Inguinal canal spermatic cord leiomyoma presenting as an incarcerated inguinal hernia

Leiomyoma is a benign neoplasm originating from smooth muscle cells and is most commonly seen in the uterus, followed by the small bowel and oesophagus. We report a rare case of a 41-year-old male patient with a spermatic cord leiomyoma that presented as an inguinal canal mass mimicking an irreducible inguinal hernia without scrotal involvement. This report highlights the rare presentation and workup of an inguinal mass, importance of intraoperative decision making based on operative findings and the significance of postoperative pathology findings.

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Hypersegmented neutrophils and oval macrocytes in the setting of B12 deficiency and pancytopaenia

Vitamin B₁₂ deficiency is a recognised pathology in several populations, with a particular prevalence in an older adult population. We present two cases whereby vitamin B₁₂ deficiency is the causative factor in marked pancytopaenia. Oval macrocytosis and hypersegmented neutrophils were noted on both peripheral blood samples, which are a characteristic finding in macrocytic anaemia due to B₁₂ deficiency. Distinct underlying pathologies were identified in both cases; food-cobalamin malabsorption and pernicious anaemia. Parenteral vitamin B₁₂ supplementation resulted in a marked reticulocytosis and rapid improvement of haematological indices in both cases. We present this series to serve as a reminder that B₁₂ deficiency can present as life-threatening pancytopaenia.It has has multiple underlying pathologies,defined risk populations and has characteristic blood film findings which can guide investigations, diagnosis and treatment.

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Mega-giant coronary aneurysm: antithrombotic therapy is an option

A 69-year-old man with a history of hypercholesterolaemia presented to the emergency department with atypical chest pain. Physical examination was normal and ECG showed no evidence of ischaemic changes. Laboratory studies were notable for a D-dimer level of 1842 ng/mL (reference value <500 ng/mL) and the troponin I level was normal.

Chest X-ray was normal. Chest CT angiography ruled out a pulmonary embolism but showed a giant and extensive aneurysm of the right coronary artery (RCA) up to 45 mm in diameter with a partly thrombosed lumen and evidence of right ventricle compression on four-chamber view (figures 1 and 2). The volume of the aorta and the RCA appeared similar (figure 3). Doppler echocardiography did not demonstrate right or left heart haemodynamic abnormalities.

Figure 1

Coronary CT angiography in four-chamber view, evidence of external diameter with arrow and coronary lumen with head arrow.

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Challenges in the anesthetic management of ambulatory patients in the MRI suites.

Purpose of review: MRI is becoming an indispensable diagnostic tool. The need for prolonged motion-free periods has substantially increased the need for deep sedation or anesthesia in a challenging environment. This review summarises recent literature with respect to pharmacological sedative strategies, nonpharmacological alternative approaches, airway management and safety issues in the ambulatory setting. Recent findings: Most literature researches the pediatric patient population. The American Society of Pediatrics published guidelines for monitoring and management of pediatric patients during sedation for diagnostic procedures. Dexmedetomidine is the most researched agent for sedation. It remains uncertain what the clinical implications are of the potential neurotoxicity of repeat sedation or anesthesia in young children. Airway strategies highlight the use of end-tidal carbon dioxide monitoring. Technical imaging advancement and nonpharmacological sedation alternatives allow for shorter procedures with a lower need for sedation. Summary: The anesthetic management of ambulatory patients in the MRI environment has its specific challenges and safety issues. However, the implementation of safety guidelines, new pharmacological and alternative nonpharmacological sedation strategies offer interesting perspectives to tackle these challenges. Copyright (C) 2017 YEAR Wolters Kluwer Health, Inc. All rights reserved.

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Super pulse CO2 laser therapy for benign eyelid tumors

Summary

Background

Benign eyelid tumors occur commonly in daily outpatient services.

Objectives

The aim of this study was to evaluate the treatment of benign eyelid lesions with a super pulse CO₂ laser as an alternative to surgical excision.

Methods

This retrospective clinical study included 80 patients with 99 benign eyelid lesions treated with super pulse CO₂ laser photocoagulation. The following areas were involved: the upper eyelid in 38 cases, the lower eyelid in 39 cases, and the angulus oculi in seven cases (the eyelid margin was included in 18 cases). The laser spot size ranged from 120 to 200 μm and the super pulse CO₂ laser power density varied between 0.6 and 21.1 W/mm². The mean follow-up period was 14.0±7.1 months (range five to 30). Histological diagnoses were obtained in 62 of the 80 patients.

Results

The cosmetic outcomes of all of the patients were satisfactory after treatment, and the wounds formed dry scabs, with no infections. They were epithelialized within 2-4 weeks with normal-appearing epithelium. Temporarily, the treated area had less hyperpigmentation than the surrounding normal skin, showing no obvious scars or notches. No complications were observed, with no relapses during the follow-up.

Conclusions

The super pulse CO₂ laser therapy of the benign eyelid tumors provided satisfactory cosmetic results in this study. It is a convenient, cheap, accessible, and well-tolerated alternative to traditional surgery, especially for diffuse tumors, or those positioned close to the lacrimal papillae.

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Myricetin protects keratinocyte damage induced by UV through IκB/NFκb signaling pathway

Summary

Objective

The aim of this study was to evaluate the potential molecular mechanism of myricetin that protecting cells from photodamage.

Methods

Myricetin had broadly chemopreventive effects and anti-inflammatory properties. The effect of myricetin was assessed on HaCaT cells. Cell viability assay was carried out. Reactive oxygen species (ROS) level was measured. The expression of pro-inflammatory factor COX2 was determined by real-time PCR and Western blot. The protein levels of p-IκBa and IκBa were determined by Western blot.

Results

Myricetin attenuated UV-induced keratinocyte death in a dose-dependent manner as determined by cell viability assay. Pretreatment with myricetin also reduced the UV-induced ROS levels. Myricetin suppresses the upregulation of COX2 induced by UV in keratinocyte as demonstrated by real-time PCR and Western blot. Furthermore, signal transduction studies confirmed that myricetin attenuates the upregulation of COX2 induced by UV via suppression of IκB/NFκB pathways.

Conclusion

These results showed that antioxidant property of myricetin can effectively attenuate UV-caused cell damage and suppress the expression of COX2 through the IκB/NFκB signaling pathways. Myricetin had potential protective effects on UV-induced skin cell damages, which might be used in cosmetic and pharmaceutical industries.

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Masthead

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