Prevalence of Adenomas and Carcinomas in the Ileal Pouch After Proctocolectomy in Patients with Familial Adenomatous Polyposis

Purpose  Restorative proctocolectomy has become the most common surgical option for patients with familial adenomatous polyposis (FAP). However, adenomas may develop in the ileal pouch mucosa over time, and even carcinoma in the pouch has been reported. Our aim was to evaluate the prevalence, nature, and etiology of ileal pouch and nonpouch adenomas and carcinoma in patients with FAP. Patients and methods  This was a retrospective study of 31 FAP patients with Kock’s continent ileostomy (Kock; n = 8), ileorectal anastomosis (IRA; n = 7), and ileal pouch–anal anastomosis (IPAA) (n = 16). All patients were followed with a standardized protocol including chromoendoscopy and biopsies of visible polyps in the ileal pouch and nonpouch mucosa. Results  Sixteen of 24 pouch patients (Kock and IPAA) developed adenomas in the ileal pouch mucosa, and all patients with IRA developed adenomas in the rectal mucosa. The prevalence of ileal adenomas was significantly higher in pouch patients than in IRA patients (P = 0.002). Only one patient with Kock showed adenoma in the prepouch area. Two cases of adenocarcinomas and one case of advanced adenoma were found in the ileal pouch mucosa. Conclusion  Our results show a high frequency of adenomas in the ileal pouch mucosa, with evolution into carcinoma in some patients. Regular endoscopic surveillance of the pouch is recommended at a frequency similar to that for the rectal mucosa after IRA in pouch patients with FAP.     

Percutaneous embolization of varicocele: technique,indications, relative contraindications,and complications

There are several options for the treatment of varicocele, including surgical repair either by open or microsurgical approach, laparoscopy, or through percutaneous embolization of the internal spermatic vein. The ultimate goal of varicocele treatment relies on the occlusion of the dilated veins that drain the testis. Percutaneous embolization offers a rapid recovery and can be successfully accomplished in approximately 90% of attempts. However, the technique demands interventional radiologic expertise and has potential serious complications, including vascular perforation, coil migration, and thrombosis of pampiniform plexus. This review discusses the common indications, relative contraindications, technical details, and risks associated with percutaneous embolization of varicocele.     

Correlation between Rotator Cuff Tears and Repeated Subacromial Steroid Injections: A Case-Controlled Study

INTRODUCTION

Concern exists regarding potential damage to the rotator cuff from repeated corticosteroid injections into the subacromial space.

PATIENTS AND METHODS

In this retrospective, case-controlled study, 230 consecutive patients presenting to three orthopaedic units with subacromial impingement and investigated as an end-point with magnetic resonance imaging (MRI) of the shoulder were divided into groups having received less than three or three or more subacromial injections of corticosteroids.

RESULTS

With no significant difference in age and sex distribution, analysis by MRI showed no significant difference between the two groups in the incidence of rotator cuff tear (P < 1.0).

CONCLUSIONS

This suggests that corticosteroid use in patients with subacromial impingement should not be considered a causative factor in rotator cuff tears.     

Outcomes following selective fetoscopic laser ablation for twin-to-twin transfusion syndrome: a single-centre experience

INTRODUCTIONFetoscopic laser photocoagulation (FLP), a treatment option for twin-to-twin transfusion syndrome (TTTS) in monochorionic twin pregnancies, is currently the treatment of choice at our centre. We previously reported on our experience of FLP from June 2011 to March 2014. This paper audits our fetal surgery performance since then.METHODS15 consecutive patients who underwent FLP for Stage II–III TTTS before 26 weeks of gestation from June 2011 to January 2017 were retrospectively reviewed, consisting of five cases from our initial experience and ten subsequent cases. Perioperative, perinatal and neonatal outcomes were analysed.RESULTSOf 15 pregnancies, 10 (66.7%) and 5 (33.3%) were for Stage II and III TTTS respectively, with FLP performed at an earlier Quintero stage in the later cohort. Overall mean gestational ages at presentation, laser and delivery were comparable between the cohorts at 19.7 (15.4–24.3) weeks, 20.3 (16.3–25.0) weeks and 31.2 (27.6–37.0) weeks, respectively. 2 (13.3%) cases had intra-amniotic bleeding and 1 (6.7%) had iatrogenic septostomy. 1 (6.7%) case had persistent TTTS requiring repeat FLP, and another (6.7%) had preterm premature rupture of membranes at seven weeks post procedure. The overall perinatal survival rate was 21 (75.0%) out of 28 infants. One mother underwent termination of pregnancy for social reasons at 1.4 weeks post procedure. Double survival occurred in 8 (57.1%) out of 14 pregnancies, while 13 (92.9%) had at least one survivor.CONCLUSIONFLP requires a highly specialised team and tertiary neonatal facility. Continual training improves maternal and perinatal outcomes, ensuring comparable standards with international centres.     

Epithelioid and polygonal cells in histoid leprosy

Salient histological features of 36 histoid leprosy were presented. Usual features like whorls and interlacing bundles of spindle cells, histoid habitus of the bacilli were noticed in all the cases. Pseudocapsule was present in 6 cases. Circumscribed islets of epithelioid cells were seen in the deeper part of the granuloma in 5 cases. Acid-fast bacilli were absent or rare in these cells. Polygonal, foamy macrophages were found in 12 cases. Presence of epithelioid and polygonal cells in histoid leprosy is rare and its significance needs to be explored.     

Oval cells and cystic structures in multiplication of M leprae

Ten preserved biopsy suspensions from leprosy patients were inoculated in biphasic medium and incubated alternatively in refrigerator and at 37 °C. The cultures were observed every week for 3 months. The typical actinomycetoid growth appeared within 3-5 days. Microscopically, two types of cysts (unstained and dark) were seen along with oval cells. Dark cysts showed developement of irregular septae or cracks breaking the mass into irregular quadrangular pieces. Granular acid-fast material could be made out inside the cracks and around the cysts. Oval cells were seen either independently or organised around pink homogeneous material. The oval cells were stained blue or pink. Some of them showed both blue and pink shades.     

Polysaccharide-based tissue adhesives for sealing corneal incisions

PURPOSE: To investigate the ability of a novel polysaccharide-based tissue adhesive to seal corneal incisions, and to determine the effect of the tissue adhesive on corneal endothelial cells. METHODS: A polysaccharide-based tissue adhesive composed of dextran aldehyde and star PEG amines was applied to a 5-mm corneal incision on an enucleated rabbit eye, and the leak pressure of the eye was measured. The tissue adhesive was additionally incubated in direct contact with bovine corneal endothelial cells to evaluate cytotoxicity. RESULTS: The polysaccharide-based tissue adhesive was successful in sealing corneal incisions to pressures of > 10 psi (500 mmHg). The tissue adhesive was non-cytotoxic to bovine corneal endothelial cells. CONCLUSIONS: Polysaccharide-based tissue adhesives are efficacious in sealing corneal wounds and are non-cytotoxic to corneal endothelial cells. Such adhesives represent a promising new technology for ophthalmic surgery.     

Effect of treatment on systolic time intervals in systemic arterial hypertension

Twenty-six hypertensive patients and 25 control subjects were studied, and their systolic time intervals (STI) were measured. It was found that an alteration in STI, signifying left ventricular dysfunction, sets in most of the hypertensives earlier than any evidence of left ventricular hypertrophy (LVH) by clinical, radiological or electrocardiographic criteria. The parameters affected are the PEP interval which shows prolongation and PEP/LVET ratio which is increased. After treatment, the left ventricular performance was found to improve in those who did not reveal evidence of LVH. Thus, STI may be a sensitive indicator of early left ventricular dysfunction in hypertensives and a useful guide to assess improvement after treatment at a stage when other non-invasive methods are not so useful.