Laparoscopic Resection of Para-Aortic Mass at the Aortic Bifurcation: An Atypical Presentation of a Tailgut Cyst.

We review the case of a 43-year-old white male who presented with an enlarging pulsatile mass in the periumbilical region. Diagnostic imaging revealed an 8-cm heterogeneous mass abutting the left iliac artery at the aortic bifurcation. Due to the patient's persistently elevated blood pressure and elevated serum and urine catecholamines, a neuroendocrine tumor was suspected. Laparoscopic resection was performed and was well tolerated. However, the mass was characterized as a tailgut cyst upon pathological examination. This case highlights the utility of laparoscopy for the removal of large para-aortic masses, which can be achieved in a safe fashion by an experienced surgeon. In addition, this case highlights the importance of differential diagnoses in surgeries due to the occurrence of unexpected outcomes.

A sustainable metal-free and additive-free olefination route to N-heteroazaarenes from methyl-substituted heterocycles and amines.

A green and sustainable metal-free, additive-free olefination approach is proposed for the facile synthesis of various unsaturated N-heteroazaarenes from simple methyl-substituted heteroarenes and amines. The developed protocol employs only air as the sole oxidant and provides a useful strategy for obtaining various E-selective conjugated heterocyclic olefins. This provides a useful strategy for application in generating grams of a variety of unsaturated N-heteroazaarenes (up to 20.33 grams) and the synthetic imaging agents of STB-8 (2.40 gram) with high regioselectivity in one pot.

Construction of Trisubstituted Hydrazones via Base-Mediated Cascade Condensation N-Alkylation.

A practical base-promoted tandem condensation N-alkylation reaction for the formation of trisubstituted hydrazones has been developed employing aldehydes and hydrazines with alkyl halides. Crucially, this reaction successfully overcomes chemoselectivity problems, allowing for the reaction of multiple components in a one-pot manner. Halo- and heterofunctional groups, as well as free hydroxyl and amino groups, are tolerated in this transformation to produce a wide range of trisubstituted hydrazones in good to excellent yields.

Emergent laparoscopic surgical intervention for perforated hemorrhagic cholecystitis with hemodynamic instability.

Hemorrhagic cholecystitis is a rare diagnosis that closely mimics acute cholecystitis. Physical examination, laboratory studies and, in particular, computed tomography imaging allow for rapid diagnosis, stabilization and emergent surgical intervention. We describe our experience with three patients requiring emergent surgical intervention for hemorrhagic cholecystitis with unique clinical features including decreased platelet function due to liver cirrhosis, dual antiplatelet therapy and intraoperative finding of cholecystohepatic communication. Furthermore, we provide video recordings of two cases highlighting the severity of the disease. All presented patients were hemodynamically unstable and showed peritoneal signs on exam. Laboratory studies revealed moderate anemia and leukocytosis, while computed tomography suggested hemorrhage in the gallbladder. All patients required blood transfusions during their care and underwent laparoscopic cholecystectomy. Hemoperitoneum and gallbladder perforation were confirmed intraoperatively. Patients fully recovered without significant postoperative complications due to expedited operative management.

The controlled synthesis of nitrogen and iron co-doped Ni3S2@NiP2 heterostructures for the oxygen evolution reaction and urea oxidation reaction.

At present, global resources are nearly exhausted and environmental pollution is becoming more and more serious, so it is urgent to develop efficient catalysts for hydrogen production. Herein, nitrogen and iron co-doped Ni3S2 and NiP2 heterostructures with high efficiency oxygen evolution reaction (OER) and urea oxidation reaction (UOR) performances were firstly successfully prepared on nickel foam by hydrothermal and high-temperature calcination methods. Benefiting from the hierarchical structure, the exposure of more active sites and the doping effect of N and Fe, the N-Fe-Ni3S2@NiP2/NF material showed excellent electrocatalytic activity for the OER and UOR. The N-Fe-Ni3S2@NiP2/NF material displays excellent catalytic OER performance; the overpotential is only 251 mV to drive 100 mA cm-2 current density, while for the UOR, the potential is only 1.353 V to drive 100 mA cm-2 current density, which is one of the best catalytic activities reported so far. It is worth noting that scanning electron microscopy showed that the surface of N-Fe-Ni3S2@NiP2/NF is rough and has some mesopores, which may have resulted in an increase of active sites during the electrocatalytic process. The N-Fe-Ni3S2@NiP2/NF electrode couple also has relatively long-term durability in alkaline solutions, maintaining a stable current density for 15 h at 1.35 V. The density functional theory (DFT) calculation shows that the in situ generated Fe doped nanooxides exhibit strong water adsorption energy, which may be one of the reasons for the good catalytic activity. Our work is conducive to the rational design of electrocatalysts for efficient hydrogen production from water splitting and wastewater treatment.

Single-incision laparoscopic cholecystectomy using a modified dome-down approach with conventional laparoscopic instruments.

INTRODUCTION: Single-incision laparoscopic cholecystectomy (SILC) may increase the risk of bile duct injury due to compromised operative exposure. Dome-down laparoscopic cholecystectomy provides the ability to evaluate the cystic duct circumferentially prior to its division, thus minimizing the risks of bile duct injury. This study assesses the feasibility and safety of SILC using a modified dome-down approach with all conventional laparoscopic instruments. METHODS: Three low-profile 5-mm trocars are placed via a single transumbilical incision. The two working trocars are aimed laterally via the rectus to achieve adequate triangulation. An extralong 5-mm 30º laparoscope with an L-shaped light-cord adaptor is used to yield more external working space. Cephalic liver retraction is achieved with one transabdominal suture through the gallbladder fundus. Leaving the gallbladder fundus attached to the liver bed, a window is first created between the gallbladder body and the liver. The dissection is then carried down retrograde toward the porta hepatis. A 360º view of the gallbladder-cystic duct junction is achieved prior to transecting the cystic duct. The gallbladder is then freed by separation of the fundal attachments. The specimen is retrieved by enlarging the fascial incision. All fascial defects are then primarily closed. RESULTS: Sixteen patients (mean age 31 years, mean BMI 26.3 kg/m(2)) were enrolled in this study. Thirteen had elective surgery for symptomatic cholelithiasis, and three had emergency surgery for acute cholecystitis. Mean operating time was 80.3 min, and blood loss was minimal. All patients were discharged within 24 h without complications. Follow-up at 1 month revealed a barely visible scar within the umbilicus. CONCLUSIONS: SILC using a modified dome-down approach is technically feasible with all straight instruments, and it is safe because of good delineation of ductal anatomy. Adoption of this approach may minimize the risk of bile duct injury during early experience of SILC.

Single incision laparoscopic cholecystectomy using the one-incision three-trocar technique with all straight instruments: how I do it?

Single incision laparoscopic surgery (SILS) is a novel minimally invasive surgical technique that is gaining popularity around the world. One of the most commonly performed procedures is single incision laparoscopic cholecystectomy (SILC). Most reported techniques utilize special purpose-made access port and articulating instruments, rendering the procedure costly and difficult to learn. This article provides a stepwise description of SILC technique using all straight instruments without the need for a special port. It aims to shorten the learning curve for surgeons wishing to adopt a safe and cost-effective SILC technique to their practice.

Severe pneumoperitoneum caused by infected pelvic hematoma: report of a case and review of the literature.

BACKGROUND: Pneumoperitoneum usually is caused by hollow viscus perforation with associated peritonitis. Severe pneumoperitoneum secondary to infection of a hematoma with gas-forming organisms is exceedingly rare. METHODS: Case report and literature review. RESULTS: A 43-year-old man with a history of abdominoperineal resection for rectal cancer developed abdominal distention, fever, and elevated white blood cell count after lysis of adhesions with bowel resection for recurrent small bowel obstruction. Abdominal radiography and a computed tomography scan demonstrated a large amount of free air in the peritoneal cavity. Contrary to expectations, reexploration revealed no signs of viscus perforation or anastomotic leak, but instead a large pelvic hematoma with an odor was identified and evacuated. Cultures from the hematoma yielded anaerobic gram-negative bacilli (not Bacteroides fragilis). The patient recovered uneventfully. CONCLUSION: Infected hematoma should be recognized as a cause of pneumoperitoneum after surgery. Awareness of this rare condition may prevent unnecessary surgical explorations in doubtful situations.

A distinct cause of necrotizing fasciitis: Aeromonas veronii biovar sobria.

BACKGROUND: Aeromonas veronii biovar sobria (veronii var. sobria) has not been implicated in the pathogenesis of necrotizing fasciitis in North America. METHODS: Case report and literature review. RESULTS: An 80-year-old man with diabetes mellitus and acute myeloblastic leukemia developed a rapidly spreading skin and soft tissue infection of the right lower extremity pathognomonic for necrotizing fasciitis with signs of sepsis. Cultures grew Aeromonas veronii biovar sobria. Despite aggressive management, including an urgent right below-knee amputation, this patient died of multiple organ dysfunction syndrome. CONCLUSIONS: A. veronii var. sobria should be recognized as one of the causative organisms for necrotizing fasciitis in immunocompromised patients. Early administration of proper antibiotics and aggressive surgical treatment may reduce morbidity and mortality rates in such infections.

Laparoscopic management of penetrating liver trauma: a safe intervention for hemostasis.

We describe the case of a 48-year-old woman who underwent emergent diagnostic and therapeutic laparoscopy after sustaining two self-inflicted abdominal stab wounds. After evacuation of approximately 1.5 L hemoperitoneum, a through-and-through liver injury with active bleeding was locally packed with hemostatic agents (Surgicel and Avitene) to achieve successful hemostasis. The patient also underwent systematic exploration of the abdominal cavity, which was free of associated injury. She had an uneventful recovery. This case adds to the growing evidence supporting the role of therapeutic laparoscopy in the safe management of carefully selected stable patients with penetrating abdominal trauma.

Multistage gene expression profiling in a differentially susceptible mouse colon cancer model.

The DNA alkylating agent, azoxymethane (AOM), induces tumor formation in the distal colon of susceptible mice. Differential susceptibility to this colonotropic carcinogen has been well characterized in A/J (sensitive) and AKR/J (resistant) mice. However, the reasons underlying the differential response to AOM and the molecular mechanisms involved in colon tumor progression remain unclear. To address these issues, we used a cDNA microarray approach to determine time-related changes in gene expression patterns in A/J and AKR/J colons following carcinogen treatment. In the present study, mice were injected intraperitoneally with either AOM (10mg/kg body weight once a week for 6 weeks) or 0.9% NaCl solution (vehicle controls). Total RNA was isolated from the distal colons at 1, 4, and 24 weeks post-AOM exposure. RNA was reverse transcribed and cDNA samples labeled with Cy3 and Cy5 were hybridized to a glass chip containing 4608 mouse cDNA duplicate clones. The resulting mRNA expression levels were analyzed using GLEAMS 3.0, a Unix/Linux-based software program. Genes with more than twofold variations in expression levels were considered significant. Further clustering analysis was performed based on gene expression patterns at different time points using a novel adaptive centroid algorithm (ACA). Of the 4608 genes, 118 clustered into 11 significant groups that displayed similar and distinct expression patterns between the strains following carcinogen treatment. Nine clusters were selected for further analysis based on their divergence in response between A/J and AKR/J and their potential role in tumorigenesis. Overall, our data indicate time- and strain-specific genetic alterations during different stages of colon tumorigenesis following AOM treatment.

Suppression of kinesin expression disrupts adenomatous polyposis coli (APC) localization and affects beta-catenin turnover in young adult mouse colon (YAMC) epithelial cells.

Mutational inactivation of the adenomatous polyposis coli (APC) protein initiates most hereditary and sporadic colon cancers. The tumor-suppressive effect of APC is mediated by promoting degradation of the oncogenic transcriptional activator beta-catenin, and loss of APC function often results in nuclear accumulation of beta-catenin in cancer cells. APC is a nuclear-cytoplasmic shuttling protein and moves along microtubules in the cytoplasm. However, the molecular motor proteins responsible for APC translocation and the implications of APC trafficking on beta-catenin turnover are unknown. Here we show that APC protein is associated with microtubules and is colocalized with kinesin heavy chain (KHC) and beta-catenin to clusters of puncta at the tip regions of cellular extensions in a conditionally immortalized mouse colon epithelial cell line, young adult mouse colon (YAMC, APC+/+). Inhibition of KHC expression using an antisense oligonucleotide disrupts peripheral translocation of APC and induces nucleocytoplasmic accumulation of beta-catenin. These data indicate that KHC-mediated APC translocation is tightly coordinated with beta-catenin turnover in the cell.