Lymphangioma of the Mesentery of the Jejunum: Report of a Case and a Brief Review of the Literature

Lymphangiomas are benign tumors of lymphatic vessels, that are more commonly found in the pediatric age group, and thought to be congenital in nature. They most commonly occur in the region of the neck, but they frequently may be found in the abdominal cavity. In the abdominal cavity, the tumors usually involve the mesentery of the small or large intestines. They are usually asymptomatic but may present with signs and symptoms of intestinal obstruction. The tumors are rare enough to arouse interest whenever a case is encountered. We present a case of lymphangioma of the mesentery of the jejunum in a young adult which clinically mimicked acute appendicitis.     

Biosynthesis of a proinsulin-like molecule in the pancreas of a lizard

The biosynthesis of insulin, in particular the occurrence of a proinsulin-like molecule (PILM), in the pancreas of the green anole, Anolis carolinensis, was investigated. The laboratory rat was used for comparison and validation of the procedures. Anolian pancreases were incubated in vitro with radiolabeled leucine or proline. Radioactivity incorporated into the acidic ethanol-soluble (AES) phase increased in an essentially linear manner with time. Selective incorporation of labeled amino acids into AES material was not enhanced by a high concentration of glucose (6 mg/ml), by the addition of glucagon, which increases cyclic AMP levels, or by the addition of cytochalasin B; yet all three conditions result in stimulated insulin secretion. Gel filtration of the AES material on columns of Bio-Gel P-30 revealed a major peak of radioactivity whose apex followed closely the apogee of porcine proinsulin. When this presumptive PILM was treated with trypsin and carboxypeptidase B, the radioactivity was shifted towards later elution volumes, but the peak of the converted anolian material was not coincidental with marker insulin. Immunopurification techniques and additional molecular filtrations resulted in the isolation of fractions with both insulin-like immunoreactivity (IRI) and radioactivity derived from tritium-labeled leucine. One peak of radiolabel was present in the region of the proinsulin standards. The level of radioactivity in the region of the insulin standards was relatively high after two days of organ culture of splenic pancreases. By polyacrylamide gel electrophoresis proteins that incorporated radiolabeled amino acids and had insulin-like immunoreactivity possessed migration patterns similar to those of mammalian proinsulin and insulin. The insulin-like component was less readily demonstrated than the proinsulin-like component and raises the possibility that anolian PILM may be a major storage form in this species. The results are consistent with the synthesis of a proinsulin-like precursor in the beta cells of the green anole. The results also provide evidence for a precursor-product relationship in the anolian beta cell.     

On the behavior of a capillary surface in a wedge

Estimates above and below are obtained for the height of the equilibrium-free surface of a liquid when the liquid partially fills a cylindrical container whose cross section contains a corner with interior angle 2α. The surface is characterized by the condition that its mean curvature be proportional to its height above a reference plane (or, in the case of zero gravity, that the mean curvature be constant), and by the requirement that it meet the container wall with prescribed contact angle γ. It turns out that the qualitative behavior of such a surface near the vertex changes markedly, according as α + γ < ½π, or α + γ ≥ ½π. In the former case, the surface is either unbounded or fails to exist, while in the latter case every such surface is bounded. Some experimental comparisons are indicated, and an application to the problem of describing the mechanism of water rise in trees is discussed.

The above results describe a limiting case among corresponding properties that hold for surfaces defined over domains with smooth boundaries. This extension is indicated, as well as a formal extension to n-dimensional surfaces; here the interest centers on the fact that it is the mean curvature of an (n-1)-dimensional boundary element that controls the local behavior of the n-dimensional solution surface.

     

Evaluation of a program monitoring the quality of the services provided by a non-governmental organization

OBJECTIVE: To evaluate the effect of a quality-monitoring program on the occurrence of sentinel events and on attitudes and behaviors of personnel's responses in a Non-Governmental-Organization (NGO). MATERIAL AND METHODS: Between 1998 and 1999, a quasi-experimental design of the before-after type was conducted in 13 NGO clinics. Analysis of changes in attitudes and behaviors consisted in differences of means and analysis of variance between groups. RESULTS: The number of sentinel events decreased from 32 events detected before the quality-monitoring program to only 2 after it. Attitudes and behaviors improved, with differences of means of +1.1 and +1.2 (p < 0.05). CONCLUSIONS: The quality-monitoring program achieved the expected effects. It is noteworthy that attitudes and behaviors to prevent the occurrence of sentinel events were more prevalent after the intervention.     

Assessing the impact of a fistula after a pancreaticoduodenectomy using the Post-operative Morbidity Index

Background

The Post-operative Morbidity Index (PMI) is a quantitative utility measure of a complication burden created by severity weighting. The Fistula Risk Score (FRS) is a validated model that predicts whether a patient will develop a post-operative pancreatic fistula (POPF). These novel tools might provide further discrimination of the ISGPF grading system.

Methods

From 2001 to 2012, 1021 pancreaticoduodenectomies were performed at four institutions. POPFs were categorized by ISGPF standards. PMI scores were calculated based on the Modified Accordion Severity Grading System. FRS scores were assigned according to the relative influence of four recognized factors for developing a clinically relevant POPF (CR-POPF).

Results

In total, 231 patients (22.6%) developed a POPF, of which 54.1% were CR-POPFs. The PMI differed significantly between the ISGPF grades and patients with no or non-fistulous complications (P < 0.001). 64.9% of POPFs and 84.0% of CR-POPFs contributed the highest Accordion grade to the PMI. Overall, the FRS correlated well with PMI (R² = 0.81, P < 0.001).

Conclusion

These data quantitatively reinforce the ISGPF grades that were developed qualitatively around the concept of clinical severity. CR-POPFs usually reflect the patient''s highest Accordion score whereas biochemical POPFs are often superseded. The correlation between FRS and PMI indicates that risk factors for a fistula contribute to overall pancreaticoduodenectomy morbidity.     

Finite Element Simulation of a Crack Growth in the Presence of a Hole in the Vicinity of the Crack Trajectory

The aim of this paper was to present a numerical simulation of a crack growth path and associated stress intensity factors (SIFs) for linear elastic material. The influence of the holes’ position and pre-crack locations in the crack growth direction were investigated. For this purpose, ANSYS Mechanical R19.2 was introduced with the use of a new feature known as Separating Morphing and Adaptive Remeshing Technology (SMART) dependent on the Unstructured Mesh Method (UMM), which can reduce the meshing time from up to several days to a few minutes, eliminating long preprocessing sessions. The presence of a hole near a propagating crack causes a deviation in the crack path. If the hole is close enough to the crack path, the crack may stop at the edge of the hole, resulting in crack arrest. The present study was carried out for two geometries, namely a cracked plate with four holes and a plate with a circular hole, and an edge crack with different pre-crack locations. Under linear elastic fracture mechanics (LEFM), the maximum circumferential stress criterion is applied as a direction criterion. Depending on the position of the hole, the results reveal that the crack propagates in the direction of the hole due to the uneven stresses at the crack tip, which are consequences of the hole’s influence. The results of this modeling are validated in terms of crack growth trajectories and SIFs by several crack growth studies reported in the literature that show trustworthy results.     

Hyperthyroidism as a clinical manifestation of a embryonal carcinoma of the testis

This case report describes a case of hyperthyroidism as manifestation of an embryonal carcinoma, and illustrates the causes that led to it. The case describes a 33-year-old male patient who complained of chest pain, palpitations, mild dyspnoea, and weight loss. Blood analysis reveals high levels of human chorionic gonadotropin (833818 mlU/ml), T3 (16.90 pg/ml), and T4 (7.77 ng/dl), as well as a fall of TSH (0.01 ulU/ml). Physical examination and imaging procedures confirm the occurrence of a left testicular tumour associated with numerous lung, hepatic and retroperitoneal metastases. Treatment with carbimazol and propanolol is established to manage hyperthyroidism, and an urgent orchiectomy is performed; the histologic diagnosis confirms an embryonal carcinoma (organoid type), but the patient died unexpectedly 24 hours later after having suffered sudden dyspnoea, tachypnoea, and tachyarrhythmia. Hyperthyroidism is a rare manifestation of a testicular tumour that should be borne in mind with regard to the patient's symptomatology and HCG levels.     

Relationship of the hematopoietic cycle to the combined activities of a stimulator and a short-lived inhibitor

Substances that circulate in the blood following drug-induced bone marrow aplasia produce a biphasic curve of DNA synthesis in cells in liquid and semisolid cultures which reflect relative concentrations of these growth regulators of hematopoiesis. This net effect magnified by induced marrow failure in human, rat, and mouse is a sinusoidal curve that is the reciprocal of the WBC. Generated in the bone marrow, humoral stimulating activity (HSA) produces peak growth of colonies in agar (CFU-GM) during the proliferative phase of bone marrow recovery, whereas humoral inhibitory activity (HIA), present at the time of marrow maturation, suppresses colony growth. Split femurs from rats given cyclophosphamide (CY) and killed at regular intervals condition media that affect DNA synthesis in a fashion similar to that of HSA-HIA in the rats' sera. In Dexter cultures, HSA is derived from the adherent rather than the hematopoietic cell, whereas HIA is produced by that nonadherent cell. Animals treated with a lethal dose of busulfan (BU) produce large amounts of HSA in vivo until death. Those transplanted with adherent bone marrow cells depleted of hematopoietic cells on day 1 after BU also die, whereas those given nonadherent marrow cells survive and generate HIA at the time of bone marrow recovery. HSA and media conditioned by bone marrow stromal cells causes an increase in spleen colonies (CFU-S), as does HIA. These studies support the contention that the net effect of putative regulators of hematopoiesis, measured in the drug-perturbed state, consist of a constantly present stimulator emanating from bone marrow stroma, and a variable inhibitor produced by maturing hematopoietic bone marrow cells.     

Attracting the attention of a fly

Organisms with complex visual systems rarely respond to just the sum of all visual stimuli impinging on their eyes. Often, they restrict their responses to stimuli in a temporarily selected region of the visual field (selective visual attention). Here, we investigate visual attention in the fly Drosophila during tethered flight at a torque meter. Flies can actively shift their attention; however, their attention can be guided to a certain location by external cues. Using visual cues, we can direct the attention of the fly to one or the other of the two visual half-fields. The cue can precede the test stimulus by several seconds and may also be spatially separated from the test by at least 20° and yet attract attention. This kind of external guidance of attention is found only in the lower visual field.     

Effects of the implementation of a smoke-free policy in a medical center.

The implementation of a smoke-free policy in this medical center was associated with a decrease in the prevalence of regular cigarette smoking from 16.7 percent to 13.8 percent and a smoking cessation rate of 22.5 percent among regular smokers over the 2 1/2 years since the policy was announced. This decrease in prevalence is the result of both smoking cessation among existing employees and less frequent regular smoking among new employees. At two-year follow-up, the policy was overwhelmingly endorsed by medical center staff overall but was viewed less favorably by those who continued to smoke. Nevertheless, over the 2 1/2 years, many of these smokers have been in the action stage of cessation (37.1 percent made a serious attempt to stop smoking, 20.7 percent had used nicotine polacrilex in a smoking-cessation effort, and 13.8 percent had attended a formal cessation program). The implementation of a smoke-free policy has made a significant contribution toward providing a healthful work environment and toward encouraging nonsmoking behavior in staff and patients.     

Lipoprotein(a): a genetically determined lipoprotein containing a glycoprotein of the plasminogen family

Lp(a) represents a genetically transmitted class of plasma LDL having apo B-100 linked by a disulfide bridge to a glycoprotein, apo(a). Lp(a) is heterogeneous in size and density. Apo(a) is also heterogeneous in size (molecular weight between approximately 300,000 and 700,000) due probably to the polymorphism of both polypeptide and carbohydrate chains. Recent studies have shown that apo(a) has a striking amino acid sequence homology with plasminogen, a serine protease zymogen that following activation to plasmin enters the fibrinolytic system. Apo(a) is severalfold larger than plasminogen (molecular weight approximately 90,000) and also differs from it because it fails to be activated to plasmin. This is due to the fact that arginine is replaced by serine at the site of cleavage by streptokinase, urokinase, or tissue plasminogen activator. A single gene locus appears to control the Lp(a) polymorphism as well as the concentration of the Lp(a) phenotypes in the plasma. Patients with high plasma levels of Lp(a) have been shown to have an increased incidence of cardiovascular disease but a causal relationship has not been firmly established. The information that is being rapidly acquired on the structure of Lp(a) should facilitate the understanding of the molecular basis of the polymorphism of this genetic variant and of the role that the various Lp(a) phenotypes play in atherosclerosis and thrombosis. The potential physiologic role of Lp(a) remains open to inquiry.     

Calculating the risk of a pancreatic fistula after a pancreaticoduodenectomy: a systematic review

BackgroundA post‐operative pancreatic fistula (POPF) is a major cause of morbidity and mortality after a pancreaticoduodenectomy (PD). This systematic review aimed to identify all scoring systems to predict POPF after a PD, consider their clinical applicability and assess the study quality.MethodAn electronic search was performed of Medline (1946–2014) and EMBASE (1996–2014) databases. Results were screened according to Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) guidelines, and quality assessed according to the QUIPS (quality in prognostic studies) tool.ResultsSix eligible scoring systems were identified. Five studies used the International Study Group on Pancreatic Fistula (ISGPF) definition. The proposed scores feature between two and five variables and of the 16 total variables, the majority (12) featured in only one score. Three scores could be fully completed pre‐operatively whereas 1 score included intra‐operative and two studies post‐operative variables. Four scores were internally validated and of these, two scores have been subject to subsequent multicentre review. The median QUIPS score was 38 out of 50 (range 16–50).ConclusionThese scores show potential in calculating the individualized patient risk of POPF. There is, however, much variation in current scoring systems and further validation in large multicentre cohorts is now needed.     

Evidence for the role of thyroxine as a hormone in the physiology of a lizard

In vivo effects of thyroxine (T4) and triiodothyronine (T3) were studied in male lizards. T4 or T3 (0.5 to 2 nmol) was administered per day over 10 days to surgically thyroidectomized male lizards (35 +/- 2.0 g) and the responses were measured in terms of scale shedding, whole body oxygen consumption (OC), and testicular weight. T3 was more effective in stimulating OC as compared to T4. T4 accelerated scale shedding to a greater extent as compared to T3. T4 was more effective than T3 in restoring the decline in the gonadal weight of thyroidectomized animals. Effect of inhibition of peripheral conversion of T4----T3 by iopanoic acid (IOP) was studied on the above response parameters. IOP at both dose levels inhibited extrathyroidal conversion of T4----T3. The T4-stimulated increase in OC of IOP-treated animals was suppressed, clearly indicating that the T4 effect could be attributed to its conversion to T3. But in these same animals, IOP failed to inhibit T4-stimulated scale shedding and gonadal weight. As the proportion of T4 converted to T3 decreased as a result of IOP treatment, the effectiveness of T4 increased in terms of scale shedding and restoration of gonadal weight. From these studies it appears that all effects of T4 in lizards need not necessarily be mediated via conversion to T3.     

Minimal coupling and the symplectic mechanics of a classical particle in the presence of a Yang-Mills field

This note is to show how to use symplectic geometry to write equations of motion of a "classical particle" in the presence of a Yang-Mills field, for any gauge group, G, and any differentiable manifold, M. In the case that M is Minkowski space and G = U(1), the equations reduce to the Lorentz equations for a charged particle in an electromagnetic field. Our procedure in the general case uses the connection form as defined on the principle bundle to introduce a symplectic structure on certain associated bundles and is automatically gauge invariant.     

Adenocarcinoma of the rat esophagus in the presence of a proton pump inhibitor: a pilot study

This study examines the effects of a proton pump inhibitor on a rat model of duodenogastric reflux. Duodenoesophageal reflux was induced in 60 rats by performing a duodenesophagostomy. The study group received daily intraperitoneal injections of a proton pump inhibitor for 6 months and the control group received an equivalent injection of saline. Rats were examined at death for macroscopic tumor, dysplasia, adenocystic changes, papillomatosis, and adenocarcinoma. Five out of 19 rats in the study group and three out of 20 rats in the control group developed dysplastic/adenocarcinomatous changes. Ten of the rats in the study group died before the end of the study, as opposed to one in the control group (this is not statistically significant). There was no difference in the number of cancers that developed in the two groups. However, there was an insignificant trend to earlier appearance of detectable disease in the study group.     

Evaluation of the impact of a clinical pathway on the organization of a multidisciplinary dental sleep clinic

Purpose

Clinical pathways are used to organize complex care processes by providing structure and standardization. The multidisciplinary approach of oral appliance (OA) therapy for sleep-disordered breathing (SDB) is a complex and dynamic process suitable for such a structured pathway approach.

Methods

A clinical pathway for patients referred for OA therapy was developed and implemented. The aim of this study was to evaluate the impact of this clinical pathway on the time to delivery of the OA and the organization of the multidisciplinary dental sleep clinic (MDSC). The latter was achieved using the care process self-evaluation tool (CPSET).

Results

First, development and implementation of the clinical pathway gave structure and shortened the mean time to delivery by 102 days (240?±?70 vs. 138?±?33 days) (Mann–Whitney U: P?<?0.001). Second, the CPSET scores were obtained in a cohort of 49 healthcare professionals involved in the pathway. Overall, patient-focused organization received the highest scores (80.5?±?9.0 %), whereas cooperation with primary care received the lowest score (66.7?±?12.4 %).

Conclusions

This is the first project on clinical pathways in OA therapy for SDB. The implementation of the pathway in our MDSC has created a significant shortening of the time to delivery. A first evaluation of the clinical pathway using the CPSET scores indicates that all disciplines involved should be thoroughly informed in an ongoing approach.     

Adenoacanthoma arising in a diverticulum of the colon: Report of a case

Summary An adenocanthoma arising in a diverticulum of the sigmoid colon is described. It is the first reported case of such a complication. The tumor appeared in an 84-year-old man who had diverticular disease of the colon. Although malignant transformation of the diverticular mucosa is exceptional, such a change is physiologically feasible?     

Idiopathic dilatation of the atria: a syndrome? Description of a case of idiopathic biatrial dilatation, review of the literature and a proposal for a pathogenetic interpretation

Idiopathic severe dilatation of bilateral atrial and urethero-pelvic systems was found in a 53-year-old woman. Degeneration of muscle fibers without inflammation is a constant feature of idiopathic atrial enlargement. Degenerative process can extensively involve atrial wall (generalized dilatation) or can be localized (aneurysmal dilatation). In both types of lesion clinical features are related to atrial arrhythmias and to compression on atrio-ventricular valves and ventricles by the enlarged atria. Only the outcome of the atrial arrhythmias can help to distinguish between the two conditions: development of irreversible atrial standstill in generalized dilatation and definitive restoration of sinus rhythm, following surgery, in aneurysmal dilatation. In each atrium, a different rate of incidence of the two types of dilatation has been documented in the literature: as for the right atrium, more than 40 cases of generalized dilatation have been reported and only 4 of the aneurysmal type. On the other hand, isolated left atrial enlargement was of aneurysmal type in all 30 reported cases. Biatrial dilatation was generalized in 7 cases and due to multiple aneurysms in a single case. The Authors support the hypothesis that idiopathic atrial dilatation could be due to a degenerative process affecting the atrial components derived from primitive atria, in which the muscular layer is structured into pectinate muscles. They also suggest to distinguish, even from the etiopathogenetic point of view, between aneurysmal dilatation (localized and fortuitous lesion) and generalized dilatation (diffuse degeneration of pectinate muscles). This distinction could well related with the different outcome of atrial arrhythmia in the two types of dilatation.(ABSTRACT TRUNCATED AT 250 WORDS)     

Primary extranodal non-Hodgkin's lymphoma of the vagina: a case report and a review of the literature

Primary lymphoma of the female genital tract is very rare. We report the case of a 36-year-old woman who was referred to our hospital because of an indeterminate Pap smear test. The colposcopy showed a thickening of the posterior vaginal wall and various irregular ulcerated nodular lesions. Histological examination, immunohistochemistry and the staging procedures were conclusive of diffuse large B-cell lymphoma of the vagina, stage IEA. Complete remission was achieved after 6 cycles of immunopolychemotherapy (rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone). No relapse has occurred during a follow-up of 71 months. Moreover, we reviewed the 62 previously reported cases of primary extranodal non-Hodgkin's lymphoma of the vagina, focusing on clinicopathological and therapeutic aspects, to better characterize this unusual disease.