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Background: Laparoscopic Cholecystectomy is one of the most commonly performed routine operation in modern general surgery. All surgical specimens are routinely sent for histopathology. A wide spectrum of variations is seen under the microscope. Rarely, carcinoma is discovered on histopathological examination. The purpose of the article was to identify and elaborate the major histopathological findings of gallbladder after laparoscopic cholecystectomy in a tertiary health care hospital in Pakistan. Methods: This was a retrospective study and included histopathological specimens of gall bladder after cholecystectomy from February 2004 to April 2013. Data was analysed using MS Excel and SPSS 19.0. Results: Total number of cases: 8376, Chronic Cholecystitis: 7705, Acute or chronic cholecystitis with empyema, mucocele or gangrene: 554, Adenocarcinoma: 91, Adenomatous polyp: 3, Squamous cell carcinoma: 5, Papillary carcinoma: 3, Clear cell carcinoma: 4, Adenosquamous carcinoma: 2, Xanthogranulomatous changes: 54, Dysplasia: 13 and Cholesterosis: 1050. Conclusion: Considering the evidence from our study and the evidence from the literature reviewed, it can be concluded that prevalence of all kinds of gall bladder disease, benign or malignant including carcinoma is no different from the rest of the world. Routine histopathology of gall bladder can be omitted without compromising patient safety as proven and practiced by many centers across the globe. Key Words: Histopathology, Gallbladder, Laparoscopic Cholecystectomy

Hemorrhoids are a common cause of rectal bleeding with a prevalence of 4 to 40% worldwide, varying in different geographical locations. The current treatment modality for 3rd degree hemorrhoids includes hemorrhoidectomy, but newer methods like rubber band ligation are rapidly gaining popularity. The purpose of our review was to establish if rubber band ligation can replace the traditional hemorrhoidectomy for the treatment of 3rd degree hemorrhoids.All databases were searched for relevant studies. A total of sixteen studies were included in the review. Current national and international literature points out that the results of rubber band ligation are comparable to hemorrhoidectomy and there are lesser complications associated with rubber band ligation.Reviewing the current recommendations, results, evidence and literature, our study recommends rubber band ligation as the treatment of choice for 3rd degree hemorrhoids. Key Words: Hemorrhoidectomy, Rubber Band Ligation, Hemmoroids

Abstract Sigma-1 Receptor has been shown to localize to sites of peripheral nerve injury and back pain. Radioligand probes have been developed to localize Sigma-1 Receptor and thus image pain source. However, in non-pain conditions, Sigma-1 Receptor expression has also been demonstrated in the central nervous system and dorsal root ganglion. This work aimed to study Sigma-1 Receptor expression in a microglial cell population in the lumbar spine following peripheral nerve injury. A publicly available transcriptomic dataset of 102,691 L4/5 mouse microglial cells from a sciatic-sural nerve spared nerve injury model and 93,027 age and sex matched cells from a sham model was used. At each of three time points—postoperative day 3, postoperative day 14, and postoperative month 5—gene expression data was recorded for both spared nerve injury and Sham cell groups. For all cells, 27,998 genes were sequenced. All cells were clustered into 12 distinct subclusters and gene set enrichment pathway analysis was performed. For both the spared nerve injury and Sham groups, Sigma-1 Receptor expression significantly decreased at each time point following surgery. At the 5-month postoperative time point, only one of twelve subclusters showed significantly increased Sigma-1 Receptor expression in spared nerve injury cells as compared to Sham cells (p = 0.0064). Pathway analysis of this cluster showed a significantly increased expression of the inflammatory response pathway in the spared nerve injury cells relative to Sham cells at the 5-month time point (p = 6.74e−05). A distinct subcluster of L4/5 microglia was identified which overexpress Sigma-1 Receptor following peripheral nerve injury consistent with neuropathic pain inflammatory response functioning. This indicates that upregulated Sigma-1 Receptor in the central nervous system characterizes post-acute peripheral nerve injury and may be further developed for clinical use in the differentiation between low back pain secondary to peripheral nerve injury and low back pain not associated with peripheral nerve injury in cases where the pain cannot be localized.

Non-linear energy harvesting devices in the form of stiffness non-linearity have emerged as among the effective solutions to overcome the performance limit of linear energy harvesting devices. However, up to now, researches on the non-linear devices are only focusing on the ability to widen the bandwidth while the limit of employing linear transduction coefficient in a non-linear system has yet to be heavily discussed. This paper investigates on the transduction coefficient for both linear and non-linear systems of an electromagnetic energy harvesting device as a function of the excitation frequency. It is proven that the transduction coefficient of the nonlinear device is larger than its equivalent linear device, especially in the multi-stable solutions region. In common practice, the non-linearity in the non-linear system is considered weak, and its transduction coefficient is assumed to converge to the one produced by the linear system. The limits to which the transduction coefficient of a linear system can be employed on the non-linear system were drawn based on the experimental analysis conducted on the proposed device. The device was designed to perform as a linear or non-linear system, where the degree of non-linearity was changed by varying the gap between the magnets. The limit of the transduction coefficient was determined from the analysis of the harmonic ratio. The results show that the linear transduction coefficient is valid to be employed to the non-linear system when the harmonic ratio is less than five per cent at the multi-stable solutions region. [ABSTRACT FROM AUTHOR]

We report the result of treatment of 69 complex clasped thumbs in 39 patients with distal arthrogryposis. The mean age at surgery was 30 months. Surgical reconstruction included skin augmentation of the first web using modified dorsal rotation advancement flap (Abdel-Ghani flap), a la Carte release of tight structures of the first web, and chondrodesis of the thumb metacarpophalangeal joint. The mean follow-up was 4 years. We prefer chondrodesis because of the presence of global instability, abnormal joint structure, abnormal articular surfaces, and inefficient muscles for transfer. Also, chondrodesis shortens the thumb and may alleviate the need for release of deficient palmar skin and lengthening of a short flexor pollicis longus. The Abdel-Ghani flap provides ample skin that gives a wide rounded web. It is a simple procedure with minimal donor site morbidity. Surgical reconstruction significantly improved the cosmetic appearance and function of the thumb.Level of evidence: IV [ABSTRACT FROM AUTHOR]

Background: Renal cell carcinoma (RCC) is responsible for 90-95% of malignant renal neoplasms. Peak incidence is between the 5th and 7th decades of life. Metastatic RCC to the breast is extremely rare. Case Report: A 55-year-old woman presented with a mass in her right breast. Mammography demonstrated a 22×32 mm mass with increased density associated with spiculation and microcalcification areas. Biopsy of the mass reported an invasive ductal carcinoma. During the evaluation of metastasis and staging, another mass (38×33×27 mm) was detected in the inferior pole of the right kidney with heterogeneous appearance. Nephrectomy was performed and the pathological evaluation of the kidney mass reported a clear cell renal carcinoma. Breast mass was vimentin-positive carcinoma that was consistent with metastasis from RCC. Breast metastasis from RCC was diagnosed and the patient treated with immunotherapy (Interferon alfa). Conclusion: It can be concluded that the breast tissue can be a site for RCC metastasis. Therefore, after detecting a malignant breast mass, a comprehensive evaluation is necessary to differentiate between the primary and metastatic breast cancers. [ABSTRACT FROM AUTHOR]

We retrospectively analyzed 63 patients with internal rotation contracture of the shoulder secondary to brachial plexus birth palsy treated with subscapularis sliding combined with either latissimus dorsi transfer (group A: n = 18) or latissimus dorsi and teres major transfer (group B: n = 45) to the rotator cuff. The mean age at time of surgery was 43 months (SD 21 months; range 8 months to 9 years). We used a modification of the Gilbert shoulder grading system for assessment. All patients showed statistically significant improvement of active shoulder abduction and external rotation without significant differences between the two groups. Significant external rotation contracture of the shoulder (inability to touch the abdomen with the wrist extended) occurred in 42 of 63 patients, and there was a greater incidence of external rotation contracture in group B. We conclude that surgery should be restricted to latissimus dorsi transfer without teres major transfer to avoid external rotation contractures. Our modification of the Gilbert grading system appears to be valid and applicable. [ABSTRACT FROM PUBLISHER]