Separation of Thoracoomphalopagus Conjoined Twins. Use of Tissue Expanders and Abdominoplasty According to the San Martín Technique

We present a set of female thoracoomphalopagus conjoined twins who were separated at ten months of age. Tissue expanders were used to expand the available soft tissue to cover the defect. The abdominal wall was closed by making a release incision on the outer aspect of the anterior sheath of the rectus muscle, detaching the anterior sheath of the muscle fibers, and flipping it over towards the midline. Meshes of decellularized collagen matrix were used to close the thorax. They had no major complications and were discharged from the hospital 60 days later. The girls are currently 5 years old and lead a normal life according to their age. We believe that the use of tissue expanders combined with the mobilization of aponeurotic flaps through discharge incisions adds a useful tool for the treatment of these patients.

Hydatid cyst of the lumbar plexus: case report with review of literature

Background Hydatid disease is widely distributed worldwide; it is caused by a parasite belonging to the Echinococcus species. It mostly affects the liver and the lungs, involvement of the spinal canal is reported to be around 0.2%, but affection of the peripheral nerves is extremely rare. Case presentation A 42-year-old lady was complaining from left loin pain and backache, with pain in the outer aspect of the left thigh for the last 5 years. During clinical examination, the ankle and the knee reflexes were normal and there was no muscle wasting. There was hyperesthesia on the outer aspect of the left leg. Magnetic resonance imaging of the back demonstrated a cystic lesion between the 4th and the 5th lumbar vertebrae which was pushing the psoas muscle anteriorly and causing atrophy of the muscle. The patient received anthelminthic medications for 1 month before surgery with little improvement of the clinical and the radiological condition. During surgery the cyst was found to arise from the lumbar nerve sheath and was apparent to be hydatid cyst because it was containing small daughter cysts. Isolation of the cyst was done and complete evacuation with deroofing of the cyst was done. The cavity of the cyst was irrigated with a solution of chlorhexidine as a scolicidal agent. The patient was discharged home after 3 days with no post-operative complications, anthelminthic medications prescribed for 3 months. Conclusion The treatment options vary depending on the region affected by the cyst; it may be treated by complete cyst excision, evacuation, and deroofing. Preventing spillage of the contents of the cyst during surgery and the use of scolicidal agents are mandatory to decrease the rate of recurrence. It is very important to exclude other organ involvement particularly pulmonary involvement before surgery.

Spectrum of vulvar lesions: patient’s anxiety, clinician’s concern and pathologist’s diagnostic challenge

Background: A wide variety of inflammatory, premalignant and malignant lesions can occur on the vulva. Some of the lesions are limited to the vulva, while some also involve other parts of the body. Although vulvar diseases can cause a significant issue in the patients, they are less commonly discussed than those of cervix, uterus and ovary. Most of the asymptomatic lesions remain un-noticed, and are seen during routine gynecological checkups. Common complaints in symptomatic lesions are lumps, discomfort, itching and pain. Since the symptoms are nonspecific; determining the location of the lesion can assist with the diagnosis. Being a genital part with skin covering on outer aspect and mucosal lining inside, it is associated with various dermatological, nutritional, and hormonal as well as sexually transmitted diseases. The present study thus was conducted to categorize vulvar lesions based on their histological diagnosis and also to study the morphological spectrum of precursor lesions for malignancy.Methods: Present study includes all types of vulvar lesions sent for pathological study in the Department of pathology, at GMC Nagpur over the period of one year.Results: Total 34 lesions were studied including a wide diagnostic range from inflammatory, dermatological to benign, premalignant and malignant. Inflammatory lesions including various infections and LSA (Lichen sclerosus atrophicus) were the most commonly seen lesions along with collection of neoplastic lesions.Conclusions: Proper diagnostic categorization of the lesions is essential for initiating therapy and reducing patient’s anxiety. Morphology of these lesions along with their diagnostic significance is discussed.

Aspectual Classes

This chapter deals with meaning elements of the predicate that are mainly connected with temporal characteristics other than those, like tense, that are directly connected to the speech act. These are sometimes referred to as inner aspect, in contrast to outer aspect, which deals with temporal operators like Progressive, Perfect and Habitual. The chapter focuses in particular on the division of predicates into aspectual classes, such as states, activities, accomplishments, achievements, and semelfactives, and criteria for such classifications. There is also some discussion of the stage level/individual level distinction, and the theory introduced by the philosopher Donald Davidson that all predicates have an event argument. Most of the data are from English but there are examples from Slavonic languages and a number of other languages.

Comparison of the Shaping Ability of Endowave and K3 Rotary Nickel-Titanium Instruments in Simulated Canals

Objectives The aim of this study was to compare canal aberrations and transportation of Endowave and K3 rotary nickel-titanium files in simulated canals with 40-degree curvature. Materials and Methods Twenty simulated canals with 40-degree curvature were divided into two groups (each of 10). In one group, canals were instrumented with Endowave and in the other group with K3. Both systems were used in crown-down manner, and canals were prepared till apical size # 25/0.06 taper. The pre- and post-instrumentation radiographic scanned images were superimposed on each other using software movements and viewed for canal aberrations and transportation. Results are statistically analyzed using Student's t-test. Results In the canals prepared with Endowave files, one (10%) ledge was created whereas in the canals prepared with K3 files, one (10%) apical zip and elbow, one (10%) ledge, and two (20%) perforations were created. When two groups were compared, results were statistically insignificant (p > 0.05) for the amount of resin removed from inner and outer aspect of the canal. Conclusions Endowave files revealed better results in terms of the canal aberrations compared to K3 files. The direction of transportation was generally toward the outer aspect with both files.

Gerakan Petani Banten: Studi Tentang Konfigurasi Sufisme Awal Abad Xix

Sufism is an esoteric dimension of Islam, which differs from the outer aspect of Islam known as shari’a. This view did not emerge at the early time because Sufism was not regarded as the inner manifestation of Islam, as it is so now. Rather, it was seen as Islam itself. Tarekat in its initial phase constituted associations of people who wanted to escape from a worldly life. However, this orientation shifted since the associations broadened their roles into socio-political life by engaging in revolts against colonialism as it occurred in Banten in 1888. This peasant revolt movement was not an independent move without a significant contribution from the sufi brotherhood since actors in the revolt were members of tarekat. According to Banten Residen, almost all of the employees in his office including police were the members of tarekat. One salient feature of the movement is concerned with the xenophobic spirit that rejected the presence of foreigners and advocated a holy war.

Case in diachrony: Or, why Greek is not English

Greek demonstrates both a change from inner (Aktionsart) into outer (grammatical) aspect as well as a change from demonstratives into definite articles, as does English. Even though aspect and definiteness are connected with Case, we argue that the tendencies in Greek with regard to the Case system differ in several aspects from the development of the Case system in English. We consider changes in the Case system of Greek in relation to syntactic properties of the clause, and in particular the realization of +/-interpretable features in inner and outer aspect. We argue that the change that takes place in the history of Greek involves a transitional stage in Ancient Greek where the relevant features can appear on the Trans[itivity] head (outer aspect) or the (inner) Asp[ect] head. The completion of the change in Post-Koine Greek involves the loss of the interpretable feature on Asp; thus Case remains (uninterpretable) on the higher Trans head.

Painful Leg Ulceration in a Poorly Controlled Hypertensive Patient: A Case Report of Martorell Ulcer

Martorell ulcer is a form of lower limb ulceration, preceded by a small area of excruciating pain. It often appears as a solitary lesion on the outer aspect of the lower limb, and is primarily associated with poorly controlled hypertension and diabetes. Treatment of the ulcer involves awareness and early correct diagnosis, adequate control of blood pressure, management of infection, and wound care. We describe a 77-year-old diabetic and hypertensive woman presenting with excruciating pain in her right lower lateral leg leading to a necrotic ulcer. Serial photographs of the evolution of the lesion and eventual healing of the ulcer are presented.

Pseudoepitheliomatous hyperplasia causing a painful plaque in a HIV-infected female

Dermatological conditions are more common and can present atypically, in human immunodeficiency virus-infected individuals. This case report describes a 22-year-old human immunodeficiency virus-positive Caucasian female who presented with a vulval lesion eight weeks after starting antiretroviral treatment. Clinical examination revealed a 2 cm well-demarcated plaque on the outer aspect of the left labium minus. The lesion was tender, no contact bleeding or ulceration present. She was presumptively treated for chancroid and herpes simplex with 500 mg ceftriaxone IM stat, 1 g azithromycin PO stat, and valacyclovir 500 mg BD for five days. The lesion persisted despite treatment, and during follow-up, a punch biopsy was carried out. She was diagnosed with pseudoepitheliomatous hyperplasia of the epidermis. In addition to highlighting this condition that has been previously reported in human immunodeficiency virus/herpes simplex virus co-infection, this case demonstrates that unusual skin presentations must be considered in human immunodeficiency virus-infected individuals and illustrates the importance of biopsy for any non-healing lesions.