BackgroundMany complications following liver transplantation are linked to ischemia‐reperfusion injury. Activation of the pregnane X receptor (PXR) has been shown to alleviate this process in animal models. The aim of this retrospective study was to investigate the effect of early activation of human PXR (hPXR) on postoperative complications and survival following liver transplantation.MethodsThe study included deceased donor liver transplants at a single center over 6 years. Estimated hPXR activation value on day 7 (EPAV7) was calculated per patient based on potency/total dose of known hPXR‐activating drugs administered in the first week post‐transplantation. Patients were divided into low and high hPXR activation groups based on EPAV7.ResultsOverall, 240 liver transplants were included. Average EPAV7 was significantly lower in patients who developed anastomotic biliary strictures (17.7 ± 5.5 vs 35.1 ± 5.7 in stricture‐free patients; P = .03) and sepsis (16.4 ± 7.1 vs 34.9 ± 5.5; P = .04). Patient survival was significantly improved in the high hPXR group (5‐year survival: 88.7% ± 3.8% versus 70.7% ± 5.8% [low hPXR]; P = .023). Regression analysis identified EPAV7 as a significant independent predictor of patient survival.ConclusionhPXR activation within the first week of liver transplantation is a prognostic indicator of patient survival, possibly due to the associated lower biliary stricture and infection rates.

Granular cell tumour is a rare, benign tumour that may arise in the soft tissues of various locations. It is often asymptomatic; hence, it gets misdiagnosed as other conditions. This is a case of an asymptomatic 50-year-old male with an incidental finding of a supraglottic lesion during routine oesophagogastroscopy. Examination under general anaesthetic showed a whitish non-ulcerating exophytic lesion on the laryngeal surface of the epiglottis, sparing anterior commissure and vocal cords. Surgical excision was performed with an open supraglottic laryngectomy approach. Histopathology confirmed GCT, strongly positive for S-100 protein and weakly positive for CD68. Accurate histologic analysis is a key to identify this rare tumour among other differentials. Although benign, ongoing monitoring is advised due to risk of recurrence.

Glomus tumor (GT) is a rare, benign neoplasm of the glomus apparatus. Being most common in the subungual region, it often misdiagnosed with dermatological conditions. Severe tenderness, paroxysmal pain and cold intolerance symptomatically denote GT. Clinical tests such as Love’s pin test and Hildreth’s test assist in diagnosing the disease. X-ray, ultrasonography and magnetic resonance imaging can confirm the severity of the lesion. Complete surgical excision is the only treatment available for these subcutaneous nodules. A middle-aged male with a hand pain, who misdiagnosed for dermatitis over 15-year period, has identified as having a large bone-boring GT. Awareness of GT among healthcare professionals is a must to increase the quality of life of patients.

A 29-year-old male, with chronic atopic dermatitis (AD), presented with a 2-week history of fatigue, pyrexia and weight loss. Examination showed eczematous patches with lichenified papules, erosions on the right shin and a new murmur. Blood cultures isolated methicillin-sensitive Staphylococcus aureus. Transthoracic echocardiography showed vegetation on the tricuspid valve (TV) that was adherent to the septal leaflet. He was treated for infective endocarditis, attributed to poorly controlled AD, with intravenous Flucloxacillin. Due to ongoing sepsis and pulmonary septic emboli, Clindamycin was added. He underwent TV repair; the septal leaflet was excised, and the remnant two leaflets were brought together with a ring. His patent foramen ovale was closed. His skin was treated with topical steroids and emollients. Right-sided endocarditis of an intact TV is uncommon in a non-intravenous drug user. Therefore, this novel case portrays the importance of aggressively managing AD as it is a risk factor for significant systemic infections.

HighlightsSchwannomas are rare in the sinosanal tract. We report the fourth case involving the columellar region.A large columellar schwannoma developed eight months into pregnancy.Pregnancy and young age seem to have a strong correlation with the lesion development.Open rhinoplasty offers a better approach to excise this kind of lesion.