Lung collapse secondary to mucus plug in a gynecologic patient after reconstructive pelvic surgery.

This is the case of a 45-year-old woman with a history of asthma and smoking who developed complete left lung and right upper lobe collapse secondary to mucus plugs that developed immediately postoperatively after an uncomplicated reconstructive pelvic surgery. This rare intraoperative complication was successfully treated in the recovery room with bedside fiber-optic bronchoscopy. This resulted in complete resolution of her pulmonary findings within 24 hours of bronchoscopy.

Endoscopic balloon dilation in the management of ureteral stricture after urogynecologic surgery: a case report.

BACKGROUND: Ureteral injuries are known complications of urogynecologic surgery. Until now, ureteral reimplantation with laparotomy has been used in cases in which ureteral stenting of distal obstruction was unsuccessful. CASE: We report a case of a 74-year-old woman with a recognized right ureteral injury after vaginal reconstructive surgery that failed ureteral stenting to relieve the obstruction and who presented with ureteral stricture and mild hydronephrosis 6 weeks postoperatively. Ureteroscopy with endoscopic balloon dilation reduced the stricture successfully. The patient remains asymptomatic, with normal renal sonogram, 6 months after the procedure. CONCLUSION: Endoscopic balloon dilation is an effective technique that can be used for the management of ureteral strictures after urogynecologic surgery and avoids further surgical intervention.

A case of a large rectovaginal mass presenting as posterior vaginal wall prolapse.

A 66-year-old female presented with symptoms suggestive of pelvic organ prolapse, history of fibroid uterus, and rectal pressure. Pelvic examination revealed a large pelvic mass filling the posterior cul-de-sac, occupying the rectovaginal septum, and compressing the rectum. There was a stage II pelvic organ prolapse of the posterior vaginal wall with distal vaginal wall extending to the hymen during valsalva. A CT scan confirmed the large pelvic mass distinct from the uterus measuring 9.4 × 9.8 × 6.2 cm. Colorectal workup revealed adenocarcinoma of colon on screening colonoscopy with biopsies. Patient underwent total abdominal hysterectomy and bilateral salpingo-oophorectomy, colon resection, and abdominal resection of the pelvic mass in the rectovaginal septum and inferior to the uterus. The patient did not require any concomitant pelvic reconstruction and the posterior vaginal wall prolapse resolved after resecting the pelvic mass.

Variant iliocaval confluence discovered during sacrocolpopexy.

BACKGROUND: Laceration of the iliac veins and their branches is a feared complication in abdominal sacral colpopexy. Hemorrhages can be extensive and difficult to control. CASE: We report a case of a patient who, while undergoing abdominal sacral colpopexy, was found to have confluence of the iliac veins at the level of the second sacral vertebra instead of the expected fourth lumbar to first sacral vertebral bodies. The intraoperative course had to be revised because of the increased risk of bleeding. The patient tolerated the procedure well and without any complications. CONCLUSION: With pelvic reconstructive surgery becoming more commonplace, knowledge of possible anomalous vessels is important because modification of planned surgical approach may be necessary to avoid short-term and long-term complications.

Role of tumor necrosis factor-alpha and TRAIL in high-dose radiation-induced bystander signaling in lung adenocarcinoma.

In the present study, ionizing radiation (IR)-induced bystander effects were investigated in two lung cancer cell lines. A549 cells were found to be more resistant to radiation-conditioned medium (RCM) obtained from A549 cells when compared with the H460 exposed to RCM procured from H460 cells. Significant release of tumor necrosis factor-alpha (TNF-alpha) was observed in A549 cells after IR/RCM exposure, and the survival was reversed with neutralizing antibody against TNF-alpha. In H460 cells, significant release of TNF-related apoptosis-inducing ligand (TRAIL), but not TNF-alpha, was observed in response to IR, RCM exposure, or RCM + 2Gy, and neutralizing antibody against TRAIL diminished clonogenic inhibition. Mechanistically, TNF-alpha present in RCM of A549 was found to mediate nuclear factor-kappaB (NF-kappaB) translocation to nucleus, whereas the soluble TRAIL present in RCM of H460 cells mobilized the nuclear translocation of PAR-4 (a proapoptotic protein). Analysis of IR-inducible early growth response-1 (EGR-1) function showed that EGR-1 was functional in A549 cells but not in H460 cells. A significant decrease in RCM-mediated apoptosis was observed in both A549 cells stably expressing small interfering RNA EGR-1 and EGR-1(-/-) mouse embryonic fibroblast cells. Thus, the high-dose IR-induced bystander responses in A549 may be dependent on the EGR-1 function and its target gene TNF-alpha. These findings show that the reduced bystander response in A549 cells is due to activation of NF-kappaB signaling by TNF-alpha, whereas enhanced response to IR-induced bystander signaling in H460 cells was due to release of TRAIL associated with nuclear translocation of PAR-4.