No abstract

No abstract

Mǔllerian cysts or paramesonephric cysts arise from the fused embryonic ducts, which typically regress in the uterus. These cysts are usually located paravertebrally. We present an unusual case of a Mǔllerian cyst developing within the mesentery of the ileocecum that was successfully resected. The patient presented to our surgical unit with abdominal pain and swelling. She underwent all the necessary tests to rule out other pathologies before she underwent right hemicolectomy. The patient was discharged without complications. Histopathology confirmed the presence of female reproductive tract epithelium, which was conclusive of a Mǔllerian cyst or paramesonephric cyst. Mǔllerian cysts are rarely malignant, and they are usually treated surgically. The incidence of Mǔllerian cysts is one in 105,000, with almost equal sex distribution. Their unusual intraperitoneal location further demonstrates their uncommon presentation.

Immunotherapy has dramatically changed the outcome of many tumours. Whether it is by using antibodies as a humoral form of tumour control and clearance or active vaccines that allow the immune system to mount a response, the methodologies are quite different yet sharing an inherent similarity; finding the right epitope and eliciting the right response within the proper time frame of cellular maturity. The initial enthusiasm of using degraded proteins and priming T-cells against these vaccines has faded away with less than satisfactory outcomes in clinical trials. Albeit our understanding of how Dendritic Cells and T-cells interact and display antigens has been improving, we have not been able to clearly pinpoint a proper way in using peptide vaccines in clinical settings. This eventually prompted the use of whole proteins, necessitating antigen processing inside antigen presenting cells to give to suitable immunogenic epitopes. This has proven successful in a few clinical trials so far; however, recent evidence clearly demonstrates that eradication of a tumour is not just a matter of which protein is most likely to be immunogenic, but a combination of several other factors in its immediate and possibly distant environment. Hence our methodology in tumour clearance by using active vaccines is unlikely to be met with much success until we clearly understand the environment which allows these tumours to be nurtured. Henceforth, a whole cell vaccine in the context of enhanced adoptive T-cell immunotherapy will most likely be successful but still will not be the ultimate way in eradicating tumours. Our discussion will focus on several treatment modalities and success stories as well as possible modalities that will prove to be successful in the not so distant future.

Necrotising fasciitis is a rare life-threatening surgical emergency in which timely diagnosis and treatment are key. We present a case in which a patient rapidly succumbed to synchronous multifocal necrotising fasciitis from a likely intra-abdominal source. The ability for the disease to present in the unusual fashion described in this case must be highlighted to all clinicians.

Objective: To understand the role of the artery of Drummond in the elderly population. The artery plays a crucial role in the anastamosis between the inferior mesenteric artery and superior mesenteric artery. Its maintenance is particularly important for the survivability of the bowel in events of stenosis of either one of the native arteries; SMA or IMA. Method: A 94 year old lady presents with post-prandial abdominal pain and significant emaciation. The patient undergoes clinical and radiological investigations to find out the cause of her ailments. Results: Abdominal X-ray revealed a serpentine structure that was later defined as the artery of Drummond, CT scan revealed a calcified and enlarged artery of Drummond in addition to an occluded origin of SMA and celiac artery as well as a severe stenosis origin of IMA. Conclusion: The artery of Drummond was immensely hypertrophied and was supplying the entire bowel through the native IMA; subsequent occlusion of the IMA was the main cause that caused the demise of the patient

No abstract

No abstract