Fish bone ingestion and impaction are known to everyone. However, such benign incidences have been reported to be associated with multiple potentially life threatening complications. Anatomical features of the oesophagus forms the basis for such incidences. We report here an elderly diabetic gentleman with an unusual left retro-paraoesophageal abscess complicated with oesophageal perforation, mediastinitis and vocal cord paresis which were fundamentally caused by a migrated fish bone into the lower part of the neck requiring therapeutic external neck exploration. Management of this case and its complications are described here comprehensively.

Antitubercular Agents ; economics ; therapeutic use ; Directly Observed Therapy ; Drug Resistance, Multiple, Bacterial ; Humans ; Singapore ; epidemiology ; Tuberculosis, Multidrug-Resistant ; drug therapy ; economics

Background & Objective: Parkinson’s disease (PD) is a chronic neurological disease, many a times presenting with non-motor symptoms. Pain is one of the most important non-motor symptom and there is no consensus regarding its exact mechanism and characterisation. This study was planned to evaluate the characteristics of pain and possible factors influencing it, in a cohort of patients with established Parkinson’s disease. Methods: 104 patients consenting to participate were included in the study. Data regarding age of onset, duration of disease, treatment, Hoehn-Yahr scale, phenotype of PD, UPDRS scores, pain type and distribution of pain were noted. Single and multiple logistical regression models with pain (1/0) as the outcome variable were used to check the association of pain with the above mentioned variables. Results: 54.8% of patients with PD experience pain. Presence of sensory symptoms was significantly associated with the pain group (42.1%) than the no pain group (21%). Pain was more pronounced on the side with predominant motor symptoms (72%) and in 68.4 % patients pain responded to dopaminergic treatment. Musculoskeletal pain (82.5%) was the commonest type and lower limbs were the commonest site of pain (43.2%). Conclusion: Pain in Parkinson’s disease has multiple dimensions and characteristics. Pain itself may be the reason for early diagnosis. Proper classification of pain will help in improved management of these patients.

Myogenic tone is the response of the vascular smooth muscle to an increase in intraluminal pressure with vasoconstriction and with vasodilation when the pressure is decreased. Such myogenic tone contributes a level of physiological basal tone in response to neurohumoral stimuli. In spite of myogenic tone discovery by Sir William Bayliss 100 years ago, questions still remain regarding the underlying signaling mechanism of the myogenic response. Studies have shown that increased intraluminal pressure or wall tension leads to membrane depolarization, voltage-operated calcium channel (VOCC), stretch-activated cation (SAC) channels, extracelullar matrix (ECM) and actin cytoskeleton. Recently, evidence has shown a potential role for reactive oxygen species (ROS) as a key signalling mediator in the genesis of myogenic tone. The identification of the primary mechanosensors in the initiation of pressure-dependent myogenic tone is essential as these components could be potential therapeutical targets in the future.

No abstract available.
Adenosine Triphosphate/pharmacology ; Anions/metabolism ; Bicarbonates/metabolism* ; Chlorides/metabolism* ; Cyclic AMP/pharmacology ; Cystic Fibrosis Transmembrane Conductance Regulator/physiology* ; Electric Conductivity ; Electrophysiology ; Gluconates/pharmacology ; Human ; Membrane Potentials/physiology ; Membrane Potentials/drug effects ; Potassium/pharmacology ; Sweat Glands/metabolism*

Schizophrenia-associated anomalies in gene expression in postmortem brain can be attributed to a combination of genetic and environmental influences. Given the small effect size of common variants, it is likely that we may only see the combined impact of some of these at the pathway level in small postmortem studies. At the gene level, however, there may be more impact from common environmental exposures mediated by influential epigenomic modifiers, such as microRNA (miRNA). We hypothesise that dysregulation of miRNAs and their alteration of gene expression have significant implications in the pathophysiology of schizophrenia. In this study, we integrate changes in cortical gene and miRNA expression to identify regulatory interactions and networks associated with the disorder. Gene expression analysis in post-mortem prefrontal dorso-lateral cortex (BA 46) (n=74 matched pairs of schizophrenia, schizoaffective, and control samples) was integrated with miRNA expression in the same cohort to identify gene-miRNA regulatory net-works. A significant gene-miRNA interaction network was identified, including miR-92a, miR-495, and miR-134, which converged with differentially expressed genes in pathways involved in neurode-velopment and oligodendrocyte function. The capacity for miRNA to directly regulate gene expres-sion through respective binding sites in BCL11A, PLP1, and SYT11 was also confirmed to support the biological relevance of this integrated network model. The observations in this study support thehypothesis that miRNA dysregulation is an important factor in the complex pathophysiology of schizophrenia.

We discuss a patient with a tumor on the anterior corpus callosum who underwent open biopsy eventually succumbing to cerebrogenic fatal arrhythmia following wounded glioma syndrome. A healthy 37-year-old female patient was admitted to our department due to a history of headache for 13 months. MRI revealed a suspicious glioma infiltrating the anterior corpus callosum. Neurologic examination only showed low cognitive assessment score (Montreal Cognitive Assessment score 20/30). ECG was normal sinus rhythm. Steroids and levetiracetam were administered prior to operation. Patient underwent right frontal craniotomy and biopsy of tumor with unremarkable events. During the first hospital day, patient had episodes of bradycardia followed by decrease in sensorium. Brain CT scan showed progression of edema without hemorrhage within the tumor bed. This was followed minutes later by two episodes of generalized tonic-clonic seizures and pulseless ventricular tachycardia. Cardiac resuscitation was done for 24 minutes but patient eventually expired. Location of the lesion and the epileptogenicity of the peritumoral cortex greatly contributed to the patient’s demise. Involvement of the frontomesial structures, particularly the insula and the cingulate cortex, and their connection to the central autonomic network, increased susceptibility to arrhythmias. Decreased seizure threshold worsened post-operative edema, further aggravating the dysregulation of the brain-heart-connection.

Benign mesenchymal tumors of the urinary bladder are extremely rare. This is a case of a 56- year old female presenting with an enlarging abdomen initially managed as a case of an ovarian new growth. Aside from the ruptured ovarian mass, a urinary bladder mass was also noted intraoperatively and a surgical dilemma was resolved by imaging review. The patient underwent exploratory laparotomy, enterolysis, total hysterectomy, bilateral salpingooophorectomy, and partial cystectomy. Final histopathology identified the bladder tumor to be a leiomyoma. The patient had an uneventful postoperative course. Awareness of this clinical entity and presentation will aid in diagnosis and management.
Leiomyoma

INTRODUCTION: Atherosclerotic diseases wherein obesity is a risk factor was shown to be the leading causes of mortality according to statistics. Body mass index (BMI), waist hip ratio (WHR) and waist circumference (WC), measurements of adiposity, were consistently identified as good measures of cardio-metabolic health risks. High-resolution B-mode ultrasound measurements of carotid intima-media thickness (CIMT) have also been used as a reliable and reproducible method to detect preclinical atherosclerosis, a precursor of cardiovascular disease.

OBJECTIVE: This study aims to investigate which of the measurements of adiposity would best correlate with early vascular changes primarily noted in the CIMT among non-high risk clinicians of Victor R. Potenciano Medical Center (VRPMC).

METHODS: A total of 38 subjects out of 42 residents and interns of VRPMC volunteered to participate in the study from August to November 2010. They had no evidence of cardiac or vascular disease. The weight, height, WC, and hip circumference of each subject were measured. High-resolution B-mode ultrasonography of the right and left common carotid arteries was then performed. 

RESULTS: A weak correlation between BMI with CMIT was found. There is no association between WC and WHR and thickness of CIMT.

CONCLUSION: WC, BMI, and WHR are insignificantly associated with CIMT in this study. 

Human ; Male ; Female ; Adult ; Adiposity ; Atherosclerosis ; Cardiovascular Diseases ; Carotid Artery, Common ; Carotid Intima-media Thickness ; Obesity ; Risk Factors