Leiomyosarcoma of the inferior vena cava: a case report and review of literature

Tumors of the inferior vena cava are rare, and most of these are leiomyosarcomas. They are most frequent in the sixth decade of life, with a female predominance. We present a 45-year-old male patient with a tumor involving the entire extent of the inferior vena cava. Computerized tomography revealed a heterogeneously enhancing mass with marked expansion of the inferior vena cava with extraluminal extension. Computerized tomography--guided biopsy of the extraluminal component showed features of a fasciculated spindle cell tumor positive for vimentin, smooth muscle actin, and calponin and negative for S-100 antigen. We discuss the clinical presentation imaging findings and review the literature.     

Sympathomimetic infusion and cardiac repolarization: the normative effects of epinephrine and isoproterenol in healthy subjects

Introduction: Catecholamines are known to affect cardiac repolarization, and provocation with either isoproterenol or epinephrine has been proposed as a tool for uncovering latent repolarization abnormalities. This study systematically compares the effects of isoproterenol and epinephrine infusions on QT interval (QT), T waves and U waves in normal subjects.
Methods and Results: Twenty-four normal subjects (29 ± 8 years) were evaluated during graded infusions of up to 0.30 μg/kg/minute epinephrine and 5.0 μg/minute isoproterenol. Heart rates at peak doses were 81 ± 13 bpm at 0.28 ± 0.04 μg/kg/minute epinephrine and 104 ± 5 bpm at 2.4 μg/minute isoproterenol. The longest absolute QT increase was 4 ± 5 msec above baseline during isoproterenol (P < 0.001) and 12 ± 23 msec during epinephrine (P = 0.07), while the longest corrected QT interval (QTc) increase was 67 ± 28 msec (P < 0.0001) and 79 ± 40 msec (P < 0.0001) above baseline during isoproterenol and epinephrine, respectively (P = 0.12 for difference). There was a 2-fold increase in U-wave amplitude during each intervention (P < 0.001). The specificity of paradoxical QT prolongation (≥30 msec at 0.05 μg/kg/minute or ≥35 msec at 0.10 μg/kg/minute epinephrine) and an increase in QTc ≥600 msec at any dose epinephrine were 100%. However, the specificity of other proposed criteria that utilized QTc measurement (≥30 msec at 0.10 μg/kg/minute or ≥65 msec at any dose) was poor whether all leads or only lead II were assessed.
Conclusion: Both epinephrine and isoproterenol are associated with QTc prolongation and amplification of the U wave in normal subjects. The specificity of proposed criteria for epinephrine provocation in diagnosis of the long-QT syndrome is variable; however, paradoxical QT prolongation at low-dose epinephrine or a QTc ≥600 msec is highly specific.     

Development and evaluation of multiplex PCR in rapid diagnosis of abdominal tuberculosis

The clinical features of abdominal tuberculosis (TB) are non-specific and establishing a diagnosis remains a challenge. A delay in diagnosis is likely to increase the morbidity in these patients. We developed a multiplex polymerase chain reaction (PCR) using 16SrRNA, IS6110, and devR, and evaluated it in comparison with other conventional tests in clinical suspects of abdominal TB. A total of 183 patients with clinical suspicion of abdominal TB (96 patients with intestinal TB and 87 with peritoneal TB) were enrolled for the study. Endoscopic or intraoperative biopsies were collected from patients suspected of intestinal TB and ascitic fluid was collected from patients with a suspicion of peritoneal TB. Of the intestinal tuberculosis group, there were 40 confirmed cases and 56 controls, while of the peritoneal tuberculosis group there were 37 confirmed cases and 50 controls. Multiplex PCR showed a high sensitivity and specificity in both the intestinal TB and peritoneal TB groups. When combined with histopathology, multiplex PCR could detect 97.5% of all the cases in the intestinal tuberculosis group, while in combination adenosine deaminase levels (ADA) in cases of peritoneal tuberculosis it increased the specificity of diagnosis of peritoneal tuberculosis to 95%. In combination with histopathology in suspected intestinal TB cases, and ADA testing in suspected peritoneal TB cases, it can be used as a highly sensitive, specific, and rapid diagnostic tool with the ability to supplement the limitations of other diagnostic modalities.     

Invasion of the therapeutic contact lens by a rare fungal species presenting as the acute red eye: A case report

Therapeutic contact lens used in the treatment of non-infective corneal pathologies are prone to infection by microorganisms like bacteria, protozoa and fungi. Bacteria cause the majority of contact lens-related infections. Although rare, fungal invasion of soft contact lenses is a potentially severe complication which may cause keratitis and more fulminating infections. Contact lens invasion can present as acute red eye warranting its replacement to prevent the development of keratitis. Different genera and species of fungi are documented to cause contact lens invasion. We report a rare case of fungal invasion of the contact lens by Aspergillus nidulans.     

Coronoidectomy,masticatory myotomy and buccal fat pad graft in management of advanced oral submucous fibrosis

The purpose of this study is to evaluate coronoidectomy, masticatory myotomy and buccal fat pad graft in advanced (Stage III–IV) oral sub mucous fibrosis (OSF). 10 patients with clinically and histologically confirmed advanced OSF underwent surgery entailing bilateral coronoidectomy, masticatory muscle myotomy and closure with a pedicled buccal fat pad graft followed by vigorous mouth opening exercises. The result was evaluated using the interincisal distance at maximum mouth opening as the objective outcome measure over a follow up period of 12 months. Results showed a mean interincisal opening of 14.7 mm preoperatively and 32.5 mm at 12 months postoperatively. Relapse was encountered in one patient who did not cooperate with the postoperative exercise regime. Results suggest this regime is effective.     

Three new tetranortriterpenoids from neem seed oil

Three new tetranortriterpenoids, 1alpha,2alpha-epoxy-17beta-hydroxyazadiradione (1), 1alpha,2alpha-epoxynimolicinol (2), and 7-deacetylnimolicinol (3), have been isolated from a methanol extract of neem oil (Azadirachta indica, seed oil) along with the known compounds epoxyazadiradione, 17beta-hydroxyazadiradione, gedunin, nimbin, and nimolicinol (4). Spectral studies and chemical transformations were used to establish the structure of compounds 1-3. The characterization of the epoxides 1 and 2 in neem oil is of biogenetic significance, as they may be considered as intermediates between A-ring enones and 1,3-diols among the A. indica tetranortriterpenoids.