Laparoscopic management of persistent mullerian duct syndrome

Persistent mullerian duct syndrome (PMDS), characterized by the presence of mullerian structures in a virilized male, frequently presents as undescended testis, either intraabdominal or within a hernial sac. We describe a 10-month-old infant with PMDS successfully managed by the laparoscopic approach. At the age of 1.5 months, the patient presented with a left inguinal hernia and bilateral nonpalpable gonads in another center and underwent left inguinal exploration. The uterus and a gonadlike structure along with the hernia sac were found in the inguinal canal. Left inguinal herniotomy was performed after reduction of the uterus and gonadlike structure. No gonadal biopsy was obtained. The patient was further investigated in the same center. His karyotype was 46,XY. Magnetic resonance imaging of the abdomen and pelvis revealed a uterinelike structure posterior to the urinary bladder, but neither testis nor ovaries were visualized. At 10 months of age, he was referred to our department for further management. A laparoscopic single-stage orchiopexy was performed. Both testes were identified and brought to the scrotum by splitting the uterus in the midline and then bringing the testes with the vas and attached uterine tissue into the scrotum. The aim of placement of well-vascularized testes in the scrotum was achieved as confirmed on follow-up color Doppler ultrasound study 6 months postoperatively, which showed normal vascularity. Laparoscopic surgical techniques for this condition are also discussed.     

Particulate matter,air pollution,and blood pressure

A short-term increase in fine particulate matter air pollution (PM_2.5) concentration increases the risk for myocardial infarctions, strokes, and heart failure exacerbations. An important mechanism likely contributing to these associations is an elevation in arterial blood pressure (BP). Exposure to ambient PM_2.5 even at present-day concentrations can increase BP within a period of a few days while long-term exposure might also promote the development of chronic hypertension. Controlled human and animal experiments have corroborated the veracity of these findings and elucidated plausible biological mechanisms. PM_2.5 deposition within the pulmonary tree is capable of rapidly triggering autonomic nervous system imbalance, thereby increasing BP within minutes of inhalation. In addition, fine particles can instigate a systemic pro-inflammatory response over a more prolonged period of exposure. Higher circulating levels of activated immune cells and inflammatory cytokines could consequently cause vascular endothelial dysfunction leading to an imbalance in vascular homeostatic responses. Indeed, chronic PM_2.5 exposure augments pro-vasoconstrictive pathways while blunting vasodilator capacity. Finally, certain particle constituents (e.g., metals, organic compounds, and ultra-fine particles) might also be capable of reaching the systemic circulation upon inhalation and thereafter directly impair vascular function. At the molecular level, the generation of oxidative stress with the consequent up-regulation of redox sensitive pathways appears to be a common and fundamental mechanism involved in the instigation of these pro-hypertensive responses. Due to the ubiquitous, continuous and often involuntary nature of exposure, PM_2.5 may be an important and under-appreciated worldwide environmental risk factor for increased arterial BP.     

Acute intestinal obstruction due to small gut hemangioma.

A 20-year-old man presented with acute intestinal obstruction due to multiple hemangiomas of small intestine extending into the adjoining mesentery. The diagnosis was made at laparotomy and subsequently confirmed on histology. Occurrence of hemangioma in the small intestine and its presentation as acute intestinal obstruction are rare.     

Deposition of cigar smoke particles in the lung: evaluation with ventilation scan using (99m)Tc-labeled sulfur colloid particles.

This study examined the degree to which cigar smokers inhale when they smoke cigars. A second objective was to assess the level of association between self-reported inhalation and observable cigar particle deposition in the lung. We hypothesized that cigar smokers with a history of cigarette smoking would show a greater amount of smoke deposition than would cigar smokers with no history of cigarette smoking. We conjectured that self-reported cigar smoke inhalation would be a reliable predictor of observable smoke particle deposition in the lung. METHODS: Twenty-four male cigar smokers were recruited to participate in the study. Twelve of the participants were current or past regular cigarette smokers, and the remaining 12 participants had no history of cigarette smoking. The volunteers completed an anonymous questionnaire commenting on the frequency of their current cigarette and cigar use as well as the degree to which they inhale when they smoke cigars. Volunteers smoked a cigar through a holder that permitted cigar smoke to mix with a radioaerosol of (99m)Tc-labeled sulfur colloid particles. The total radioactivity administered to each volunteer was 100 MBq. Lung ventilation scanning was subsequently performed. RESULTS: Total lung counts showed that volunteers inhaled the cigar smoke to varying degrees, although 100% of nonsmokers and 58% of smokers in the study reported that they never or rarely inhaled when they smoked cigars. With respect to total lung counts, smokers as a group inhaled less than their nonsmoking counterparts; however, this difference reflected a trend in the data and did not reach statistical significance. CONCLUSION: Contrary to the widely held belief that cigar smokers do not inhale when they smoke cigars, we concluded that cigar smoke is inhaled regardless of self-reported inhalation and smoking history.     

Right lobe donor hepatectomy: is it safe? A retrospective study

Donor safety is utmost important in Living donor liver transplantation (LDLT). Small for size syndrome in some recipients with left lobe donors led to the evolution of right lobe LDLT. The aim of the study was to analyze the safety of large series of right lobe (RL) donor hepatectomies and compare outcomes with left lobe (LL) and left lateral segment (LLS) donations. A consecutive cohort of 726 donors from January 2011 to January 2014 were studied; RL (n = 641, 88.3%), LL (n = 36, 4.9%) or LLS (n = 49, 6.8%) depending on the type of donation. The mean age was 34.6 ± 10 years. The overall complication rate was 22.3%. Most were Clavien grade I and II. Clavien grade IIIa, IIIb, IV and V were noted in 4.2% donors. The incidence of these major complications were comparable among RL (n = 28, 4.2%), LL (n = 1, 2.7%) and LLS (n = 2, 4.08%) (P = 0.89). Bile leak was seen in 20 donors (2.7%) and 13 were managed conservatively with prolonged or additional intra‐abdominal drainage. Seven underwent re‐exploration for bile leak. In centres experienced in right lobe LDLT, morbidity after RL donation is similar to that of LL donation; and with adequate GRWR, same 1‐year recipient outcomes.     

Association of immunological features with clinical manifestations in primary Sjogren’s syndrome: a single-center cross-sectional study

Clinical and Experimental Medicine - The objectives of this study were to describe the clinical features and evaluate the utility of immunological features as predictors of organ involvement and...     

Peritoneal mesothelioma simulating pseudomyxoma peritonei on CT and sonography

We present an unusual case of peritoneal mesothelioma with ultrasound (US) and computed tomographic (CT) features of scalloping of liver margins and ascitic septations mimicking pseudomyxoma peritonei. A brief review of the literature is also presented.