Colonic volvulus accounts for 15-20% of large bowel obstructions. A very small percentage of colonic volvulus occur in the transverse colon and splenic flexure (<5%). Colonic volvulus is a surgical emergency and requires urgent decompression to prevent bowel ischaemia and perforation. The incidence of colonic volvulus post colonoscopy is rare, and aetiology is believed to be secondary to insufflation in the context of a non-fixed/mobile segment. We present a case of a 75-year-old man who presented to the emergency department with abdominal pain following a colonoscopy. Computer tomography (CT) imaging of his abdomen demonstrated an acute volvulus of the transverse colon. He proceeded to a diagnostic laparoscopy where the volvulus had resolved. The transverse colon was noted to have redundancy, but both the caecal pole and splenic flexure were fixed. The decision was made not to respect the bowel. Transverse colon volvulus is a rare occurrence, and accurate assessment and investigation of patients presenting with obstructive bowel symptoms is essential to allow prompt surgical management and prevent ischaemia and bowel wall perforation.
Rehydration of air dried smears: application in body cavity fluid cytology Two types of smears are commonly used for cytological examination of body cavity fluids: (i) wet alcohol-fixed, Papanicolaou stained or haematoxylin and eosin stained smears; and (ii) air-dried Romanowsky stained smears.'2 We discuss our improvement on the alcohol-fixed smear technique.Wet-fixed Papanicolaou stained smears have some disadvantages. Floating of the cells off the slide is a not uncommon occurrence. Albuminisation of the slides to prevent this, however, gives the smears a heavy green background. The nuclei are sometimes, particulary in adenocarcinoma with prominent morula formation, stained rather dark which obscures detailed nuclear morphology (fig la). The central or thicker areas of a cell cluster are often artefactually stained orange rather than green. Air-drying artefacts are quite common.In our institute we use the air-dried rehydration technique for fine needle aspiration cytology smears.3 In view of the fact that body cavity fluids are good nutrients, and that the cells suspended in the fluid should be viable just like aspirated tissue we tried the same technique on fluid specimens.Centrifuged, concentrated cell suspensions were spread on to albuminised glass slides. The slides were dried at room temperature. As soon as they were dry they were rehydrated for 30 seconds in 0 9% sodium chloride solution and finally fixed in 95% ethyl alcohol. They were then stained with haematoxylin and eosin. Two control,smears were prepared for each case, one air-dried and rehydrated as above and stained with Papanicolaou stain, and another wet-fixed and stained with Papanicolaou stain as usual.Of 300 cases examined over three months, haematoxylin and eosin stained rehydrated air-dried smcars offered several advantages: the nuclear morphology was better than wetfixed Papanicolaou-stained smears; the nuclei were crisper, the chromatin pattern clearer, and nucleoli more conspicuous. In thick cell clusters staining was still uniform and cells could be "seen through" (fig lb). The background was very clear; unexpectedly the albumin did not take up haematoxylin and eosin.. On the whole, these slides were more pleasant to look at. The only disadvantage of which we are aware up to now is the extra time needed for air drying and rehydration.Rehydrated air-dried Papanicolaoustained slides were better than wet-fixed smears but not as good as those stained with haematoxylin and eosin.We feel that the availability of a crisp chromatin pattern for examination in difficult cases may help in deciding whether the lesion is a malignant or a reactive process, and in our institute, rehydrated airdried smears are used routinely to complement wet-fixed and air-dried smears.
Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is a rare but serious complication of breast implants. The incidence of BIA-ALCL varies between 1:9121 and 1:13745, and a recent meta-analysis found that countries where specific monitoring measures have been implemented have higher rates of cases. While a significant complication, there is no current evidence to support surgical risk management strategies to prevent BIA-ALCL. Many countries have adopted a model of surveillance, and in Australia the Therapeutic Goods Administration has endorsed data collection through the Australian Breast Device Registry (ABDR). We present a case of a 67-year-old woman who presented to her GP with 2 months of left breast swelling, on a background of a left breast implant in 2004. MRI of the left breast demonstrated a large peri-implant fluid collection, and cytology confirmed BIA-ALCL, CD30-positive and ALK-negative. She underwent a capsulectomy and final histology demonstrated a Breast Implant-Associated Anaplastic Large Cell Lymphoma with focal penetration of neoplastic cells beyond the capsule and into pericapsular fat (stage T4). While development of registries and national guidelines has ensured the safeguarding of health outcomes for patients moving forward, there is still a concern for women with pre-existing breast implants who are unaware of the risk of BIA-ALCL. This case highlights the importance of raising awareness and providing support to primary health care providers to ensure their patients are given the necessary information to avoid this rare, but serious complication.
Ureteroinguinal hernias are a rare phenomenon where the ureter is found in the hernia sac of an inguinal hernia, with less than 150 cases reported worldwide. They can be asymptomatic or symptomatic, and are commonly found perioperatively. We present a case of a 74-year-old man who was initially referred for consideration of surgery of bilateral inguinal hernias. The patient was relatively asymptomatic and given comorbidities the risk of surgery outweighed the benefits and he was discharged from the clinic. He was re-referred to general surgery after he sustained a fall, and subsequent computer tomography (CT) imaging of his abdomen demonstrated a right inguinal hernia containing the right distal ureter, resulting in ureteric obstruction and hydronephrosis. He subsequently underwent an open right inguinal hernia repair where the ureter was not able to be identified, but was safeguarded with blunt dissection techniques. Post operatively his renal function was stable. Ureteroinguinal hernias are most commonly found perioperatively, and therefore are at risk during dissection. Preoperative CT imaging is invaluable in the detection of ureteroinguinal hernias, and can help in the safeguarding of the ureter during operation. While a clinical diagnosis is usually all that is required for decision-making for an inguinal hernia repair; the surgeon should consider the addition of radiological work-up when the patient presents with atypical symptoms, or the hernia sac may contain intra-abdominal structures. This will ensure correct diagnosis of the contents and subtype of inguinal hernia, and help prevent iatrogenic injury.
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