Incidental finding of heterotopic supradiaphragmatic liver

Here we describe a case of heterotopic, supradiaphragmatic liver in a 65-year-old woman who was referred for investigation of a soft tissue gallbladder mass. Contrast-enhanced magnetic resonance imaging revealed adenomyomatosis of the gallbladder and supradiaphragmatic accessory liver tissue. This is a remarkably rare normal variant

Paediatric pancreatic trauma in North Queensland: a 10-year retrospective review

Purpose: To establish the incidence of pancreatic trauma in North Queensland to the region’s only tertiary paediatric referral centre, and to determine the patient’s outcomes based on their management. Methods: A single centre, retrospective cohort study of patients < 18 years with pancreatic trauma from 2009 to 2020 was performed. There were no exclusion criteria. Results: Between 2009 and 2020 there were 145 intra-abdominal trauma cases, 37% from motor vehicle accidents (MVA), 18.6% motorbike or quadbike, and 12.4% bicycle or scooter accidents. There were 19 cases of pancreatic trauma (13%), all from blunt trauma and with associated injuries. There were 5 AAST grade I, 3 grade II, 3 grade III, 3 grade IV injuries, and 4 with traumatic pancreatitis. Twelve patients were managed conservatively, 2 were managed operatively for another reason, and 5 were managed operatively for the pancreatic injury. Only 1 patient with a high grade AAST injury was successfully managed non-operatively. Complications included pancreatic pseudocyst (n = 4/19; 3 post-op), pancreatitis (n = 2/19; 1 post op), and post-operative pancreatic fistula (POPF) (n = 1/19). Conclusion: Due to North Queensland’s geography, diagnosis and management of traumatic pancreatic injury is often delayed. Pancreatic injuries requiring surgery are at high risk for complications, prolonged length of stay, and further interventions

Culture results at pancreatic necrosectomy: the microbiology of infected pancreatic necrosis

Introduction: Necrotizing pancreatitis occurs in 5-10% of patients with acute pancreatitis. Infected pancreatic necrosis (IPN) is a feared complication. Historically, causative organisms were Gramnegative bacteria, but recent international studies now report a predominance of Gram-positive bacteria. Not all the literature is consistent, and there may be regional variation. There is very limited Australian data. This study aims to report causative organisms in IPN in the Australian setting. Materials and Methods: Retrospective medical record review of all patients who underwent pancreatic necrosectomy at a single centre (tertiary referral center in Adelaide, South Australia) between January 2005 and December 2015. Intraoperative culture specimens were reviewed and the Gram-status and antimicrobial sensitivities noted. Discussion and Results: A total of 1296 patients were admitted for acute pancreatitis in the study period. 28 patients underwent pancreatic necrosectomy. Mean age 55.71 years (range 30-79), including twenty males and eight females. All patients had intraoperative cultures taken. 20 cultures demonstrated growth. There were 12 Gram-negative isolates (34.3%), 20 Gram-positive isolates (57.1%) and three fungal isolates (8.6%). Two bacterial isolates were antibiotic resistant organisms (one MRSA and one VRE). Conclusion: The findings were consistent with the majority of recent international studies demonstrating a predominance of Gram-positive organisms

Targeting the PI3K/Akt/mTOR pathway in hepatocellular carcinoma

Despite advances in the treatment of cancers through surgical procedures and new pharmaceuticals, the treatment of hepatocellular carcinoma (HCC) remains challenging as reflected by low survival rates. The PI3K/Akt/mTOR pathway is an important signaling mechanism that regulates the cell cycle, proliferation, apoptosis, and metabolism. Importantly, deregulation of the PI3K/Akt/mTOR pathway leading to activation is common in HCC and is hence the subject of intense investigation and the focus of current therapeutics. In this review article, we consider the role of this pathway in the pathogenesis of HCC, focusing on its downstream effectors such as glycogen synthase kinase-3 (GSK-3), cAMP-response element-binding protein (CREB), forkhead box O protein (FOXO), murine double minute 2 (MDM2), p53, and nuclear factor-κB (NF-κB), and the cellular processes of lipogenesis and autophagy. In addition, we provide an update on the current ongoing clinical development of agents targeting this pathway for HCC treatments

Bochdalek herniation: an unusual cause of bowel obstruction in an adult

[Extract] An 85-year-old woman presented to the emergency department with a 3-day history of vomiting and abdominal pain on a background of a known large right-sided diaphragmatic herniation first documented via radiological imaging in 2012. Her comorbidities of significance included vasculopathy and symptomatic chronic obstructive pulmonary disease. On examination, the patient was hypertensive with a soft abdomen, generalized tenderness, voluntary guarding and no evidence of peritonitis. There were no signs of respiratory distress. The patient was managed in the emergency department with a provisional diagnosis of small bowel obstruction with laboratory workup and radiological imaging performed

Immune checkpoint inhibitors in HCC: Cellular, molecular and systemic data

Hepatocellular carcinoma (HCC) is one of the leading causes of cancer related deaths in the world, and for patients with advanced disease there are few therapeutic options available. The complex immunological microenvironment of HCC and the success of immunotherapy in several types of tumours, has raised the prospect of potential benefit for immune based therapies, such as immune checkpoint inhibitors (ICIs), in HCC. This has led to significant breakthrough research, numerous clinical trials and the rapid approval of multiple systemic drugs for HCC by regulatory bodies worldwide. Although some patients responded well to ICIs, many have failed to achieve significant benefit, while others showed unexpected and paradoxical deterioration. The aim of this review is to discuss the pathophysiology of HCC, the tumour microenvironment, key clinical trials evaluating ICIs in HCC, various resistance mechanisms to ICIs, and possible ways to overcome these impediments to improve patient outcomes