Neuromesenchymal hamartoma of small bowel - an extremely rare entity: a case report

Neuromuscular and vascular hamartoma (NMVH) is a very rare stricturing condition of the small intestine, occurring focally and causing recurrent obstructive symptoms or occult chronic gastrointestinal bleeding. Salas et al. (Neuromesenchymal hamartoma of the small bowel. J Clin Gastroenterol. 1990, 12 (6): 705-9) proposed the term of "Neuromesenchymal hamartoma" for the cases of NMVH with participation of mesenchymal tissues

Evidence of functional deficits at the single muscle fiber level in experimentally-induced renal insufficiency

Chronic kidney disease patients present with metabolic and functional muscle abnormalities, called uremic myopathy, whose mechanisms have not yet been fully elucidated. We investigated whether chronic renal insufficiency (CRI) affects skeletal muscle contractile properties at the cellular level. CRI was induced surgically in New Zealand rabbits (UREM), with sham-operation for controls (CON), and samples were collected at 3 months post-surgery, following euthanasia. All protocols had University Ethics approval following national and European guidelines. Sample treatments and evaluations were blinded. Maximal isometric force was assessed in 382 permeabilized psoas fibers (CON, n=142, UREM, n=240) initially at pH7, 10oC (‘standard’ conditions), in subsets of fibers in acidic conditions (pH6.2, 10oC) but also at near physiological temperature (pH7, 30oC and pH6.2, 30oC). CRI resulted in significant smaller average CSA (~11%) for UREM muscle fibers (vs CON, P<0.01). At standard conditions, UREM fibers produced lower absolute and specific forces (i.e. normalized force per fiber CSA) (vs CON, P<0.01); force increased in 30oC for both groups (P<0.01), but the disparity between UREM and CON remained significant. Acidosis significantly reduced force (vs pH7, 10oC P<0.01), similarly in both groups (in UREM by -48% and in CON by -43%, P>0.05). For the first time, we give evidence that CRI can induce significant impairments in single psoas muscle fibers force generation, only partially explained by fiber atrophy, thus affecting muscle mechanics at the cellular level

Prevention of postoperative adhesion formation by individual and combined administration of icodextrin 4% and dimetindene: an experimental study

To date, no single method has been successful in eliminating peritoneal adhesionformation after major abdominal surgery. This study evaluated the individual andpossible synergistic effect of a local intraperitoneal barrier, 4 per cent icodextrin, andan intravenously administered antihistamine drug, dimetindene maleate, in theprevention of adhesion development following surgical trauma.De novo experimental adhesions were induced by standardized trauma of theperitoneum and large bowel in 120 New Zealand White rabbits. The animals wererandomized into four groups receiving intraperitoneal saline, intraperitoneal 4 per centicodextrin (60 ml), intravenous dimetindene maleate (0·1 mg/kg) and 4 per centicodextrin–dimetindene in combination (n = 30 per group). Ten days later, adhesionscores and incidence were assessed by two independent surgeons and surface area bycomputer-aided planimetry.Treatment with either icodextrin or dimetindene maleate significantly reducedadhesion scores and increased the incidence of adhesion-free animals in an equipotentmanner. The effect of combined treatment on severity, incidence and surface area ofadhesions was more pronounced than that of each drug administered separately.Serum concentrations of matrix metalloproteinases-2 and -9 were significantlyincreased in groups of icodextrin 4%, dimetindene maleate and combined group ofthese two therapeutical agents compared to animals with severe adhesions in controlgroup.Combined administration of 4 per cent icodextrin and dimetindene maleate may beused safely and efficaciously to prevent surgically induced adhesions.Έως και σήμερα, καμία μέθοδος δεν έχει αποδειχθεί να έχει πλήρη επιτυχία στηνεξάλειψη των ενδοπεριτοναϊκών συμφύσεων μετά από μία χειρουργική επέμβαση.Αυτή η μελέτη αξιολόγησε την μεμονωμένη και την συνεργική δράση ενός τοπικούενδοπεριτοναϊκού φραγμού, του διαλύματος ικοδεξτρίνης 4%, και ενός ενδοφλέβιαχορηγούμενου αντισταμινικού φαρμάκου, της διμεθινδένης, στην πρόληψη τηςανάπτυξης συμφύσεων που ακολουθούν το χειρουργικό τραύμα.Προκλήθηκαν μετεγχειρητικές συμφύσεις πειραματικά από τυποποιημένο μοντέλοτραύματος του περιτοναίου και του παχέως εντέρου σε 120 λευκούς κόνικλους ΝέαςΖηλανδίας. Τα πειραματόζωα τυχαιοποιήθηκαν σε 4 ομάδες και τους χορηγήθηκεενδοπεριτοναϊκα αλατούχο διάλυμα 0,9%, διάλυμα ικοδεξτρίνης 4% (60ml)ενδοπεριτοναϊκα, ενδοφλέβια διμεθινδένη (0.1 mg/kg) και συνδυασμός ικοδεξτρίνης4% και διμεθινδένης (n=30 ανά ομάδα). Μετά την πάροδο 10 ημερών ταπειραματόζωα υποβλήθησαν σε ευθανασία και αξιολογήθηκε ο βαθμός, η συχνότητακαι η έκταση των μετεγχειρητικών συμφύσεων. Επίσης αξιολογήθηκε ο ρόλος τωνμεταλλοπρωτεινασων-2 και -9 και των ουδετερόφιλων κυττάρων στον σχηματισμόενδοπεριτοναϊκων συμφύσεωνΗ θεραπεία τόσο με ικοδεξτρίνη 4% όσο και με διμεθινδένη μείωσαν σημαντικά τονβαθμό τον συμφύσεων και αύξησαν την συχνότητα των ελεύθερων από συμφύσειςπειραματόζωων με ένα ισοδύναμο τρόπο. Το αποτέλεσμα της συνδυασμένηςχορήγησης ικοδεξτρίνης 4% και διμεθινδένης όσον αφορά την σοβαρότητα, τηνσυχνότητα και την έκταση των μετεγχειρητικών συμφύσεων ήταν στατιστικάσημαντικά ανώτερο από αυτό του κάθε φαρμάκου ξεχωριστά. Τα επίπεδα τωνμεταλλοπρωτεινασών-2 και -9 αναδείχθηκαν στατιστικά σημαντικά υψηλότερα στηνομάδα των πειραματόζωων που έλαβαν συνδυασμένη αγωγή και χαρακτηρίζονταναπό απουσία συμφύσεων.Η συνδυασμένη χορήγηση διαλύματος ικοδεξτρίνης 4% και διμεθινδένης φαίνεταινα μπορεί να χρησιμοποιηθεί με ασφάλεια και αποτελεσματικότητα στην πρόληψητων μετεγχειρητικών συμφύσεων

Damage Control Surgery for Hepatocellular Cancer Rupture in an Elderly Patient: Survival and Quality of Life

Spontaneous rupture of hepatocellular carcinoma (HCC) is a rare emergency condition with high mortality rate. Successful management depends on patients’ hemodynamic condition upon presentation and comorbidities, correct diagnosis, HCC status, liver function, and future liver remnant, as well as available sources. There is still a debate in the literature concerning the best approach in this devastating complication. Nevertheless, the primary goal should be a definitive bleeding arrest. In most cases, patients with spontaneous rupture of HCC present with hemodynamic instability, due to hemoperitoneum, necessitating an emergency treatment modality. In such cases, transcatheter arterial embolization (TAE) should be the treatment of choice. Emergency liver resection is an option when TAE fails or in cases with preserved liver function and limited tumors. Otherwise, damage control strategies, as in liver trauma, are a reasonable alternative. We report a case of an elderly patient with hemoperitoneum and hypovolemic shock from spontaneous rupture of undiagnosed HCC, who was treated successfully by emergency surgery and damage control approach

Intestinal Obstruction and Ileocolic Fistula due to Intraluminal Migration of a Gossypiboma

Gossypiboma refers, as a term, to a retained surgical sponge. It is considered as a rare surgical complication which can occur despite precautions. We report a case of a 36-year-old woman who was admitted to our surgical department with symptoms of abdominal pain associated with episodes of nausea and vomiting that lasted for 2 months. Six months ago she had undergone a cesarean section in a private clinic. Computed tomography revealed a high-density mass occupying a portion of the intestinal lumen, which was reported as a “calcified parasite.” The patient was subjected to laparotomy. The intraoperative findings included signs of obstructive ileus and ileosigmoid fistula and a large sponge was found at the resected portion of the small intestine. Although gossypiboma is a rare entity, it should be included in the differential diagnosis

Demystifying the Value of Minimal Clinically Important Difference in the Cardiothoracic Surgery Context

The aim of this review is to describe the different statistical methods used in estimating the minimal clinically important difference (MCID) for the assessment of quality of life (QOL)-related and clinical improvement interventions, along with their implementation in cardiothoracic surgery. A thorough literature search was performed in three databases (PubMed/Medline, Scopus, Google Scholar) for relevant articles from 1980 to 2022. We included articles that implemented and assessed statistical methods used to estimate the concept of MCID in cardiothoracic surgery. MCID has been successfully implemented in several medical specialties. Anchor-based and distribution-based methods are the most common approaches when evaluating the MCID. Nonetheless, we found only five studies investigating the MCID in the context of cardiothoracic surgery. Four of them used anchor-based approaches, and one used both anchor-based and distribution-based methods. MCID values were very variable depending on the methods applied, as was the clinical context of the study. The variables of interest were certain QOL measuring questionnaires, used as anchors. Multiple anchors and methods were applied, leading to different estimations of MCID. Since cardiothoracic surgery is related to important perioperative morbidity, MCID might represent an important and efficient adjunct tool to interpret clinical outcomes. The need for MCID methodology implementation is even higher in patients with heart failure undergoing cardiac surgery. More studies are needed to validate different MCID methods in this context.</p

Gastric Cancer in the Era of Epigenetics

Gastric cancer (GC) remains a significant contributor to cancer-related mortality. Novel high-throughput techniques have enlightened the epigenetic mechanisms governing gene-expression regulation. Epigenetic characteristics contribute to molecular taxonomy and give rise to cancer-specific epigenetic patterns. Helicobacter pylori (Hp) infection has an impact on aberrant DNA methylation either through its pathogenic CagA protein or by inducing chronic inflammation. The hypomethylation of specific repetitive elements generates an epigenetic field effect early in tumorigenesis. Epstein–Barr virus (EBV) infection triggers DNA methylation by dysregulating DNA methyltransferases (DNMT) enzyme activity, while persistent Hp-EBV co-infection leads to aggressive tumor behavior. Distinct histone modifications are also responsible for oncogene upregulation and tumor-suppressor gene silencing in gastric carcinomas. While histone methylation and acetylation processes have been extensively studied, other less prevalent alterations contribute to the development and migration of gastric cancer via a complex network of interactions. Enzymes, such as Nicotinamide N-methyltransferase (NNMT), which is involved in tumor’s metabolic reprogramming, interact with methyltransferases and modify gene expression. Non-coding RNA molecules, including long non-coding RNAs, circular RNAs, and miRNAs serve as epigenetic regulators contributing to GC development, metastasis, poor outcomes and therapy resistance. Serum RNA molecules hold the potential to serve as non-invasive biomarkers for diagnostic, prognostic or therapeutic applications. Gastric fluids represent a valuable source to identify potential biomarkers with diagnostic use in terms of liquid biopsy. Ongoing clinical trials are currently evaluating the efficacy of next-generation epigenetic drugs, displaying promising outcomes. Various approaches including multiple miRNA inhibitors or targeted nanoparticles carrying epigenetic drugs are being designed to enhance existing treatment efficacy and overcome treatment resistance

Diaphragmatic rupture causing repeated vomiting in a combined abdominal and head injury patient: a case report and review of the literature

<p>Abstract</p> <p>Background</p> <p>Diaphragmatic rupture after blunt abdominal injury is a rare trauma condition. Delayed diagnosis is not uncommon especially in the emergency room setting. Associated injuries often shift diagnosis and treatment priorities towards other more life-threatening conditions.</p> <p>Case presentation</p> <p>We present a challenging case of a young male with combined abdominal and head trauma. Repeated episodes of vomiting dominated on clinical presentation that in the presence of a deep scalp laceration and facial bruising shifted differential diagnosis towards a traumatic brain injury. However, a computed tomography scan of the brain ruled out any intracranial pathology. Finally, a more meticulous investigation with additional imaging studies confirmed the presence of diaphragmatic rupture that justified the clinical symptoms.</p> <p>Conclusions</p> <p>The combination of diaphragmatic rupture with head injury creates a challenging trauma scenario. Increased level of suspicion is essential in order to diagnose timely diaphragmatic rupture in multiple trauma patients.</p