Spontaneous expulsion from rectum: a rare presentation of intestinal lipomas

Lipomas are rare, subserosal, usually solitary, pedunculated small lesions appearing mainly in the large intestine with a minimal malignancy potential. They usually run asymptomatic and become symptomatic when they become enlarged or complicated causing intestinal obstruction, perforation, intusucception or massive bleeding. In rare cases they can be self-detached and expulsed via the rectum as fleshy masses. This event mainly occurs in large, pendunculated lipomas which detach from their pedicle. The reason for this event remains in most of cases unclear although in some cases a predisposing factor does exist. Abdominal pain and obstructive ileus may be observed while in many cases bleeding occurs. The expulsed mass sets the diagnosis and in most of the cases all symptoms subside. Diagnosis is rarely established before surgery with the use of barium enema, computed tomography and colonoscopy which additionally provides measures of treatment and diagnosis. In atypical cases though, in cases where the malignancy can not be excluded or in complicated cases, surgery is recommended. Usually the resection of the affected intestinal part is adequate. If during surgery a lipoma is encountered simple lipomatectomy seems also to be adequate

Inhaled nitric oxide reduces ischemia-reperfusion injury in rat lungs from non–heart-beating donors

If lungs could be retrieved from non–heart-beating donors, the critical shortage of lungs for transplantation could be alleviated. However, lungs subjected to warm ischemia develop edema when reperfused. We hypothesized that ventilation of rat lungs from non–heart-beating donors with nitric oxide during the period of warm ischemia alone, with reperfusion, or both might reduce ischemia-reperfusion injury.An isolated perfused rat lung model measured the filtration coefficient and accumulation of lung water by the wet/dry weight ratio. Donor rats were euthanized, and then lungs were retrieved immediately after death or 2 or 3 hours postmortem. Lungs retrieved postmortem were either not ventilated or ventilated with 100% oxygen alone or 40 ppm nitric oxide in oxygen. In the circuit, lungs were ventilated with alveolar gas with or without 40 ppm nitric oxide.Nitric oxide administration to the non–heart-beating donor or in the perfusion circuit reduced filtration coefficient and wet/dry weight ratio. Lungs retrieved 2 hours postmortem ventilated with nitric oxide or treated with nitric oxide on reperfusion had filtration coefficients and wet/dry weight ratios similar to those of lungs retrieved immediately after death. Nitric oxide was most beneficial when administered both during warm ischemia and at reperfusion in lungs retrieved 3 hours postmortem. Nitric oxide administration in the circuit was associated with increased lung levels of lung cyclic guanosine monophosphate, determined by enzyme-linked immunosorbent assay.Administration of nitric oxide to non–heart-beating donors during warm ischemia and with reperfusion might facilitate transplantation of lungs from non–heart-beating donors by reducing ischemia-reperfusion injury and capillary leak

Mechanical Thrombectomy for Stroke After Cardiac Surgery

Stroke after cardiac surgery remains a devastating complication and its treatment options are limited. Systemic fibrinolysis is a relative contraindication, because it raises the risk of systemic hemorrhage. Endovascular therapy, mechanical thrombectomy, and intra-arterial fibrinolysis have emerged as safer options. We present three patients who developed strokes following cardiac surgery who underwent successful mechanical thrombectomy and review the literature on this subject. doi: 10.1111/jocs.12776 (J Card Surg 2016;31:517-520).info:eu-repo/semantics/publishedVersio

The revised international autoimmune hepatitis score in chronic liver diseases including autoimmune hepatitis/overlap syndromes and autoimmune hepatitis with concurrent other liver disorders

Background. We conducted a study in order to determine the usefulness and diagnostic value of International Autoimmune Hepatitis Group (IAHG) score in non-autoimmune hepatitis (AIH) hepatic disorders as well as in AIH/overlap syndromes and in cases with coexistence of AIH and other liver diseases. Methods. We applied the IAHG score in 423 patients with liver diseases excluding patients with AIH, AIH/overlap syndromes and AIH with concurrent other liver disease namely, patients with chronic hepatitis B (n = 109), chronic hepatitis C (n = 95), chronic hepatitis D (n = 4), alchoholic liver disease (n = 28), non-alcoholic fatty liver disease (n = 55), autoimmune cholestatic liver diseases (n = 77), liver disorders of undefined origin (n = 32) and with miscellaneous hepatic disorders (n = 23). 24 patients with AIH associated with any kind of liver disorder including 10 patients with AIH/overlap syndromes and 14 AIH with concurrent other liver disease were also investigated. 43 patients with AIH consisted the control group. Results. The specificity of the score was 98.1% while the sensitivity in unmasking AIH in patients with either AIH/overlap syndromes or AIH with concurrent other liver diseases was only 50% and 78.6%. In the binary logistic regression model, the presence of other autoimmune diseases (p < 0.001), the total histological score (p < 0.001) and positivity for autoantibodies (p < 0.05) were identified as independent predictors for the presnce of AIH/ovea syndromes o AI with concurren other liver diseass. Conclusion. The IAHG scoring system has very good specificity for excluding AIH in patients with chronic liver diseases but not that sensitivity in order to unmask AIH/overlap syndromes or AIH with concurrent other liver diseases. The presence of other autoimmune diseases or autoantibody markers in the absence of hepatitis viral markers should alarm physicians for the possible presence of AIH either as "pure" AIH or in association with other liver disorders (AIH/overlap syndromes or AIH with concurrent other liver diseases). Under these conditions, liver histology seems essential and it must always be included in the work up of hepatic patients. © 2007 Papamichalis et al; licensee BioMed Central Ltd

HIGH-RESOLUTION GEOMORPHOLOGICAL MAPPING OF THE SHALLOW CONTINENTAL SHELF WEST OF THE KAVALA BAY, NORTH AEGEAN

Σημαντικές γεωμορφολογικές δομές του ρηχού τμήματος της υφαλοκρηπίδας δυτικά του Κόλπου της Καβάλας χαρτογραφήθηκαν χρησιμοποιώντας τα δεδομένα από μια υδρογραφική αποτύπωση (τον Ιούνιο 2014) 320 ναυτικών μιλίων, η οποία περιελάμβανε υψηλής διακριτικότητας πολυδεσμική βαθυμετρική καταγραφή και διασκόπηση πυθμένα με σεισμική ανάκλαση. Αναγνωρίστηκε ένα σύστημα ρηγμάτων αποτελούμενο από ένα σετ δυο κυρίων κανονικών ρηγμάτων (καταγεγραμμένο μήκος και μετρημένο κατακόρυφο άλμα αυτών: 12 χλμ, 5 χλμ και > 40 μ, 25 μ, αντίστοιχα,) με έντονη επιφανειακή εκδήλωση στο θαλάσσιο πυθμένα, καθώς και τρία δευτερεύοντα ρήγματα νότια των κύριων ρηγμάτων, τα οποία φανερώνουν συνιζηματογενή τεκτονισμό. Η εντυπωσιακή διαφορά στις υφές των ιζημάτων που καλύπτουν αφενός το υποκείμενο ρηξιτέμαχος του βορειότερου κυρίου ρήγματος και αφετέρου την οροφή του νοτιότερου κυρίου ρήγματος δείχνει τη σημαντική επίδραση του τεκτονισμού στις ιζηματολογκές διεργασίες της περιοχής μελέτης. Όσον αφορά τις υπάρχουσες γεωμορφές, οι περισσότερο ενδιαφέρουσες είναι εκείνες των αμμωδών θινών στο βορειοανατολικό τμήμα της περιοχής μελέτης, ευρισκόμενες σε βάθη από 25 μ μέχρι τουλάχιστον 65 μ. Οι μεγάλες διαστάσεις τους καθώς και ο προσανατολισμός τους ως προς την ακτογραμμή υποδηλώνουν ως μηχανισμό σχηματισμού τους την δράση ισχυρών πυθμιαίων ρευμάτωνProminent geomorphological features of the shallow continental shelf west of the Kavala Bay (Loutra Eleftheron-Nea Peramos) were mapped using the data from a hydrographic survey (June 2014) of 320 nautical miles during which high resolution multibeam bathymetry and seismic-reflection subbottom profiling were carried out simultaneously. A fault zone comprised by a set of two primary sigmoidal gravity faults (recorded lengths and measured offsets: 12 km, 5 km and > 40 m, 25 m, respectively), with distinct expression on the seabed, and three other secondary gravity faults situated southern of the major faults, revealing synsedimentary tectonics, was identified. The striking difference between the texture of the footwall block sediments of the northern major fault and the texture of the sediments occupying the deep hanging wall block of the southern major fault emphasizes the impact of local tectonics on the sedimentary evolution of the study area. Concerning the observed bedforms, the most interesting were the sand dunes occurring at depths from 25 m to 65 m at least and occupying the northeast part of the study area. Their large dimensions and orientation in relation to the coastline position imply as a mechanism for their formation intense bottom-current activity

European Crohn's and Colitis Organisation Topical Review on prediction, diagnosis and management of fibrostenosing Crohn's disease

This ECCO topical review of the European Crohn's and Colitis Organisation [ECCO] focused on prediction, diagnosis, and management of fibrostenosing Crohn's disease [CD]. The objective was to achieve evidence-supported, expert consensus that provides guidance for clinical practice