Method & Materials: The study was cross-sectional, and the data were collected from January to February 2019. The study included 509 students. A demographic data form and the Ageism Attitude Scale were used to collect data. Results: The mean age of the participants was 20.94±1.30 years and 439 (86.2%) participants were female. Female nurse students show lower ageist attitudes than males (p<0.001) and between the year of study and attitudes to ageism (p = 0.001). A statistically significant difference was found between nurse students caring for older people and those not caring for older people and attitudes to ageism (p<0.001). Conclusion: In nursing students, giving care to older people during their education, and having lived with an older relative should be considered to reduce ageism. We offer that nurse curriculums revised to reduce ageism according to factors affecting attitudes to ageism. © 2020, Tehran University of Medical Sciences. All rights reserved

Full-Thickness Macular Hole Formation after Internal Limiting Membrane Peeling: Beware the “Omega Sign”

Purpose. To introduce a clinical sign on spectral domain optical coherence tomography (SDOCT), which may indicate high risk for full-thickness macular hole formation after internal limiting membrane (ILM) peeling. Methods. The preoperative SDOCT images of two patients—one with multilaminar hemorrhage from ruptured retinal artery macroaneurysm and one with serous retinal detachment and severe macular schisis from optic pit maculopathy—who developed full-thickness macular hole (FTMH) after ILM peeling were evaluated retrospectively. Results. On the preoperative SDOCT images of both patients there was a thin bridge of tissue on either side of the foveal center with an outer retinal defect. The photoreceptors were displaced laterally away from the foveal center to create an “omega-” shaped configuration of the remaining tissue. Conclusion. “Omega-” shaped configuration on SDOCT may represent a higher risk of FTMH following ILM peeling. Vitreoretinal surgeons may wish to consider this sign in the process of their surgical decision making

Some electrolytes and in vitro smooth muscle concentration

[No abstract available

Deep geothermal groundwater flow in the Seferihisar-Balcova area, Turkey: results from transient numerical simulations of coupled fluid flow and heat transport processes

The Seferihisar-Balcova Geothermal system (SBG) is characterized by complex temperature and hydrochemical anomalies. Previous geophysical and hydrochemical investigations suggest that hydrothermal convection in the faulted areas of the SBG and recharge flow from the Horst may be responsible for the observed patterns. A numerical model of coupled fluid flow and heat transport processes has been built in order to study the possible fluid dynamics of deep geothermal groundwater flow in the SBG. The results support the hypothesis derived from interpreted data. The simulated scenarios provide a better understanding of the geophysical conditions under which the different fluid dynamics develop. When recharge processes are weak, the convective patterns in the faults can expand to surrounding reservoir units or below the seafloor. These fault-induced drag forces can cause natural seawater intrusion. In the Melange of the Seferihisar Horst, the regional flow is modified by buoyant-driven flow focused in the series of vertical faults. As a result, the main groundwater divide can shift. Sealing caprocks prevent fault-induced cells from being overwhelmed by vigorous regional flow. In this case, over-pressured, blind geothermal reservoirs form below the caprocks. Transient results showed that the front of rising hot waters in faults is unstable: the tip of the hydrothermal plumes can split and lead to periodical temperature oscillations. This phenomenon known as Taylor-Saffman fingering has been described in mid-ocean ridge hydrothermal systems. Our findings suggest that this type of thermal pulsing can also develop in active, faulted geothermal systems. To some extent, the role of an impervious fault core on the flow patterns has been investigated. Although it is not possible to reproduce basin-scale transport processes, this first attempt to model deep groundwater geothermal flow in the SBG qualitatively supported the interpreted data and described the different fluid dynamics of the basin

Numerical investigations of fault-induced seawater circulation in the Seferihisar-Balcova Geothermal system, western Turkey

The Seferihisar-Bal double dagger ova Geothermal system (SBG), Turkey, is characterized by temperature and hydrochemical anomalies along the faults: thermal waters in northern Bal double dagger ova are heated meteoric freshwater, whereas the hot springs of the southern Seferihisar region have a strong seawater contribution. Previous numerical simulations of fluid flow and heat transport indicated that focused upsurge of hot water in faults induces a convective-like flow motion in surrounding units. Salt transport is fully coupled to thermally driven flow to study whether fault-induced convection cells could be responsible for seawater encroachment in the SBG. Isotope data are presented to support the numerical findings. The results show that fault-induced convection cells generate seawater plumes that extend from the seafloor toward the faults. At fault intersections, seawater mixes with rising hot thermal waters. The resulting saline fluids ascend to the surface along the fault, driven by buoyant forces. In Bal double dagger ova, thick alluvium, minor faults and regional flow prevent ascending salty water from spreading at the surface, whereas the weak recharge flow in the thin alluvium of the southern SBG is not sufficient to flush the ascending hot salty waters. These mechanisms could develop in any faulted geothermal system, with implications for minerals and energy migration in sedimentary basins