Review of imaging and endovascular intervention of iliocaval venous compression syndrome

Iliocaval venous compression syndrome (ICS) is the extrinsic compression of the common iliac vein by the overlying iliac artery against the vertebra. Chronic compression can lead to venous stenosis and stasis, which manifests as chronic venous disease and treatment resistance. Therefore, early recognition of ICS and prompt treatment are essential. Clinical presentations of ICS can be ambiguous and diagnosis requires a high index of suspicion with the relevant imaging studies. The initial imaging test is typically a Duplex ultrasound for vessel assessment and pelvic ultrasound to exclude a compressive mass, which is followed by computed tomography (CT) or magnetic resonance (MR) venography. CT and MRI can identify the anatomical causes for venous compression. In patients with high clinical suspicion for ICS, negative findings on CT and MR venography would still warrant further investigations. Definitive diagnosis can be established using catheter-based venography complemented with intravascular ultrasonography but the nature of their invasiveness limits its utility as a routine imaging modality. In this review paper, we will discuss the evidence, utility and limitations of the existing imaging modalities and endovascular intervention used in the management of ICS.     

Toxicity of Nickel on the Selected Species of Marine Diatoms and Copepods

Toxicity values for nickel on marine diatoms and copepods were derived based on bioassay tests. The 96 h IC₅₀ of nickel on diatoms, Odontella mobiliensis and Coscinodiscus centralis were 0.31?±?0.01 and 0.62?±?0.02 mg/L and LC₅₀ values on copepods, Oithona similis and Acartia danae were 2.78?±?0.14 and 2.34?±?0.32 mg/L, respectively. The species mean chronic values of nickel were 0.016, 0.17, 0.57 and 0.42 mg/L for O. mobiliensis, C. centralis, O. similis and A. danae, respectively. A hazardous concentration was derived and evaluated using the species sensitivity distribution (SSD) method. SSD indicated that 13 µg Ni/L is the maximum allowable concentration for protection of 95% plankton species in coastal and marine ecosystem of India. Diatoms are more sensitive to nickel than copepods by almost an order of magnitude. The toxicity values derived in the present study may be useful to calculate ambient water quality criteria/standard for nickel.     

Recent progress in therapeutic strategies for microglia-mediated neuroinflammation in neuropathologies

Introduction: Chronic activation of microglia is the hallmark of numerous neuropathologies such as Alzheimer’s disease, Parkinson’s disease, and multiple sclerosis. The activated microglia perpetuate inflammation by releasing an array of pro-inflammatory and neurotoxic factors, which eventually exacerbate neurotoxicity and neurodegeneration upon chronic activation of these cells. However, under acute conditions, activated microglia elicit pro-inflammatory as well as anti-inflammatory responses that are associated with neuroprotection. Given the role of microglia in neuroinflammation, recent studies have attempted to unravel the mechanisms that aid to establish microglial cell-based therapy.

Areas covered: While total suppression of microglial activation may compromise its beneficial role in tissue repair in the aftermath of an insult, the benefits of modulating microglial activation and promoting microglia polarization to a neuroprotective phenotype have been highlighted recently.

Expert opinion: So far, the therapeutic strategy focussed on neutralizing microglia-mediated neuroinflammation using drugs that block the release of pro-inflammatory mediators has limitations, such as unwarranted side effects. Recent advances reveal several alternative molecular targets and potential epi-drugs that are capable of modulating microglial function and promoting neuroprotection. This review discusses the recent progress made in understanding the mechanisms of microglia-mediated neuroinflammation in various neuropathologies, and the emerging anti-inflammatory therapeutic strategies in this field.     

Antimicrobial activity of nanoemulsion on cariogenic Streptococcus mutans

Objective

To assess antimicrobial activities of nanoemulsion (NE) to control the adhesion and biofilm formation by Streptococcus mutans by in vitro.

Design

In vitro antimicrobial susceptibility of nanoemulsion was determined as per National Committee for Clinical Laboratory Standards guidelines and agar diffusion, serial dilution technique for the determination of minimum inhibitory concentration and minimum bactericidal concentration (MIC/MBC). Efficacy was tested by kinetics of killing, biofilm assay and scanning electron microscopy.

Results

: NE concentrations ranging from 1:100 to 1:10,000 dilutions were effective against S. mutans as shown through MIC/MBC assays. NE showed antimicrobial activity against planktonic cells at high dilutions, confirmed by time kill studies. 4-day-old S. mutans biofilms were treated with NE; subsequent reductions of bacterial cell counts were noticed with decreasing dilutions. Staining of NE-treated biofilms with LIVE/DEAD BacLight resulted in dead cell areas of up to 48% in 1 min, 84% at 1 h and significant (<0.05) increases in dead cell counts at all time points. Damage to cell membranes and cell walls of S. mutans by NE was demonstrated using scanning electron microscopy (SEM).

Conclusion

These results suggest that nanoemulsion has effective antibacterial activity against S. mutans and may be a useful medication in the prevention of dental caries.     

Guided bone regeneration with a synthetic biodegradable membrane: a comparative study in dogs

Objectives: The aim of the present study was to compare a newly developed biodegradable polylactide/polyglycolide/N‐methyl‐2‐pyrrolidone (PLGA/NMP) membrane with a standard resorbable collagen membrane (RCM) in combination with and without the use of a bone substitute material (deproteinized bovine bone mineral [DBBM]) looking at the proposed tenting effect and bone regeneration. Materials and methods: In five adult German sheepdogs, the mandibular premolars P2, P3, P4, and the molar M1 were bilaterally extracted creating two bony defects on each site. A total of 20 dental implants were inserted and allocated to four different treatment modalities within each dog: PLGA/NMP membrane only (Test 1), PLGA/NMP membrane with DBBM (Test 2), RCM only (negative control), and RCM with DBBM (positive control). A histomorphometric analysis was performed 12 weeks after implantation. For statistical analysis, a Friedman test and subsequently a Wilcoxon signed ranks test were applied. Results: In four out of five PLGA/NMP membrane‐treated defects, the membranes had broken into pieces without the support of DBBM. This led to a worse outcome than in the RCM group. In combination with DBBM, both membranes revealed similar amounts of area of bone regeneration and bone‐to‐implant contact without significant differences. On the level of the third implant thread, the PLGA/NMP membrane induced more horizontal bone formation beyond the graft than the RCM. Conclusion: The newly developed PLGA/NMP membrane performs equally well as the RCM when applied in combination with DBBM. Without bone substitute material, the PLGA/NMP membrane performed worse than the RCM in challenging defects, and therefore, a combination with a bone substitute material is recommended. To cite this article:
Jung RE, Kokovic V, Jurisic M, Yaman D, Subramani K, Weber FE. Guided bone regeneration with a synthetic biodegradable membrane: a comparative study in dogs.
Clin. Oral Impl. Res. 22 , 2011; 802–807
doi: 10.1111/j.1600‐0501.2010.02068.x     

Giant Inguinoscrotal Hernia—Report of a Rare Case With Literature Review

Massive inguinoscrotal hernias extending below the midpoint of the inner thigh, in the standing position constitute giant inguinoscrotal hernias. We report a patient who presented with giant right inguinal hernia with bilateral hydrocele for 25 years. He had no cardiorespiratory illnesses. He was taken up for surgery under general anesthesia after preoperative respiratory exercises. Sliding hernia with entire greater omentum, small bowel, and appendix as contents was identified. Meshplasty after omentectomy with bilateral subtotal excision of sac, right orchidectomy, and scrotoplasty were done. Giant inguinoscrotal hernias pose significant problems while replacing bowel contents because of the increase in intraabdominal and intrathoracic pressures. Recurrence is another complication seen after successful surgical management. Various techniques such as preoperative pneumoperitoneum, debulking abdominal contents with extensive bowel resections, or omentectomy and phrenectomy have been tried. Postoperative elective ventilation is also needed in many cases. We describe simple reduction with omentectomy as a viable technique in this patient. He did not need elective ventilation due to preoperative respiratory exercises and preparation and review of the literature.Key words: Debulking, Giant inguinoscrotal hernia, Massive inguinoscrotal hernia, Phrenectomy, VentilationGiant inguinoscrotal hernias are defined as those extending below the midpoint of the inner thigh, in the standing position.¹ These hernias are rare and usually the result of neglect or fear of surgical procedures and are prevalent in the rural population.² These massive hernias pose significant problems resulting from cardiorespiratory compromise following sudden increase in intra-abdominal pressure during replacement of herniated viscera.³ In order to circumvent these complications, techniques such as debulking, phrenectomy, and progressive pneumoperitoneum have been described.³ Here, we present a patient with giant inguinoscrotal hernia where simple reduction with omentectomy was successful, and we review the literature.     

Carcinoma Cecum Presenting as Right Gluteal Abscess Through Inferior Lumbar Triangle Pathway—Report of a Rare Case

Gluteal abscess commonly follows intramuscular injections with contaminated needles. Carcinoma cecum is known to present with pericolic abscess due to microperforations and may rupture intraperitoneally. Gluteal abscess secondary to perforated carcinoma cecum with pericolic abscess is extremely uncommon. A 50-year-old woman who was receiving intramuscular iron injections for anemia presented with a 10 × 10-cm abscess in the right gluteal region and a vague mass in the right iliac fossa. After investigations, a diagnosis of perforated carcinoma cecum with pericolic abscess tracking into the right gluteal region was made, and incision and drainage were done. Fine-needle aspiration cytology from the cecal growth revealed adenocarcinoma. Unfortunately, the patient was not willing to undergo definitive treatment. This case is being reported for its rarity and as an uncommon etiology for a common condition.Key words: Gluteal abscess, Carcinoma cecum, Inferior lumbar triangleGluteal abscess is a common condition and most commonly follows intramuscular injections with contaminated needles.^1,2 Carcinoma cecum is known to present with pericolic abscess due to microperforations and may rupture intraperitoneally. Retroperitoneal abscess is rare with carcinoma cecum. Gluteal abscess secondary to perforated carcinoma cecum with pericolic abscess is extremely uncommon. Here we report a case of carcinoma cecum presenting as right gluteal abscess for its rarity and diagnostic challenge and to review its pathogenesis.     

Metachronous Multiple Primary Malignant Neoplasms of the Stomach and the Breast: Report of Two Cases With Review of Literature

Multiple primary malignant neoplasm is the occurrence of a second primary malignancy in the same patient within 6 months of the detection of first primary (synchronous), or 6 months or more after primary detection (metachronous). Multiple primary malignant neoplasms are not very frequently encountered in clinical practice. The relative risk for a second primary malignancy increases by 1.111-fold every month from the detection of the first primary malignancy in any individual. We present 2 patients treated for carcinoma of the breast who developed a metachronous primary malignancy in the stomach to highlight the rare occurrence of multiple primary malignant neoplasms. These tumors were histologically dissimilar, with distinct immunohistochemical parameters. The importance lies in carefully identifying the second primary malignancies, not dismissing them as metastases, and treating them accordingly.Key words: Breast neoplasms, Stomach neoplasms, Neoplasms, Second primaryBreast cancer is the most common malignancy among women worldwide. With proper screening, earlier detection, and improved treatment, survival has greatly increased, with the result that there is now a large population of women with a present or past history of breast cancer. This has led to an increased detection of second primary malignancies among these women. The relative risk for a second primary malignancy increases by 1.111-fold every month from the detection of the first primary malignancy in any individual.¹ Several authors have reported on a lesion in the stomach being labeled as a second primary malignancy and subsequently found to be metastasis. When the primary breast tumor is positive for estrogen and progesterone receptors (ER/PRs) and the stomach tumor is ER/PR negative, the diagnosis is established easily.² However, studies have shown that some primary gastric cancers can have ER/PR positivity. Further, if the primary breast lesion is ER/PR negative, the same cannot be used as a marker. Here, we present 2 breast cancer patients who developed second primary malignancies in the stomach and the final diagnosis was established based on histopathology and immunohistochemistry.