A novel technique for nonoperative removal of round rectal foreign bodies

Extraction of rectal foreign bodies is challenging. The medical literature confirms the diversity of the problem and equally some ingenious solutions, the majority of which requires either an anesthetic agent or a laparotomy to remove them. This case report presents a simple nonoperative technique to deal with one such situation.     

Renal lymphangiectasia

Renal lymphangiectasia is a benign disorder of renal lymphatics. Seldom observed, the pathophysiology is unclear. The clinical course may vary, and management alternatives range from percutaneous drainage in symptomatic cases to pharmacological substitutes in the form of anti-hypertensives and diuretics. We present a case of bilateral perinephric collections on imaging, which presented with gross ascites, abdominal pain and reversible hypertension. Ultrasound examination indicated ascites. Computerized tomography revealed bilateral symmetrical large perinephric collections. This is consistent with the appearance of renal lymphangiectasis (enlarged kidneys with fluid collections seen to be abutting the surrounding structures) reported in the literature. Needle aspiration of the perinephric fluid was undertaken, and laboratory analysis was carried out, which revealed a protein level of 643 mg dl(-1) and a total leucocyte count of 50, of which 80% were lymphocytes. Thereafter, a diagnosis of renal lymphangiectasia was made, and conservative treatment with diuretics and anti-hypertensives was initiated. Reassessment at subsequent follow up visits showed improvement in the patient's clinical condition.     

Radioembolization for primary and metastatic liver cancer

The incidence of hepatocellular carcinoma is increasing. Most patients present beyond potentially curative options and are usually affected by underlying cirrhosis. In this scenario, transarterial therapies, such as radioembolization, are rapidly gaining acceptance as a potential therapy for hepatocellular carcinoma and liver metastases. Radioembolization is a catheter-based liver-directed therapy that involves the injection of micron-sized embolic particles loaded with a radioisotope by use of percutaneous transarterial techniques. Cancer cells are preferentially supplied by arterial blood and normal hepatocytes by portal venous blood; therefore, radioembolization specifically targets tumor cells with a high dose of lethal radiation and spares healthy hepatocytes. The antitumor effect mostly comes from radiation rather than embolization. The most commonly used radioisotope is yttrium-90. The commercially available devices are TheraSphere (glass based; MDS Nordion, Ottawa, Canada) and SIR-Sphere (resin based; Sirtex, Lane Cove, Australia). The procedure is performed on an outpatient basis. The incidence of complications is comparatively less than other locoregional therapies and may include nausea, fatigue, abdominal pain, hepatic dysfunction, biliary injury, fibrosis, radiation pneumonitis, gastrointestinal ulcers, and vascular injury. However, these complications can be avoided by meticulous pretreatment assessment, careful patient selection, and adequate dosimetry. This article focuses on both the technical and clinical aspects of radioembolization with emphasis on patient selection, uses and complications.     

Milk fatty acid composition of indigenous goat and ewe breeds from Sindh,Pakistan

The present study was undertaken to evaluate the breed influence on milk fatty acid (FA) composition, particularly on the concentration of conjugated linoleic acid (CLA) from two different indigenous breeds of goats (Pateri and Kamori; n = 30 for each breed) and ewes (Kachi and Kooka; n = 25 for each) from Sindh, Pakistan. All animals were managed together and received the same diet. Statistical significant differences (P < 0.05) in the proportions of individual fatty acids were observed among goat and ewe breeds. Milk fat cis-9, trans-11 CLA concentration from Kamori goats and Kooka ewes were [17–28%] higher when compared to Pateri goats and Kachi ewes, with mean values of 0.48 g/100 g for goat breeds and 0.82 g/100 g for ewes. The greatest differences (P < 0.01) were observed between the group of saturated fatty acids (SFA) in goat (Pateri and Kamori 64.37 vs. 59.07 g/100 g) and ewe breeds (Kachi and Kooka 66.96 vs. 59.00 g/100 g). The sum of the mono-unsaturated fatty acids (MUFAs) was lower in Pateri goat and Kooka breed ewe as compared to Kamori goats and Kachi ewes (27.60 vs. 31.04 g/100 g and 25.35 vs. 30.33 g/100 g). The proportion of polyunsaturated fatty acids (PUFAs) did not differ statistically (P > 0.05) among goat and ewe breads, ranging from 2.45 to 3.60 for goats and 2.48 to 3.27 g/100 g for ewes. The present study reveals that the breed has a pronounced effect on FA composition of goat and ewes milk fat, and in the future genetic selection plans along with improved nutrition program of goats and ewes may result in optimum levels of various fatty acids in milk.