Notes

Ggct (γ-glutamyl cyclotransferase) plays a vital role in erythrocyte antioxidant safeguard and reddish body cell success.
Multifactor dimensionality reduction (MDR) analysis showed that there was a negative interaction between CYP1A2 rs762551, ABCB1 rs1045642, DRD2 rs1799978, 5-HTR2A rs6311 and the interaction model was the optimal model. Our findings could partially explain the different olanzapine outcome and provided evidence for clarifying the predictive indicators of olanzapine response in further.
Acute lower gastrointestinal haemorrhage can potentially be life-threatening. We present a case of a massive rectal bleed which was managed successfully with a balloon tamponade device designed for upper gastrointestinal haemorrhage.

A 75-year-old gentleman, with a history of human immunodeficiency virus and cirrhosis with portal hypertension, presented with bright red rectal bleeding. Investigations showed a low haemoglobin level (74 g/L) and deranged clotting. Oesophago-gastro-duodenoscopy demonstrated no fresh or altered blood. Flexible sigmoidoscopy revealed active bleeding from a varix within the anterior rectal wall 4 cm from the anal verge. Efforts to stop the bleeding, including endoscopic clips, adrenaline injection and rectal packing, were unsuccessful and the patient became haemodynamically unstable. A Sengstaken-Blakemore tube was inserted per rectum and the gastric balloon was inflated to tamponade the lower rectum. The oesophageal balloon was then inflated to hold the gastric balloon firmly in place. A computed tomography angiogram demonstrated no evidence of haemorrhage with balloon tamponade. After 36 h, the balloon was removed with no further episodes of bleeding.

The application of a balloon tamponade device should be considered in the management algorithm for acute lower gastrointestinal bleed. Advantages include its rapid insertion, immediate results and ability to measure further bleeding after the catheter has been placed.

Sengstaken-Blakemore tube per rectum may effectively control massive low rectal bleeding when alternative methods have been unsuccessful.
Sengstaken-Blakemore tube per rectum may effectively control massive low rectal bleeding when alternative methods have been unsuccessful.
Acromioclavicular joint cyst (AJC) is a very uncommon condition of the shoulder observed in elderly patients, caused by a degenerative acromioclavicular (AC) joint, frequently associated to a rotator cuff tendon tear. There are two possible cause for the cyst formation. We report two different cases of a AC synovial cyst, with and without rotator cuff tear.

We report two cases, in patients aged respectively 80 and 77 years, with a very large AJC. In one case, the cyst was associated to a rotator cuff tear, while in the other case, the rotator cuff did not present any evident lesion. Both cysts were successfully surgical excised and a distal clavicle resection was performed.

AJC is a rare complication observed in degenerative AC joint and in the majority of cases is associated to a rotator cuff tear. read more The diagnosis may be made by ultrasound and conventional radiographic examination, although MRI of the shoulder is generally preferred as it allows to better identify the condition of the rotator cuff. Generally, local aspiration of the cyst and corticosteroid injection fails with recurrence of the cyst and surgically treatment is indicated, especially in painful cases.

Painful AJC should be surgically treated by excision of the cyst associated to a lateral clavicle resection; when a symptomatic massive rotator cuff is present, a reverse total shoulder arthroplasty may be considered. However, in elderly patients, who have no discomfort, watchful waiting may be the treatment of choice.
Painful AJC should be surgically treated by excision of the cyst associated to a lateral clavicle resection; when a symptomatic massive rotator cuff is present, a reverse total shoulder arthroplasty may be considered. However, in elderly patients, who have no discomfort, watchful waiting may be the treatment of choice.
Lymph node metastasis in bladder cancer (BC) is common and has been associated with a very poor prognosis. Bc rarely metastasizes to inguinal lymph nodes.

We reported an unusual case of right inguinal lymph node metastasis of transitional cell carcinoma of the bladder. Metastasis occurred 9 months after radical cystectomy for BC. The patient refused chemotherapy and underwent only surgical excision of lymph nodes without any adjuvant therapy. During a follow-up period of 3 years, the patient still having complete remission.

Multiple studies showed an improved clinical outcome with adjuvant chemotherapy for pathological node-positive patients with BC. Long-term survival could be achieved for some patients with limited lymph node metastasis who underwent metastasectomy. Some studies supported the benefit of surgical consolidation after a good response to systemic chemotherapy. The best management plan for clinically node-positive BC is not established yet.

There is little evidence on which to base the management of inguinal lymph node metastasis from BC. Metastasectomy could be an option with good outcomes.
There is little evidence on which to base the management of inguinal lymph node metastasis from BC. Metastasectomy could be an option with good outcomes.
Glomus tumor located in the lower limb could be easily mistaken as lower extremity pain whether it is radiating, sciatic, or just a localized one. This could lead to misdiagnosis and improper management.

This case reported a 56-year-old man complaining of pain in his left thigh. The pain was characterized as sharp and sometimes radiated to the skin of the calf muscles region. There was no history of trauma. Physical examination of the left thigh region revealed a small and barely palpable deep subcutaneous mass. Ultrasound examination showed a 6 × 5.3 mm partly cystic subcutaneous mass in the posteromedial region of the left distal femur. Doppler USG showed that the blood flow in the cystic lesion originated from the medial genicular artery. Surgical tumor excision through the medial femoral approach exposed a 15 × 10 × 5 mm yellowish-white thin encapsulated subdermal tumor attached to the vascular wall. Histopathology examination resulted in a Glomus Tumor.

Glomus tumor usually occurs in areas that are rich in glomus bodies.
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