Slight Dilatation Research Articles

Neurotoxicity of low-dose repeatedly intranasal instillation of nano- and submicron-sized ferric oxide particles in mice

Olfactory tract has been demonstrated to be an important portal for inhaled solid nanoparticle transportation into the central nervous system (CNS). We have previously demonstrated that intranasally instilled Fe2O3 nanoparticles could transport into the CNS via olfactory pathway. In this study, we investigated the neurotoxicity and size effect of repeatedly low-dose (130 μg) intranasal exposure of nano- and submicron-sized Fe2O3 particles (21 nm and 280 nm) to mice. The biomarkers of oxidative stress, activity of nitric oxide synthases and release of monoamine neurotransmitter in the brain were studied. Our results showed that significant oxidative stress was induced by the two sizes of Fe2O3 particles. The activities of GSH-Px, Cu,Zn-SOD, and cNOS significantly elevated and the total GSH and GSH/GSSG ratio significantly decreased in the olfactory bulb and hippocampus after the nano- and submicron-sized Fe2O3 particle treatment (p < 0.05). The nano-sized Fe2O3 generally induced greater alteration and more significant dose–effect response than the submicron-sized particle did. Some slight perturbation of monoamine neurotransmitters were found in the hippocampus after exposure to the two sizes of Fe2O3 particle. The TEM image showed that some ultrastructural alterations in nerve cells, including neurodendron degeneration, membranous structure disruption and lysosome increase in the olfactory bulb, slight dilation in the rough endoplasmic reticulum and lysosome increase in the hippocampus were induced by the nano-sized Fe2O3 treatment. In contrast, in the submicron-sized Fe2O3 treated mice, slightly swollen mitochondria and some vacuoles were observed in the olfactory bulb and hippocampus, respectively. These results indicate that intranasal exposure of Fe2O3 nanoparticles could induce more severe oxidative stress and nerve cell damage in the brain than the larger particle did. This is the first study to compare the neurotoxicity of nano- and submicron-sized Fe2O3 particles in the central nervous system after long-term and low-dose intranasal exposure.

Ist eine Rehabilitation nach einer kompletten Bulbusluxation in die Kieferhöhle bei Orbitabodenfraktur möglich?

The complete traumatic dislocation of the globe into the maxillary sinus after orbital floor fractures is a very rare event. It results from direct transmission of a traumatic force which impinges the orbital frame or may result from an increasing pressure to the orbital contents. Diplopia or evidence of a displaced globe necessitates an exploration and reconstruction of the orbital floor. A 62-year-old male was admitted to our hospital because of a blunt injury to the orbital region caused by a machine for planing timber. On examination the patient had a massive right periorbital haematoma and no globe was visibly found. The CT scan revealed a blow-out fracture of the orbital floor with a complete dislocation of the right globe into the right maxillary sinus. Using a bright flashlight on the right maxillary region the patient reported light perception. The operative exploration showed no impaired integrity of the globe, no apparent laceration of the orbital muscles and a preserved continuity of the optic nerve. The dislocated globe was repositioned manually into the orbit and secured by an antral balloon catheter. Postoperative magnetic resonance imaging showed a correct anatomic status. The muscles did not seem to be lacerated and the continuity of the optic nerve was demonstrated. Incarcerations were not existent. 9 months postoperatively the vision recovered to 1.0 p. The motility was slightly diminished (elevation and abduction 20 degrees, adduction 25 degrees and downwards 20 degrees over midline). The patient suffered from diplopia when looking 25 degrees to the right and 20 degrees upwards. The anisocoria with a slight dilation of the pupil had declined in the right eye but was still present. This case of complete dislocation of the globe into the maxillary sinus demonstrates that only few injuries may result and that after operative reconstruction of the orbital floor a good functional result can achieved.

Gallbladder carcinoma associated with occult pancreatobiliary reflux in the absence of pancreaticobiliary maljunction

We herein report a case of gallbladder carcinoma associated with occult pancreatobiliary reflux (PR) in the absence of pancreatobiliary maljunction. A 67-year-old woman was referred to our hospital for the evaluation and treatment of a gallbladder tumor. Ultrasonography and computed tomography showed a nodular lesion in the fundus of the gallbladder, indicating the possibility of a gallbladder carcinoma. Endoscopic ultrasonography showed the nodular tumor and thickness of the surrounding epithelium. Endoscopic retrograde cholangiopancreatography revealed a normal pancreaticobiliary junction without the common channel and a slight dilatation of the common bile duct (15 mm in diameter). An open cholecystectomy and partial resection of the liver bed of the gallbladder with regional lymphadenectomy was performed. A C-tube was inserted from the cut end of the cystic duct into the common bile duct to prevent bile stasis. Biliary amylase and lipase levels sampled in the gallbladder were 2604 IU/l and 775 IU/l, respectively. Biliary amylase level in the bile collected from the C-tube in the common bile duct was 119 550 IU/l on postoperative day (POD) 6 and 22 265 IU/l on POD 12. These observations suggested that PR was present in this patient. The histopathological findings of the resected specimen showed a well-differentiated adenocarcinoma of the gallbladder with invasion to the muscle layer and no metastasis of the resected lymph nodes. A high index of nuclear staining for MIB-I in the cancer cells (about 10%) was exhibited, and a few cells in the normal epithelium also stained positive.

Synchronous Adenocarcinoma of the Major and Minor Duodenal Papilla

A 50-year-old woman presented with pancreatitis, fluctuant jaundice, weight loss, and abdominal pain. Contrast-enhanced computed tomography and abdominal ultrasound showed slight dilatation of the biliary tree and gallbladder without calculi. Endoscopy demonstrated a tumor protruding from the papilla of Vater. First endoscopically biopsy diagnosed no tumor, and a second biopsy diagnosed as papillary adenocarcinoma. The patient underwent duodenopancreatectomy. The specimen was fixed in formalin (10%). The tissue was processed routinely, and paraffin sections were stained with hematoxylin–eosin and periodic acid Schiff. Gross examination showed two tumors seen as prolapsed nodules growing isolated from the minor and major duodenal papillae measuring 1.5 and 1.0 cm, respectively, both covered by duodenal mucosa and the histologic study of both lesions demonstrated a moderately differentiated tubular adenocarcinoma, which invaded duodenal wall. After surgery, she is alive 24 months without evidence of recurrence.

Facial diplegia revealing ventriculoperitoneal shunt failure in a patient with Crouzon syndrome

The authors report on the case of a 15-year-old boy with Crouzon syndrome (CS) who presented with headache and facial diplegia. He had undergone several craniofacial interventions and a posterior fossa decompression for tonsillar herniation caused by the CS. A ventriculoperitoneal (VP) shunt had been inserted for hydrocephalus. Emergency computed tomography (CT) disclosed slight dilation of the ventricular cavities compared with their appearance on a baseline CT scan. Magnetic resonance imaging showed a deformed brainstem but no compression at the occipital foramen; there was no apparent explanation for the facial diplegia. The neuroophthalmological examination revealed neither papilledema nor oculomotor palsy. Electromyography confirmed incomplete peripheral facial diplegia. The patient underwent emergency shunt revision, during which complete obstruction of the ventricular catheter and severe cerebrospinal fluid hypertension were found. After surgery, cranial hypertension symptoms completely resolved and the facial diplegia improved slowly with a persistent and incomplete right superior facial palsy. Cranial 3D CT scanning reconstructions and brain magnetic resonance imaging demonstrated severe petrous bone distortion that could have been responsible for direct stretching injuries on the facial nerves at the level of the internal acoustic meatus. The present case represents the first reported occurrence of VP shunt failure as revealed by a facial palsy; the authors discuss the pathophysiology of facial palsy in intracranial hypertension.

Double sigmoid colon perforation following a migrated biliary stent

A 76-year-old woman was admitted to our hospital with abdominal pain, distension, nausea and fever. Three weeks earlier the patient was jaundiced and the medical check-up with ERCP revealed slight dilatation of the common bile duct due to an impacted stone in its distal part. The stone was extracted, and a plastic stent 10French/11cm was inserted for internal biliary drainage. The routine clinical investigations revealed diverticulosis of the colon. The patient had been scheduled for elective laparoscopic cholecystectomy and resection of the sigma. Based on that past medical history, the clinical signs and the radiological findings her current condition was diagnosed as local peritonitis due to perforated diverticulitis of the left colon. A midline laparotomy was performed. There were no signs of peritonitis in the abdomen. The gall bladder was chronically inflamed with a stone in the infundibulum. Neither stones, nor a stent were found in the common bile duct. A cholecystectomy was perfomed. The sigmoid colon was hyperaemic and edematous, with numerous small diverticula sized up to 8mm. After mobilization of the left colon, a covered double perforation on the posterior wall of the sigma was discovered. It was caused by the biliary stent, which had migrated per via naturalis and perforated the wall of the distal sigmoid colon both medially and laterally. A sigmoid colon resection with primary hand-sewn end-to-end colo-colostomy was performed. The patient is now doing well at home, after an uneventful postoperative period of 10 days at the ward. Long-term complications from biliary stents, such as migration and perforation, are uncommon but potentially life-threatening. If a stent becomes stuck in the gastrointestinal tract and is not accessible for endoscopic removal, early operative revision is mandatory to prevent further complications. In the absence of peritonitis a primary anastomosis is the method of choice, while in cases of contaminated peritoneal cavity and unprepared bowel, a Hartmann's procedure should be performed. With the increasing use of biliary stents, perforation of the intestine is a diagnosis to consider in anyone with acute abdominal pain and radiology demonstrating a migrated biliary stent.

Heart failure-associated alterations in troponin I phosphorylation impair ventricular relaxation-afterload and force-frequency responses and systolic function

Recent studies have found that selective stimulation of troponin (Tn)I protein kinase A (PKA) phosphorylation enhances heart rate-dependent inotropy and blunts relaxation delay coupled to increased afterload. However, in failing hearts, TnI phosphorylation by PKA declines while protein kinase C (PKC) activity is enhanced, potentially augmenting TnI PKC phosphorylation. Accordingly, we hypothesized that these site-specific changes deleteriously affect both rate-responsive cardiac function and afterload dependence of relaxation, both prominent phenotypic features of the failing heart. A transgenic (TG) mouse model was generated in which PKA-TnI sites were mutated to mimic partial dephosphorylation (Ser22 to Ala; Ser23 to Asp) and dominant PKC sites were mutated to mimic constitutive phosphorylation (Ser42 and Ser44 to Asp). The two highest-expressing lines were further characterized. TG mice had reduced fractional shortening of 34.7 +/- 1.4% vs. 41.3 +/- 2.0% (P = 0.018) and slight chamber dilation on echocardiography. In vivo cardiac pressure-volume studies revealed near doubling of isovolumic relaxation prolongation with increasing afterload in TG animals (P < 0.001), and this remained elevated despite isoproterenol infusion (PKA stimulation). Increasing heart rate from 400 to 700 beats/min elevated contractility 13% in TG hearts, nearly half the response observed in nontransgenic animals (P = 0.005). This blunted frequency response was normalized by isoproterenol infusion. Abnormal TnI phosphorylation observed in cardiac failure may explain exacerbated relaxation delay in response to increased afterload and contribute to blunted chronotropic reserve.

Intraductal papillary neoplasm of the bile duct extending superficially from the intrahepatic to extrahepatic bile duct

Intraductal papillary neoplasm of the bile duct (IPNB) or liver is a recently noted rare disease, and its pathogenesis remains unclear. Here we present a case of IPNB with an interesting morphology, which was treated by resection of the right hemiliver and extrahepatic bile duct. A 79-year-old woman was found to have a high alkaline phosphatase level and slight dilatation of the right intrahepatic bile duct on imaging studies. The right intrahepatic bile duct became dilated over a 2-year period; however, no solid mass could be detected, and tumor markers were not elevated. Hepatic resection was scheduled because a mucin-producing bile duct carcinoma of the liver was suspected. A right hemihepatectomy was conducted, and the extrahepatic bile duct was also resected after malignant cells were found in the surgical stump of the right bile duct and in the bile itself. Macroscopically, diffuse dilatation of the intrahepatic bile duct was noted, but no solid component or mucin within the duct was found. Histopathological findings revealed carcinoma in situ, IPNB, in the majority of intrahepatic bile ducts, with no lymph node metastasis, and it extended continuously to the epithelium of the common bile duct. No tumor recurrence or biliary dilatation was observed at follow-up 2 years after surgery. It is important to consider malignancy in the presence of a dilated bile duct and in the absence of any cause of occlusion. Complete resection of IPNB results in a good prognosis and no recurrence.

Acroqueratodermia siríngea acuagénica. Presentación de dos casos

Aquagenic syringeal acrokeratoderma is an infrequently described acquired, transitory keratoderma that is exacerbated when the palms and/or soles are immersed in water. It manifests as whitish or yellowish flattened, translucent papules and plaques, located in areas of pressure or trauma on the palms and/or soles. Involvement is usually bilateral. The histologic features are non-specific, showing a slight dilation of the intraepidermal portion of the eccrine sweat duct. The process tends to remit spontaneously. We present the case of two women, aged 20 and 21.

External Carotid Artery Aneurysm Developing After Embolization of a Ruptured Posterior Inferior Cerebellar Artery Aneurysm in a Patient With Cervicocephalic Fibromuscular Dysplasia-Case Report-

A 30-year-old man presented with an aneurysm of the left posterior inferior cerebellar artery manifesting as subarachnoid hemorrhage and cerebellar infarction. Angiography demonstrated string-of-beads sign typical of fibromuscular dysplasia (FMD) in the extracranial carotid and vertebral arteries. The aneurysm and the parent artery were successfully embolized with Guglielmi detachable coils. Severe vasospasm developed 1 week after admission, and was treated several times by selective injection of vasodilator. A new aneurysm of the left external carotid artery became evident 1 month later, whereas only slight dilation had previously been apparent. This angiographic sequence demonstrated a new arterial dissection. Despite the possibility of damage to the artery during multiple catheterizations, arterial wall changes caused by FMD appear to have been primarily responsible. This case emphasizes the need for particular care in performing vascular interventional procedures in the presence of FMD.

Obstructive jaundice due to hepatobiliary cystadenoma or cystadenocarcinoma

Hepatobiliary cystadenomas (HBC) and cystadenocarcinomas are rare cystic lesions. Most patients with these lesions are asymptomatic, but presentation with obstructive jaundice may occur. The first patient presented with intermittent colicky pain and recurrent obstructive jaundice. Imaging studies revealed a polypoid lesion in the left hepatic duct. The second patient had recurrent jaundice and cholangitis. Endoscopic retrograde cholangiopancreatography (ERCP) showed a cystic lesion at the confluence of the hepatic duct. In the third patient with intermittent jaundice and cholangitis, cholangioscopy revealed a papillomatous structure protruding into the left bile duct system. In the fourth patient with obstructive jaundice, CT-scan showed slight dilatation of the intrahepatic bile ducts and dilatation of the common bile duct of 3 cm. ERCP showed filling of a cystic lesion. All patients underwent partial liver resection, revealing HBC in the specimen. In the fifth patient presenting with obstructive jaundice, ultrasound examination showed a hyperechogenic cystic lesion centrally in the liver. The resection specimen revealed a hepatobiliary cystadenocarcinoma. HBC and cystadenocarcinoma may give rise to obstructive jaundice. Evaluation with cross-sectional imaging techniques is useful. ERCP is a useful tool to differentiate extraductal from intraductal obstruction.

Unilateral temporary functional stasis in the upper urinary tract caused by “a filled bladder” on Tc-99m DTPA diuresis renography: A teaching case

A 2-year-old girl with recurrent urinary tract infection having slight left pelvicaliceal dilatation on her renal ultrasound underwent a Tc-99m DTPA diuresis renography. During the excretion phase, a prominent and persisting left pelvicaliceal stasis was noticed even after the diuretic injection. However, it disappeared simultaneously with an uncontrolled micturition. This patient is presented to show the effect of filled bladder on the physiological drainage of urine. Since urine flow in the urinary system is more complicated than simple drainage, a thorough understanding of the physiological basis for diuresis renography and the pitfalls of the technique is required for its appropriate use in the management of patients suspected of urinary tract obstruction.

Fifteen-year-old patient with «pulseless disease»

We report on a 15-year-old and apparently healthy boy, who was in search of work. He was planning to become an apprentice for train track building in the Swiss Railway company. As usual in Switzerland, the boy had a checkup performed by the Railway company doctor. His main clinical finding was a moderate hypertension measured at the right arm (142/ 88 mm Hg) and at the left arm (134/98 mm Hg). Furthermore, in this tall patient (181 cm, 68 kg), a 2⁄6-systolic murmur was audible at the mid portion of the left sternal border. The patient was therefore referred to a cardiological examination including echocardiography, to identify the cause of the murmur. The chest radiograph showed no abnormality. The ECG at rest did not show left ventricular hypertrophy nor any other abnormality. However, on clinical examination, there was no palpable pulse in the lower extremities. The echocardiogram revealed the expected stenosis of the descending aorta with a peak gradient of 62 mm Hg. The left ventricle was not dilated (60 mm), but showed apical thinning (4.4 mm) and trabeculations with local hypokinesia. There was no valvular abnormality such as eg a bicuspid aortic valve, but a slight aortic root dilation (40 mm) was detected. A cardiovascular magnetic resonance study (CMR) was performed at our institution in order to assess the exact location, the degree and severity of the aortic stenosis and to rule out associated congenital anomalies. CMR showed a normal left ventricular mass (181 g, 95.3 g/m2, [normal: 91 ± 11 g/m2]), a moderately reduced left ventricular ejection fraction of 37.6%, a diffuse, apically pronounced hypokinesia with apical trabeculations (fig. 1), and no late contrast enhancement. In CMR, the aortic root was slightly dilatated (40 mm), the ascending aorta was normal but the aortic arch was slightly hypoplastic. The proximal part of the descending aorta showed a severe postductal stenosis (fig. 2) of 28 mm in length, a small poststenotic saccular aneurysm (confirmed by surgery, fig. 3), and an extensive collateral vascular system through the subclavian, scapular, internal thoracic, and intercostal arteries. The

Brimonidine versus dapiprazole: Influence on pupil size at various illumination levels

To evaluate the influence of dapiprazole versus brimonidine on pupil size at various illumination levels. Department of Ophthalmology, Johannes Gutenberg-University, Mainz, Germany. In randomized prospective study, 19 healthy volunteers received 2 ophthalmic solutions, dapiprazole and brimonidine, 1 in each eye, for intraindividual comparison. Before and after application, pupil diameter was measured using an infrared binocular pupillometer at 3 illumination levels (0.03, 0.82, and 6.4 lux). Only slight pupil dilation was observed under scotopic conditions after application of both agents. After 20 minutes, the median reduction in pupil width was 1.4 mm for brimonidine and 0.9 mm for dapiprazole. These effects were statistically significant for both agents (both P < .001). The maximum effect was observed after 40 minutes and remained stable through the next measurement at 180 minutes. Under mesopic lighting conditions, only a slight effect (<1 mm) was seen. Pupil mydriasis at scotopic illumination levels was reduced by both drugs in a similar fashion. Because of the slightly stronger effect of brimonidine, application of this agent 20 minutes before activities in dimly lit areas or at night may be recommended for photic phenomena following refractive surgery.

Reconstruction of the common bile duct by a vascular prosthetic graft: an experimental study in pigs

The purpose of the present study was to investigate whether it was possible to use a vascular graft for reconstruction of the common bile duct (CBD) in pigs. Eight pigs, each weighing approximately 60 kg, were used for the experiments. The gallbladder was dissected and the cystic duct and cystic artery were ligated and divided. The CBD was displayed and divided. Then the CBD was reconstructed with a standard walled expanded polytetrafluoroethylene (ePTFE) vascular graft (internal diameter 4 mm) by means of 12 interrupted monofilament glycomer 63 (Biosyn) 4.0 sutures. The ends of the vascular graft were inserted into the CBD and the sutures were placed through the graft and the CBD in such a way that the latter would cover the former. The anastomotic line was covered by fibrin glue. On postoperative day 8, a laparotomy was performed; the pigs were investigated for signs of gall leakage, and cholangiography was performed. Blood samples for the determination of liver parameters were taken before the primary surgery and before the explorative laparotomy. At evaluations on the eighth postoperative day, all animals except one were without signs of bile leakage. One pig had an encapsulated biloma. Another animal had to be operated on day 6 because of illness, and laparotomy showed a perforated gastric ulcer, but no bile leakage. Cholangiography revealed slight intrahepatic dilatation in all animals. Bilirubin and alkaline phosphatase levels were unaffected by the surgery. Reconstruction of the CBD by means of a vascular graft seems to be a safe procedure in the short term in a pig model.

Carcinoid tumor of the papilla of Vater

Carcinoid tumor of the papilla of Vater is an extremly rare entity. Only 73 cases have been reported in the world literature to date and only 1 case in Hungary. This tumor differes clinically and prognostically from other carcinoid tumors of the gastrointestinal tract having a more agressive behaviour. The clinical feature is determinated by the expansion and infiltrative nature of the tumor. Endoscopic retrograde cholangiography (ERC) and endoscopic biopsy (EB) are the most accurate diagnostic methods, while endoscopic ultrasonography (EUS) has an utmost importancy in determinating the surgical strategy. Depending on the tumor size and the grade of invasion of other structures the surgical treatment can be local excision or radical resection. The authors present a case of a 67-year-old female patient who was admitted because of obstructive jaundice. On ERC the papilla was prominent but covered with normal mucosa. The main bile duct was markedly dilated with slight dilation of intrahepatic branches. Endoscopic sphyncterotomy was done and multiple biopsy specimen were taken. Hystology proved carcinoid tumor. Having detected local invasion by EUS a pylorus preserving pancreatoduodenectomy was performed. One year after the operation there is no recurrence of the tumor.

Nephrotoxicity of a novel antineoplastic platinum complex, nedaplatin: a comparative study with cisplatin in rats

The present study was designed to characterize the nephrotoxicity induced by the antineoplastic platinum complex nedaplatin (NDP) in rats of different ages in comparison with cisplatin (CDDP). A single dose of 15 mg/kg NDP or 7.5 mg/kg CDDP was administered intravenously to 8-, 11-, or 15-week-old male and female SD rats, which were then sacrificed after ten days. Body weight decreases were observed for both drugs, in direct relation to age. CDDP treatment markedly increased urinary excretion of NAG, gamma-GTP, LDH and protein, with peaks on day 4 and complete or partial recovery on day 7; NDP increased NAG, LDH and protein excretion, but to a lesser extent, and these elevations were generally more marked for females. CDDP increased plasma creatinine and BUN in males and females of all age groups at necropsy. No apparent changes were seen following NDP treatment except in the 15-week-old rats. These results also show that NDP is less nephrotoxic than CDDP. CDDP-treated rats showed remarkable proximal tubular lesions in the renal cortex and corticomedullary region, and the papillary lesions were minor. On the other hand, the NDP-induced nephrotoxicity was morphologically characterized by hyaline droplet changes (electron microscopically, hyperplasia of lysosomes), necrosis or hyperplasia of the collecting duct epithelium in the renal papilla and the epithelium covering the papilla. Cortical lesions, indicated by slight tubular dilatation, were found only in the animals with papillary lesions. In summary, NDP is a promising second-generation platinum complex with reduced nephrotoxicity.

A new approach in the treatment of faecaloma of the colon

A 43-year-old woman presented with a 12-hour history of colicky abdominal pain increasing in severity and frequency. There was nausea but no vomiting. She last opened her bowels and passed flatus 48 hours before and otherwise had no history of constipation. There was no recent change in bowel habit and no blood or mucus per rectum. There had been no systemic disturbance and there was no family history of malignancy of the large intestine. The only surgical history was an appendicectomy performed at the age of 39 years. There was no relevant medical history. On clinical examination, the patient was apyrexial, normotensive, tachycardic and distressed. The abdomen was distended and tympanic but with no signs of peritonism. There was a palpable non-tender mass in the left lower abdominal quadrant. Her basic haematology and biochemistry were unremarkable; plain radiography of the chest showed a right basal pleural effusion with some patchy collapse at the right lung base. Erect and supine abdominal radiographs showed severe distension of the colon with only slight dilatation of the small intestine and multiple fluid levels. A computed tomograph examination of the abdomen and pelvis (Figure 1) showed free fluid in the pelvis and a small amount of inflammatory change in the fat of the abdominal cavity. There was extensive dilatation of the large intestine, with only slight dilatation of the small intestine. The appearances were consistant with a distal large bowel obstruction with an essentially competent ileocaecal valve. A large faecal sphere was shown in the sigmoid colon, which appeared rather thick-walled. There was no evidence of free peritoneal gas. A gastrografin enema showed a rounded filling defect in the upper sigmoid colon. Following a period of resuscitation, the patient was taken to theatre for colonoscopy to exclude a malignant or benign stricture and to attempt to disrupt the faecaloma to relieve the large bowel obstruction and avoid proximal and/or local perforation. The procedure was performed under general anaesthetic with the patient in the lithotomy position and with an arrangement to proceed to laparotomy should the colonoscopy procedure fail. Colonoscopy showed a faecal mass 55 cm from the anal verge, which proved resistant to all attempts at dislodging and disruption. A size 18F nasogastric tube (NGT) was inserted under direct vision through the anus and past the faecal obstruction (Figure 2). The proximal large intestine was successfully decompressed with the NGT. Liquid paraffin 200 ml was injected proximal to the faecaloma. In the post-procedure period, care was taken to keep the lumen of the NGT clear by an occasional injection of normal saline (30 ml hourly) to ensure free drainage. The catheter was left in situ. The patient was returned to theatre the next morning for a repeat colonoscopy. On this occasion the faecal mass was noted to be slowly showing signs of fragmentation and softening (Figure 3). Vigorous saline irrigation completely disrupted the mass with relief of the obstruction. There was an area of superficial ulceration at the site of the impaction but no evidence of a benign or neoplastic stricture. Subsequent colonoscopy 3 weeks later showed no abnormalities, with the superficial ulceration completely healed and benign biopsies. The patient remains well 6 months after the episode and has increased her fibre intake and now exercises regularly.

Toxic impact of ingested Jatropherol‐I on selected enzymatic activities and the ultrastructure of midgut cells in silkworm, Bombyx mori L.

Abstract: Jatropherol‐I, a phorbol‐type diterpene from Jatropha curcas seeds was found highly toxic to third instars silkworm larvae after ingestion with LC50 values 0.5793, 0.2197 and 0.1578 mg/ml at 48, 72 and 120 h respectively. The acute toxicity was associated with changes in activities of several midgut enzymes and pathological changes in midgut epithelial cells. Jatropherol‐I caused various fluctuations in activities of different midgut enzymes in third instars larvae of silkworm. Compared with controls, both esterase and carboxyliesterase showed significantly depressed activities at 3 h (t‐test, P &lt; 0.05) and increased activities at 24 h and rapidly decreased activities at 48 h after ingestion of 0.125 and 0.25 mg/ml of Jatropherol‐I. Jatropherol‐I induced two (E4 and E5) and depressed one (E2) of midgut esterase isozymes analysed 3 h after ingestion. There was no significantly different glutathione S‐transferase activity between most of treated silkworm and control (t‐test, P &gt; 0.05). Activities of acetylcholinesterase fluctuated weakly in treated silkworm in 48 h. Jatropherol‐I induced a gradual decline in midgut protease activities in silkworm with an obvious dose‐ and time‐dependent effect. Jatropherol‐I also caused pathological changes in midgut cells, especially in their endoplasmic reticulum. They were noted slight dilatation on 12 h exposure, while extreme dilatation, vesiculations and shedding of ribosome from membrane were observed in endoplasmic reticulum after a longer time exposure. Other pathological changes in microvilli, lysosome, mitochondria and chromatin were also observed in midgut cell of treated silkworm.

Carcinoid Tumor of the Vater's Papilla Presenting with Chronic Pancreatitis-A Case Report-

Carcinoid tumors are common in the duodenum except for in the Vater's papilla [1-9]. We report here a case of carcinoid tumor arising in the Vater's papilla with repeated episods of pancreatitis. The patient is a 28 year-old-woman who had repeated abdominal pain with elevated serum amylase and had been treated as chronic pancreatitis. Computed tomography (CT) revealed a slight dilatation of the main pancreatic duct from the pancreatic head to the tail, and mild swelling of the pancreas. A submucosal tumor measuring 1.3 cm in diameter was detected in the ampulla of Vater by esophagogastroduodenscopy (EGD), and total papillectomy was performed under the suspicious of carcinoid tumor. The tumor was not encapsulated, 1.0 cm in diameter, undefined, and whitish in color. Histologically monomorphic tumor cells with lightly eosinophlic cytoplasm and round nuclei proliferate in trabecular and solid patterns. Immunohistochemically tumor cells were positive for neuron-specific enolase, chromogranin A and synaptophysin, and the tumor was diagnosed as carcinoid tumor. It should be noted that carcinoid tumor in the ampulla may occur with initial signs of acute or chronic pancreatitis.