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Milk thistle (Silybum marianum L.) is a baceous plant that belongs to the Asteraceae (daisy) family and is a member of the Carduae clan. Since antiquity, a several diseases has been treated by milk thistle such as to treat liver problems, spleen problems, gallbladder problems, hepatitis, and gallstones. Milk thistle seeds are utilized in herbal remedies, and there are six flavonolignans that make up silymarins: silychristin, silydianin, silybin A& B, isosilybin A & B. Because of its membrane-stabilizing qualities, silymarin is effective in chronic liver disorders. Many disorders, such as anti-cancer, anti-diabetic, anti-hypertenshaion, and anti- Alzheimer's, are caused by S. Marianum. Milk thistle is now utilized in a diversity of supplements, including oil seed and capsules of soft gel.

Corn silk is an herb plant used as traditional medicine throughout the world to treat many diseases. The scientific name of corn silk is Stigma Maydis. Corn silk consists, of carbohydrates, vitamins, and proteins some calcium, Na salts, K, and Magnesium. Corn silk contains volatile oils, certain steroids such as stigmasterol and sitosterol, tannins, saponins, alkaloids, and flavonoids. Organic acids found in corn silk include formic acid, oleic acid, palmitic acid, linoleic acid, stearic acid, succinic acid, and lactic acid. For decades, corn silk has been used as a diuretic, Antilithiatic, and uricosuric, as well as to treat cystitis, gout, and kidney stone and as an oral antidiabetic medication. The antioxidant potential of the corn silk and its healthcare applications as agents of diuretics, for the reduction of hyperglycemia, as an anti-fatigue, and as an anti-depressant, use have been claimed in many studies. Teas and supplements of corn silk are used to treat urinary-related problems. The present reviews will provide the complete health potential of corn silk.

Reduction in ambient pressure within the containment of a light water reactor in the event of a hypothetical Loss of Coolant Accident (LOCA) is crucial for containment integrity. This article introduces the distinct concept of a Passive Containment Cooling System (PCCS). In the proposed PCCS concept, the containment is divided into two compartments with appropriate volumes. An external heat exchanger is connected between the two compartments of the containment for heat transfer and pressure reduction in the case of LOCA. This concept has unique characteristics and provides many advantages over previous designs. A RELAP5 model was developed to perform thermal-hydraulic analysis of the proposed PCCS concept. The performance of the PCCS after its deployment on a small reactor (998.6 MWth) has been assessed under various conditions following LOCA. The results indicate that partitioning of the containment creates a differential pressure that acts as a driving force for flow through the PCCS heat exchanger. Consequently, a decrease in long-term containment pressure is observed. In the case of equal volume fractions in the two containment compartments, the PCCS reduces long-term pressure in the containment by 16.5%. Sensitivity analysis was conducted in which the flow area of the PCCS inlet line, the heat transfer area, and the size of the heat exchanger tank were varied. The PCCS heat transfer capacity increases as these parameters are increased. However, the former is less sensitive than the latter two. The performance of the PCCS heat exchanger under steady-state conditions was validated using RELAP5 simulations, empirical correlations, and analytical models. The evaluation of heat exchanger parameters by various methods (presented in Appendix 1 ) was found in close agreement.

Herbal remedies are widely utilized as therapeutic approaches for different medical conditions all over the globe. Various chemical herbicides and pesticides, including the organic and inorganic Sulphur compounds, benzimidazoles, imazalil, and oxidizing compounds, have just been proposed to handle the diseases in plants in recent years to achieve this goal. Anti-inflammatory, antihyperlipidemic, anticancer, and oxidative, analgesics, anorexiant, plasmid curing, and antihyperglycemic properties prominent in medicinal plants. The leaves of another medicinal plant , Dracocephalum moldavica have been used for the treatment of stomach and liver disorders, headaches and congestion. Different plants also exhibit the multiple action against variety of microbial pathogens. Baccharis trimera used against the infections caused by Staphylococcus aureus, Salmonella gallinarum and Escherichia coli, Bacillus cereus strains. Ascorbic acid (vitamin C), carotenoids, tocopherol (vitamin E), and plant phenolic compounds are examples of low-molecular-weight compounds, non-enzymatic anti - oxidants obtained from nutrition. Bilirubin, serotonin, lipoic acid, ketoacids, uric acid, sex hormones, coenzyme Q, and other low-molecular-mass antioxidant chemicals are produced in vivo.

The direct contact condensation (DCC) of steam in subcooled water encounters in wide range of the industrial applications. On one side, it is an efficient and rapid, mass and heat transfer phenomenon. But, on the other side, it may generate condensation induced water hammers (CIWH) events which may cause high pressure peaks resulting in severe damage to the mechanical systems. This computational study intends to explore the underlying physics of CIWH events while injecting subcooled water into steam filled horizontal pipe section. The Reynolds number is varied from, Re w = 60,750 to 646,900, to study the flow regimes (stratified and slug), onset of CIWH and local flooding conditions. The results have been compared with the published data and found in good agreement. It has been observed that for Re w = 182,300, flow remains stratified. However, the flow regime changes from stratified to slug flow at Re w = 303,850–646,900, possibly due to the onset of CIWH. Extensive steam pockets have been observed at Re w = 303,850, which may be considered as onset of CIWH. Local flooding condition is also started at Re w = 303,850 and is observed to be shifted upstream with the increase in Reynolds number. This study is considered to be useful for the safe design and economical operation of the relevant systems in nuclear and other related industry.

Introduction: Mucinous Carcinoma (MC) is a special type of breast cancer. It comprises 4% (1-7%) of all invasive breast cancer. MC is also called colloid breast cancer characterised by nests of cells floating in lakes of mucin. It is divided into two subtypes Pure Mucinous Carcinoma (PMC) and Mixed Mucinous Carcinoma (MMC). PMC classified into two main types according to its structural and cytological features type A (paucicellular) the classical variant with a large amount of extracellular mucin, and type B (hypercellular) a hypercellular variant with less mucin and often with neuroendocrine differentiation. Hormone receptors, Human Epidermal growth factor Receptor-2 (HER2) and MUC2 status play an important role in prognosis and management. Aim: To study histopathological features of MC breast and Immunohistochemical (IHC) status. Materials and Methods: A retrospective study of patients who presented with breast cancer were studied at Department of Pathology, Karnataka Institute of Medical Sciences, Hubballi, Karnataka, India. The study was analysed in June 2002 and authors included data from January 2021 to June 2022. The data included the age at diagnosis, Tumour (T), Lymph Nodes (N), and Metastases (M) (TNM) stage, presence and number of Lymph Node (LN) metastases, Oestrogen Receptor (ER), Progesterone Receptor (PR), HER2 and MUC2 status. The patients in whom the diagnosis of MC of breast was given on histopathology were only included in the study. Patients of breast cancer of other pathological types were excluded from the detailed study. Descriptive statistics like mean, tables, and charts were used with the help of Microsoft office 2007 to interpret the results. Results: A total of 245 patients reported as invasive breast cancer during 18 months of study period, out of which 12 cases diagnosed as MC were taken in study. Amongst 12 cases, eight cases were PMC and four cases were MMC. The mean age at presentation was 63.37±16.38 years (eight PMC) and 60.0±19.30 years (four MMC). A total of 11 out of 12 cases were females and only one was male case (PMC). Majority of PMC 04 (50.0%) and MMC 03 (75.0%) were observed to be in TNM Stage 2, and four of 12 cases of MC had LN metastasis with no distant metastasis. MC showed higher expression of hormone receptors and lower expression of HER2/neu and MUC2 positivity, which corroborates with other studies and concluded that, MC with such an immunohistochemistry profile was prognostically better. Conclusion: Mucinous Breast Carcinoma (MBC) is a rare type of breast cancer accounting for about 4% of all diagnosed breast cancers. These are associated with a better long-term prognosis than other breast cancers. Hormone receptors and HER2 status play an important role in prognosis and management. MUC2 also plays a major role in mediating the proliferation, apoptosis, metastases of breast cancer cells and determining the use of chemotherapy drugs.

High on-treatment platelet reactivity (HOPR) is associated with increased risk of cardiovascular events in patients undergoing percutaneous coronary intervention (PCI). We randomised post-PCI patients with HOPR after 5 days of standard dual antiplatelet therapy (DAPT) to intensified therapy with aspirin 100 mg once daily in combination with either clopidogrel 150 mg once daily, clopidogrel 75 mg once daily plus cilostazol 100 mg twice daily, ticagrelor 90 mg twice daily, or standard therapy with clopidogrel 75 mg once daily (STD) for 1 month, after which all patients were switched to standard DAPT for a further 11 months. The primary outcome was residual HOPR rate at 1 month. We screened 1724 patients with light transmission aggregation studies and randomised 434 with HOPR. At 1 month the proportion of patients with persistent HOPR was significantly lower in the intensified therapy groups compared with STD group. Compared to the group receiving STD therapy, those receiving intensified therapy had significantly lower rate of major adverse cardiovascular events (MACE) at both 1 month and 12 months with no significant increase in bleeding. In patients with post-PCI HOPR, 1 month of intensified antiplatelet therapy provides greater platelet inhibition and improves outcomes without increasing bleeding. Clinical Trial Registration URL: http://www.clinicaltrials.gov; Unique Identifier: NCT01955200.

BackgroundOpinion is divided as to optimum management of grade III acromioclavicular joint injuries that have failed conservative management. We objectively investigated the radiological and functional outcome of acromioclavicular joint reconstruction using the Ligament Augmentation Reconstruction System (LARS®).MethodsRetrospective review of patients with LARS reconstruction of acromioclavicular joint dislocations with minimum six-year follow-up. Functional assessment was performed using the constant score, Disability of Arm Shoulder and Hand score and simple satisfaction score. Radiological assessment was undertaken using plain radiographs. Results were compared with the uninjured limb.ResultsTwenty-four of 25 patients were included. Mean constant score for the injured shoulder was 87.0, Disability of Arm Shoulder and Hand score was 11.6. All patients indicated that they would have the operation again. There were five complications including two patients that suffered small cracks in the clavicle. Coracoid erosion was frequently seen but was most often minor. In two cases, this resulted in a complete dissociation of the coracoid tip but without functional detriment.DiscussionLARS is a safe and effective method of acromioclavicular joint reconstruction producing good results, and we recommend its use for these injuries. We also caution clinicians who use cerclage methods to be aware of coracoid erosion when following up their patients.

Introduction COVID-19 was declared a pandemic by the World Health Organization on the 11th of March 2020 with the NHS deferring all non-urgent activity from the 15th of April 2020. The aim of our study was to assess the impact of COVID-19 on Trauma and Orthopaedic trainees nationally. Methods Trauma and Orthopaedic (T&O) specialty trainees nationally were asked to complete an electronic survey specifically on the impact of COVID-19 on their training. This UK based survey was conducted between May 2020 and July 2020. Results A total of 185 out of 975 (19%) T&O specialty trainees completed the survey. Redeployment was experienced by 25% of trainees. 84% of respondents had experienced a fall in total operating numbers in comparison with the same time period in 2019. 89% experienced a fall in elective operating and 63% experienced a fall in trauma operating. The pandemic has also had an effect on the delivery of teaching, with face to face teaching being replaced by webinar-based teaching. 63% of training programmes delivered regular weekly teaching, whilst 19% provided infrequent sessions and 11% provided no teaching. Conclusion This study has objectively demonstrated the significant impact of the COVID-19 pandemic on all aspects of T&O training.

Background Recent studies have shown a decline in theatre efficiency and productivity coinciding with the coronavirus disease 2019 (COVID-19) pandemic. In this study, we evaluate trauma theatre task efficiency in three different time periods (April 2019, April 2020, and November 2020), and analyse if productivity has altered since the start of the pandemic. Methods The records of a total of 320 patients who underwent orthopaedic trauma surgery at a large district general hospital in April 2019, April 2020 (during the first wave of the pandemic) and November 2020 (during the second wave of the pandemic) were analysed. Primary outcomes measured include time to get to the theatre, anaesthetic preparation time, the sum of time of anaesthesia and surgical preparation time, duration of surgery and time to transfer to recovery. Patient demographics as well as the type of surgery were also analysed. Results The time to get to the theatre and anaesthetic preparation time significantly increased in April 2020 (p0.05). The duration of surgery and time to transfer to recovery significantly increased in April 2020 (p

The safety of the nuclear reactor revolves around the accurate analysis of rapid flow transient for the design and manufacturing of reactor coolant pumps. In this article, the coastdown transient initiated by the loss of offsite power is simulated. In this case, the pumps are operated by the inertia of the flywheel, therefore, the reliable operation of reactor coolant pumps is the key to the safety of the nuclear reactor. A new hydraulic, as well as the thermal model, is developed for simulating various core parameters during the coastdown period. The present hydraulic model accounts for both the pump half-time and the loop half-time, which is used to increase the accuracy of predicted results over a longer period of time. The results predicted by the hydraulic model are incorporated into a thermal model, which also includes the decay heat following the reactor shutdown. This new model depends upon the core time constant, loop time constant, pump half-time, and hydraulic constant coefficient. The predicted results of flow rate, pressure, temperature, and departure from nucleate boiling ratio are compared with the experimental data and have found good agreement between the two cases. Finally, the departure from nucleate boiling ratio shows that the transient behavior of the reactor is moving toward safety.

Malignant oncocytoma is an extremely rare neoplasm of the salivary gland accounting for 0.5% of epithelial salivary gland malignancies and 0.18% of epithelial salivary gland tumors. We report a case of malignant oncocytoma of left parotid gland in a 61-year old female patient. Patient presented with a 6-year history of painless swelling in the left parotid region. Fine needle aspiration cytology of the swelling was suggestive of pleomorphic adenoma. A computed tomography scan performed did not reveal any features suggestive of malignancy. Patient underwent left superficial parotidectomy. However, histopathological examination of the specimen turned out to be malignant oncocytoma. Malignant oncocytoma of salivary glands have rare incidence and may have similar morphologic features with other neoplasms. Despite the tumor being large and malignant in this case, there was no facial palsy preoperatively. As histopathology is often diagnostic, the possibility of malignancy always must be kept in mind preoperatively even when there is no facial palsy or fine needle aspiration cytology not showing up malignancy.

Point kinetic equations (PKEs) represent a simplified approach to study the reactor transients at first hand, and help to develop an insight for reactor control, operation and safety. Several methods have been around for over last five decades for accurate, stable, and reliable solution of PKEs however, their realization has become possible with the advent of modern computers. Additionally, the stiffness of PKEs inspires researchers to seek further for more robust algorithms. In this paper, an explicit algorithm based upon Generating Function Method (GFM) is proposed for the solution of such a complex system of differential equations. The method was implemented to solve conventional reactivity problems, such as step, ramp, and sinusoidal reactivity insertions and compared with the other numerical algorithms. In these problems, GFM has been found to provide numerical estimates of neutron population with comparable accuracy to other algorithms, and it is computationally efficient and relatively stable. In order to explore the feasibility of the GFM for problems in reactor dynamics, a delayed-supercritical process with temperature feedback was also simulated, and results found were numerically equivalent to available techniques, however with lesser computational effort and time.

This paper is about development of a uniform robust exact differentiator observer for estimation of the change in reactivity and average fuel temperature of a pressurized water reactor. The change in reactivity and average fuel temperature are important parameters in a nuclear power reactor, but there is no physical sensor available to measure these parameters directly. Therefore an observer is needed to estimate these parameters. There are different linear and non linear techniques to estimate the parameters with their own benefits and drawbacks. We have used uniform robust exact differentiator observer which is based on second order sliding mode and remains independent of initial conditions. This estimation is done under varying load conditions so that the estimated change in reactivity has the effect of control rod motion, coolant temperature and fuel temperature. For the proposed estimation scheme the measurement data of an actual plant is used. These measurements include normalized neutron density, coolant temperature and control rod position.

In this paper a uniform second order sliding mode observer is used to estimate the precursor density of a pressurized water reactor (PWR). Precursors produce delayed neutrons which are most important in control of nuclear reactor, but cannot be measured directly. This estimation is done under varying load conditions and taking into account the effects of reactivity feedback due to temperature. For the proposed estimation scheme the measurement data of Chashma Nuclear Power Plant Unit-1, Pakistan is used. These measurements include neutron density, coolant temperature and control rod position. Before the estimation a model of 998 MW (thermal) pressurized water nuclear power reactor is validated with experimental data because the mathematical model of plant should be accurate and precise for parameter estimation as well as controller design. Measured neutron density and modeled neutron density are compared and found close to each other. Further more measured and modeled coolant temperatures are also compared. The response of mathematical model coincides with actual plant with minor error. This error may be due to uncertainties and unmodeled dynamics.

In this paper we have presented the degradation of Phenol in aqueous solution which is caused by pulse discharge. The reaction products in the wastewater dissolved phenol under pulsed discharge were tested using GC-MS. Based on the experimental results intermediate products include 2,4hydroxyphnel, polyhydroxy phenethyl alcohol and so on. The final products are carbon dioxide and water. In addition, the theoretical analysis has been conducted These results will be helpful for further studying degradation mechanism of wastewater dissolved phenol under pulsed discharge, using either AC or DC voltage.

A 77-year-old male presented with diarrhoea, weight loss and faeculent vomiting. CT scan identified a stricturing lesion in the transverse colon. The man, however, had no features suggestive of large bowel obstruction. This unusual presentation of faeculent vomiting raised a suspicion of a possible communication between the colon and stomach. A subsequent CT scan with oral contrast confirmed the presence of a gastrocolic fistula. During explorative laparotomy, a transverse colonic tumour communicating into the stomach via the gastrocolic fistula was detected. The patient underwent an extended right hemicolectomy and distal gastrectomy as a palliative measure. A gastrocolic fistula is a rare, yet important find and should be recognized as a possible sequel of this disease process.

Background: Number of cancelled electiveorthopaedic surgeries has increased over the last decade as strains on surgicalservices exacerbates. Being told an operation is cancelled is disappointing forthe patient, the clinician and is not without a financial loss. This experienceis frustrating for patients who are often not informed of cancellations bydoctors and sent home dissatisfied without clarity of treatment plans.Alternatives have to be sought to safeguard the patient experience, maintaincommunication and avoid wastage of resources. Methods: Over a 1-year period, 117 patientswere prospectively shortlisted with a cancellation on the day of surgery in adedicated elective orthopaedic unit. Questionnaire data assessed adherence toAssociation of Anaesthetists of Great Britain and Ireland Theatre Efficiencyguidance, including: healthcare professional informing patients; time offeredfor explanation; patient understanding and satisfaction as well as perceptionof being kept nil by mouth (NBM) longer than necessary. Opinions of alternativesatisfactory professionals to lead cancellation discussion was also evaluated. Results: 35.04% of cancellations were informedby consultants, 23.77% by junior doctors and 38.46% by nurses. Out of 10,patient understanding was 8.31 and satisfaction 6.37 for consultant leddiscussions against 5.12 and 4.07 for nurses, respectively. Overall, 35.04% ofpatients felt they were kept NBM longer than necessary vs. 60% of the 45patients told by nurses. 90.60% felt consultants were the ideal professional tolead cancellation discussions however 70.94% stated a registrar would besatisfactory. Conclusions: Cancelledelective surgery that a patient has mentally prepared for is extremelydemoralising. Poor peri-operative communication and management further worsensthe patient experience and represents sub-standard care. It is paramount thatguidelines exist where patients are informed of reasons for cancellation by asenior surgeon in a manner that accounts for availability of resources.

Lateral epicondylitis, or ’tennis elbow’, is a common condition that usually affects patients between 35 and 55 years of age. It is generally self-limiting, but in some patients it may continue to cause persistent symptoms, which can be refractory to treatment. This review discusses the mechanism of disease, symptoms and signs, investigations, current management protocols and potential new treatments. Cite this article: Bone Joint J 2013;95-B:1158–64.

In our series of 710 consecutive laparoscopic total-extra-peritoneal hernia repairs over a period of 10 years (2001–2010), the authors report a rare case of delayed mesh infection developing 7 years postoperatively. A 56-year-old patient presented with diarrhoea and fullness in right iliac fossa region. Radiological imaging confirmed a floating mesh in a fluid-containing cavity. Subsequent exploration revealed a large preperitoneal cavity containing 550 ml of pus with a floating mesh in it. The mesh was removed and the patient was discharged after making a good recovery.

Management of rectal cancer has evolved over the years. In this condition preoperative investigations assist in deciding the optimal treatment. The relation of the tumor edge to the circumferential margin (CRM) is an important factor in deciding the need for neoadjuvant treatment and determines the prognosis. Those with threatened or involved margins are offered long course chemoradiation to enable R0 surgical resection. Endoanal ultrasound (EUS) is useful for tumor (T) staging; hence EUS is a useful imaging modality for early rectal cancer. Magnetic resonance imaging (MRI) is useful for assessing the mesorectum and the mesorectal fascia which has useful prognostic significance and for early identification of local recurrence. Computerized tomography (CT) of the chest, abdomen and pelvis is used to rule out distant metastasis. Identification of the malignant nodes using EUS, CT and MRI is based on the size, morphology and internal characteristics but has drawbacks. Most of the common imaging techniques are suboptimal for imaging following chemoradiation as they struggle to differentiate fibrotic changes and tumor. In this situation, EUS and MRI may provide complementary information to decide further treatment. Functional imaging using positron emission tomography (PET) is useful, particularly PET/CT fusion scans to identify areas of the functionally hot spots. In the current state, imaging has enabled the multidisciplinary team of surgeons, oncologists, radiologists and pathologists to decide on the patient centered management of rectal cancer. In future, functional imaging may play an active role in identifying patients with lymph node metastasis and those with residual and recurrent disease following neoadjuvant chemoradiotherapy.

A 52-year-old woman was admitted with neutropenic sepsis, 3 days following the final cycle of adjuvant chemotherapy for breast cancer. Her condition deteriorated with progressive abdominal distension, bilious vomiting and diarrhoea. Abdominal examination revealed a mild degree of peritonism. Five days later she passed a small bowel cast per rectum, showing gross fungal contamination on histology. She was managed conservatively with antibiotics and antifungal medications and nutritional support.

The role of laparoscopic ultrasound (LUS) during staging laparoscopy for pancreatic cancers is established but remains debatable in evaluating oesophagogastric cancers.A retrospective consecutive case series consisting of patients undergoing staging laparoscopy in two centres (centre A and B) was carried out over a 5-year period (2000-2005). Patients in centre B underwent LUS following laparoscopic assessment using a 7.5-MHz probe. Staging laparoscopy in both centres was performed using a standardised three-port protocol using a 30 degrees laparoscope. All suspicious lesions were sent for histological assessment for confirmation of malignancy.There were 201 patients in centre A (83 gastric, 138 lower oesophageal/junctional cancers) and 119 patients in centre B (51 and 68, respectively). There were no differences between the two centres for patient demographics and tumour site. There was no difference between the two centres for the detection of metastatic disease using laparoscopic assessment alone (A 13% versus B 20%, p = 0.12). However, there was a significant difference (13% versus 28%, p = 0.001) with the additional use of LUS in centre B. The findings in the additional 8% (n = 9) were para-aortic lymphadenopathy (n = 5), liver metastasis (n = 3) and local extension (n = 1). Five had gastric and four lower oesophageal/junctional cancers. The negative predictive value was 6.4% for centre A and 4.5% for centre B.The addition of LUS increased the detection rate of metastasis by 8% but there was little impact on the false-negative rate. LUS is useful in detecting metastatic lymphadenopathy beyond the limits of curative resection and liver metastasis.

AIM To describe a CT technique for guiding diagnostic and therapeutic injections in the hind- and mid-foot. MATERIALS AND METHODS Over a period of 50 months, 28 individuals were referred for diagnostic and therapeutic hind- and mid-foot injections before possible arthrodesis. A CT technique was developed that allowed entry into the various joints using a vertical approach. Numbers of joints injected were as follows: posterior subtalar, 21; talonavicular, 4; calcaneonavicular, calcaneocuboid, navicular-cuneiform and 5th metatarsocuboid joints, 1 each. RESULTS All injections but one were technically successful. Significant relief of symptoms was noted by 16 participants, whereas for 9 there was no improvement and for 3 a partial response was achieved. CONCLUSION CT is a simple and safe alternative to fluoroscopy for guiding diagnostic and therapeutic foot injections, and may be the technique of choice in cases of disordered anatomy.

Mucosa-associated lymphoid tissue (MALT) is a type of extra nodal malignant lymphoma seen in organs such as the stomach, thyroid and salivary glands. Furthermore, occurrence of colorectal MALT lymphoma is extremely rare. We report a case of a solitary rectal MALT lymphoma treated by surgical resection and radiotherapy. Lymphoma should be considered as a rare differential diagnosis when dealing with large bowel pathology. We would advocate the use of surgery as a primary treatment option for a medically fit patient.

Appendicitis in a remaining duplicate appendix is a rare phenomenon and we report such a case. The unusual presentation of this anomaly can cause diagnostic dilemmas. Awareness of this condition is important because failure to recognise the condition may lead to errors in diagnosis and subsequent management. A young woman was admitted with a 3 day history of sudden onset, severe, central abdominal pain radiating towards the right iliac fossa, anorexia, rigors and vomiting. Her only significant past history was open appendectomy 4 years previously for a gangrenous appendix. The patient was pyrexial on admission but haemodynamically …

Introduction and aim of study: there is recent evidence that the immune system plays an essential role in the pathogenesis of atherosclerosis, with both cellular and humoral mechanisms being involved. Heat-shock proteins (HSPs) have been detected in atherosclerotic lesions, and antibodies to HSPs have also been found to be raised in patients with carotid stenoses. The aim of our study was to examine the level of anti-HSP70 antibodies in patients with other vascular diseases. Materials and methods: a questionnaire was designed for the subjects in the study, with documentation of clinical details and ankle–brachial pressure index. Patients with concomitant infection, malignancy, hepatorenal failure, or recent surgery were excluded. Enzyme-linked immunosorbent assay (ELISA) was used to identify anti-HSP70 antibodies in the sera in different dilutions. Graphs of optical density (OD) vs. negative log dilution were plotted, the gradient of which was taken to be the estimated optical density for each subject (proportional to antibody level). Our groups consisted of controls (n =21, mean age 59.0±19.2), lower limb claudicants ( n =19, mean age 60.0±12.6), patients with lower-limb critical ischaemia ( n =22, mean age 68.5±10.07), and patients with abdominal aortic aneurysms ( n =20, mean age 69.9±6.2). Results: we found no correlation between age and the estimated OD in our subjects (Spearman's correlation coefficient ( r )=0.123, one-tailed p value was 0.135). Patients with intermittent claudication, critical lower limb ischaemia, and aneurysms had higher estimated OD, and therefore higher anti-HSP70 antibody levels, than controls (Mann–Whitney test p =0.0127, 0.0037, 0.0008, respectively). Conclusions: our data provide the first evidence of a correlation between anti-HSP70 antibodies and different types of vascular diseases, suggesting that HSP70 might be involved in the pathogenesis and propagation of atherosclerosis. Since the immune response to HSPs can be modulated, this opens up the possibility of new therapeutic approaches.