Follicular carcinoma of thyroid following successful liver transplantation – A report

Dantuluri S, Urs A, Karthik SV. Follicular carcinoma of thyroid following successful liver transplantation – A report. Abstract: Follicular carcinoma of the thyroid is a relatively rare malignancy in childhood even in paediatric solid organ transplant recipients. The risk of developing de novo malignancies after liver transplantation is higher compared to the general population. We report an 18‐yr‐old girl who had successfully undergone liver transplantation five yr earlier for neonatal sclerosing cholangitis complicated by the development of dysplastic nodules. Baseline immunosuppression was with tacrolimus and prednisolone. Mycophenolate mofetil was later added in view of steroid‐resistant episodes of graft rejection. She subsequently suffered from marked obesity and essential hypertension needing antihypertensive medication. Five yr after liver transplantation, she presented with a right‐sided thyroid swelling that was rapidly progressive with no associated lymphadenopathy and normal systemic examination. Ultrasound of her neck revealed a solid lesion in the right lobe of the thyroid gland with ill‐defined margins, and a diagnostic right thyroid lobectomy confirmed the diagnosis of follicular carcinoma with focal capsular and vascular invasion. She underwent total thyroidectomy and currently remains well on thyroxine supplements. Our report highlights the need for high level of suspicion and prompt investigation into any abnormal lesion in the long‐term follow‐up of solid organ transplant recipients.     

Ileocecal masses in patients with amebic liver abscess： Etiology and management

AIM:To assess the causes of ileocecal mass in patientswith amebic liver abscess.METHODS:Patients with amebic liver abscess andileocecal mass were carefully examined and investigatedby contrast-enhanced CT scan followed by colonoscopyand histological examination of biopsy materials fromlesions during colonoscopy.RESULTS:Ileocecal masses were found in seventeenpatients with amebic liver abscess.The cause of themass was ameboma in 14 patients,cecal tuberculosisin 2 patients and adenocarcinoma of the cecum in 1patient.Colonic ulcers were noted in five of the six(83%)patients with active diarrhea at presentation.Theileocecal mass in all these patients was ameboma.Ulcerswere seen in only one of the 11(9%)patients withoutdiarrhea.The difference was statistically significant fromthe group with diarrhea(P<0.005).CONCLUSION:Ileocecal mass is not an uncommonfinding in patients with amebic liver abscess.Although,the ileocecal mass is due to ameboma formation in mostcases,it should not be assumed that this is the case inall patients.Colonoscopy and histological examinationof the target biopsies are mandatory to avoid missing amore sinister lesion.     

Endovascular clamping of porcelain aorta in aortic valve surgery using Foley Catheter

Unclampable calcified aorta is an uncommon condition that all cardiac surgeons may encounter and performing aortic valve surgery in this condition with a non cross-clamping technique of using Foley Catheter has rarely been reported. Aortic valve surgery invariably becomes a high-risk, challenging procedure to cardiac surgeon or even a contraindication to surgery when the ascending aorta cannot be clamped due to extensive calcification precluding safe dissection and clamping. We describe and recommend a non cross-clamping technique of using Foley Catheter and report it successful use in two patients who underwent aortic valve replacement with "porcelain" unclampable aorta.     

Aluminum phosphide-induced esophageal strictures: a new cause of benign esophageal strictures

Fifteen consecutive patients presenting with dysphagia due to aluminum phosphide (AP)-induced esophageal strictures were studied retrospectively to elucidate the natural history of AP-induced esophageal strictures and to evaluate the efficacy of bougie dilation. The median time lag between consumption of AP and occurrence of dysphagia was 3 weeks. All patients had a single stricture and could be dilated using a bougie dilator. Thirteen patients were relieved of dysphagia on a mean (SD) follow-up of 18 (7.3) months. Two patients had recalcitrant strictures and needed needle-knife incision of the stricture followed by balloon dilation. The strictures opened up well in both the patients and they were relieved of dysphagia. AP-induced esophageal stricture is a new cause of benign esophageal stricture. Most patients present with dysphagia around 3 weeks after consumption of AP tablets. A single esophageal stricture is found in these patients. Most strictures respond very well to bougie dilation. However, some of the strictures may be recalcitrant and may require needle-knife incision and balloon dilation.     

Antidermatophyte and antimelanogenesis compound from <Emphasis Type="Italic">Eleutherine americana</Emphasis> grown in Indonesia

An active compound from the bulb of Eleutherine americana L. Merr. (Iridaceae) collected from East Kalimantan, Indonesia, was tested for its antidermatophyte and antimelanogenesis activity. Antifungal assay-directed fractionation of the n-hexane-soluble fraction of the methanolic extract of the bulb of E. americana led to the isolation of 1 as an active compound. The compound was identified as the naphthoquinone eleutherin by EI-MS and ¹H-, ¹³C-, and two-dimensional NMR analyses. Antidermatophyte assay of 1 at concentrations of 10, 20, 40, 60, and 80 μg/disk and myconazole, a commercial antidermatophyte, at 10 μg/disk displayed 7, 8, 13, 16, 17, and 14 mm of inhibition zone against Trichophyton mentagrophytes, respectively. In a melanin formation inhibition assay, compound 1 displayed potent antimelanogenesis activity at 5 ppm with low toxicity compared with arbutin, a commercial skin-whitening agent. The results showed the high potential of 1, an active compound from E. americana, to be applied as an antidermatophyte and antimelanogenesis agent.     

Biological activity of the essential oil of Kadsura longipedunculata (Schisandraceae) and its major components

Objectives The aim was to determine the chemical composition of the essential oil of Kadsura longipedunculata and the biological activity of the oil and its major components. Methods The essential oil from stem bark of Kadsura longipedunculata was analysed by capillary gas chromatography (GLC/FID) and gas chromatography–mass spectrometry (GLC/MS). The ability of the oil to reduce diphenylpicrylhydrazine (DPPH^?) was used to evaluate the antioxidant activity. Inhibition of both lipoxygenase and prostaglandin E₂ was used to assess the anti‐inflammatory activity. Antimicrobial activity was studied in vitro against a range of bacteria and fungi using diffusion and microdilution methods. Inhibition of trypanosome proliferation was assessed using resazurin as vital stain. The in‐vitro cytotoxicity of the essential oil on six human cancer cell lines (HepG2, MIA PaCa‐2, HeLa, HL‐60, MDA‐MB‐231 and SW‐480) was examined using the MTT assay. Key findings Fifty compounds, representing 97.63% of total oil, were identified. δ‐Cadinene (21.79%), camphene (7.27%), borneol (6.05%), cubenol (5.12%) and δ‐cadinol (5.11%) were found to be the major components of the oil. The oil exerted a good antimicrobial activity against all Gram‐positive bacteria tested, including methicillin‐resistant Staphylococcus aureus and vancomycin‐resistant Enterococcus faecalis. Streptococcus pyogenes and S. agalactiae were the most sensitive bacteria with a minimal inhibitory concentration (MIC) of 60 µg/ml oil. The essential oil showed a moderate fungicidal activity against yeasts, but it did not show any activity against Gram‐negative bacteria. The essential oil showed a good trypanocidal activity in Trypanosoma b. brucei with an IC50 value of 50.52 ± 0.029 µg/ml. Radical scavenging activity had an IC50 value of 3.06 ± 0.79 mg/ml. 5‐Lipoxygenase inhibition (IC50 = 38.58 µg/ml) and prostaglandin E₂ production inhibition (28.82% at 25 µg/ml) accounted for anti‐inflammatory activity of the oil. The oil exhibited some degree of cytotoxic activity against MIA PaCa‐2, HepG‐2 and SW‐480 cell lines with IC50 values of 133.53, 136.96 and 136.62 µg/ml, respectively. The oil increased caspase 3/7 activity (an indicator of apoptosis) 2.5–4 fold in MIA Paca‐2 cells. Camphene and borneol did not show antioxidant activity. However, both compounds exhibited some degree of antimicrobial, trypanocidal, anti‐inflammatory and cytotoxic activity. Conclusions This investigation provided evidence for, and confirmed the efficacy of, K. longipedunculata, a traditionally used Chinese medicinal plant for the treatment of inflammation and infection.     

Comparison of Manning, Rome I, II, and III, and Asian diagnostic criteria: Report of the Multicentric Indian Irritable Bowel Syndrome (MIIBS) study

Background

Attempts to diagnose and subtype irritable bowel syndrome (IBS) by symptom-based criteria have limitations, as these are developed in the West and might not be applicable in other populations.

Objectives

This study aimed to compare different criteria for diagnosing and subtyping of IBS in India.

Method

Manning's and the Rome I, II, and III criteria as well as the Asian criteria were applied to 1,618 patients (from 17 centers in India) with chronic lower gastrointestinal (GI) symptoms with no alarm features and negative investigations.

Results

Of 1,618 patients (aged 37.5 [SD 12.6] years; 71.2 % male), 1,476 (91.2 %), 1,098 (67.9 %), 649 (40.1 %), 849 (52.5 %), and 1,206 (74.5 %) fulfilled Manning's, Rome I, II, and III, and the Asian criteria, respectively. The most common reason for not fulfilling the criteria was absence of the following symptoms: “more frequent stools with onset of pain,” “loose stool with onset of pain,” “relief of pain with passage of stool,” “other abdominal discomfort/bloating,” and, in a minority, not meeting the duration criterion of 3 months/12 weeks. By stool frequency, constipation-predominant IBS (<3 stools/week) was diagnosed in 319 (19.7 %), diarrhea-predominant IBS (>3 stools/day) in 43 (2.7 %), and unclassified in 1,256 (77.6 %). By Bristol stool form, constipation, diarrhea, and unclassified were diagnosed in 655 (40.5 %), 709 (43.8 %), and 254 (15.7 %) patients, respectively. By their own perception, 462 (28.6 %), 541 (33.4 %), and 452 (27.9 %) patients reported constipation-predominant, diarrhea-predominant, and alternating types, respectively.

Conclusion

By Manning's and the Asian criteria, a diagnosis of IBS was made frequently among Indian patients with chronic functional lower GI symptoms with no alarm features; the Rome II criteria gave the lowest yield. By the stool frequency criteria, a majority of patients had unclassified pattern, unlike by the stool form and patients' perception of their symptoms.     

Centenarian scientists: an unusual cluster newly formed in the 20th century

From biographical data sources on ranking scientists, I was able to identify 35 centenarians. Among these, only one (Michel Chevereul from France) lived before the 20th century. Since the remaining 34 individuals became centenarians only from 1965, I propose that centenarian scientists are an unusual cluster, first formed in the 20th century. Among these, all except one (Alice Hamilton) were men. Six centenarian scientists, including Hamilton, had received professional medical training. The nationality ranks of the 34 centenarian scientists identified in the 20th century show 26 Americans, 6 British, one German and one French. Four of the 26 Americans were immigrants from Europe. At least three centenarians, namely Michael Heidelberger, Nathaniel Kleitman and Victor Hamburger, belong to the 'Nobel class' category, being pioneers in the disciplines of immunochemistry, sleep physiology and neuroembryology respectively.