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.     

Silencing of a metaphase I-specific gene results in a phenotype similar to that of the Pairing homeologous 1 (Ph1) gene mutations

Although studied extensively since 1958, the molecular mode of action of the Pairing homeologous 1 (Ph1) gene is still unknown. In polyploid wheat, the diploid-like chromosome pairing is principally controlled by the Ph1 gene via preventing homeologous chromosome pairing (HECP). Here, we report a candidate Ph1 gene (C-Ph1) present in the Ph1 locus, transient as well as stable silencing of which resulted in a phenotype characteristic of the Ph1 gene mutants, including HECP, multivalent formation, and disrupted chromosome alignment on the metaphase I (MI) plate. Despite a highly conserved DNA sequence, the C-Ph1 gene homeologues showed a dramatically different structure and expression pattern, with only the 5B copy showing MI-specific expression, further supporting our claim for the Ph1 gene. In agreement with the previous reports about the Ph1 gene, the predicted protein of the 5A copy of the C-Ph1 gene is truncated, and thus perhaps less effective. The 5D copy is expressed around the onset of meiosis; thus, it may function during the earlier stages of chromosome pairing. Along with alternate splicing, the predicted protein of the 5B copy is different from the protein of the other two copies because of an insertion. These structural and expression differences among the homeologues concurred with the previous observations about Ph1 gene function. Stable RNAi silencing of the wheat gene in Arabidopsis showed multivalents and centromere clustering during meiosis I.The Pairing homeologous 1 (Ph1) gene was discovered in 1958 based on the observation that plants lacking wheat chromosome 5B exhibit homeologous pairing (1, 2). Lack of the gene results in multivalents during metaphase I (MI) of meiosis, resulting in partial sterility. Conversely, six doses of the gene in the triisosomic line of chromosome 5BL resulted in interlocking of the bivalents and reduced chiasmata frequency even among homologs, along with rare multivalents (3). Several other genes promoting or suppressing homeologous chromosome pairing (HECP) have also been reported (4, 5), although their effect is difficult to measure in the presence of the Ph1 gene (6). Ph1-like genes were also reported in other sexually propagating polyploids, including Avena sativa, Festuca arundinacea, Brassica napus, Gossypium hirsutum, and Gossypium barbadense, as well as in some diploids, including Lolium perenne, Lolium multiflorum, and Lolium rigidum (7–11).Ph1 gene mutants in tetraploid (ph1c) (12, 13) and hexaploid (ph1b) (14) wheat were shown to be interstitial deletions involving an ∼0.84-μm region and an ∼1.05-μm region around the gene, respectively (15, 16) (SI Appendix, Fig. S1). Physical mapping localized the gene to an ∼2.5-Mb chromosomal region referred to as “Ph1 gene region,” bracketed by the distal breakpoint of ph1c deletion on the distal end and the breakpoint of deletion line 5BL-1 on the proximal end (16) (SI Appendix, Fig. S1). Various marker enrichment efforts identified nine markers for the region (17). Detailed microsynteny analyses and comparative mapping identified a 450-kb region of rice chromosome 9 (17). The corresponding rice region contained 91 genes. The major objective of the present study is to identify the gene(s) responsible for the Ph1 gene-like function using the available mapping information.     

Chemically induced Salmonella enteritidis ghosts as a novel vaccine candidate against virulent challenge in a rat model

Salmonella enteritidis ghosts (SEGs), non-living empty bacterial cell envelopes were generated by using the minimum inhibitory concentration (MIC) of sodium hydroxide (NaOH) and investigated as a vaccine candidate in rats. To determine the immunogenicity and protective efficacy of SEG vaccine, rats were divided into four groups: group A (non-vaccinated control), group B (orally vaccinated), group C (intramuscularly vaccinated) and group D (intramuscularly vaccinated with complete Freund's adjuvant). Vaccination of rats with SEGs induced significant immune responses before and after virulent challenge. Rats vaccinated with SEGs showed significant increases in serum IgG antibodies after challenging with virulent S. enteritidis on week 8 and week 10 (P < 0.01). During the vaccination period, groups B, C and D showed significantly higher serum bactericidal activity (SBA) compared to group A (P < 0.01). Most importantly, bacterial loads in vaccinated groups were significantly lower than in the non-vaccinated group (P < 0.01). In conclusion, these results show that the chemically induced SEGs as a vaccine candidate against virulent challenge.     

Complex airway reconstruction in children with tracheobronchial injuries: a case series

Paediatric airway surgery in the setting of complex tracheobronchial defects is challenging. This report describes the surgical management and outcomes of pericardial flap repair in three children. The first patient was a 4-month-old boy with a history of tracheoesophageal fistula repair who presented after out-of-hospital cardiac arrest. He was treated by re-do tracheobronchial reconstruction of the carina using a pedicled pericardial flap. The second patient was an 11-month-old boy who presented following aspiration of a button battery. Bronchoscopy showed erosion of the battery through both main bronchi and the oesophagus. The patient underwent emergency reconstruction of the extensive tracheobronchial defect with pedicled right and left pericardial patches. The third patient was a 5-year-old girl who fell from a swing, resulting in avulsion of the right main bronchus. Pedicled pericardium was used to reconstruct the damaged posterior tracheal wall and the right and left main bronchi. All three patients underwent successful repair of complex tracheobronchial defects with good outcomes in terms of survival and quality of life during 6 to 21 months of follow-up. Pedicled pericardial flap repair may be a viable option for achieving improved results in children with severe tracheobronchial defects.     

Is hyperaldosteronism a pathognomonic feature of conn’s syndrome?

A 10-year-old female child presented with resistant hypertension and hypokalaemia. There was no muscle weakness or periodic paralysis. The ratio of plasma aldosterone concentration to plasma renin activity was increased. MRI of the abdomen showed the right adrenal mass. The child underwent open right adrenalectomy. she had natriuresis in the postoperative period. She was normotensive without antihypertensive drugs at discharge and 2 months after surgery.     

Chemistry of the Fe2O3/BiFeO3 Interface in BiFeO3 Thin Film Heterostructures

We investigate the interfacial chemistry of secondary Fe₂O₃ phases formed in a BiFeO₃ (BFO) layer in BFO/ La_0.67Sr_0.33MnO₃ (LSMO)/SrTiO₃ (STO) heterostructures. A combination of high-resolution spherical aberration corrected scanning TEM and spectroscopy results, reveals that specific chemical and crystallographic similarities between Fe₂O₃ and BFO, enable the BFO layer to form a facile host for Fe₂O₃.     

Modulation of the auditory cortex during speech: an MEG study

Several behavioral and brain imaging studies have demonstrated a significant interaction between speech perception and speech production. In this study, auditory cortical responses to speech were examined during self-production and feedback alteration. Magnetic field recordings were obtained from both hemispheres in subjects who spoke while hearing controlled acoustic versions of their speech feedback via earphones. These responses were compared to recordings made while subjects listened to a tape playback of their production. The amplitude of tape playback was adjusted to match the amplitude of self-produced speech. Recordings of evoked responses to both self-produced and tape-recorded speech were obtained free of movement-related artifacts. Responses to self-produced speech were weaker than were responses to tape-recorded speech. Responses to tones were also weaker during speech production, when compared with responses to tones recorded in the presence of speech from tape playback. However, responses evoked by gated noise stimuli did not differ for recordings made during self-produced speech versus recordings made during tape-recorded speech playback. These data suggest that during speech production, the auditory cortex (1) attenuates its sensitivity and (2) modulates its activity as a function of the expected acoustic feedback.