Idiopathic Pneumatosis Intestinalis Requiring Decompressive Laparotomy.

INTRODUCTION: Pneumatosis intestinalis (PI) and hepatic portal venous gas (HPVG) are radiographic signs of questionable bowel ischemia. Pneumatosis intestinalis can be associated with possible benign conditions such as obstructive airway disease. We present a patient who demonstrated clinical signs of overt sepsis with corresponding radiological findings of PI and HPVG concering for possible small or large bowel ischemia. However at exploration, no sign of small or large bowel injury or ischemia could be detected. CASE PRESENTATION: A 36-year-old male with a history of alcohol abuse presented to Danbury Hospital as a trauma alert after he slid on his motorcycle. He had a complete transection of the thoracic spinal cord which required multilevel laminectomies and a spinal fusion. He developed overt signs of sepsis with vital signs of a temperature of 38.5 degrees C (101.4 degrees F), heart rate of 141 bpm, white blood cell (WBC) count of 24.7 c/mcL, and lactic acid of 2.4 mg/dL. A CT scan of the abdomen and pelvis revealed a pneumatosis and hepatic portal venous gas. An exploratory laparotomy was performed which showed distended small bowel, but no evidence for ischemia or injury. An ABthera Open Abdomen Negative Pressure Therapy System (Kinetic Concepts, Inc., San Antonio, TX) was placed due to the fact that the abdominal wall could not be closed. A second look laparotomy revealed no injury or ischemia, and the patient's abdomen was closed primarily. CONCLUSION: Pneumatosis intestinalis and hepatic portal venous gas are radiographic findings that can be associated with bowel ischemia. The clinical status of the patient should guide operative management. There is no evidence to suggest that there is an association with spinal trauma and pneumatosis intestinalis or hepatic portal venous gas.

HIV-1 capsid-targeting domain of cleavage and polyadenylation specificity factor 6.

The antiviral factor CPSF6-358 restricts human immunodeficiency virus type 1 (HIV-1) infection through an interaction with capsid (CA), preventing virus nuclear entry and integration. HIV-1 acquires resistance to CPSF6-358 through an N74D mutation of CA that impairs binding of the antiviral factor. Here we examined the determinants within CPSF6-358 that are necessary for CA-specific interaction. Residues 314 to 322 include amino acids that are essential for CPSF6-358 restriction of HIV-1. Fusion of CPSF6 residues 301 to 358 to rhesus TRIM5α is also sufficient to restrict wild-type but not N74D HIV-1. Restriction is lost if CPSF6 residues in the amino acid 314 to 322 interaction motif are mutated. Examination of the CA targeting motif in CPSF6-358 did not reveal evidence of positive selection. Given the sensitivity of different primate lentiviruses to CPSF6-358 and apparent conservation of this interaction, our data suggest that CPSF6-358-mediated targeting of HIV-1 could provide a broadly effective antiviral strategy.

Perioperative Risks of Untreated Obstructive Sleep Apnea in the Bariatric Surgery Patient: a Retrospective Study.

BACKGROUND: The use of continuous positive airway pressure (CPAP) perioperatively in bariatric surgery patients with obstructive sleep apnea (OSA) has been controversial. Although studies have demonstrated that CPAP use is safe in bariatric patients, prior studies have not shown improvement in outcomes in these patients. METHODS: A retrospective review of patients who underwent bariatric surgery from 2005 to 2009 was performed. All patients underwent polysomnography preoperatively. Patient age, sex, BMI, comorbidities, polysomnogram data, type of bariatric procedure, length of hospital stay, and postoperative complications were reviewed. The Fisher exact test was used for statistical analysis. RESULTS: Among the 352 patients studied, 47 with apnea-hypopnea index (AHI) ≥5 did not receive CPAP postoperatively. A total of 7/47 (14.9 %) developed postoperative pulmonary complications. There were no non-pulmonary complications. Some 9/305 (2.95 %) with CPAP developed pulmonary complications. There were 26/305 patients with all-cause complications (8.52 %). The AHI was higher in the group receiving treatment. There was a statistically significant difference in pulmonary complications between patients with and those without treatment (p value 0.0002). The average length of stay was 3.0 and 3.2 days in treatment and comparison groups, respectively, a difference that did not reach statistical significance. CONCLUSIONS: Patients who did not receive CPAP postoperatively developed more pulmonary complications than those with CPAP, suggesting that CPAP might be beneficial in decreasing pulmonary complications in patients undergoing bariatric surgery. However, further investigation is warranted to better delineate other risk factors due to small sample size in our study group.