Ogilvie's syndrome with caecal perforation after Caesarean section: a case report

<p>Abstract</p> <p>Introduction</p> <p>Ogilvie's syndrome describes the phenomenon of an acute colonic pseudo-obstruction without a mechanical cause. It is rare but has been reported to occur after Caesarean section. It can lead to bowel perforation or ischaemia.</p> <p>Case presentation</p> <p>A healthy, 28-year-old Caucasian woman presented 2 weeks past her expected date of delivery for her first pregnancy. She underwent an uncomplicated elective Caesarean section but developed abdominal pain and bloating postoperatively and was subsequently diagnosed with acute colonic pseudo-obstruction, also known as Ogilvie's syndrome.</p> <p>Conclusion</p> <p>This case report highlights the rare, but potentially dangerous, diagnosis of Ogilvie's syndrome after Caesarean section. It is of particular interest to obstetricians, midwifery staff and general surgeons and shows the importance of accurate diagnosis, regular abdominal reassessment and early senior input to ensure appropriate and rapid treatment.</p

Pemphigus autoimmunity: Hypotheses and realities

The goal of contemporary research in pemphigus vulgaris and pemphigus foliaceus is to achieve and maintain clinical remission without corticosteroids. Recent advances of knowledge on pemphigus autoimmunity scrutinize old dogmas, resolve controversies, and open novel perspectives for treatment. Elucidation of intimate mechanisms of keratinocyte detachment and death in pemphigus has challenged the monopathogenic explanation of disease immunopathology. Over 50 organ-specific and non-organ-specific antigens can be targeted by pemphigus autoimmunity, including desmosomal cadherins and other adhesion molecules, PERP cholinergic and other cell membrane (CM) receptors, and mitochondrial proteins. The initial insult is sustained by the autoantibodies to the cell membrane receptor antigens triggering the intracellular signaling by Src, epidermal growth factor receptor kinase, protein kinases A and C, phospholipase C, mTOR, p38 MAPK, JNK, other tyrosine kinases, and calmodulin that cause basal cell shrinkage and ripping desmosomes off the CM. Autoantibodies synergize with effectors of apoptotic and oncotic pathways, serine proteases, and inflammatory cytokines to overcome the natural resistance and activate the cell death program in keratinocytes. The process of keratinocyte shrinkage/detachment and death via apoptosis/oncosis has been termed apoptolysis to emphasize that it is triggered by the same signal effectors and mediated by the same cell death enzymes. The natural course of pemphigus has improved due to a substantial progress in developing of the steroid-sparing therapies combining the immunosuppressive and direct anti-acantholytic effects. Further elucidation of the molecular mechanisms mediating immune dysregulation and apoptolysis in pemphigus should improve our understanding of disease pathogenesis and facilitate development of steroid-free treatment of patients

PANC Study (Pancreatitis: A National Cohort Study): national cohort study examining the first 30 days from presentation of acute pancreatitis in the UK

Abstract Background Acute pancreatitis is a common, yet complex, emergency surgical presentation. Multiple guidelines exist and management can vary significantly. The aim of this first UK, multicentre, prospective cohort study was to assess the variation in management of acute pancreatitis to guide resource planning and optimize treatment. Methods All patients aged greater than or equal to 18 years presenting with acute pancreatitis, as per the Atlanta criteria, from March to April 2021 were eligible for inclusion and followed up for 30 days. Anonymized data were uploaded to a secure electronic database in line with local governance approvals. Results A total of 113 hospitals contributed data on 2580 patients, with an equal sex distribution and a mean age of 57 years. The aetiology was gallstones in 50.6 per cent, with idiopathic the next most common (22.4 per cent). In addition to the 7.6 per cent with a diagnosis of chronic pancreatitis, 20.1 per cent of patients had a previous episode of acute pancreatitis. One in 20 patients were classed as having severe pancreatitis, as per the Atlanta criteria. The overall mortality rate was 2.3 per cent at 30 days, but rose to one in three in the severe group. Predictors of death included male sex, increased age, and frailty; previous acute pancreatitis and gallstones as aetiologies were protective. Smoking status and body mass index did not affect death. Conclusion Most patients presenting with acute pancreatitis have a mild, self-limiting disease. Rates of patients with idiopathic pancreatitis are high. Recurrent attacks of pancreatitis are common, but are likely to have reduced risk of death on subsequent admissions. </jats:sec

On the prediction of response to neo-adjuvant chemotherapy for primary oesophageal adenocarcinoma

Management of oesophageal cancer is associated with poor outcomes and it has become apparent that surgery alone is not sufficient to effect genuine long term survival. In the UK, it is standard practice to treat oesophageal adenocarcinoma with neo-adjuvant chemotherapy (no radiation) and surgery. One problem with this approach is the issue of those patients who do not respond. The aim of this study was to investigate biomarkers which might predict response to chemotherapy. Methods A retrospective audit was carried out on post-operative outcome after oesophagectomy from 2000 to 2006 and results compared with those from previous similar audits. Patients who received neo-adjuvant chemotherapy were identified and pre-treatment oesophageal biopsies were obtained. Immunohistochemistry was used to analyse expression ofthymidylate synthase, excision cross-complementation group 1, vascular endothelial growth factor, hypoxia-inducible factor 1 and carbonic anhydrase IX. Expression was compared with histopathological evidence of response to chemotherapy after surgical resection. In a separate prospective study from 2007 to 2008 the single-cell gel electrophoresis (comet) assay was used to measure DNA damage in response to in vivo exposure to 5-fluorouracil (5FU) and compared with subsequent response to chemotherapy. Results Post-operative mortality after oesophagectomy improved from 27% in the 1970s and 80s to less than 3% in the 2000s. At the same time, 5-year survival increased from 7% to 55%. Low expression of thymidylate synthase, VEGF and ERCC 1 was significantly associated with . good response to chemotherapy. High VEGF expression was significantly associated with nodal metastases. VB Baseline levels of DNA damage were higher in cancer cells compared to adjacent Barrett's and normal oesophageal epithelium. Response to chemotherapy was predicted by high levels of DNA damage induced by in vivo exposure to 5FU. Conclusions Methods of measuring these biomarkers should be considered and developed to aid individualised treatment plans for patients with oesophageal adenocarcinoma and predict response to chemotherapy.EThOS - Electronic Theses Online ServiceGBUnited Kingdo

A case of small bowel mesenteric pneumatosis: A multidisciplinary approach to clinical interpretation and intervention

Introduction: Pneumatosis of the small bowel mesentery is rare and the preserve of case reports. This case report describes the importance of a multi-disciplinary team (MDT) approach to rare pathologies. Case report: A 78-year-old man presented to our unit with a two-day history of upper abdominal pain associated with nausea and intermittent vomiting. An urgent computed tomography (CT) scan was organised. The scan was grossly abnormal and difficult to interpret; it was reported as widespread intra-mural gas within the small bowel wall most likely secondary to extensive small bowel ischaemia. Although surgical intervention was very high risk (predicted P-possum mortality of over 60%) and there was a strong possibility that the patient would not recover from surgery, the disparity between clinical and radiological findings meant that a diagnostic laparoscopy was indicated. A diagnostic laparoscopy showed that the small bowel itself was normal but there was extensive gas within the mesentery, caused by a band adhesion which had eroded into the peritoneal layer of the small bowel mesentery. Discussion: Pneumatosis of the small bowel mesentery is a pathological sign rather than a diagnosis and is characterised by gas within the mesenteric sleeves. It is likely associated with significant morbidity and therefore rarely observed as the majority with this sign would not be deemed suitable for surgical intervention. Conclusion: The case highlights an unusual pathology, rare imaging findings, the importance of a multi-disciplinary approach and the value of clear communication and informed consent when considering major intervention or surgery