Ascariasis ; diagnosis ; Bile Duct Diseases ; diagnosis ; Bile Duct Neoplasms ; diagnosis ; Bile Ducts, Extrahepatic ; Bile Ducts, Intrahepatic ; Cholangiocarcinoma ; diagnosis ; Diagnosis, Differential ; Humans

A 24-year-old lady with recurrent upper abdominal pain, underwent surgery for cholelithiasis based on imaging diagnosis by ultrasound scanning. At laparotomy, the gall bladder could not be found either in its normal or ectopic locations. The diagnosis of agenesis of the gall bladder was confirmed by operative cholangiography. Duplication cysts of the hepatic flexure were discovered in the position normally occupied by the gall bladder. The stony hard faeces in the cysts were probably interpreted as gallstones on ultrasound. This rare condition is discussed and the importance of intraoperative cholangiography is stressed.
Adult ; Cholelithiasis ; diagnosis ; Colonic Diseases ; complications ; pathology ; Cysts ; complications ; pathology ; Diagnosis, Differential ; Female ; Gallbladder ; abnormalities ; Humans

Twenty bilio-enteric anastomoses were performed or managed from May 1990 to December 1992. Recurrent pyogenic cholangitis (RPC) and pancreatic cancer were the commonest conditions which required drainage procedures. Roux-en-Y hepatico-jejunostomy (RHJ) was performed in 9 patients, 4 for RPC, one for pancreatic cancer, another for a cholangiocarcinoma, 2 following excision of choledochal cyst and one hepatico-jejunostomy was part of a Whipple reconstruction. Roux-en-Y side to side choledocho-jejunostomy (CDJ) was performed in one patient. Choledocho-duodenostomy (CDD) was performed in 6, 4 for obstructive jaundice due to choledocholithiasis, one for RPC and one in a choledochal cyst. One patient operated elsewhere presented with complications after a CDD. Palliative cholecysto-jejunostomy (CYJ) was carried out in 4 patients with pancreatic malignancy. All benign conditions were treated by hepatico-jejunostomy and choledocho-duodenostomy, while three patients with malignant conditions were treated by hepatico-jejunostomy. Permanent subcutaneous access loops were provided when recurrent problems were anticipated, 4 in RPC and one after subtotal resection of a cholangiocarcinoma. Based on this study, we found Roux-en-Y hepatico-jejunostomy a versatile drainage procedure, which was useful in both benign and malignant diseases.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Anastomosis, Roux-en-Y ; Anastomosis, Surgical ; methods ; Child ; Cholecystostomy ; Choledochostomy ; Common Bile Duct ; surgery ; Common Bile Duct Diseases ; surgery ; Female ; Follow-Up Studies ; Hepatic Duct, Common ; surgery ; Humans ; Intestine, Small ; surgery ; Male ; Middle Aged ; Pancreatic Neoplasms ; surgery ; Retrospective Studies ; Treatment Outcome

Sulconazole has been reported to degrade into sulconazole sulfoxide via sulfur oxidation; however, structural characterization data was lacking and the potential formation of an N-oxide or sulfone could not be excluded. To clarify the degradation pathways and incorporate the impurity profile of sulconazole into the United States Pharmacopeia–National Formulary (USP–NF) monographs, a multifaceted approach was utilized to confirm the identity of the degradant. The approach combines stress testing of sulco-nazole nitrate, chemical synthesis of the degradant via a hydrogen peroxide-mediated oxidation reaction, semi-preparative HPLC purification, and structural elucidation by LC―MS/MS and NMR spectroscopy. Structural determination was primarily based on the comparison of spectroscopic data of sulconazole and the oxidative degradant. The mass spectrometric data have revealed a McLafferty-type rearrange-ment as the characteristic fragmentation pathway for alkyl sulfoxides with aβ-hydrogen atom, and was used to distinguish the sulfoxide from N-oxide or sulfone derivatives. Moreover, the generated sulco-nazole sulfoxide was utilized as reference material for compendial procedure development and valida-tion, which provides support for USP monograph modernization.

Anomalous pancreatico-biliary junction (APBJ) is commonly associated with cystic dilatation of the bile ducts but recently, several cases without the cystic dilatation have been reported. We treated a young female patient with intractable back and epigastric pain of three months duration. The spine was normal on magnetic resonance imaging (MRI), but several lymph nodes were seen around the coeliac axis. An APBJ, a non-cystic biliary system, non-filling of the gallbladder and an irregular right margin of the bile duct were evident on endoscopic retrograde pancreatography (ERCP), which was highly suggestive of gallbladder (GB) malignancy. At surgery, the GB was hard with local infiltration of the bile duct. Numerous large para-aortic and supraduodenal lymph nodes were present and only a biopsy was possible. Details of the case are presented and the growing etiological importance of an APBJ, especially without cystic biliary dilatation in gallbladder carcinogenesis is discussed.
Adenocarcinoma ; diagnosis ; Adult ; Cholangiopancreatography, Endoscopic Retrograde ; Common Bile Duct ; abnormalities ; Female ; Gallbladder Neoplasms ; diagnosis ; Humans ; Magnetic Resonance Imaging ; Pancreatic Ducts ; abnormalities

Introduction: To assess outcomes of FHL transfer and V-Y plasty for chronic Achilles rupture due to insertional Achilles tendinopathy. Materials and methods: A case series of 12 patients was conducted between 1st January 2017 and 31st December 2018. The patients had short flexor hallucis longus tendon transfer with gastrocnemius lengthening by V-Y plasty for Achilles tendon rupture. Patients were allowed full weight bearing at six weeks post-operatively, and were followed up at three months and six months post-operatively, when the range of motion of the ankle was examined, and the outcome was assessed using the EFAS score. Results: Of the 12 patients in the study, the majority were males; the mean age was 50.6±8.96 years. A significant improvement in dorsiflexion and plantarflexion was noted at the six-month follow-up compared to the three-month follow-up (P=<0.001 for both). When compared to the normal side, dorsiflexion and plantarflexion of the affected ankle were significantly less at three months but were comparable at six months post-operatively. A significant improvement was noted in the mean EFAS score at the sixmonth follow-up (25.5±5.71) compared to three months (18.6±0.90) post-surgery (P=0.001). Males were also noted to have significantly higher EFAS scores at their six-month follow-up than females (P=0.022). In contrast, a negative correlation was noted between the European Foot and Ankle Society (EFAS) score at the final follow-up and age (P=0.011). Conclusion: FHL tendon transfer with V-Y plasty in chronic Achilles rupture due to insertional Achilles tendinopathy is an effective procedure resulting in the restoration of the ankle range of motion and improvement in functional scores.

Purpose: This study was performed to assess the performance and accuracy of artificial intelligence (AI) in the detection and diagnosis of maxillary sinus pathologies using computed tomography (CT)/cone-beam computed tomography (CBCT) imaging. Materials and Methods: A comprehensive literature search was conducted across 4 databases: Google Scholar, BioMed Central (BMC), ProQuest, and PubMed. Combinations of keywords such as “DCNN,” “deep learning,” “convolutional neural network,” “machine learning,” “predictive modeling,” and “data mining” were used to identify relevant articles. The study included articles that were published within the last 5 years, written in English, available in full text, and focused on diagnostic accuracy. Results: Of an initial 530 records, 12 studies with a total of 3,349 patients (7,358 images) were included. All articles employed deep learning methods. The most commonly tested pathologies were maxillary rhinosinusitis and maxillary sinusitis, while the most frequently used AI models were convolutional neural network architectures, including ResNet and DenseNet, YOLO, and U-Net. DenseNet and ResNet architectures have demonstrated superior precision in detecting maxillary sinus pathologies due to their capacity to handle deeper networks without overfitting. The performance in detecting maxillary sinus pathology varied, with an accuracy ranging from 85% to 97%, a sensitivityof 87% to 100%, a specificity of 87.2% to 99.7%, and an area under the curve of 0.80 to 0.91. Conclusion AI with various architectures has been used to detect maxillary sinus abnormalities on CT/CBCT images, achieving near-perfect results. However, further improvements are needed to increase accuracy and consistency.

Purpose: This study was performed to assess the performance and accuracy of artificial intelligence (AI) in the detection and diagnosis of maxillary sinus pathologies using computed tomography (CT)/cone-beam computed tomography (CBCT) imaging. Materials and Methods: A comprehensive literature search was conducted across 4 databases: Google Scholar, BioMed Central (BMC), ProQuest, and PubMed. Combinations of keywords such as “DCNN,” “deep learning,” “convolutional neural network,” “machine learning,” “predictive modeling,” and “data mining” were used to identify relevant articles. The study included articles that were published within the last 5 years, written in English, available in full text, and focused on diagnostic accuracy. Results: Of an initial 530 records, 12 studies with a total of 3,349 patients (7,358 images) were included. All articles employed deep learning methods. The most commonly tested pathologies were maxillary rhinosinusitis and maxillary sinusitis, while the most frequently used AI models were convolutional neural network architectures, including ResNet and DenseNet, YOLO, and U-Net. DenseNet and ResNet architectures have demonstrated superior precision in detecting maxillary sinus pathologies due to their capacity to handle deeper networks without overfitting. The performance in detecting maxillary sinus pathology varied, with an accuracy ranging from 85% to 97%, a sensitivityof 87% to 100%, a specificity of 87.2% to 99.7%, and an area under the curve of 0.80 to 0.91. Conclusion AI with various architectures has been used to detect maxillary sinus abnormalities on CT/CBCT images, achieving near-perfect results. However, further improvements are needed to increase accuracy and consistency.

Purpose: This study was performed to assess the performance and accuracy of artificial intelligence (AI) in the detection and diagnosis of maxillary sinus pathologies using computed tomography (CT)/cone-beam computed tomography (CBCT) imaging. Materials and Methods: A comprehensive literature search was conducted across 4 databases: Google Scholar, BioMed Central (BMC), ProQuest, and PubMed. Combinations of keywords such as “DCNN,” “deep learning,” “convolutional neural network,” “machine learning,” “predictive modeling,” and “data mining” were used to identify relevant articles. The study included articles that were published within the last 5 years, written in English, available in full text, and focused on diagnostic accuracy. Results: Of an initial 530 records, 12 studies with a total of 3,349 patients (7,358 images) were included. All articles employed deep learning methods. The most commonly tested pathologies were maxillary rhinosinusitis and maxillary sinusitis, while the most frequently used AI models were convolutional neural network architectures, including ResNet and DenseNet, YOLO, and U-Net. DenseNet and ResNet architectures have demonstrated superior precision in detecting maxillary sinus pathologies due to their capacity to handle deeper networks without overfitting. The performance in detecting maxillary sinus pathology varied, with an accuracy ranging from 85% to 97%, a sensitivityof 87% to 100%, a specificity of 87.2% to 99.7%, and an area under the curve of 0.80 to 0.91. Conclusion AI with various architectures has been used to detect maxillary sinus abnormalities on CT/CBCT images, achieving near-perfect results. However, further improvements are needed to increase accuracy and consistency.

Plants are alternative source of natural medicines due to secondary active metabolites. Fagonia cretica extracts and Gradient High-Pressure Liquid Chromatography fractionations were checked against multidrug-resistant gastrointestinal pathogens including, Salmonella typhi, Escherichia coli and Shigella flexneri. ESI-MS/MS analysis of bioactive HPLC fractions was performed to elucidate antibacterial compounds. F. cretica extracts exhibited potential antibacterial activity. Twenty-four (24) HPLC fractions were obtained from methanol, ethanol and aqueous extracts of F. cretica. Eighteen (18) fractions showed antibacterial activity, while no activity was observed by the remaining six (6) fractions. HPLC fractions, F1 (25g ± 0.20 mm) and F2 (15f ± 0.12 mm) of aqueous extract exhibited activity against multidrug resistant GI pathogens. Gallic acid, quinic acid, cyclo-l-leu-l-pro, vidalenolone, liquirtigenin, rosmarinic acid and cerebronic acid were identified in F1 fraction of aqueous extract, while succinic acid, cyclo (l-Leul-Pro) and liquirtigenin were identified in F2 fraction of aqueous extract through ESI-MS/MS analysis. F. cretica extracts and HPLC fractions showed potential activity against MDR GI pathogens. Vidalenolone, Cyclo-1-leu-1-pro and Cerebronic acid are first time reported in F. cretica. Further characterization of bioactive compounds from F. cretica may be helpful to elucidate antibacterial therapeutic molecules.