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Introduction. The genitourinary system is a recognized site for multiple primary malignant neoplasms even without syndromic anomalies. However, to the best of our knowledge, a case of upper tract urothelial carcinoma (UTUC) with contralateral renal cell carcinoma (RCC) is not reported in surgical literature so far. Case Presentation. A 52-year-old Sri Lankan male patient was found to have a right lower ureteric tumour and a left renal mass together upon investigating for painless visible hematuria. The right ureteric tumour measured 32 × 22 mm resulting in moderate hydronephrosis and cortical thinning of the right kidney, and the left renal mass measured 43 × 38 mm involving the lower pole. The biopsy of the right ureteric lesion revealed a high-grade transitional cell carcinoma with focal nested pattern and that of the left renal mass revealed a clear cell carcinoma. Right nephroureterectomy followed by a left partial nephrectomy was performed in six weeks' interval. The histology of both the resected specimens confirmed the biopsy findings. Discussion. A high-risk upper tract urothelial carcinoma such as the right ureteric tumour of this patient required a nephroureterectomy which makes the management of the contralateral renal cell carcinoma more complex. An adequate functional renal remnant was ensured after offering oncologically sound surgical treatment for both the malignancies of this patient. Conclusion. A UTUC when associated with a contralateral RCC poses challenges in patient management. The preservation of renal excretory function has to be considered as an important determinant in addition to oncologically sound surgical resection when managing complex cases of genitourinary malignancies involving both sides of the upper urinary tract. [ABSTRACT FROM AUTHOR]

Protein is the most costly nutrient in fish feed, and while diets offered in the early stages of development typically have high levels of CP, they do not always correspond to the real requirements of the animals. Thus, research that seeks to learn the true nutritional requirements of fish is fundamental to improving commercial fish culture. The present study evaluated the protein requirements of Nile tilapia (Oreochromis niloticus) under larviculture. Fish performance, gene expression for digestive enzymes and their enzymatic activity and stress response to air exposure were analyzed. Four experimental diets differing in CP level were formulated: 30%, 36%, 42% and 48%. Fish larvae were fed the experimental diets during development and sampled 10, 20 and 30 days after the beginning of the experiment for performance, gene expression and enzymatic activity. At sampling time 30, stress resistance was also evaluated by means of an air exposure test. At sampling time 10, CP levels between 36% and 48% could be used for a better performance. During this period, pepsinogen expression was greater for 30% CP, intermediate for 42% and lower for 36% and 48%. After this initial period, diets of between 30% and 42% CP are recommended for better performance. At sampling time 20, gene expression for digestive enzymes and their enzymatic activity were similar for all diets tested. At sampling time 30, the diet of 42% CP induced both greater pepsinogen expression and pepsin activity. Survival after the air exposure test after 30 days of feeding was influenced by CP level in the diet, with the highest survival being for fish fed with 36% CP. Taken together, the present results demonstrate that dietary CP influences digestive enzyme gene expression and activity, and suggest that the best CP levels for Nile tilapia larviculture vary depending on larval stage. [ABSTRACT FROM AUTHOR]

Background: A wide variety of complications due to the extrauterine migration of intrauterine contraceptive devices have been reported in the literature. Here we describe the case of a large bladder stone formed around a migrated Copper T380A device that was neglected and detected 15 years after insertion.Case Presentation: A 48-year-old Sri Lankan woman underwent a workup for lower urinary tract symptoms and recurrent urinary tract infections over the previous 6 months. The radiographs showed a large bladder stone with an imprint of an intrauterine contraceptive device in the center of it. The device had been inserted 15 years previously. Two years after the insertion, it was considered to be missing, but our patient did not comply with the recommended follow-up. She had been completely asymptomatic until she developed lower urinary tract symptoms. After confirming the location of the stone via ultrasonography, a vesicolithotomy was performed, revealing a stone with three limbs corresponding to the shape of the Copper T380A device. The device and the threads were fully covered with the stone material. Our patient was asymptomatic following the surgery.Conclusions: A migrated intrauterine contraceptive device can act as the nidus for the formation of a secondary bladder stone. The detailed imprint of the device inside the stone and the laminated appearance of the stone material were characteristic of a secondary bladder stone formed around an intrauterine contraceptive device. Radiography and ultrasonography are adequate for the diagnosis of intravesical migration of intrauterine contraceptive devices. [ABSTRACT FROM AUTHOR]

Background: Splenic artery aneurysm is rare and its diagnosis is challenging due to the nonspecific nature of the clinical presentation. We report a case of a splenic artery aneurysm in which the patient presented with chronic dyspepsia and multiple episodes of minor intragastric bleeding.Case Presentation: A 60-year-old, previously healthy Sri Lankan man presented with four episodes of hematemesis and severe dyspeptic symptoms over a period of 6 months. The results of two initial upper gastrointestinal endoscopies and an abdominal ultrasound scan were unremarkable. A third upper gastrointestinal endoscopy detected a pulsatile bulge at the posterior wall of the gastric antrum. A contrast-enhanced computed tomogram of his abdomen detected a splenic artery aneurysm measuring 3 × 3 × 2.5 cm. While awaiting routine surgery, he developed a torrential upper gastrointestinal bleeding and shock, leading to emergency laparotomy. Splenectomy and en bloc resection of the aneurysm with the posterior stomach wall were performed. Histology revealed evidence for a true aneurysm without overt, acute, or chronic inflammation of the surrounding gastric mucosa. He became completely asymptomatic 2 weeks after the surgery.Conclusions: Splenic artery aneurysms can result in recurrent upper gastrointestinal bleeding. The possibility of impending catastrophic bleeding should be remembered when managing patients with splenic artery aneurysms after a minor bleeding. Negative endoscopy and ultrasonography should require contrast-enhanced computed tomography to look for the cause of recurrent upper gastrointestinal bleeding. [ABSTRACT FROM AUTHOR]

Background: Only a limited number of multiple synchronous primary malignancies of the pancreas have been reported in the medical literature. We report a case of two solid malignant tumors of the pancreas diagnosed preoperatively.Case Presentation: We describe a 65-year-old Sri Lankan woman who presented with progressive obstructive jaundice. Initial contrast-enhanced computed tomography imaging detected a malignant tumor at the tail of her pancreas. A second tumor of the pancreatic head was detected with integrated imaging using multidetector computed tomography and multimodal magnetic resonance imaging. She underwent total pancreaticoduodenectomy and splenectomy. Gross examination of the specimen confirmed the presence of two separate tumors. Histology of the ampullary tumor showed pancreatic-type adenocarcinoma and the tumor in the tail of her pancreas showed a colloid-type adenocarcinoma.Conclusion: The possibility of multiple primary malignant solid tumors of different types with malignant potential has to be considered even without background pathology when managing multiple tumors in the pancreas. [ABSTRACT FROM AUTHOR]

The growth, physiology and skin pigmentation of pacamã Lophiosilurus alexandri juveniles were evaluated in an experiment using different tank colours (white, yellow, green, blue, brown and black) over an 80 day period. The tank colours did not cause significant differences to final body mass, total length, survival rate, carcass composition (moisture, crude protein, ash, ether extract, calcium, phosphorus, energy), or to plasma protein, triglyceride and cholesterol values. Haematocrit values, however, were highest for fish kept in white tanks ( ANOVA P < 0·05), while the greatest haemoglobin levels were recorded for fish kept in blue and brown tanks ( P < 0·01). The concentrations of cortisol ( P < 0·001) and glucose ( P < 0·01) were the most in fish in the black tanks. Tank colour affected skin pigmentation significantly, with fish in white tanks having the highest values of L* (brightness) and the lowest values in blue and black tanks. L*, however, decreased in all treatments throughout the experiment. C*ab increased significantly over the course of the experiment in fish kept in white tanks. Similar increases of C*ab were recorded in the other treatments but to a lesser extent. The use of black tanks during the cultivation of L. alexandri caused stress and should be avoided. Cultivation in white and yellow tanks produced individuals with a pale skin colour, while cultivation in blue and black tanks resulted in juveniles with a darker and more pigmented skin. [ABSTRACT FROM AUTHOR]

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Background: Duodenal Peutz-Jeghers polyp is a rare cause of duodenal or biliary obstruction. However, a sporadic Peutz-Jeghers polyp leading to simultaneous biliary and duodenal obstruction has not been reported.Case Presentation: We report a case of a 25-year-old Sri Lankan woman presenting with features of recurrent upper small intestinal obstruction and biliary obstruction. She had clinical as well as biochemical evidence of intermittent biliary obstruction. Evidence of duodenal intussusception was found in a computed tomography enterogram and a duodenal polyp was noted as the lead point. Marked elongation and distortion of her lower common bile duct with intrahepatic duct dilatation was also noted and the ampulla was found to be on the left side of the midline pulled toward the intussusceptum. Open polypectomy and reduction of intussusception were done and she became fully asymptomatic following surgery. Histology of the resected specimen was reported as a typical "Peutz-Jeghers polyp". As there was not enough evidence to diagnose Peutz-Jeghers syndrome this was considered to be a sporadic Peutz-Jeghers polyp.Conclusion: Rare benign causes such as a duodenal polyp should be considered and looked for in initial imaging, when the cause for concurrent biliary and intestinal obstruction is uncertain, particularly in young individuals. [ABSTRACT FROM AUTHOR]