Oxidative stress and alterations in cellular calcium homeostasis are associated with the development of cardiac hypertrophy. However, the early cellular mechanisms for the development of hypertrophy are not well understood. Guinea pig ventricular myocytes were exposed to 30 microM H(2)O(2) for 5 min followed by 10 units/mL catalase to degrade the H(2)O(2), and effects on protein expression were examined 48 h later. Transient exposure to H(2)O(2) increased the level of protein synthesis more than 2-fold, assessed as incorporation of [(3)H]leucine (n = 12; p < 0.05). Cell size was increased slightly, but there was no evidence of major cytoskeletal disorganization assessed using fluorescence microscopy. Changes in the expression of individual proteins were assessed using iTRAQ protein labeling followed by mass spectrometry analysis (LC-MALDI-MSMS); 669 proteins were identified, and transient exposure of myocytes to H(2)O(2) altered expression of 35 proteins that were predominantly mitochondrial in origin, including TCA cycle enzymes and oxidative phosphorylation proteins. Consistent with changes in the expression of mitochondrial proteins, transient exposure of myocytes to H(2)O(2) increased the magnitude of the mitochondrial NADH signal 10.5 +/- 2.3% compared to cells exposed to 0 microM H(2)O(2) for 5 min followed by 10 units/mL catalase (n = 8; p < 0.05). In addition, metabolic activity was significantly increased in the myocytes 48 h after transient exposure to H(2)O(2), assessed as formation of formazan from tetrazolium salt. We conclude that a 5 min exposure of ventricular myocytes to 30 microM H(2)O(2) is sufficient to significantly alter protein expression, consistent with the development of hypertrophy in the myocytes. Changes in mitochondrial protein expression and function appear to be early sequelae in the development of hypertrophy.
Laparotomy incisions provide easy and rapid access to the peritoneal cavity in case of emergency surgery. Incisional hernia (IH) is a late manifestation of the failure of abdominal wall closure and represents frequent complication of any abdominal incision: IHs can cause pain and discomfort to the patients but also clinical serious sequelae like bowel obstruction, incarceration, strangulation, and necessity of reoperation. Previous guidelines and indications in the literature consider elective settings and evidence about laparotomy closure in emergency settings is lacking. This paper aims to present the World Society of Emergency Surgery (WSES) project called ECLAPTE (Effective Closure of LAParoTomy in Emergency): the final manuscript includes guidelines on the closure of emergency laparotomy.
Introduction and importance This is the first case of delayed tracheal perforation post total thyroidectomy in the context of previous radiotherapy to the neck. Such a presentation can be easily misdiagnosed and managed as a seroma at significant risk to the patient, as the latter had no precipitating factors and cardiorespiratory compromise. There are nineteen previously described cases of delayed tracheal injury post thyroidectomy of variable severity and variable intervention. Case presentation A 51-year-old man presented with non-tender anterior neck surgical emphysema initially diagnosed on bedside ultrasound and plain X-ray, 22 days following total thyroidectomy and central neck dissection. His background was significant for childhood acute lymphoblastic leukaemia requiring chemotherapy and cranio-spinal radiotherapy. He underwent total thyroidectomy, for multiple bilateral thyroid nodules found on cranio-spinal MRI surveillance concerning for follicular neoplasm. There were significant amount of adhesions tethering the thyroid secondary to prior radiotherapy but no tracheal injury intra-operatively. Clinical discussion At presentation, no source of air leak was identified on Computer Tomography. He failed conservative management. During surgical exploration, a 2 mm tracheal perforation at the right cricothyroid joint was closed with the right sternothyroid muscle due to the proximity of the perforation with the recurrent right laryngeal nerve. Tisseel was applied over the repair. He recovered without further complications. Conclusion Sudden onset neck swelling post thyroidectomy in the context of significant scaring from radiotherapy, should raise the suspicion of surgical emphysema in the neck patients and confirmed with plain x-ray. Such patients should have multidisciplinary tertiary care.
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