Surgical treatment of acute limb iscahemia in the presence of malignancy

AbstractObjectivesThe aim of this study was to examine the outcome of surgical treatment of acute limb ischaemia (ALI) developing in the presence of malignancy.MethodsPatients undergoing emergency surgery were identified from theatre registers, notes were reviewed, and data collected in relation to indications for, and outcome following operation. All patients with a current or past medical history of histologically confirmed malignant disease were identified and their notes specifically reviewed to determine the staging of their tumours. The results of the malignancy cohort were compared to a group of patients undergoing surgery for ALI of other aetiologies.ResultsFourteen patients with a malignancy were identified with ALI and in addition there were 102 without malignancy. The cohort with a malignancy contained a higher proportion of males (p=0.0305), and a greater number of smokers (p=0.037) than those with other aetiologies for ALI. The peri-operative management of the 2 groups was similar. Histological examination revealed tumour thrombus in only 1 case. The recurrence (29% versus 18%; p=0.328) and amputation rates (29% versus 17%; p=0.278) were similar, however, the 30-day (50% versus 30%; p=0.038) and 60-day mortality rates (100% versus 35%; p<0.001) were significantly higher in the malignancy group.ConclusionsThe development of ALI in patients with malignant disease may be regarded as a terminal event despite comparable performance status at the time of surgery to those with other cause for ALI. The role of surgery in patients with known advanced malignancies appears to be of dubious benefit with little survival benefit

Mucinous adenocarcinoma presenting as an isolated sternal metastasis

<p>Abstract</p> <p>Background</p> <p>As a result of improvements in diagnostic accuracy, the primary source of the tumour is identified in more than 99% of cases presenting with a malignancy. Whilst the axial skeleton is a common site of metastases, the sternum is rarely affected, especially by isolated metastases.</p> <p>Case presentation</p> <p>We report a case of a 68 year old male who was referred to the surgical outpatient clinic with a six month history of sternal pain. The patient was known to have essential thrombocythaemia, which had recently transformed into acute myeloid leukaemia but a sternal biospy showed mucinous adenocarcinoma. He had not localising symptoms and full evaluation failed to localise the primary tumour.</p> <p>Conclusion</p> <p>Solitary sternal metastases are rare and when found an underlying neoplasm is usually identified allowing targeted treatment. If however, there is no symptomatic tumour, the metastasis should simply be treated symptomatically.</p

Prophase-Specific Perinuclear Actin Coordinates Centrosome Separation and Positioning to Ensure Accurate Chromosome Segregation

Centrosome separation in late G2/ early prophase requires precise spatial coordination that is determined by a balance of forces promoting and antagonizing separation. The major effector of centrosome separation is the kinesin Eg5. However, the identity and regulation of Eg5-antagonizing forces is less well characterized. By manipulating candidate components, we find that centrosome separation is reversible and that separated centrosomes congress toward a central position underneath the flat nucleus. This positioning mechanism requires microtubule polymerization, as well as actin polymerization. We identify perinuclear actin structures that form in late G2/early prophase and interact with microtubules emanating from the centrosomes. Disrupting these structures by breaking the interactions of the linker of nucleoskeleton and cytoskeleton (LINC) complex with perinuclear actin filaments abrogates this centrosome positioning mechanism and causes an increase in subsequent chromosome segregation errors. Our results demonstrate how geometrical cues from the cell nucleus coordinate the orientation of the emanating spindle poles before nuclear envelope breakdown

Map of Carver Heights, Spartanburg, S.C.

Map of Carver Heights, Spartanburg, S.C. owned by W.W. Lancaster, Wm. B. Harrison, Dr. J.T. Montgomery, subdivided by Newbury Realty & Auctions Co., Spartanburg, S.C., November 21, 1924.Scale 50 - 1 inch. Lots lines are drawn on Beacon St., Concord Ave., and Highland Ave. This area is part of the neighborhood in Spartanburg known as Highland.https://digitalcommons.wofford.edu/littlejohnmss/1341/thumbnail.jp

Internal jugular vein thrombosis in a warfarinised patient: a case report

<p>Abstract</p> <p>Introduction</p> <p>Internal jugular vein thrombosis (IJVT) is a rare but potentially fatal condition. It usually arises following trauma to the internal jugular vein but is also seen in association with coagulopathies and advanced malignancies as part of a para-neoplastic syndrome.</p> <p>Case presentation</p> <p>We report a case of a 44 year old woman with a strong past medical history and family history of thrombotic disease who presented with abdominal pain and ascites. A stage III ovarian carcinoma was diagnosed and she underwent debulking of the tumour. She sustained a peri-operative haemorrhage and required insertion of a central line into the right internal jugular vein. At one month follow-up she presented as an emergency with a left neck mass and painful swallowing. A duplex ultrasound of her neck identified a left IJVT to the level of the brachiocephalic vein which had occurred despite warfarinisation and an INR of greater than 2. She was commenced on intravenous heparin and the swelling resolved over the course of a week.</p> <p>Conclusion</p> <p>This case illustrates an unusual presentation of a rare condition. In this case, the precise aetiology is unclear as the IJVT may have been related to a coagulopathy or the presence of advanced malignancy and occurred despite adequate anticoagulation.</p

Perigraft air is not always pathological: a case report

© 2007 Ball et al; licensee BioMed Central Ltd

Self-Consistent Theory of Halo Mergers

The rate of merging of dark-matter halos is an absolutely essential ingredient for studies of both structure and galaxy formation. Remarkably, however, our quantitative understanding of the halo merger rate is still quite limited, and current analytic descriptions based upon the extended Press-Schechter formalism are fundamentally flawed. We show that a mathematically self-consistent merger rate must be consistent with the evolution of the halo abundance in the following sense: The merger rate must, when inserted into the Smoluchowski coagulation equation, yield the correct evolution of the halo abundance. We then describe a numerical technique to find merger rates that are consistent with this evolution. We present results from a preliminary study in which we find merger rates that reproduce the evolution of the halo abundance according to Press-Schechter for power-law power spectra. We discuss the limitations of the current approach and outline the questions that must still be answered before we have a fully consistent and correct theory of halo merger rates.Comment: 13 pages, 8 figures, submitted to MNRAS. Version with full resolution figures available at http://www-astro.physics.ox.ac.uk/~abenson/Papers/smoluchow.pd

Mutations in pericentrin cause Seckel syndrome with defective ATR-dependent DNA damage signaling

Large brain size is one of the defining characteristics of modern humans. Seckel syndrome (MIM 210600), a disorder of markedly reduced brain and body size, is associated with defective ATR-dependent DNA damage signaling. Only a single hypomorphic mutation of ATR has been identified in this genetically heterogeneous condition. We now report that mutations in the gene encoding pericentrin (PCNT)--resulting in the loss of pericentrin from the centrosome, where it has key functions anchoring both structural and regulatory proteins--also cause Seckel syndrome. Furthermore, we find that cells of individuals with Seckel syndrome due to mutations in PCNT (PCNT-Seckel) have defects in ATR-dependent checkpoint signaling, providing the first evidence linking a structural centrosomal protein with DNA damage signaling. These findings also suggest that other known microcephaly genes implicated in either DNA repair responses or centrosomal function may act in common developmental pathways determining human brain and body size