Perivascular epithelioid cell tumor (PEComa) of falciform ligament — an extremely rare tumor

Primary tumor of falciform ligament is exceedingly uncommon. So far, seven cases of Perivascular Epithelioid Cell tumor (PECom), a recently described histological entity with characteristic perivascular tumor cell arrangement and expression of muscle and melanocytic marker by the cells, have been reported in literature. Here, we report a case of PEComa of falciform ligament, which presented with a huge abdominal lump. Pre-surgical CT scan of abdomen was uninformative regarding the nature and organ of origin of the tumor. On laparotomy, it was surprisingly found to arise from the falciform ligament, and this was easily removed. Histopathological diagnosis confirmed PEComa. There was no recurrence of disease after two years of follow up.     

Open port placement through the umbilical cicatrix

Peritoneal access and creation of pneumoperitoneum are the key initial steps of laparoscopic surgery. This is commonly achieved by either introducing Veress needle or by gradual dissection of all the layers of the abdominal wall and then introducing a port under direct vision. The two techniques are extremely safe, but large outcome studies have found slightly increased complications with the Veress needle. Randomized trials do not support such finding and both techniques continue to have their enthusiasts. We hereby describe an open method of initial port placement, wherein the port is introduced through the umbilical cicatrix under direct vision.     

Mandibular canal variant: a case report

The mandibular canal transmits the inferior alveolar artery, vein and the inferior alveolar nerve. From an embryological perspective, there might be three inferior dental nerves innervating three groups of mandibular teeth. During rapid prenatal growth and remodeling in the ramus region there is spread of intramembranous ossification that eventually forms the mandibular canal. Occurrence of bifid/trifid mandibular canals in some patients is secondary to incomplete fusion of these three nerves. Various types of bifid mandibular canals have been classified according to anatomical location and configuration. This case report highlights an unusual variant of the mandibular canal.     

Inhibition of complement by covalent attachment of rosmarinic acid to activated C3b.

Rosmarinic acid has been reported to inhibit complement activation in vivo as well as in vitro. Previous studies suggested that the inhibitory effect was due to inhibition of C3/C5 convertases, but inhibition of C3b attachment would yield the same results. Recent work in our laboratory demonstrated that compounds with polyhydroxylated phenyl rings are highly reactive with the thioester bond in nascent C3b. These compounds block complement activation by preventing attachment of C3b to the activating surface. Because rosmarinic acid contains two 3,4-dihydroxyphenyl groups, the current study was undertaken to re-examine the mechanism of inhibition by analyzing the effect of rosmarinic acid on C3b attachment. In assays using purified complement proteins, rosmarinic acid inhibited covalent attachment of C3b to cells with an 1C50 = 34 microM. Inhibition of C5 convertase activity required 1500 microM rosmarinic acid, and no significant inhibition of the C3 convertase enzyme, which produces C3b from C3, was observed at 10,000 microM. In hemolytic assays using human serum, rosmarinic acid was shown to inhibit activation of both the classical (IC50 = 180 microM) and the alternative (IC50 = 160 microM) pathways of complement. Rosmarinic acid concentrations up to 10,000 microM did not cause direct inactivation of C3. Radioiodination of rosmarinic acid was used to demonstrate covalent activation-dependent incorporation of rosmarinic acid specifically into the thioester-containing alpha'-chain of nascent C3b. These findings indicate that inhibition of complement activation by rosmarinic acid is due to the reaction of rosmarinic acid with the activated thioester of metastable C3b, resulting in covalent attachment of the inhibitor to the protein.     

Why immunization coverage fails to catch up in India? A community‐based analysis

Background An effort has been made in this paper to examine the impact of community and household vis‐à‐vis individual‐level variables on immunization coverage among Indian children. Methods National Family Health Survey‐2 data set has been used for the analysis. Multilevel regression analyses have been used to explore the relative effects of community‐, household‐ and individual‐level factors on immunization coverage. Three community‐level variables, i.e. availability of health facilities, availability of all‐weather roads and information, education and communication (IEC) activities conducted during last year, are included in this analysis. Results Availability of health facility and information, education and communication activities plays a significant role in determining the level of immunization coverage among children. Even with community‐level variables in the model, individual‐level variables, i.e. parent's education, birth order of child and number of antenatal care visits, retain their predictive role for the potential immunization coverage. Conclusions Universal immunization can be achieved by providing services at community level and information about the available services and their benefits to the community. There is a considerable, unexplained variation in the immunization coverage between different communities, even in the most complex model used in this study, which could explain the entire heterogeneity of immunization coverage among Indian states.     

Advances in the management of gastric cancer

Gastric cancer is a common malignancy in our country and patients continue to present at an advanced stage. Following confirmation of diagnosis, CT scan, endoscopic ultrasound and laparoscopy are the essential staging modalities. Radical gastrectomy remains the initial treatment of choice. Although controversy persists about the extent of lymph node dissection, there is a general consensus in performing D2 dissection but with preservation of pancreas and spleen. Patients who have high risk of relapse are treated with postoperative chemoradiotherapy. The regimen of preoperative chemotherapy followed by gastrectomy and postoperative chemotherapy has also become important in recent years. Both these chemotherapeutic options confer survival advantage and patients need to be appraised about various treatment strategies at the very outset.     

Nutritional and Antioxidant Potential of <Emphasis Type="Italic">Aegle marmelos</Emphasis> Fermented Fruit Juice

Aegle marmelos fruit, leaf and bark, are traditionally used for treatment of diabetes, liver toxicity, fungal infection, microbial infection, inflammation and pyrexia. In the present study, an attempt has been made to ferment the A. marmelos fruit juice and evaluate its nutritional and antioxidant potential as well as its sensory attributes. The nutritional potential of the fermented fruit juice showed an increased level of titratable acidity and lactic acid content of 1.7 g tartaric acid/L and 7.2 mg/L respectively. The 2, 2-diphenyl-1-picrylhydrazyl (DPPH), 2,2′-azino-bis-3-ethylbenzothiazoline-6-sulphonic acid (ABTS) and Hydrogen peroxide (H₂O₂) scavenging activity of the fermented fruit juice was found out to be 81.10, 34.44 and 33.33 % respectively at 15 µl/mL concentration. Principal component analysis (PCA) reduced five sensory attributes (aroma, color, flavor, taste and aftertaste) to three independent components, which accounted for a 79.265 % variance (PC1, 31.278 %; PC2, 27.288 %; PC3, 20.699 %). It is concluded that the fermented fruit juice is rich in antioxidants and can be potentially used as a medicinal drink with higher nutritional potential.