Indomethacin may reduce the incidence and severity of acute pancreatitis after ERCP

OBJECTIVES: Acute pancreatitis is the most common complication of endoscopic retrograde cholangiopancreatography (ERCP). Many medications have been used to prevent this complication. We aimed to evaluate the efficacy of rectally administered indomethacin for the prevention of post-ERCP pancreatitis. METHODS: During 18 months, all eligible patients who underwent ERCP were enrolled in this study. In a double-blind randomized trial, patients received a suppository containing indomethacin, 100 mg, or an inert placebo immediately before ERCP. Serum amylase levels and clinically pertinent evaluations were measured in all patients after ERCP. RESULTS: A total of 490 patients entered the trial, of which half received indomethacin. Twenty-two patients developed pancreatitis; seven cases in the indomethacin group and 15 in the placebo group (P=0.06). Pancreatic duct injection (OR=3.0, 95% CI: 1.3-7.4), pancreatic duct cannulation more than once (OR=4.2, 95% CI: 1.7-10.0), and age less than 60 yr (OR=2.7, 95% CI: 1.0-7.1) were shown to be significant risk factors for developing post-ERCP pancreatitis. In patients who underwent pancreatography with or without cholangiography, the risk of pancreatitis was significantly lower in the indomethacin group compared with the control group (P=0.01, RRR=88%, ARR=0.16, NNT=6). Moderate to severe pancreatitis was significantly higher in the placebo group (P= 0.03). CONCLUSIONS: This trial shows that rectal indomethacin given immediately before ERCP can reduce the incidence and severity of post-ERCP pancreatitis.     

Primary transitional cell carcinoma of the fallopian tube

The fallopian tube is the least common site for origin of malignancy in the female genital tract. Most primary fallopian tube malignancies are adenocarcinomas. Primary transitional cell carcinoma (TCC) of the fallopian tube is an extremely rare tumor with a small number of cases reported in the literature. We present a 67-year-old woman who was found incidentally to have a left adnexal mass on a screening pelvic ultrasound. Subsequently the patient underwent laparoscopic left salpingo-oophorectomy and the specimen was submitted for intraoperative frozen section, which revealed a high-grade carcinoma; therefore, she underwent a laparotomy and total abdominal hysterectomy, right salpingo-oophorectomy and omentectomy. Histopathology revealed high-grade transitional cell carcinoma in the left fallopian tube. Post-surgery she was treated with four cycles of adjuvant chemotherapy with carboplatin and paclitaxel with no complications. Our patient had a family history of malignancy, so genetic testing for BRCA1 and BRCA2 mutations was undertaken and did not reveal any mutation or unclassified variants. Multiplex ligation-dependent probe amplification (MLPA) was normal.     

Opium poisoning following self‐medication of radiation‐induced dermatitis with topical use of opium latex traditional extract; a teaching case

Despite Radiation‐induced dermatitis is a self‐limiting complication, it can be complicated if inappropriate self‐medications have been used such as opium latex traditional extract.     

Mucormycosis after scorpion sting: case report

Mucor is a fungus, which give rise to opportunistic infection in immunocompromised patients. We described a 55‐year‐old immunocompetent woman with cutaneous mucormycosis after scorpion sting. Mucormycosis may happen in patients with intact immunity and is not allocated only to patients with immune deficiency.     

Efficacy of clove powder solution on stress mitigation in juvenile common carps, Cyprinus carpio (Linnaeus)

Effects of clove powder solution on stress response were investigated in juvenile common carp. Juvenile common carp (about 10 g in weight), reared in 3 g/L salinity, were used in this study. Blood samples were collected before stress as pre-stress values. Thereafter, fish were exposed to crowding stress (density of 25 g/L over a 45-min period) with 0, 50, 200 and 300 mg/L clove powder. Experimental treatments were 0 mg/L clove powder (C0), 50 mg/L clove powder (C50), 200 mg/L clove powder (C200) and 300 mg/L clove powder (C300). After 45-min stress, blood samples were collected from all group in order to determine the effects of stress on blood cortisol, glucose, Na⁺ and Cl⁻ levels. Results showed that clove powder significantly prevented cortisol elevation after stress in C50, C200 and C300 compared to pre-stress values. But, glucose levels were significantly high after stress in all groups compared to pre-stress values. Na⁺ and Cl⁻ concentrations did not significantly change after stress in all groups. Results suggest that clove powder is capable of reducing cortisol elevation after stress in carp, particularly at concentrations of 300 mg/L. However, additional studies are needed to determine the effects of various clove powder concentrations on post-stress recovery period.     

Effect of anterior chamber air bubble on prevention of experimental Staphylococcus epidermidis endophthalmitis

Background  

Bacterial endophthalmitis is a serious complication of penetrating ocular trauma and cataract surgery. The purpose of this study is to assess the ability of an anterior chamber air bubble to prevent experimental Staphylococcus epidermidis endophthalmitis.     

Contrast-enhanced intravascular ultrasound: combining morphology with activity-based assessment of plaque vulnerability

Acute coronary syndromes are the result of coronary plaque rupture in the majority of cases. Available diagnostic techniques that focus on the early detection of plaques that are prone to rupture are still limited. Increased neovascularization in the vasa vasorum of the atherosclerotic plaque has been identified recently as a common feature of inflammation and plaque vulnerability. Microbubbles, which have been used for ultrasound imaging, can be used to trace neovascularization. We present recent advances in contrast agents and contrast-enhanced intravascular ultrasound that may be used for the detection of vasa vasorum, including fundamental and harmonic contrast imaging. Identification of vasa vasorum proliferation in atherosclerotic plaques presents important clinical implications; in particular it could provide a means to detect vulnerability in vivo, thereby guiding targeted treatments.