Objectives To investigate the effects of detergent sclerosants, sodium tetradecyl sulphate and polidocanol, on endothelial cell activation and microparticle release and the effects of detergent sclerosants, sirolimus and propranolol, on apoptosis in vitro. Methods Cultured human umbilical vein endothelial cells and murine haemangioendothelioma (EOMA) cell lines were incubated with different concentrations of sodium tetradecyl sulphate and polidocanol, as well as sirolimus and propranolol. Endothelial activation was assessed using flow cytometry for CD62e (E-Selectin), CD54 (ICAM-1), CD105 (endoglin), CD144 (VE-Cadherin), CD146 (MCAM) and the release of endothelial microparticles. Cell proliferation was assessed using [3-(4,5-dimethylthiazol-2-yl)-5-(3-carboxymethoxyphenyl)-2-(4-sulfophenyl)-2H-tetrazolium] and carboxyfluorescein succinimidyl ester assays. Apoptosis was assessed using flow cytometry for lactadherin/propidium iodide staining and for Caspase-3 expression. Results Sublytic concentrations of sodium tetradecyl sulphate and polidocanol (0.075%–0.3%) increased the expression of the activation markers CD62e and CD54. The expression of CD105 decreased in sclerosant treated cultured human umbilical vein endothelial cells. Both sodium tetradecyl sulphate and polidocanol induced the release of endothelial microparticles. All agents inhibited cell proliferation. Sodium tetradecyl sulphate and polidocanol-induced apoptosis as evidenced by increased phosphatidylserine exposure and caspase-3 expression, whereas sirolimus and propranolol increased caspase-3 expression only. Conclusion Sublytic concentrations of detergent sclerosants induce endothelial activation and the release of endothelial microparticles. All agents were anti-proliferative in EOMA cell lines, with sodium tetradecyl sulphate and polidocanol inducing cellular apoptosis.
Bouveret syndrome is a rare complication of cholecystitis, in which impaction of a gallstone creates a cholecystoduodenal fistula leading to gastric outlet obstruction. We report a case of a 90-year-old female who presented with nausea and vomiting on a background of previous necrotic cholecystitis managed conservatively. Computed tomography of the abdomen demonstrated a large gallstone impacted in the third part of the duodenum leading to gastric outlet obstruction. Given her frailty, the patient underwent endoscopy to relieve the obstruction; however, complete retrieval of the gallstone fragments after lithotripsy was not possible. She subsequently developed distal gallstone ileus due to migration of the gallstone fragments and underwent laparotomy, enterotomy and retrieval of the fragments. This case highlights the dilemma of managing elderly patients with Bouveret syndrome with open or endoscopic surgery and the importance of retrieving all gallstone fragments after lithotripsy to avoid iatrogenic complications, such as gallstone ileus.
A 23-year-old female presented to the emergency department with lower abdominal pain 1 day following a motor vehicle accident. She was a restrained front seat passenger travelling at 50 km/h and reported generalized abdominal pain since the accident with no evidence of a seatbelt sign. Computed tomography of the abdomen and pelvis was performed, which demonstrated a 60 × 37 × 44 mm collection in the left upper quadrant suspected to represent a large jejunal intramural haematoma with involvement of the adjacent mesentery (Fig. 1). It was inseparable from the loop of proximal jejunum and, distally, there was concentric mural thickening of the jejunum. The patient was managed conservatively with nasogastric tube (NGT) decompression and gradual upgrade of diet. She was well and tolerating a light diet on discharge 5 days later.She subsequently represented 3 days later with worsening abdominal pain, nausea and persistent vomiting with normal bowel motions. On examination, her abdomen was soft, with tenderness in the epigastrium and left upper quadrant. A repeat computed tomography showed an increase in the size of the known collection (now 68 × 42 × 50 mm). There was new marked dilation of the duodenum and stomach proximal to the collection, with an abrupt
A 15-year-old female presented with a 9-month history of intermittent periumbilical pain associated with nausea and vomiting. Her past medical and family history were unremarkable. Initially, she was investigated with a pelvic ultrasound, which was normal. One month later, she presented to the emergency department with persistent symptoms. Repeat ultrasound demonstrated terminal ileal
Backgrounds: Surgery remains mainstay management for colon cancer. Post-operative anastomotic leak (AL) carries significant morbidity and mortality. Rates of, and risk factors associated with AL following right hemicolectomy remain poorly documented across Australia and New Zealand. This study examines the Bowel Cancer Outcomes Registry (BCOR) to address this. Methods: A retrospective cohort study was undertaken of consecutive BCOR-registered right hemicolectomy patients undergoing resection for colon cancer (2007)(2008)(2009)(2010)(2011)(2012)(2013)(2014)(2015)(2016)(2017)(2018)(2019)(2020)(2021). The primary outcome measure was AL incidence. Clinicopathological data were extracted from the BCOR. Factors associated with AL and primary anastomosis were identified using logistic regression. AL-rate trends were assessed by linear regression. Results: Of 13 512 patients who had a right hemicolectomy (45.2% male, mean age 72.5 years, SD 12.1), 258 (2.0%) had an AL. On multivariate analysis, male sex (OR 1.33; 95% CI 1.03-1.71) and emergency surgery (OR 1.41; 95% CI 1.04-1.92) were associated with AL. Private health insurance status (OR 0.66; 95% CI 0.50-0.88) and minimallyinvasive surgery (OR 0.61; 95% CI 0.47-0.79) were protective for AL. Anastomotic technique (handsewn versus stapled) was not associated with AL (P = 0.84). Patients with higher ASA status (OR 0.47; 95% CI 0.39-0.58), advanced tumour stage (OR 0.56; 95% CI 0.50-0.63), and emergency surgery (OR 0.16; 95% CI 0.13-0.20) were less likely to have a primary anastomosis. AL-rate and year of surgery showed no association (P = 0.521). Conclusion:The AL rate in Australia and New Zealand following right hemicolectomy is consistent with the published literature and was stable throughout the study period. Sex, emergency surgery, insurance status, and minimally invasive surgery are associated with AL incidence.
Background and aim Gastro-oesophageal reflux disease (GORD) and a spectrum of pulmonary diseases, including idiopathic pulmonary fibrosis (IPF) and bronchiectasis have a complex but poorly understood relationship. IPF is characterised by chronic progressive interstitial pneumonia due to the deposition of fibrous tissue in the pulmonary interstitium. It has a median survival time from diagnosis of 2 to 5 years. Bronchiectasis is defined as irreversible dilatation of the bronchial tree, leading to severe pulmonary infections and gradual deterioration in lung function. Chronic micro aspiration of acid and non-acid refluxate leading to airway irritation, repeated lung injury and respiratory tree remodelling has been implicated in the pathophysiology and progression of both diseases. Current studies have shown that patients with severe GORD will demonstrate pulmonary aspiration of refluxate on scintigraphic scanning. We aim to demonstrate the presence of pulmonary aspiration of refluxate on oesophageal scintigraphy and correlate this with changes of fibrosis, scarring, bronchiectatic and ground glass changes on high resolution computed tomography (HRCT) chest imaging. Methods Retrospective data was obtained from 114 patients who underwent oesophageal scintigraphy reflux studies at a single nuclear medicine imaging facility to evaluate for significant GORD or extra-oesophageal symptoms. Scintigraphy results were then compared with HRCT chest studies of the respective patients. Lobar locations of parenchymal changes on CT were correlated with location of isotope in lungs seen during aspiration on scintigraphy. Results 114 of patients demonstrated evidence of pulmonary aspiration on scintigraphy in the delayed study. All patients had intermittent or continuous full column gastro-oesophageal reflux with evidence of tracer in both lungs or the right lung. Of these patients, 35 underwent HRCT chest studies. 23 of the 35 patients had evidence of pulmonary disease on HRCT, demonstrated by fibrosis, scarring, bronchiectatic changes or ground glass opacities. 11 patients showed evidence of pulmonary fibrosis or scarring, and 10 of these demonstrated co-location of pulmonary aspiration on scintigraphy. 10 of 11 patients with bronchiectactic change were co-located with pulmonary aspiration. Conclusion These results demonstrate a likely relationship between GORD, IPF and bronchiectasis, indicating that the current clinical paradigm of GORD and respiratory disease being two separate entities must be re-evaluated.
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