Central pancreatectomy for pancreatic schwannoma: A case report and literature review

Schwannomas are mesenchymal tumors originating from Schwann cells in peripheral nerve sheaths. Although the tumor can be located in any part of the human body, the most common locations are the head, neck, trunk and extremities. Pancreaticschwannomas are rare. To our knowledge, only 64 cases of pancreatic schwannoma have been reported in the English literature over the past 40 years. In this paper, we present a pancreatic schwannoma in a 59-year-old female. Ultrasound, computed tomography and magnetic resonance imaging revealed the tumor located in the pancreatic body; however, accurate diagnosis was hard to obtain preoperatively and a pancreatic cystadenoma was preliminarily considered. During laparotomy, the mass was found in the body of the pancreas. An enlarged gallbladder with multiple stones was also observed. We performed central pancreatectomy, end-to-side pancreaticojejunostomy and cholecystectomy. Notably, central pancreatectomy has been reported in only one case prior to this report. The gross specimen showed a mass with a thin capsule, 1.6 cm × 1.1 cm × 1.1 cm in size. Microscopic examination showed that the tumor was mainly composed of spindle-shaped cells with palisading arrangement and no atypia, which is consistent with a benign tumor. Both hypercellular and hypocellular areas were visible. Immunohistochemical staining revealed strongly positive results for protein S-100. Finally, the tumor was diagnosed as a schwannoma of the pancreatic body. Postoperatively, the patient recovered well and left the hospital 6 d later. During the 53-mo follow-up period, the patient remained well and free of complications.     

Burden of Fluoroquinolone Resistance in Clinical Isolates of Escherichia coli at the Ho Teaching Hospital,Ghana

BackgroundThe growing burden of antibiotic resistance is a threat to the management of infections. Infections by Escherichia coli are routinely treated with fluoroquinolone antimicrobial agents. Due to their frequent use, there has been increasing resistance to these drugs. We set out to determine the burden of fluoroquinolone resistance among clinical E. coli isolates at the Ho Teaching Hospital, Ghana.MethodsThis was a cross-sectional study conducted from July 2018 to June 2019. One hundred and thirty-five E. coli isolates were cultured from various clinical samples. Antimicrobial susceptibility testing was performed using the Kirby-Bauer disk diffusion method with discs of nalidixic acid (NAL), ciprofloxacin (CIP), norfloxacin (NOR) and levofloxacin (LEV). Deoxyribonucleic acid (DNA) was extracted from the resistant isolates for the detection of fluoroquinolone resistant genes by polymerase chain reaction.ResultsNinety of the 135 isolates (66.7%) were resistant to at least one of the four fluoroquinolone drugs investigated. Resistance to NAL, CIP, NOR, and LEV was 51.0%, 51.1%, 38.8% and 35.7% respectively. Out of the fluoroquinolone resistant isolates, 69 carried one or more fluoroquinolone resistant genes. The predominant resistant genes were aac(6′)-Ib-cr (48.9%) and qnrD (25.6%). Seven of the isolates carried both qnrS and aac(6′)-Ib-cr genes. Two isolates carried 5 different fluoroquinolone resistant genes.ConclusionHigh prevalence of resistance to 4 fluoroquinolone drugs was recorded with associated resistant genes. This is a threat to current efforts to control the spread of antibiotic resistance and calls for concerted efforts to curb the spread of these resistant organisms.     

Building Child and Adolescent Psychiatry Expertise in Ghana Through Training and Knowledge Dissemination: a Review of the Initial Collaboration Stages,Opportunities, and Challenges

Purpose of Review

Improving child and adolescent mental health (CAMH) is a priority worldwide. The majority of children with psychiatric conditions in low-middle-income countries (LMIC), like Ghana, receive no treatment due largely to limited resources and few CAMH training opportunities. The Komfo Anokye Teaching Hospital (KATH) and University of Michigan (UM) established a partnership to expand CAMH training for general psychiatrists in Ghana. Lessons learned from the early stages of the collaboration can serve as an adaptable roadmap for similar efforts to expand CAMH training in LMIC.

Recent Findings

Previous articles have discussed global academic partnership, training, and capacity building programs; however, early challenges, opportunities, and preparatory stages involved in creating a mutually beneficial collaboration aimed at improving child psychiatry expertise in a LMIC are under explored in the global mental health literature. This article seeks to fill that gap by using examples to highlight unique considerations for institutions in the initial stages of establishing their global partnership.

Summary

The early stages of a global partnership can impact the success of the collaboration. Collaborations should be bi-directional, sensitive to local culture, and flexible and establish achievable sustainable goals.

     

Monofunctional adenine N-3 adducts of melphalan: Occurrence at a mutational hotspot sequence and resistance to removal by AlkA protein

Previous work showed that a CTAAA sequence in the supF gene of the shuttle plasmid pZ189 was a hotspot for mutagenesis by the aromatic nitrogen mustards melphalan and chlorambucil, and indirect evidence suggested adenine N-3 adducts as premutagenic lesions. In order to characterize the adducts formed at this sequence more directly, a substrate was prepared in which the three adjacent adenines in the CTAAA sequence were ³H-labeled. Following treatment of this substrate with [¹⁴C]melphalan, thermolabile adducts were depurinated and analyzed by HPLC. Only a single peak bearing both ³H and ¹⁴C label was detected and it coeluted with the single major adduct formed by the reaction of melphalan with free adenine base. Various spectrometric analyses of this species were all consistent with its identification as a monofunctional adenine N-3 adduct of melphalan. There was no evidence for any bifunctional adducts involving the labeled adenines. There was little if any release of the adenine N-3 adduct of melphalan by Escherichia coli AlkA protein, under conditions where 3-methyladenine was quantitatively released. The results support the proposal that monofunctional adenine N-3 adducts are intermediates in the generation of T → A and T → G transversions by aromatic nitrogen mustards. Environ. Mol. Mutagen. 31:333–339, 1998 © 1998 Wiley-Liss, Inc.     

In-Country Training by the Ghana College of Physicians and Surgeons: An Initiative that has Aided Surgeon Retention and Distribution in Ghana

World Journal of Surgery - Prior to 2003, production of new surgeons in Ghana was limited. In 2003, the Ghana College of Physicians and Surgeons (GCPS) initiated the first wholly in-country...     

Humanitarian ventures or ‘fistula tourism?’: the ethical perils of pelvic surgery in the developing world

The vesico-vaginal fistula from prolonged obstructed labor has become a rarity in the industrialized West but still continues to afflict millions of women in impoverished Third World countries. As awareness of this problem has grown more widespread, increasing numbers of American and European surgeons are volunteering to go on short-term medical mission trips to perform fistula repair operations in African and Asian countries. Although motivated by genuine humanitarian concerns, such projects may serve to promote ‘fistula tourism’ rather than significant improvements in the medical infrastructure of the countries where these problems exist. This article raises practical and ethical questions that ought to be asked about ‘fistula trips’ of this kind, and suggests strategies to help insure that unintended harm does not result from such projects. The importance of accurate data collection, thoughtful study design, critical ethical oversight, logistical and financial support systems, and the importance of nurturing local capacity are stressed. The most critical elements in the development of successful programs for treating obstetric vesico-vaginal fistulas are a commitment to developing holistic approaches that meet the multifaceted needs of the fistula victim and identifying and supporting a ‘fistula champion’ who can provide passionate advocacy for these women at the local level to sustain the momentum necessary to make long-term success a reality for such programs.Brief Summary: To avoid becoming ‘fistula tourists,’ short-term expatriate surgical volunteers need special training and should work only in environments that facilitate long-term institutional development.