CT and MRI findings with histopathologic correlation of a unique bilateral orbital mantle cell lymphoma in Graves’ disease: a case report and brief review of literature

Bilateral orbital mantle cell lymphoma is rare. We present an unusual case report of a patient with Graves’ disease and no previous history of lymphoma, who was found to have bilateral orbital mantle cell lymphoma on CT and MR imaging which was confirmed histopathologically. To our knowledge, there have been no previously described cases of bilateral mantle cell lymphoma in Graves’ disease. Of particular radiologic interest, the left orbital mass presented in a bicompartmental fashion with a discreet intraconal component separated by a fat plane from an extraconal component that extended intraconally. In our review of radiologic literature, this presentation has not been described previously.     

Outpatient management of severe ovarian hyperstimulation syndrome: a systematic review and a review of existing guidelines

Ovarian hyperstimulation syndrome (OHSS) is a potentially serious complication of assisted reproductive treatment. Management of women with severe OHSS has traditionally included hospitalisation for close monitoring and supportive treatment. The aim of this review is to assess the evidence for safety and efficacy of outpatient management of severe OHSS. A systematic review of studies describing outpatient management options was performed. Current guidance from advisory bodies was also reviewed. Outpatient management has been found in observational studies to be safe and cost-effective compared to inpatient management. Paracentesis of ascitic fluid seems to be effective treatment for severe OHSS along with supportive management including maintenance of fluid balance and preventative measures against thrombo-embolism. GnRH antagonist was shown in few studies to be effective in treatment of early severe OHSS although further research is required to assess its role in this context. Appropriate outpatient set up and protocols are essential to provide safe outpatient management for women with severe OHSS.     

The appendix as ureteral substitute: a report of 10 cases

BackgroundUreteric replacement in part or in total is rarely needed in children. We present our experience in using the appendix to replace the ureter.MethodsA retrospective case note review was carried out at Sheffield Children's Hospital (UK), Ekta Institute of Child Health (Raipur, Chhattisgarh, India) and Christian Medical College Hospital (Vellore, India) of all cases of ureteric substitution using the appendix.ResultsTen patients were identified, operated in 2002–2007: seven males and three females with a median age of 2.5 years (range 2.5 months to 12 years). The reasons for ureteric replacement were traumatic ureteric avulsion (n = 1), congenital ureteric stenosis (n = 5), non-drainage following previous pyeloplasty for pelvi-ureteric junction obstruction (n = 3) and ureteric stricture following reimplantation for vesico-ureteric reflux (n = 1). The appendix was used in an anti-peristaltic manner in all cases, and in one case a transureteroureterostomy was performed. At a median follow up of 16 months (1–72 months), all the patients were well except one whose kidney function had deteriorated.ConclusionsTotal or partial replacement of the ureter using the appendix, even in the first year of life, preserved renal function in nine cases. Ureteric continuity can be successfully restored in children using the appendix.     

Refractory enuresis in children and adolescents: How can urodynamics affect management and what is the optimum test?

ObjectiveAfter failure of medical and behavioral therapy in enuresis, the usual next step is to investigate using urodynamics. The aim of this study was to determine the actual benefit and optimal method of urodynamics in the treatment of refractory enuresis.MethodsThis prospective randomized study included 56 patients: 17 males and 39 females with an age range of 7–16 years. All had tried multiple courses of medical treatment for enuresis for at least 6 months without response. Thirty patients underwent investigation by cystometrogram, uroflowmetry and electromyogram (UFM/EMG), while 26 patients underwent pressure/flow/EMG (P/F/EMG) studies.ResultsBladder filling abnormalities were found in 25 out of the 56 patients (44.6%) and included low bladder capacity in 39%, hypocompliance in 32%, and detrusor overactivity in 45%. With regard to voiding dysfunction, 70% of the UFM/EMG group had detrusor‒sphincter dyssynergia and 67% of the P/F/EMG group had bladder outlet obstruction.ConclusionsUrodynamics can help in cases of refractory enuresis by detecting dysfunctional voiding, which is present in a large percentage of these patients. This can be diagnosed by UFM/EMG, rather than P/F/EMG, as a non-invasive test. UFM alone may be misleading. Alpha adrenergic blockers may be of benefit in treating these patients.     

Engineered peptides for the development of actively tumor targeted liposomal carriers of doxorubicin

Chemotherapy is still the treatment of choice for many types of cancer; but its effectiveness is hampered by dose limiting toxicity. Properly designed delivery systems can overcome this shortcoming by reducing the non-specific distribution and toxicity of chemotherapeutics in healthy organs and at the same time increasing drug concentrations at tumor tissue. In this study, we developed stealth liposomal formulations of doxorubicin (DOX) having a novel stable engineered peptide ligand, namely p18-4, that binds specifically to breast cancer cell line MDA-MB-435 on its surface. The coupling of p18-4 to liposomes was carried out through conventional, post insertion and post conjugation techniques and prepared liposomes were characterized for their size and level of peptide modification. The p18-4 decorated liposomal DOX formulations were then evaluated for their cellular uptake as well as cytotoxicity against the human breast cancer MDA-MB-435 cells. In this context, the effect of coupling technique on the uptake and cytotoxicity of p18-4 liposomal DOX in MDA-MB-435 cells was evaluated. The conventional and post conjugation methods of peptide incorporation were found to be more reliable for the preparation of p18-4 decorated liposomes for active DOX targeting to MDA-MB-435 cells. p18-4 decoration of liposomes by these methods did not have a notable effect on the size of prepared liposomes and DOX release, but increased the uptake and cytotoxicity of encapsulated DOX in MDA-MB-435 cells. The results show a potential for p18-4 decorated liposomes prepared by conventional and post conjugation method for tumor targeted delivery of DOX in breast tumor models.     

Isolated colonic metastasis from breast cancer 11 years after primary diagnosis

Colon is a very rare site of metastasis from breast cancer. Its diagnosis is challenging. We report a new case of 56-year-old woman who was previously treated for lobular breast carcinoma 11 years ago. Radiologic features on barium enema and computed tomography (CT) were concordant with primary cancer of the transverse colon. The true diagnosis was made by immunohistochemical study of hemicolectomy specimen, which showed positivity for CA 15-3, cytokeratin 7, estrogen receptor, and progesterone receptor and negativity for cytokeratin 20 and carcinoembryonic antigen (CEA). The patient received chemotherapy and hormonal therapy. After a follow-up of 17 months, she is still alive with no evidence of recurrence. Literature review revealed that diagnosis should be suspected in the presence of bowel disorders in women with history of breast cancer even several years later. Surgery is beneficial in only isolated colonic metastasis. Otherwise, the treatment is based on systemic therapy. The prognosis is usually poor.     

Correlating skin phototype and minimum erythema dose in Arab skin

Skin typing, as proposed by Fitzpatrick, has been used for estimating the initial dose in phototherapy.1 However, several reports have questioned the reliability of the method.2-4 It has been suggested that skin typing should not be the sole basis for starting UV-B phototherapy, and that determining the minimum erythema dose (MED) is a more reliable method of estimating the UV-B dosage.5 There is little published data with respect to skin types and MED values in Arab skin. In this review, we present our experience on the subject with Bahraini patients.