Changing causes of mortality in patients with familial adenomatous polyposis

Widespread use of prophylactic colectomy has resulted in a reduction in the incidence of colorectal cancer in familial adenomatous polyposis (FAP) patients. A retrospective chart review of families registered at the Steve Atanas Stavro Familial Gastrointestinal Cancer Registry in Toronto was performed to determine whether the decrease in the number of patients developing colorectal cancer implies that causes of mortality in FAP patients are shifting to that of extracolonic manifestations of FAP. Information was available on 140 deaths within 158 families and among 461 individuals with FAP. When stratified by decade, from the 1930s to the 1990s, the ratio of deaths caused by extracolonic manifestations of FAP compared with deaths caused by colorectal cancer was noted to have risen. Even though most deaths in FAP patients are still from colorectal cancer, it appears that screening policies and prophylactic colectomy have resulted in a reduction in the number of FAP patients who develop colorectal cancer. Thus, in recent decades, a greater percentage of deaths in FAP patients appears to be attributable to extracolonic manifestations of the disease.     

Computer-Based Identification of Type 2 Diabetic Subjects with and Without Neuropathy Using Dynamic Planter Pressure and Principal Component Analysis

Diabetes is a chronic disease that is characterized by an increased blood glucose level due to insulin resistance. Type 2 diabetes is common in middle aged and old people. In this work, we present a technique to analyze dynamic foot pressures images and classify them into normal, diabetes type 2 with and without neuropathy classes. Plantar pressure images were obtained using the F-Scan (Tekscan, USA) in-shoe measurement system. We used Principal Component Analysis (PCA) and extracted the eigenvalues from different regions of the foot image. The features extracted from region 1 of the foot pressure image, which were found to be clinically significant, were fed into the Fuzzy classifier (Sugeno model) for automatic classification. Our results show that the proposed method is able to identify the unknown class with an accuracy of 93.7%, sensitivity of 100%, and specificity of 83.3%. Moreover, in this work, we have proposed an integrated index using the eigenvalues to differentiate the normal subjects from diabetes with and without neuropathy subjects using just one number. This index will help the clinicians in easy and objective daily screening, and it can also be used as an adjunct tool to cross check their diagnosis.     

Talar neck fracture associated with talonavicular dislocation and fracture of posteromedial process of talus

Canale and Kelly modified the Hawkins classification of talar neck fractures by adding a type IV fracture dislocation to the original 3 types described. Type IV injury occurs rarely and is the only type involving dislocation of the talonavicular joint. To our knowledge, only 2 unusual cases have been described in published studies in which a fracture of neck of the talus occurred in association with talonavicular dislocation but the ankle and subtalar joints remained intact. We describe a very unusual case of an adult male with a fracture of the neck of the talus with talonavicular dislocation, subtalar subluxation, an intact ankle joint, and a fracture of the posteromedial tubercle of talus. Open reduction and internal fixation of the talar neck and posteromedial tubercle was undertaken. The talar neck fracture united without any evidence of avascular necrosis, but the posteromedial tubercle remained un-united. Such an injury is unusual, and the injury pattern is unique and cannot be classified using existing systems.     

Radiological review of rhinocerebral mucormycosis cases during the COVID-19 Pandemic: A single-center experience

Mucormycosis is caused by the fungi belonging to the order Mucorales and class Zygomycetes. The incidence of mucormycosis has increased with the onset of the severe acute respiratory syndrome coronavirus 2 infections leading to the coronavirus disease 2019 (COVID-19) pandemic. This rise is attributed to the use of immunosuppressive medication to treat COVID-19 infections. Authors have retrospectively collected data of our cases of mucormycosis diagnosed from April 2020 to April 2021 at our institute. A total of 20 patients with rhinocerebral mucormycosis were studied. Most of the study subjects were male patients (90%) and were of the age group 41-50 years. Most patients in the review had comorbidities (85%) with diabetes being the most common comorbidity. Para nasal sinuses were involved in all the cases. Involvement of the neck spaces was present in 60% of the cases. Involvement of the central nervous system was present in 80% of the cases. Orbital involvement was present in 90% of the cases. The authors reviewed the various imaging findings of mucormycosis on computed tomography and magnetic resonance imaging in this article.     

Coronary endarterectomy for diffuse extensive coronary artery disease

Introduction Atherosclerotic coronary artery disease is in an increasing trend in India. With the advancement of non-surgical methods of revascularisation, the patients coming for surgery are of less attractive anatomy. The role of coronary endarterectomy along with coronary artery bypass grafting for a selected group of these patients is quite promising. Materials and Methods From March 2000 to March 2005, out of 362 CABGs performed, 42 patients had undergone coronary endarterectomy. The age range being from 35 to 76 years, M: F is 38∶4 Hypertension was present in 26 (61%), diabetes mellitus in 20 (47.6%), smoking in 26 (61%) and dyslipidemia in 12 (28.5%) cases. Old myocardial infarction was present in 52.3% cases, unstable angina in 16.6%, stable angina in 23.8% and cardiogenic shock in 7.1% cases. All cases had undergone coronary artery bypass grafting with endarterectomy. Out of 18 LAD endarterectomies 17 cases LIMA was used as onlay patch. Result The average number of grafts anastomosed was 3.7. Single-vessel endarterectomy was done in 37, double vessel in 4 and four vessel in one case. LAD endarterectomy was done in 18, RCA in 12, diagonal in 10, intermediate in 1 and marginals in 8 cases. Postoperatively 3 patients had arrhythmia, two perioperative MI, one recurrent angina and one congestive cardiac failure (CCF). There was 2 (4.76%) mortality. Conclusion Hypertension and smoking are major risk factors. LAD is the most common artery requiring endarterectomy. Usage of LIMA following endarterectomy of LAD is quite satisfactory and short term results are encouraging.     

Primary carcinoma of the fallopian tube--a case report

After performing its role in procreation during the reproductive years, the fallopian tube harbours a malignancy during the postmenopausal years like any other reproductive organ and putting a diagnostic dilemma as to the source of primary focus. A rare case of primary adenocarcinoma of fallopian tube is reported in a 71 years postmenopausal P6L5, presented with pain abdomen for 6 months, loss of appetite and abdominal distension for 4 months and on and off serosanguineous vaginal discharge for 1 month. After clinical and laboratory evaluation it was provisionally diagnosed as a case of adenocarcinoma of ovary. Exploratory laparotomy was carried out and the intra-operative diagnosis was fallopian tube carcinoma with intraperitoneal metastasis--surgical stage III disease. Cytoreductive surgery was performed. Histopathology confirmed the diagnosis. Surgery was followed by chemotherapy with cisplatin and cyclophosphamide regime. Due to advanced stage of the disease and general debility of the patient, although dubulking and chemotherapy course was not perfect but patient improved in her general condition. Now she is leading a symptom-free healthy life after 3 years of treatment; follow-up with CA-125 and USG showing no evidence of secondaries. The disease process is presented in advanced stage early in the course of disease even without involving the muscularis and serosa in contrast to ovarian carcinoma which has to come through the capsule.     

Selective transepicardial ablation in the immature canine myocardium. A more precise method

The numerous surgical and transcatheter ablation methods widely applicable to the adult heart have had limited use and efficacy in the immature myocardium. This study introduces a more precise modification of the transepicardial approach to ablation, applicable to the immature heart, by combining selective mapping and simultaneous ablation techniques. To determine the specificity of this method, we attempted His bundle and sinus node ablations in 14 beagle puppies (aged 2 to 4 months). After a thoracotomy, a custom bipolar needle mapping/ablation probe, attached to a standard electrophysiologic recorder, was applied along the aortoatrial and atrial-superior vena caval junctions to record maximal epicardial His bundle and sinus node impulses, respectively. Complete ablation was achieved by the single injection of 10% formalin specifically into the desired target region of the conduction system after the probe was advanced into the myocardium proper. Ventricular pacing was then instituted, the thoracotomy closed, and the animals allowed to recover. After 4 months' observation, bidirectional complete atrioventricular block persisted. High right atrial electrical activity was absent in the animals that underwent sinus node ablation. Programmed stimulation failed to induce any arrhythmias. Histologic study demonstrated selective His bundle and sinus node destruction with minimal involvement of surrounding tissue. This study demonstrates a reproducible transepicardial approach to precise ablation in the immature heart.     

Regulation of polymerase exchange between Poleta and Poldelta by monoubiquitination of PCNA and the movement of DNA polymerase holoenzyme

To ensure efficient and timely replication of genomic DNA, organisms in all three kingdoms of life possess specialized translesion DNA synthesis (TLS) polymerases (Pols) that tolerate various types of DNA lesions. It has been proposed that an exchange between the replicative DNA Pol and the TLS Pol at the site of DNA damage enables lesion bypass to occur. However, to date the molecular mechanism underlying this process is not fully understood. In this study, we demonstrated in a reconstituted system that the exchange of Saccharomyces cerevisiae Poldelta with Poleta requires both the stalling of the holoenzyme and the monoubiquitination of proliferating cell nuclear antigen (PCNA). A moving Poldelta holoenzyme is refractory to the incoming Poleta. Furthermore, we showed that the Poleta C-terminal PCNA-interacting protein motif is required for the exchange process. We also demonstrated that the second exchange step to bring back Poldelta is prohibited when Lys-164 of PCNA is monoubiquitinated. Thus the removal of the ubiquitin moiety from PCNA is likely required for the reverse exchange step after the lesion bypass synthesis by Poleta.