Huge toxic goiter extending to the posterior mediastinum; Case report with literature review

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Retrosternal goiter is defined when the thyroid gland extends below the thoracic inlet.

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It causes compression over the respiratory and the digestive passages, or pressure over the superior vena cava.

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It needs surgical treatment in most patients and usually requires the combined cervical and the thoracic approach.

Introduction

Retrosternal goiter may occur in up to 7% of the cases, most of them extend to the anterior mediastinum, extension to the posterior mediastinum is very rare. It causes compression on mediastinal structures such as the trachea, the bronchi, the esophagus, and great vessels. The diagnosis is done mostly by CT scan. Most cases need surgery which is done by the combined cervical and the thoracic incisions.

Case presentation

A 70-year-old man had history of thyroid enlargement for 10 years which was hyper-functioning and controlled with medical therapy. For the last 2 months the patient was complaining from dyspnea especially during supine posture and dysphagia. CT-scan showed huge extension of the thyroid gland to the posterior mediastinum causing compression over the tracheal and the esophagus. Surgery done through both cervical incision and manubriotomy and the huge thyroid gland extracted. The patient had uneventful recovery with no postoperative complications.

Conclusion

Retrosternal goiter causes airway compromise in most patients. Surgery for such cases is a challenging procedure with higher rate of complications, CT-scan is the most single valuable tool in selecting patients for sternotomy before surgery but the final decision for sternotomy is best done during surgery. A team work between a thyroid surgeon and a thoracic surgeon has better results.

Congenital pouch colon in Duhok, outcome and complications: Case series

Background

Congenital pouch colon (CPC) is a rare congenital abnormality associated with anorectal malformations with high incidence of complications and mortality. The aim of this study is to describe the various types of congenital colon pouch, their management aspects, complications of surgery, and the best management options.

Results

The incidence of congenital pouch colon in the present study was 5.3% (18 patients) of all anorectal malformations. Sixteen cases (88.8%) were males and 2 cases (12.5%) were females, (M: F ratio was 8:1). The age of presentation was ranged from 1day to 1year; 17 cases were presented in first week of life. Preoperative diagnosis of congenital pouch colon was done in 7 patients. As an initial procedure tabularization of the pouch with end colostomy was done in 15 cases, window colostomy was done in 2 cases, and excision of the pouch and proximal ileostomy was done in one patient. As a definitive procedure, abdomino-perineal pull-through of the tabularized pouch was done in 15 cases, ileo-anal anastomosis after pouch excision was done in 3 cases.

Conclusions

Pouch tabularization and end colostomy had better outcome than other types of interventions. Abdomino-perineal pull through of the tabularized pouch was the definitive surgical procedure for treatment of complete pouch colon in our study.

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Congenital pouch colon is a rare disease that requires early diagnosis and treatment.

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Window colostomy at the pouch is better to be avoided due to high incidence of complications.

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Pouch tabularization and end colostomy has better outcome than other types of interventions.

Limy bile (Milk of calcium bile) associated with gall stones discovered incidentally during laparoscopic cholecystectomy

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Limy bile referred to high level of calcium carbonate inside the bile causing the characteristic whitish appearance .

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The condition may be asymptomatic and may be associated with gall stone disease.

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It is readily diagnosed by radiology showing the gall bladder or sometimes the biliary system are filled with a radiopaque material.

Introduction

Limy bile is very rare condition in which the gall bladder is filled with a whitish material formed mainly of calcium carbonate. It may be associated with gall stones and present with epigastric and right upper quadrant pain, fever, nausea, and jaundice.

The diagnosis is easily made during radiology showing opacification of the gallbladder or the bile ducts on plain abdominal X-rays and CT-scan. Most patients are treated with cholecystectomy.

Case presentation

A 35-year-old lady was complaining from right hypochondrial pain for 8 months. The pain was mainly at the late night and relieved with analgesics. During examination the patient had no jaundice and during abdominal examination there was deep tenderness in the right hypochonrdium. Ultrasound of the gallbladder showed evidence of multiple gall stones with bile sludge. During laparoscopic cholecystectomy the gall bladder was found to be filled with white creamy substance and multiple gall stones. The patient discharged next day with no postoperative complications.

Conclusion

Limy bile is a rare clinical entity of unknown etiology but obstruction of the cystic duct may be the most important step in its occurrence. The condition needs cholecystectomy as in most of the cases it is associated with gall stones. There are no reported long term sequelae and long term follows up is not recommended.

Surgical excision of a giant pedunculated hydatid cyst of the liver

Hydatid disease is caused by a tape worm Echinococcus Granulosus that lives in the intestines of the definitive host which is the dog or other carnivore. Human is the accidental intermediate host and become infected by ingesting contaminated vegetables or water with the eggs of the parasite.

A-37-year old male presented with right side abdominal pain for 2 months. Abdominal examination showed a large right side abdominal mass extending from the right subcostal region to the right iliac fossa. CT-scan showed two cystic lesions in the right lobe of the and a third one extending to the pelvis. During surgery aspiration of 10 liters of bile stained fluid done. Excision of the cysts done. Tube drain put inside the cyst cavity with omentoplasty. There was bile leak to the drain which stopped over one month. The patient received anthelminthic medication for 3 months.

Urinothorax causing massive left side pleural effusion in a young lady; case report and literature review

Urinothorax is the presence of the urine in the pleural space. This condition is very rare and occurs due to unrelieved obstruction of urinary flow.

A 20-year-old female presented 7 days after cesarean section with tachypnea, and generalized abdominal pain. There was absent air entry over the left hemithorax. CT scan showed massive left pleural effusion and a stone obstructing the renal pelvis with hydronephrosis and peri-renal collection. The pleural fluid had high fluid creatinine level suggesting urine collection. Ureteroscopy done and double J catheter inserted.

The effusion became loculated, thoracotomy and pleural decortication done.

Predictive factors affecting axillary lymph node involvement in patients with breast cancer in Duhok: Cross-sectional study

Background

Breast cancer is the most common type of cancer affecting women during their life, there are many histological types of breast cancer that have different biological behaviors. Tumors have different genetic and molecular differences which affect the expression of various hormone receptors.

Patients and methods

The aim of this study is to show the factors that determine the axillary lymph node involvement in patients with breast cancer in Duhok city.

A total number of 479 female patients with breast cancer of various histological types, immunohistochemical characteristics, and clinical stages were included in this study. These patients underwent modified radical mastectomy and axillary lymph node dissection.

Results

The mean age of our patients was 48.24 years, the mean number of the positive lymph nodes were 2 lymph nodes, the median size of the tumor was 30 mm. A significant correlation was found with the size of the tumor and the estrogen receptor status (P values (0.000 and 0.042) respectively, while there was no significant correlation with other factors such as the age, stage of the tumor, grade of the tumor, tumor necrosis, progesterone and HER-2 receptors status.

Conclusion

Size of the tumor and the estrogen receptor status were the most common factors that determined axillary lymph node involvement in patients with breast cancer in our study.

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Breast cancer is the commonest type of cancer affecting women during their life.

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Early diagnosis is the most important step in the management.

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Axillary lymph node involvement is one of the most important factors that affects the long term survival.

Hydatid cyst of the calf presenting as painless mass: A case report

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Hydatid disease is endemic in certain parts of the globe.

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High index of suspicion is required for the diagnosis of this disease specially in rare anatomical sites like the calf.

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Involvement of other organs must be excluded as the disease may affects many organs simultaneously.

Background

Hydatid disease is a zoonotic disease that is transmitted to the human by ingesting the eggs of the parasite Echinococcus granulosus, it most commonly affects the liver but every organ could be affected, musculoskeletal system involvement occurs in 0.5–4% of patients. Most patients present as soft tissue mass in the affected muscle.

Preoperative diagnosis usually done radiologically by ultrasound or MRI examination.

Case presentation

We present a 60-year-old lady presented with painless mass in the right calf for 2 years.

The mass was soft, non-tender, mobile from side to side. Ultrasound of the mass showed cystic lesion that contained multiple small cysts inside, and the diagnosis of hydatid disease was made before surgery.

During surgery and after opening the mass the lesion appeared to be hydatid cyst containing innumerable daughter cysts. Complete evacuation of the all the daughter cysts done. The patient discharged next day with no postoperative complications.

The patient received postoperative albendazole therapy for 2 months and follow up done 6 months after surgery with no complications.

Conclusion

Hydatid disease should be thought when patients present with mass lesion in any part of the body especially in endemic areas. The most important step in the diagnosis is to exclude the presence of other cysts in other parts of the body.

Inflammatory pseudotumor of the tunica albuginea and the tunica vaginalis: Case-report

Inflammatory pseudo tumor of the tunica is rare and typically presents as long standing, painless scrotal mass.

A 23-year-old man had palpable, multiple, hard scrotal masses for 3 months. Laboratory investigations were normal (including LDH, AFP, HCG).

Radical inguinal orchiectomy done.

Macroscopically the testis and epididymis were normal, with multiple gray nodules surrounding the testis and epididymis, attached to the tunica albuginea and vaginalis, had smooth surface, partly whorled cut surface.

Histologically, the nodules were well circumscribed, consisting of fibrous tissue, with infiltration by plasma cells and mononuclear inflammatory cells, giving the diagnosis of plasma cell granulomas.

Migrated intrauterine device presented as anterior abdominal wall abscess

The migrated intrauterine contraceptive device can cause various presentations depending on the location, some may have late presentations like our case presenting after 5 years and after pregnancy and delivery by cesarean section. A 34-year-old lady had painful suprapubic mass for 1-week, with fever. She had history of intrauterine device (IUD) placed before 5 years. The patient became pregnant 1 year before presentation and delivery done by cesarean section. Examination showed a tender mass 3 cm above the scar of the previous cesarean section. The clinical picture was consistent with abdominal wall abscess. During surgery pus drained and the IUD extracted from the cavity of the abscess. High index of suspicion is needed when there is history of missed IUD and any abdominal complain. Abdominal X-ray and ultrasound will give better diagnostic value. Most cases need surgical extraction of the device which can be done laparoscopically.

Duplicated gall bladder with gall bladder polyp presenting with cholecystitis: Case report with literature review

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Duplicated gall bladder is a very rare finding.

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Complete identification of the anatomy is required before cholecystectomy.

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Sometimes one of the gallbladders may be missed during the first surgery which may require another operation.

Introduction

Gall bladder anomalies may be in the form of abnormalities in the shape, position, or number. It could be true duplication being completely separated or Y-shaped being united with single cystic duct.

Presentation of case

A 38-year-old lady presented with frequent attacks of right hypochondrial pain for the last 4 months. Ultrasound of the abdomen showed distended gall bladder with 1.3 cm gall bladder polyp at the region of the fundus. Decision done for laparoscopic cholecystectomy. During surgery a duplicated gall bladder found with single cystic duct. Successful surgery done and the gall bladder sent for the histopathological examination which showed a benign gall bladder polyp. There were no post-operative complications and the patient discharged on the third days.

Discussion

Duplicated gall bladder may be diagnosed with ultrasound or magnetic resonance cholangiopancreatography (MRCP) which is the investigation of choice however most cases diagnosed intraoperatively. It may be associated with other biliary anomalies. In some occasions a single gall bladder may be removed during the first operation and the second may be missed which require another surgery. In asymptomatic individuals with duplicated gall bladder no specific treatment is required and role of surgery is controversial.

Conclusion

duplicated gall bladder is a rare finding which may be completely asymptomatic. In symptomatic patients specially if associated with gall stones, surgery is required and the surgeon must be aware of any associated biliary anomalies.

Acute necrotising gastritis in a 14-year-old girl

A 14-year-old female patient presented with acute generalised abdominal pain and two attacks of non-bilious vomiting for 2 days. She visited the emergency department and at presentation she was pale, dyspnaeic and there was no jaundice. Abdominal examination showed moderate abdominal distension with generalised abdominal tenderness. The bowel sounds were negative on auscultation. Plain abdominal X-ray showed hugely distended stomach with no free air detected in the peritoneal cavity. During laparotomy there was huge distension and gangrene of the stomach involving the whole stomach up to the fundus. Total gastrectomy done with roux-en-y reconstruction of the gastrointestinal continuity. The histopathological study of the sample showed gastric necrosis.

Echinococcus granulosus cyst fluid enhances epithelial-mesenchymal transition

Cystic echinococcosis is characterized by fluid-filled hydatid cysts in the liver and lungs. The cysts are surrounded by a host fibrous layer (the pericyst) which acts to isolate the parasite from surrounding tissues. Previous studies in liver cysts have indicated that the parasite may be a stimulating fibrosis. The aim of this study was to investigate whether hydatid cyst fluid (HCF) could influence the potential for fibrosis to occur in lung tissue by stimulating epithelial to mesenchymal transition (EMT) in a human lung epithelial cell line. An adenocarcinoma-derived alveolar basal epithelial cell line (A549) was used as a model for human alveolar epithelial cells (AEC II). These were cultured in vitro with HCF (UK sheep origin). Assays to investigate cell proliferation, cell migration and expression of cytoskeletal markers showed that HCF could stimulate changes indicative of EMT, including enhanced cell proliferation and migration; increased expression of mesenchymal cytoskeletal markers (fibronectin and vimentin) accompanied by a down-regulation of an epithelial marker (E-cadherin). Molecules within hydatid cyst fluid are capable of inducing phenotypic changes in A549 cells indicating that the parasite has the potential to modify lung epithelial cells which could contribute to fibrotic reactions.

Ingested metallic foreign body impacted in the vermiform appendix presenting as acute appendicitis: Case report

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Foreign body appendicitis in children may be caused by a variety of ingested foreign bodies.

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Pins are the most common cause of foreign body appendicitis.

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The reported incidence of bowel perforation is less than 1%, especially with sharp, thin, pointed or long objects.

Introduction

Ingestion of foreign bodies and their impaction at the lumen of the appendix is a very rare finding and only few cases have been reported all over the world. A variety of metallic foreign bodies when ingested may be lodged in the lumen of the appendix such as screws, bird shots, and needles. This is called in most literatures as foreign body appendicitis.

Case presentation

A 4-year-old boy with history of an accidental ingestion of a metallic nail presented to the emergency department one week later with right iliac fossa pain and one attack of vomiting. During abdominal examination there was tenderness and rebound tenderness at the right iliac fossa. Plain abdominal X-ray showed the metallic nail in the region of the right iliac fossa. Ultrasound examination was normal apart from tenderness of putting the probe on the right lilac fossa. The white blood cell counts were 14,000 cell per microliter.

During surgery the nail was found to be impacted inside the lumen of the vermiform appendix causing inflammation of the appendix. Appendicectomy done and the patient discharged on the third day in a good general condition.

Conclusion

Acute appendicitis may be caused by a variety of causes including ingested foreign bodies if impacted in its lumen. When the patient has signs of generalized peritonitis it is important to exclude bowel perforation. The surgery can be done by the open surgery or laparoscopically.

Limy bile syndrome presenting as acute acalculous cholecystitis

A 35-year-old woman presented to the surgical clinic complaining of right hypochondrial pain for 4 days. Abdominal examination revealed tenderness on deep palpation in the right hypochonrdium, with no palpable organs or masses. The patient had repeated attacks of the same pain that mandated repeated admissions to the emergency hospital and treated conservatively. The white blood cell count was 13 000 cells/μL. Ultrasound examination of the abdomen showed thick-walled gall bladder, thick bile, with no visible stones and acalculous cholecystitis was the diagnosis. Decision done for laparoscopic cholecystectomy. After removal of the gall bladder and opening the bladder, a thick milky contents was found to fill the gall bladder with no stones. The diagnosis of limy bile syndrome then done. Histopathological examination of the gall bladder showed features of chronic cholecystitis with no malignancy. The patient discharged on the third postoperative day with no complications.

Midline gallbladder makes a challenge for surgeons during laparoscopic cholecystectomy; case series of 6 patients

INTRODUCTION

Gall bladder anomalies varies from variations in the size, site, duct systems, and shape. Abnormal location comprises the commonest one.The presence of an ectopic gall bladder is estimated to occur in around 0.1-0.7% of individuals, it can be truly ectopic locating under the left lobe of the liver or just to the left of falciform ligament.Gall stones are common disorder that may mandate cholecystectomy especially in symptomatic patients, surgery can be done laparoscopically safely in cases of abnormal anatomical position, but such cases may be at higher rate of complications especially if associated with other biliary tract anomalies.

METHODS

Six cases of symptomatic gall stones who underwent laparoscopic cholecystectomy included in this case series. During insertion of the telescope through the umbilical port, we found midline gallbladder under the falciform ligament instead being under right lobe of the liver. We did modification of the port sites by placing epigastric port in the left hypochonrdium.

RESULTS

In all the six cases the surgery had been done successfully laparoscopically without conversion to open technique. Follow up of the patients done for 2 months with no post-operative sequelae.

CONCLUSION

Laparoscopic cholecystectomy for midline gall bladder is technically difficult. Modifying the port sites make the surgery easier. MRCP preoperatively, intraoperative cholangiography, or fluorescent cholangiography may be needed if there is any concern about biliary anomalies or for real time detection of biliary injuries.

Huge trichobezoar presenting as abdominal mass and weight loss: Case report

INTRODUCTION

Trichobezoar is a condition in which hair is accumulated in the stomach forming a ball like mass. Human hair is resistant to digestion and peristalsis therefore over time it accumulates in the gastric folds. Trichophagia and trichotillomania is a psychiatric disorder in which the affected person has the tendency to pull her or his own hair and ingest it. The condition is almost exclusively seen in females.

CASE PRESENTATION

A 48-year-old lady presented for the last 6 months with epigastric pain, early satiety and weight loss. There are episodic attacks of vomiting. Abdominal examination showed a large, 30 cm × 15 cm, firm, oval shaped mass occupying the left hypochondrial region and extending below the umbilicus. The mass was mobile from side to side but not from up and down it has smooth surface. The mass was non pulsatile. The CT scan of the abdomen was taken and it showed a large oval mass with interspersed gas. Endoscopy showed a huge ball of hair occupying the whole gastric cavity and extending to the upper part of the duodenum. During laparotomy a huge hair mass extracted from the stomach.

CONCLUSION

Trichobezoar is an extremely rare condition that may be encountered during the surgical practice, high index of suspicion is needed to diagnose the condition and endoscopy is still the gold standard method for investigation and diagnosis. The main treatment modality if the open surgery. All patients need psychiatric consultation and long term follow up.

Solid pseudopapillary tumor of the pancreas in a 17-year-old girl

INTRODUCTION

Solid pseudopapillary tumor of the pancreas is a rare tumor of low malignant potential. The aim of this paper is to present and discuss a case of solid pseudopapillary tumor of the pancreas occurring in a 17-year-old female. A 17-year-old girl presented with dull aching poorly localized left hypochondrial pain for two years, she had no clinical findings on physical examination. Ultrasound of the abdomen showed well-defined 9 cm * 7 cm heterogeneous lesion with cystic contents in the region of the tail of the pancreas. Computed tomography scan (CT scan) of the abdomen showed a mass of 8 cm * 7 cm in the region of the tail of the pancreas; that could be pancreatic mass, left suprarenal mass, or lymphoma. Resection of the mass and histopathological examination confirmed the diagnosis of pseudopapillary tumor of the pancreas.

CONCLUSION

Pseudopapillary neoplasm of the pancreas is a rare condition, which needs surgical intervention. Close follow up is necessary to early detection of the recurrence and metastasis.

Accessory nipple over the right scapula of a 14-year-old boy: An extremely rare and unreported location, case report

INTRODUCTION

Accessory or supernumerary nipples can be applied when more than 2 breasts present in human beings. Usually they are seen in the embryonic milk line; however, their presence outside this line is extremely rare. A 14-year-old boy presented to the surgical consultation room complaining from a round brown skin lesion over the right shoulder area, there were no symptoms associated with this lesion but the family was worried about it. During examination the lesion was diagnosed on the basis of clinical examination and appearance as a supernumerary nipple located over the right scapula. This is an extremely rare location, and no case has been reported before. The family was reassured about the diagnosis that this condition is congenital and the patient discharged with no specific treatment.

CONCLUSION

Accessory nipple is not uncommon, and may present in some rare locations. The main work up should be reassurance of the patient about the diagnosis, and most patients need no intervention however it may be removed for cosmetic concerns, if enlarge in size, or associated with any symptom.

Primary hydatid cyst of the urinary bladder

A 35-year-old man presented with poorly localised lower abdominal pain for 3 months. Abdominal examination revealed lower abdominal tenderness, with normal other parts of examination. CT scan of the abdomen showed irregular multiloculated mass related to the upper part of the urinary bladder with mild rim enhancement in the postcontrast study with no areas of calcifications. During laparotomy, we found a mass attached to the superior part of the urinary bladder and arising from its wall. Complete excision was done without opening the cavity of the bladder. The mass was opened and was a hydatid cyst of the bladder containing multiple daughter cysts.

Small bowel obstruction from migrated intragastric balloon

Intestinal obstruction resulted from balloon migration is an extremely rare but serious late complication of the intragastric balloon (IGB). The aim of this study is to report a case of small bowel obstruction occurring in a middle age corpulent female following embedding of IGB. A 47-year-old obese female presented with abdominal pain, nausea, and vomiting for two days. She had a history of an endoscopically placed IGB nine months before presentation. Physical examination showed an obese woman with mild distress, and the right upper abdomen was tender. The plain abdominal radiograph showed gas shadow in the stomach and the duodenum, esophago-gastro-duodenoscopy showed an empty stomach and balloon migration from the stomach. Under general anesthesia, laparotomy was performed, a three-centimeter antimesenteric enterotomy was done and the balloon extracted from the proximal jejunum. Intestinal obstruction is an extremely rare complication of IGB. It should be managed by laparotomy and extraction of the balloon.

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Intestinal obstruction resulted from intragastric balloon migration is an extremely rare complication.

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It is serious complication and needs general anesthesia and laparotomy.

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In this study, a case of small bowel obstruction occurring in a middle age female following inserting of intragastric ballon has been presented and discussed.

Influence of organic phosphorus on reproductive performance and metabolic profiles of anoestrous Farafra ewes in subtropics at the end of breeding season

The effect of organic phosphorus on metabolic, haematological and hormonal status, restoration of ovarian functions and conception rate in anoestrous Farafra ewes in subtropics were evaluated. Anoestrous Farafra ewes (n = 24; 34.72 ± 0.52 kg body weight) were allocated into two equal groups: control and phosphorus groups. The ewes of phosphorus group were treated with sodium 4-dimethylamino-2-methyl-phenyl-phosphonate as an organic bound phosphorous twice a week for successive 3 weeks. Ovarian follicle development and corpora lutea were checked three times a week till occurrence of oestrus using ultrasonography while pregnancy was confirmed at 30 days post-service. Plasma metabolites, reproductive hormones, thyroid hormones and minerals were detected at weeks -2, -1, 0 (mating day) and + 4 weeks post-oestrus. Phosphorus group had significantly (p < .05) short interval to oestrous resumption if compared to control ewes (2.1 ± 0.8 weeks vs. 4.6 ± 1.1 weeks). In addition, phosphorous supplementation significantly (p < .05) increased the number of antral follicles (developed and their sizes in addition to sizes of corpora lutea (8.72 ± 0.3 mm vs. 7.46 ± 0.9 mm) as well. Number of services per conception (2.6 vs. 1.4; p < .01) was higher in control group than that of phosphorus group. Pregnancy rate (80 vs. 50%) was significantly (p < .01) higher in phosphorus group when compared to control. White blood cells in treated ewes (10.8 ± 0.44; p < .05) and monocytes (2.93 ± 0.13; p < .01) were higher than that of control group (white blood cells; 9.53 ± 0.50 and monocytes; 2.24 ± 0.14). Metabolic parameters did not differ between phosphorus and control groups during different times of treatment. It could be concluded that phosphorous administration to anoestrous Farafra ewes in subtropics could improve reproductive performance and restore ovarian activity at the end of spring and early summer.

Effects of feeding green microalgae on ovarian activity, reproductive hormones and metabolic parameters of Boer goats in arid subtropics

The present study aimed to improve ovarian follicle development and plasma metabolites and hormone concentrations upon supplementation of Boer goats with green microalga (Dunaliella salina; 10 g/head/day) (N = 20; MAT group) compared to control (N = 10; not receive microalgae) in subtropics. Estrus was synchronized in all animals by two intramuscular administration of 12.5 mg dinoprost 11 days a part. MAT group was supplemented with Dunaliella salina for 11 days (from the day of first injection of dinoprost till the second injection). Ovarian performance, steroids, LH, FSH and blood metabolites were assessed every three days during the estrous cycle. Numbers and sizes of ovarian follicles and corpora lutea were significantly (P < 0.05) increased in MAT group. Progesterone, estrogen, FSH and LH were higher in MAT group during estrous cycle. Blood metabolites including glucose, total cholesterol and blood urea nitrogen were significantly (P < 0.05) increased upon D. salina administration. On the other hand, supplementation of D. salina resulted in significant decrease of plasma total protein, albumin, aspartate aminotransferase and alanine aminotransferase. In conclusion, supplementation with D. salina could improve ovarian follicle development and concentrations of plasma metabolites and hormones which subsequently improves reproductive performance of Boer goats.

Histopathological confirmation of disseminated larvae (iL3) of Strongyloides ratti in an immunosuppressed Wistar rat

Human strongyloidiasis research requires a large supply of Strongyloides stercoralis. This can be achieved through in vivo maintenance of Strongyloides stercoralis in Meriones unguiculatus, but isolating a large quantity of Strongyloides stercoralis to establish the colony from an infected patient is too difficult to achieve. Hence, Strongyloides ratti have been used as a model in human strongyloidiasis research. This study describes a successful establishment and maintenance of Strongyloides ratti infection in experimentally immunosuppressed Wistar rats. Large quantities of filariform (iL3) larvae of Strongyloides ratti for research related to human strongyloidiasis have been harvested following this protocol. Molecular detection method based on PCR using species specific primers was used to confirm the species of the harvested infective larvae (iL3). Additionally, the identification of histopathological lesions confirmed the presence of infective larvae (iL3) in the liver and lungs as a result of an increased parasite burden due to hyperinfection and disseminated disease. This pathological presentation was found to be similar to that reported in Strongyloides stercoralis-infected immunocompromised human subjects.

Genetic Characterization of Vibrio cholerae O1 isolates from outbreaks between 2011 and 2015 in Tanzania

Background

Cholera outbreaks have occurred in Tanzania since 1974. To date, the genetic epidemiology of these outbreaks has not been assessed.

Methods

96 Vibrio cholerae O1 isolates from five regions were characterized, and their genetic relatedness assessed using multi-locus variable-number tandem-repeat analysis (MLVA) and whole genome sequencing (WGS).

Results

Of the 48 MLVA genotypes observed, 3 were genetically unrelated to any others, while the remaining 45 genotypes separated into three MLVA clonal complexes (CCs) - each comprised of genotypes differing by a single allelic change. In Kigoma, two separate outbreaks, 4 months apart (January and May, 2015), were each caused by genetically distinct strains by MLVA and WGS. Remarkably, one MLVA CC contained isolates from both the May outbreak and ones from the 2011/2012 outbreak in Dar-es-Salaam. However, WGS revealed the isolates from the two outbreaks to be distinct clades. The outbreak that started in August 2015 in Dar-es-Salaam and spread to Morogoro, Singida and Mara was comprised of a single MLVA CC and WGS clade. Isolates from within an outbreak were closely related differing at fewer than 5 nucleotides. All isolates were part of the 3^rd wave of the 7^th pandemic and were found in four clades related to isolates from Kenya and Asia.

Conclusions

We conclude that genetically related V. cholerae cluster in outbreaks, and distinct strains circulate simultaneously.

Electronic supplementary material

The online version of this article (doi:10.1186/s12879-017-2252-9) contains supplementary material, which is available to authorized users.

Update knowledge of dry mouth- A guideline for dentists

BACKGROUND

Dry mouth is usually caused by a reduced salivary flow or by changes in the biochemical composition of saliva.

OBJECTIVE

The aim of this paper is a review of the update literature of dry mouth.

METHODS

We search in pubmed in the past 10 years using the words «dry mouth», «causes», «symptoms», «treatment» and «dentistry». A large number of papers have been identified. Papers not relevant to the issue were removed reducing the entries to 56 only.

RESULTS

There are no clearly established protocols for the treatment of dry mouth in the literature. Most of identified papers were systematic reviews, non-systematic reviews, and observational studies. The most studied patients were Sjögren's syndrome and the irradiated patients. Treatments are focused on the etiology, prevention, symptomatic, local salivary stimulation and systemic treatments.

CONCLUSION

It can be concluded that there is no clear evidence for the causes and treatment of dry mouth, therefore the majority of the general dental practitioners refer most of the cases to appropriate specialist. Treatment must be individualized, salivary substitutes and mechanical stimulation techniques can be applied.

Spectrum of haematologic malignancies and survival outcomes of adult lymphomas in Maiduguri, north eastern Nigeria--a fourteen year review

BACKGROUND

The incidence of Haematologic malignancies has been shown to vary according to gender, age, geographic region, and histologic subtypes, while cure rates can vary according to region and may be impacted by treatment availability and access to care.

METHOD

This was an institution based review of data from the Medical Records Department, Department of Haematology and Cancer Registry of the Histopathology Department of the University of Maiduguri Teaching Hospital between January 1998 and December 2011. The aim was to study the spectrum of Haematologic malignancies and the survival pattern of adult lymphomas in this region and to compare our findings to studies reported elsewhere.

RESULTS

The Haematologic malignancies represented 6.05% of all cancer cases seen and 0.31% of hospital admissions. Among the Haematologic malignancies, Non-Hodgkins Lymphoma (NHL) was the most frequent, constituting 51.3% while others include: Hodgkins Lymphoma (HL), 26.7% Chronic Myeloid Leukaemia (CML), 5.5%, Acute Myeloblastic leukaemia (AML), 4.2% Multiple Myeloma (MM), 4.2% Acute Lymphoblastic leukaemia (ALL), 3.8%, Chronic Lymphocytic Leukaemia (CLL), 3.4% Myelodysplastic Syndrome (MDS), 0.4% and Chronic Myelofibrosis 0.4%. Haematologic malignancies are more common in younger age group and also more common in males than females. Lymphomas are particularly common in young adults and the incidence tends to fall after 70 years. Similarly, the characteristic bimodal age incidence for HL found in western world has not been seen in this study. The histological subtypes for both NHL and HL are similar to the pattern reported elsewhere. Default rate was high and we found a strong association between cycles of chemotherapy given and survival in lymphoma patients.

CONCLUSION

This study has shown that Haematologic malignancies are not uncommon in our environment. There is need to provide basic facilities and training for immunophenotyping and immunohistochemistry in all cancer treatment centers across the country. Cytotoxic drugs must be subsidized and also be made readily available to all patients with Haematologic malignancies.

Case report: Biphasic presentation of multicystic haemorrhagic metastatic adenocarconoma of the lung

Lung cancer is the one of the leading causes of death worldwide. Adenocarcinoma of the lung makes up over a quarter of all incidence of lung cancer. Multiple case reports describe haemorrhage resulting from primary or metastatic lesions affecting different organs. This case report describes an unusual presentation of a benign lung lesion that later progressed to multiple metastases with a characteristic radiological appearance. A review of prior similar reported cases is also included.

Residency training program: perceptions of residents

BACKGROUND

There is a phobia among doctors for the residency training program, since the establishment of the program over 30 years ago. The reason for establishing the program was mainly to provide the much-needed specialists in medicine.

OBJECTIVES

To ascertain the perception of the residency training program among residents.

MATERIALS AND METHODS

Structured questionnaires were administered to residents at 3 training institutions in Nigeria.

RESULTS

One hundred nineteen (85.5%) questionnaires were returned out of 140. The ages of respondents ranged from 27 to 42 years, the median age being 30 years. There were 110 males and 9 females. One hundred six (89.1%) were junior residents. Ninety (75.6%) were sponsored by the training institutions. Seventy-four (62.25%) felt their consultants were contributing just 50% or less to their training. Sixty-two (52.2%) of the respondents had attended a revision course, conference or seminar within the last 6 months. Majority of the residents would want better remuneration, up-front payment of examination and revision fees, more teaching by the consultants and less emphasis on the provision of services as ways of improving the program.

CONCLUSION

Majority of the residents are sponsored by the training institutions.

Force-frequency relation in frog-ventricle is dependent on the direction of sodium/calcium exchange in diastole

AIM

Force of contraction increases with stimulus-frequency in mammalian and amphibian hearts under control conditions. Here, we have analysed the mechanism of the force-frequency relation (FFR) in frog-ventricle.

METHODS

Circular strips of frog-ventricle were subjected to field-stimulation with frequencies in the range 0.03-0.2 Hz and force recorded on a chart-recorder. In another protocol, varying rest-periods were imposed while the preparation beat steadily at 0.2 Hz and the effect of rest on post-rest beat amplitude was noted.

RESULTS

Under control conditions, a positive FFR and a rest-induced decay of contraction amplitude (RID) were seen in the frequency range 0.03-0.2 Hz. With cadmium, nifedipine, nickel (40 micromol L(-1)), ryanodine and adrenaline (all drugs at 10 micromol L(-1) concentration, except nickel), the positive FFR and RID seen under control conditions persisted. When the bathing solution contained ouabain (10 micromol L(-1)) or low external sodium (40 mmol L(-1)), or high external calcium (5 mmol L(-1)), the FFR turned negative in the frequency range stated above and there were rest-induced potentiations (RIP).

CONCLUSION

When the conditions favour a net leak of calcium in diastole from intracellular stores via the calcium-extrusive mode of sodium-calcium exchanger (NCX), FFR is positive. An increase in frequency lessens the diastolic interval and therefore the diastolic calcium leak, thereby augmenting force. On the other hand, interventions which favour the calcium-acquisitive mode of NCX during diastole, changed the pattern of RID to RIP and converted FFR from positive to negative. With net diastolic calcium uptake, there is better store-filling and therefore higher force at lower frequencies.

STR data for the GenePrint PowerPlex 1.2 system loci from three United Arab Emirates populations

Allele frequencies for the eight STRs included in the GenePrint PowerPlex 1.2 kit were obtained from three population groups that are resident in the United Arab Emirates (UAE); 228 unrelated UAE individuals, 194 unrelated Indian individuals and 197 unrelated Pakistani individuals were analysed.

STR population data for 10 STR loci including the GenePrint PowerPlex 1.2 kit from El-Minia (Central Egypt)

Allele frequencies for 10 STRs including the GenePrint PowerPlex 1.2 loci and also D3S1358, HumvWA and HumFGA were obtained from a sample of unrelated individuals from El-Minia City.

Concordant expression of Hirschsprung's disease in monozygous twins

A monozygous pair of twins with long segment Hirschsprung's disease born to non consanguineous parents is presented. Mother's history was uneventful. In the absence of prenatal and postnatal illness, the concordant lesions in this pair could be attributed to genetic factors.

Factors affecting the outcome of foetal hydrocephaly

In this study, the authors attempt to provide an account of the factors that affect the outcome of hydrocephaly in 26 foetuses. The hydrocephalus was related to a myelomeningocele in 35% of patients. Sixty-two percent of foetuses showed intra-uterine progression of their hydrocephalus and 50% were shunted postnatally. At a mean follow up of 2 years, the outcome was considered "fair" in 54% of patients. Our findings demonstrate that in foetal hydrocephaly a more favourable outcome is expected in patients with hydrocephalus which does not progress in utero, in whom the labour is not induced before 36 weeks of gestation, who are delivered vaginally weighing more than 2.5 kg and have a head circumference below the 95th centile and a CT cortical mantle thickness of 2 cm and more and who are treated by CSF shunting. The diagnosis of the foetal hydrocephaly at or before 28 weeks of gestation and the presence of a myelomeningocele did not affect the outcome significantly. Neurosurgeons are reminded to keep an open mind for infants with foetal hydrocephaly and to offer active treatment to patients with a potentially favourable outcome.

Multiloculated hydrocephalus related to cerebrospinal fluid shunt infection

This study is an attempt to establish that CSF shunt infection has a role in the aetiology of multiloculated hydrocephalus. The authors carried out a review of 12 cases of multiloculated hydrocephalus who were treated at King Khalid University Hospital between 1988-1994. The multiloculation appears to have developed following the shunt infection in all cases. The hydrocephalus was related to an intraventricular haemorrhage (IVH) in 9 patients and was congenital in 2 patients and post-meningitic in 1 patient. The shunt infection was caused by a gram-negative organism in 8 patients and duration of external ventricular drainage ranged from 9-24 (median 13) days. The diagnosis of multiloculated hydrocephalus was made on average 2 months after the shunt infection. In three patients endoscopic fenestration of intraventricular septations was attempted but was effective in only one case. The other patients were managed by two shunts (9 patients) and three shunts (2 patients). At a mean follow-up of 15 months, the shunt revision rate of the patients was 0.4/year. One patient died of multiple brain abscesses and 6 patients remain severely disabled. The poor outcome may also be related to the original IVH as well as the multiloculated hydrocephalus. The study also shows that patients with post-haemorrhagic hydrocephalus, who develop a shunt infection due to gram-negative organisms and in whom the CSF fails to be cleared of the infection following 12 days of external drainage appear to be at risk of developing multiloculated hydrocephalus.

Susceptibility of Brugia malayi and Onchocerca lienalis microfilariae to nitric oxide and hydrogen peroxide in cell-free culture and from IFN gamma-activated macrophages

The susceptibility of Brugia malayi and Onchocerca lienalis microfilariae to H2O2 and NO either in cell-free culture or from IFN gamma-activated macrophages was examined. In cell-free culture, O. lienalis microfilariae were highly susceptible to H2O2 induced toxicity, exhibiting rapid reductions in motility and viability. The addition of exogenous catalase abrogated H2O2-induced killing. In contrast, B. malayi microfilariae were relatively resistant to H2O2, with concentrations as high as 50 microM having no effect on motility or viability. On exposure to NO, both species showed reductions in motility within 5-30 min, but longer was required to see effects on the viability of microfilariae. Parasites incubated with IFN gamma-activated macrophages also exhibited marked reductions in motility and viability. In cultures with B. malayi and activated macrophages, inhibition of these effects was achieved by the addition of either L-NMMA, to abolish NO production, or neutralizing anti-TNF alpha antibodies. Attempts to inhibit parasite killing by the addition of catalase to macrophage cultures were ineffective. The results of this study show that B. malayi and O. lienalis microfilariae have different susceptibility to H2O2, but are equally affected by exposure to NO. Moreover both species are killed by IFN gamma-activated macrophages and in the case of B. malayi, killing is dependent on the generation of NO via TNF alpha.

Laparoscopic cholecystectomy: Initial experience at Riyadh Central Hospital

This paper presents our experience with laparoscopic cholecystectomy during the initial three months since its introduction at Riyadh Central Hospital. One hundred and sixty patients were admitted with gallstone disease. The majority were females (74%) and Saudis (56%). Seventy-six patients (47.5%) were admitted through the emergency department with acute cholecystitis, mucocele of the gallbladder, biliary pancreatitis, biliary colicm or obstructive jaundice. One hundred twenty-seven patients (69.4%) were submitted to laparoscopic cholecystectomy, which was successfully performed on 120 patients (94.5%). Laparoscopic cholecystectomy was converted to open cholecystectomy in seven patients (5.5%). Thirty-three patients (20.6%) were directly submitted to open cholecystectomy for various contraindications to laparoscopic cholecystectomy. Overall, 75% of patients with gallstone disease were treated by laparoscopic cholecystectomy. There was only one major complication (duodenal perforation) of laparoscopic cholecystectomy and no mortality in the series. The average operating time for laparoscopic cholecystectomy and no mortality in the series. The average operating time for laparoscopic cholecystectomy was 175 minutes. The average hospital stay was 3.6 days and 8.9 days following laparoscopic cholecystectomy and open cholecystectomy, respectively.