Type B choledochocele vs duodenal duplication cyst: a diagnostic dilemma and its management: a case report

INTRODUCTION

Duplication cyst of the alimentary tract is a rare congenital anomaly. Duodenal duplication cyst accounts for less than 5% overall. These entities rarely present in adults. They are often mistaken as choledochoceles. Management is most often complete excision, but it is individualized to the particular case.

CASE PRESENTATION

A 22-year-old woman was admitted to our hospital with a history of intermittent colicky right hypochondrial pain not relieved by any medications for the past 3 months. Initially, she was given proton pump inhibitors, but her pain was not relieved. Further evaluation was done, and preoperative imaging showed a cyst in the second part of the duodenum. Magnetic resonance imaging revealed it as a choledochocele, but duodenal duplication cyst was kept in the differential diagnosis. Further ultrasound identified it to be a duplication cyst. After failed endotreatment, the patient was successfully managed with partial excision and marsupialization.

CONCLUSION

Duodenal duplication cyst is uncommon and rarely diagnosed in adults. Duplications in the duodenum should always be a part of the differential diagnosis, especially in cystic lesions. Ultrasonogram of the cyst might lead to the proper diagnosis. Surgery is the treatment of choice if endotherapy is not successful.

Caudal regression syndrome in a fetus of a glucokinase-maturity-onset diabetes of the young pregnancy

BACKGROUND

Glucokinase-maturity-onset diabetes of the young (GCK-MODY) is a form of diabetes caused by heterozygous inactivating mutations in the GCK gene. Affected individuals maintain their fasting glucose levels at a higher set point (5.4-8.3 mmol/l) than the general population. Hyperglycaemia in women with Type 1 or Type 2 diabetes is known to confer increased risk of fetal congenital abnormalities. The association between GCK-MODY and congenital abnormalities, however, remains uncertain.

CASE REPORT

A 35-year-old woman in her third pregnancy was diagnosed with gestational diabetes at 13 weeks' gestation (fasting blood glucose 6.0 mmol/L, 1-h blood glucose 9.2 mmol/l, 2-h blood glucose 7.3 mmol/l). The morphology scan at 19+2 weeks' gestation showed a Type III sacral agenesis. The woman elected to terminate the pregnancy. Her postpartum oral glucose tolerance test was suggestive of GCK-MODY (fasting blood glucose 7.4 mmol/l, 1-h blood glucose 9.3 mmol/l, 2-h blood glucose 7.3 mmol/l). Mutation analysis of the GCK gene identified a novel heterozygous GCK missense mutation, p.V199M, classified as likely pathogenic, providing molecular confirmation of the suspected GCK-MODY diagnosis.

DISCUSSION

Sacral agenesis is a rare form of sacral abnormality affecting 0.005% to 0.1% of pregnancies. It is a subtype of the caudal regression sequence, a cardinal feature of diabetic embryopathy. This case raises the question as to whether hyperglycaemia in GCK-MODY may increase the risk of fetal caudal regression syndrome as reported in women with pre-existing diabetes mellitus. Improved diagnostic rates of GCK-MODY, and MODY registers that include pregnancy outcomes, are important to further elucidate risk of congenital abnormalities in GCK-MODY.

Hydronephrotic kidney with multiple extra-renal calyces

Extra-renal calyces are a rare anomaly of the renal collecting system, characterised by the presence of calyces and pelvis outside the renal parenchyma. It may also be associated with other anomalies, such as renal ectopia, fusion and malrotation. We describe an unusual case of extra-renal calyces with six long calyces arising from a suspected multicystic dysplastic kidney that was successfully managed laparoscopically.

RNA interference in mosquito: understanding immune responses, double-stranded RNA delivery systems and potential applications in vector control

RNA interference (RNAi) refers to the process of post-transcriptional silencing of cellular mRNA by the application of double-stranded RNA (dsRNA). RNAi strategies have been widely employed to regulate gene expression in plants and animals including insects. With the availability of the full genome sequences of major vector mosquitoes, RNAi has been increasingly used to conduct genetic studies of human pathogens in mosquito vectors and to study the evolution of insecticide resistance in mosquitoes. This review summarizes the recent progress in our understanding of mosquito-pathogen interactions using RNAi and various methods of dsRNA delivery in mosquitoes at different stages. We also discuss potential applications of this technology to develop novel tools for vector control.

Lithium Ion Conduction in PVdC-co-AN Based Polymer Blend Electrolytes Doped with Different Lithium Salts

Polymer electrolytes prepared by the complexation of lithium salts with poly(ethylene oxide) (PEO) and poly(vinylidene chloride-co-acrylonitrile) (PVdC-co-AN) will be of great use as separators in lithium polymer batteries. The amorphous nature of the blend electrolyte shows that the conductivity increases by the addition of lithium salts. The presence of C≡N and C=N in PVdC-co-AN are confirmed from the Fourier transform infrared studies. Among the various lithium salts studied, lithium trifluoro methane sulfonoimide [LiN(CF3SO2)2] based electrolyte exhibits the highest ionic conductivity of the order of 0.265 × 10−5 Scm−1 at room temperature. The sample having a maximum ionic conductivity PEO(80 wt%)/PVdC-co-AN(20 wt%)/LiN(CF3SO2)2(8 wt%) is supported by the lower optical band gap in UV-Visible analysis and low intensity in luminescence studies. Two and three dimensional topographic images of the above sample reveal the presence of micropores. Thermal stability of the prepared electrolytes is studied by thermo gravimetric/differential thermal analysis. Using differential scanning calorimetric analysis, the minimum glass transition temperature (30°C) is observed for the sample doped with LiN(CF3SO2)2. The cyclic voltammetric studies reveal the strong capacitive behavior of the prepared polymer electrolytes. The electrochemical stability windows for the prepared samples are observed using linear sweep voltammetry.

FT-IR and DSC studies of poly(vinylidene chloride-co-acrylonitrile) complexed with LiBF4

Poly(vinylidene chloride-co-acrylonitrile) (PVdC-co-AN) based solvent free electrolytes were prepared for different compositions of PVdC-co-AN and LiBF4 using solution casting technique. The ionic conductivity, thermal behavior, complexation and structure of polymer electrolytes have been investigated as a function of LiBF4 content at different weight ratios. DSC studies revealed that the glass transition temperature Tg decreases with the increase of salt concentration up to an optimum level. The change in the glass transition temperature (Tg) with respect to the LiBF4 concentration is reflected in the bulk resistance of the electrolytes and the sample containing 6 wt.% of LiBF4 exhibited minimum bulk resistance compared to other samples. FT-IR studies confirm the interaction of polymer and salt which is mainly between Li-cation and nitrogen atom of C≡N group. The crystalline phase of polymer host is completely changed on the addition of Li salt.