Paradidymis – Fact/Fiction and its Significance

A 30-year old infertile male was admitted for microsurgical sub inguinal varicocelectomy. Intraoperatively, two tubular structures of the caliber of neighboring veins were noted. They were distinct from the vas, which was carefully preserved. Histopathology revealed varicose veins along with two convoluted tubular structures lined by ciliated pseudo-stratified epithelium. There was an incomplete thin muscle coat. The lumina were irregular and contained no spermatozoa (Fig. 1). These structures were identified as paradidymis based on the location in the cord and microscopic morphology. We have tried to analyze the medico-legal significance of these benign lesions in our every day practice.

A randomized control study comparing the pharyngolaryngeal morbidity of laryngeal mask airway versus endotracheal tube

Introduction:

Endotracheal tube (ETT) has been associated with various pharyngolaryngeal morbidities (PLMs) following general anesthesia (GA). Laryngeal mask airway (LMA), currently the most commonly used supraglottic airway device, has several advantageous over the ETT but has been associated with varying results of PLM. The aim of our study was to compare the PLM between them and to know whether LMA is a better alternative.

Materials and Methods:

One hundred and seventy American Society of Anesthesiologists Grades 1 and 2 women scheduled for elective mastectomy were included in the study, 85 each in either group, E Group (intubated with ETT) and L Group (using LMA) on a random basis. All patients received GA with controlled ventilation using a muscle relaxant. PLMs such as hoarseness, pain on phonation, sore throat, and difficulty in swallowing were documented by an interview done postoperatively. Peroperative parameters such as intubation attempts, trauma during airway device insertion, and intraoperative incidents were also analyzed. A sample size of 85 patients in each group was calculated in order to achieve a study power of 0.8 and alpha level was taken as 0.05. Data were analyzed using SPSS version 16 using Chi-square test, Mann–Whitney U-test and Fisher's exact test were used as nonparametric tests. A two-tailed P< 0.05 was considered significant.

Results:

Patients in E Group had statistically significant increased incidence of a sore throat and voice complaints whereas L Group showed a statistically significant increase of swallowing problems. There was also a significant correlation between traumatic insertion and sore throat, pain on swallowing in the L Group, which could be due to direct trauma.

Conclusions:

ETT was associated with an increased incidence of voice problems and sore throat whereas LMA had an increased incidence of dysphagia and odynophagia. Use of LMA changes the pharyngolaryngeal profile to a more acceptable one.

Selective hydrogenation of levulinic acid to γ-valerolactone over a Ru/Mg–LaO catalyst

Ruthenium on a base support was developed for the conversion of biomass derived levulinic acid to γ-valerolactone at low temperature and pressure. γ-Valerolactone synthesis which can replace ethanol in petrol and in the production of jet fuels.

Disseminated intravascular coagulation

Disseminated intravascular coagulation (DIC) is a reflection of an underlying systemic disorder which affects the coagulation system, simultaneously resulting in pro-coagulant activation, fibrinolytic activation, and consumption coagulopathy and finally may result in organ dysfunction and death. Though septicaemia is the most common cause of DIC, several other conditions can also lead to it. A diagnosis of DIC should be made only in the presence of a causative factor supported by repeated laboratory tests for coagulation profile and clotting factors. An effective scoring system helps to detect an overt DIC and a high score closely correlates with mortality. Treatment of DIC is aimed at combating the underlying disorder followed by supportive management. Low molecular weight heparin is advocated in special situations whereas anti-thrombin III and activated protein C are of doubtful value. Early diagnosis and prompt treatment backed by laboratory support can reduce the morbidity and mortality associated with it. The methodology of search for this review article involved hand search from text books and internet search using Medline (via PubMed) using key words DIC, thrombosis, fibrin degradation products, anti-thrombin and tissue factor for the last 25 years and also recent evidence-based reviews.

Note: A vortex cross-correlation flowmeter with enhanced turndown ratio

In the present study, a novel dual sensor vortex cross correlation technique is suggested and implemented to extend the lower operating range of the flowmeter. The first sensor located at an optimum streamwise location of 0.85 times the width of the bluff body is employed to compute the vortex shedding frequency under high Reynolds number conditions. Under low Reynolds number conditions, when the strength of the vortex signal is poor, the outputs from the two piezoelectric sensors are correlated to compute the vortex convection velocity. This vortex convection velocity is used to compute the volume flow rate. This novel dual flow rate estimation technique has demonstrated its robustness under low Reynolds number flow conditions with a remarkable turndown ratio of 1:66 as compared to 1:20 for conventional vortex flowmeters.

An efficient iterative algorithm for computation of scattering from dielectric objects

We have developed an efficient iterative algorithm for electromagnetic scattering of arbitrary but relatively smooth dielectric objects. The algorithm iteratively adapts the equivalent surface currents until the electromagnetic fields inside and outside the dielectric objects match the boundary conditions. Theoretical convergence is analyzed for two examples that solve scattering of plane waves incident upon air/dielectric slabs of semi-infinite and finite thicknesses. We applied the iterative algorithm for simulation of sinusoidally-perturbed dielectric slab on one side and the method converged for such unsmooth surfaces. We next simulated the shift in radiation pattern of a 6-inch dielectric lens for different offsets of the feed antenna on the focal plane. The result is compared to that of the Geometrical Optics (GO).

CA 19-9 to differentiate benign and malignant masses in chronic pancreatitis: is there any benefit?

BACKGROUND

The role of the tumor marker CA 19-9 in differentiating benign from malignant masses in chronic pancreatitis has not been extensively studied.

AIM

This study aims at assessing the accuracy of CA 19-9 in differentiating inflammatory head masses in chronic pancreatitis from superimposed carcinomas on chronic pancreatitis.

METHODS

The data of 84 consecutive patients who had mass lesions in chronic pancreatitis were analyzed to determine the sensitivity, specificity and predictive values at cut-off values of 37, 100, 200 and 300 U/mL. Receiver operating characteristic (ROC) curves were used to assess the sensitivity and specificity.

RESULTS

There were 50 benign masses and 34 malignancies. The overall sensitivity and specificity of CA 19-9 for cancer was 68% and 70%, respectively. There was a higher positivity of CA 19-9 in cancers than in benign masses (23/34; 68% versus 15/50; 30%, P<0.01) with cut-off values of 37 U/mL. Higher positivity rates were obtained in cancers using other cut-off values such as 100, 200 and 300 U/mL. Values over 300 U/mL were 100% specific for malignancy, but occurred in only 5 (of whom had distant metastases) of 34 patients.

CONCLUSION

CA 19-9 level in excess of 300 U/mL in mass lesions in chronic pancreatitis was always indicative of malignancy.

Surgical management of chronic pancreatitis with portal hypertension--a 19-year experience

BACKGROUND

The presence of portal hypertension in chronic pancreatitis imposes great challenges on the clinician. The objective of this retrospective analysis is to identify the demographics, presentation, management and outcomes among patients suffering from chronic pancreatitis with associated portal hypertension.

PATIENTS

The data of fifty-seven patients (36 males, 21 females, age range 23 to 54 years; median 34.5) with chronic pancreatitis and portal hypertension who were operated either for intractable pain or complications over a 19-year period were analyzed. The etiology was alcohol abuse in 28 and idiopathic (tropical) in the remainder. The commonest presentation was abdominal pain in 52 patients (91%). Only 11 patients presented with gastrointestinal bleeding (19%), and they were managed by endoscopic therapy (sclerotherapy, banding, or ethoxysklerol injection). The surgical procedures were: 43 Frey procedures, 11 lateral pancreaticojejunostomies, and 3 Whipple's resections with additional procedures (cyst/biliary drainage or distal pancreatectomy) when appropriate. Direct operations for portal hypertension were required in only 19 patients (splenectomy (n = 15) and gastric devascularization (n = 4)).

RESULTS

Operating times ranged from 210 to 490 minutes (median 320), yet only 11 patients required blood transfusion. There were 24 complications in 18 patients, and hospital stay ranged between 11 and 62 days (median 18.5). One patient died of liver failure on day 17 after operation. Forty-nine out of 53 patients available for follow-up had excellent or good pain relief.

CONCLUSION

Surgery provided good relief of pain and complications in patients with chronic pancreatitis and portal hypertension. Isolated surgery for portal hypertension alone was not required in any of the patients.

Intussusception due to ileal metastases from renal cell carcinoma

Small bowel secondaries from renal cell carcinoma are rare. Patients usually present with features of intestinal obstruction or GI bleeding. Management should be aggressive since metastasectomy can improve the quality of life and survival.

Hydroxyapatite-supported Ag-TiO2 as Escherichia coli disinfection photocatalyst

A series of hydroxyapatite (HAP), 1wt% Ag-TiO(2) (AT1), 1wt% Ag-HAP and 5wt% AT1/HAP composite catalysts were prepared by incipient wetness and mechanical mixing methods. They were characterized by X-ray diffraction (XRD), FT-IR, SEM and ESCA analyses and their photocatalytic bactericidal activities were measured in suspension using Escherichia coli (E. coli), a water pollutant indicator. The surface analysis revealed that the Ag/Ti ratio is found to be ca. 0.0273 and also it indicated that the titania is present in the form of Ti(4+) and Ag is present as metallic silver. Both the XRD and ESCA analyses confirmed the phase of metallic Ag particles, which played a significant role on the bactericidal activity of the Ag doped TiO(2) catalysts. The FT-IR analysis of HAP revealed that the peak intensity is due to the absorbance of surface PO(4)(3-) group centered at wave number 1030cm(-1) and is drastically decreased upon exposure to UV for 1h. The HAP displayed high amount of bacteria adsorption, ca. 80% during the dark experiments compared to other catalytic systems tested. The cumulative photocatalytic properties of AT1/HAP catalytic system resulted in 100% E. coli bacteria reduction within 2min.