Plasma soluble e-selectin in necrotising enterocolitis

Aim: E-selectin is an important mediator of leukocyte-endothelial adhesion. It is expressed on activated endothelium, and shed into the circulation in its soluble form. In babies with necrotising enterocolitis (NEC), increased intestinal expression of E-selectin has been associated with multiple organ failure and an adverse outcome. The aim of this study was to determine whether increased circulating soluble E-selectin (sE-selectin) was associated with a worse prognosis.Methods: With ethical approval, plasma samples from 20 infants with Bell stage II and III NEC were analysed. Both pre- and postoperative samples were available in 6 infants. The severity of illness was assessed using a sequential organ failure assessment score (SOFA) specifically designed for use in NEC. Plasma concentration of sE-selectin was determined by ELISA. Data, which were not normally distributed, were compared by Spearman's rank correlation coefficient and Wilcoxon signed rank test.Results: Plasma sE-selectin was strongly negatively correlated with corrected gestational age at the time of sampling (r?=???0.425, p?=?0.006). There was no association between plasma sE-selectin and outcome (death or survival to discharge), severity of intestinal disease (focal, multifocal or pan-intestinal), or SOFA score. Surgery for suspected perforation, however, caused a significant elevation in sE-selectin levels (p?=?0.031). Conclusions: Plasma sE-selectin, a described marker of endothelial activation, is increased following surgery for NEC. However, prematurity appears to be the cause of an increase in sE-selectin level, confounding the potential use of sE-selectin levels as a predictor of severity of illness in NEC

Nonocclusive mesenteric ischaemia: think about it

Nonocclusive mesenteric ischaemia (NOMI) is an acute mesenteric circulatory disorder that is not caused by an organic occlusion of blood vessels. It could involve all the abdominal parenchymas and viscera and the whole gastrointestinal tract (from the oesophagus to the rectum), insomuch that the involvement of the entire colon should be considered a distinctive tract in diagnosing this condition in respect of the occlusive forms of ischaemia. The aim of this article is to review the role of imaging in the diagnosis of NOMI and in particular its CT appearances. Recognition of the characteristic CT appearances and the variations associated with a reperfusion event may help in the accurate interpretation of CT in the diagnosis and management of NOMI