OBJECTIVE: The study aimed to describe a case of vaginal polypoid endometriosis and its management. MATERIALS AND METHODS: This study is a case report. The patient was a nulliparous woman aged 27 years who presented with pain in her lower abdomen and continuous bleeding per vaginum for 2 months. On speculum examination, multiple, smooth, polypoid masses were seen arising all around the vaginal fornices; cervix was healthy. Ultrasound revealed a bulky uterus with a 5 × 6-cm fibroid in the posterior wall with echogenic area adjacent to cervix and gross left hydroureteronephrosis. The right kidney was removed 6 years consequent to pyonephrosis. Biopsy of the vaginal polypoidal mass was reported as vaginal polypoid endometriosis. The patient was planned for myomectomy and vaginal mass excision. On examination under anesthesia, the base of polypoid mass was thick and fixed and could not be excised completely. Myomectomy was done. Postoperatively, the patient received 3 injections of gonadotropin-releasing hormone agonist, but the size of the mass did not decrease. She was then planned for ureteric reimplantation and panhysterectomy. Hysterectomy was not possible because of extensive parametrial involvement, but Boari flap ureteric implantation with bilateral salpingo-oophorectomy was done. RESULTS: Vaginal polypoid endometriosis did not respond to medical treatment. However, the widespread vaginal polypoidal masses regressed significantly after oophorectomy. CONCLUSION: Bilateral oophorectomy was resorted to as an option in this case of vaginal polypoid and extensive pelvic endometriosis not amenable to medical treatment and surgical excision.

A series of aluminium complex ions with trifluoromethyl-heteroarylalkenolato (TMHA) ligands are studied by gas-phase infrared multiphoton-dissociation (IRMPD) spectroscopy and computational modelling. The selected series of aluminium TMHA complex ions are promising species for the initial study of intrinsic binding characteristics of Al(III) cations in the gas phase as corresponding molecular ions. They are readily available for examination by (+) and (-) electrospray ionization mass spectrometry (ESI-MS) by spraying of [Al(3+) ⋅(L(-))(3)] solutions. The complex ions under investigation contain trivalent Al(3+) cations with two chelating anionic enolate ligands,[Al(3+) ⋅(L(-))(2)](+), providing insights in the nature of the heteroatom-Al bonds. Additionally, the structure of a deprotonated benzimidazole ligand, L(-,) and an anionic complex ion of Al(III) with two doubly deprotonated benzimidazole ligands,[Al(3+) ⋅(L(2-))(2)](-), are examined by (-)ESI-IRMPD spectroscopy. Experimental and computational results are highly consistent and allow a reliable identification of the ion structures. In all complex ions examined the planar TMHA ligands are oriented perpendicular to each other around the metal ion, leading to a tetrahedral coordination sphere in which aluminium interacts with the enolate oxygen and heteroaryl nitrogen atoms available in each of the bidentate ligands.

Standard endoscopy is an insensitive test for gastroesophageal reflux disease (GERD). Narrow band imaging (NBI) endoscopy enhances visualization of the distal esophagus. NBI patterns like intrapapillary capillary loop (IPCL) dilatation, tortuosity, and increased number; microerosions; increased vascularity at the squamocolumnar junction (SCJ); ridge-villous pattern below the SCJ; and presence of columnar islands in the distal esophagus have been suggested as features of GERD. We evaluated the effect of proton pump inhibitor (PPI) therapy on NBI findings in GERD patients. Patients prospectively underwent NBI upper endoscopy before and after PPI therapy. NBI findings were recorded at each endoscopy. Twenty-one patients with GERD symptoms (mean age 60.0 years; males 90.5%; white 90.5%) were studied. After PPI therapy, there was a significant reduction in the proportion of patients with the following NBI features: IPCL tortuosity (90% vs. 4.8%, P < 0.0001), dilated IPCLs (86% vs. 9.5%, P < 0.0001), and increased vascularity at the SCJ (43% vs. 9.5%, P= 0.0082). PPI led to healing of all microerosions (71% vs. 0%, P < 0.0001) and disappearance of ridge-villous patterns below the SCJ (14% vs. 0%, P < 0.0001). There was no significant change in the proportion of patients with increased numbers of IPCLs pre- and post-PPI therapy (71% vs. 48%, P= 0.09) or columnar islands in the distal esophagus (38% vs. 29%, P= 0.31). In patients with GERD symptoms, NBI features suggestive of GERD respond to PPI; suggesting these features are truly acid-mediated. These findings need to be confirmed by randomized controlled trials.

Abstract ZnO nanoparticles (NPs) elicit significant adverse effects in various cell types, organisms and in the environment. The toxicity of nanoscale ZnO has often been ascribed to the release of zinc ions from the NPs but it is not yet understood to which extent these ions contribute to ZnO NP toxicity and what are the underlying mechanisms. Here, we take one step forward by demonstrating that ZnO-induced Jurkat cell death is largely an ionic effect involving the ex-tracellular release of high amounts of Zn(II), their rapid uptake by the cells and the induction of a caspase-independent alternative apoptosis pathway that is independent of the formation of ROS. In addition, we identified novel coating strategies to reduce ZnO NP dissolution and subsequent adverse effects.

BACKGROUND: Autonomously functioning thyroid nodules (AFTN) are extremely rare in children. Malignancy may be rarely found in hyperfunctioning 'hot' nodules in adults. However, there are limited reports of AFTNs in young children presenting as or developing malignancy in future. We report here two young children aged < 6 years old at the time of diagnosis as having an AFTN, which eventually turned out to be papillary carcinoma of thyroid (PTC) on follow-up. PATIENT FINDINGS: A 2-month-old baby had a right-sided neck swelling since birth. On examination, the baby had clinical and biochemical features of thyrotoxicosis. On sonography, and subsequently on 99mTc-pertechnetate thyroid scan, a hot nodule was found. Patient was treated with carbimazole for 5 years. In spite of euthyroidism achieved, the nodule continuously grew in size. Thyroid cytology was inconclusive, hence hemithyroidectomy was performed and histopathology turned out to be PTC. Another 5-year-old female child had a large right-sided AFTN on thyroid scan. She was treated with radioiodine; however, like the previous case, the nodule started growing in size. She subsequently underwent near total thyroidectomy and histology was reported as PTC. CONCLUSION: In the light of this report that shows that solitary hyperfunctioning nodules in very young children have high chance of malignancy, we recommend hemithyroidectomy as the treatment of choice.

Microsomal glutathione transferase 1 (MGST1) is an antioxidant enzyme located predominantly in the mitochondrial outer membrane and endoplasmic reticulum and has been shown to protect cells from lipid peroxidation induced by a variety of cytostatic drugs and pro-oxidant stimuli. We hypothesized that MGST1 may also protect against nanomaterial-induced cytotoxicity through a specific effect on lipid peroxidation. We evaluated the induction of cytotoxicity and oxidative stress by TiO(2), CeO(2), SiO(2), and ZnO in the human MCF-7 cell line with or without overexpression of MGST1. SiO(2) and ZnO nanoparticles caused dose- and time-dependent toxicity, whereas no obvious cytotoxic effects were induced by nanoparticles of TiO(2) and CeO(2). We also noted pronounced cytotoxicity for three out of four additional SiO(2) nanoparticles tested. Overexpression of MGST1 reversed the cytotoxicity of the main SiO(2) nanoparticles tested and for one of the supplementary SiO(2) nanoparticles but did not protect cells against ZnO-induced cytotoxic effects. The data point toward a role of lipid peroxidation in SiO(2) nanoparticle-induced cell death. For ZnO nanoparticles, rapid dissolution was observed, and the subsequent interaction of Zn(2+) with cellular targets is likely to contribute to the cytotoxic effects. A direct inhibition of MGST1 by Zn(2+) could provide a possible explanation for the lack of protection against ZnO nanoparticles in this model. Our data also showed that SiO(2) nanoparticle-induced cytotoxicity is mitigated in the presence of serum, potentially through masking of reactive surface groups by serum proteins, whereas ZnO nanoparticles were cytotoxic both in the presence and in the absence of serum.