Double pylorus (DP) or duplication of the pylorus is an uncommon condition that is either congenital or acquired. Acquired double pylorus (DP) results from a peptic ulcer eroding through and creating a fistula between the duodenal bulb and the distal stomach. We report a case of an acquired double pylorus in an adult gentleman that resulted from the erosion of a duodenal and prepyloric ulcer.
Duodenal Ulcer/*pathology ; Pylorus/*pathology ; Stomach Ulcer/*pathology

Gallstone disease is a common association in patients with haematological splenomegaly. When indicated, simultaneous splenectomy and cholecystectomy should be performed and traditionally this is accomplished by open surgery. We report a 17 year old thalassaemic girl with splenomegaly complicated by gallstone pancreatitis. We treated her with a combination of needlescopic cholecystectomy and laparoscopic splenectomy as well as delivering the huge spleen via a pfannenstiel incision to hide the scar. We believe this technique is an acceptable alternative mainly for rapid delivery of the spleen and to minimize visible scars hence improving cosmesis.
Cholecystectomy, Laparoscopic/*methods ; Cholelithiasis/etiology ; Cholelithiasis/*surgery ; Splenectomy/*methods ; Splenomegaly/etiology ; Splenomegaly/*surgery ; beta-Thalassemia/*complications

Presence of a hypofunctioning pigmented adenoma are commonly asymptomatic and is usually only found during an autopsy. In contrast, hyperfunctioning pigmented adenoma is a rare clinical entity and in the majority of cases results in Cushing‟s syndrome. In this case study, we report a 66-year-old male who presented instead with the clinical and biochemical features of Conn‟s syndrome. On laparoscopic adrenalectomy, it was found that the tumour had a functioning black adenoma which does not usually present with Conn‟s syndrome but rather to that of a Cushing‟s. The intraoperative changes and histopathological findings are discussed.
Laparoscopy

Thyroid nodules are common but thyroid malignancies are not. Fine needle aspiration (FNA) cytology is a diagnostic tool used to screen patients with thyroid nodules who require surgery. We study the diagnostic accuracy of FNA as the initial diagnostic modality in the clinical assessment of thyroid nodules. Between January 1995 until December 2000, 2131 FNA of thyroid nodules were performed. Four hundred and forty-one (20.7%) of these were unsatisfactory and 1690 (79.3%) cases were satisfactory for cytological evaluation. Histopathological diagnosis were available for 361 cases. Cyto-histopathological correlation was carried out for these cases. Our results showed a diagnostic accuracy of 96.2% with sensitivity and specificity rates of 87.7% and 98.4% respectively. Our positive predictive value is 93.4% and our negative predictive value is 96.8%. From this study, we conclude that fine needle aspiration is an important initial screening diagnostic tool for the investigation of thyroid nodules.

In experienced hands, ultrasonic shears had been found to be a useful tool in total thyroidectomy surgery as long as the safety precautions are adhered to closely. It has the advantage of minimising operating time and will eventually reduce the cost of surgery. A randomised controlled trial is thus suggested to further evaluate its efficacy.

Aims: This study aimed to isolate and characterize putative new probiotic with antimicrobial properties against common fish pathogens from the gut of Oreochromis spp. (red tilapia). Methodology and results: A total of 28 colonies were isolated from gut of Oreochromis spp. and characterized phenotypically. Eight isolates were selected for probiotic characterization. Temperature, salinity, pH and bile salt tolerance, antibiotic susceptibility and antimicrobial test against selected fish pathogens (Aeromonas hydrophila, Edwardsiella tarda and Staphylococcus aureus subsp. aureus ATCC 25923) were conducted. Characterization studies revealed isolates suited for freshwater environment and exhibited tolerance against wide range of salinity, pH and bile salt. Isolates displayed different antibiotic susceptibility profile, with six exhibited antimicrobial properties against E. tarda. Molecular identification based on 16S rRNA gene sequencing showed 99.44%, 98.59% and 91.21% sequence similarity with Leuconostoc pseudomesenteroides strain 3832T, Leuconostoc lactis strain KCC202369T and Leuconostoc mesenteroides strain 4332T, respectively as compared to known sequence in the GenBank. When identified Leuconostoc spp. were coated on feed pellets, no major decrease in viability over 21 days of storage at 4 °C were observed, with an average of 8 log CFU/mL. Conclusion, significance and impact of study The characterized species allow further application assessment of the probiotic-supplemented tilapia feed. Host-originated Leuconostoc displayed potential antimicrobial properties against fish pathogen E. tarda. The isolates Leuconostoc is expected to provide protective effect for Oreochromis spp. against edwardsiellosis and to exert beneficial effects more efficiently as compared to commercial probiotics which are not specifically target for Oreochromis spp., thereby indirectly helping fish farmers in achieving economic sustainability and increase affordability of fish.
Leuconostoc ; Anti-Infective Agents ; Tilapia ; Edwardsiella tarda--pathogenicity ; Probiotics