Use of temporary tracheostomy occlusion to reduce the risk of sternal wound infection after sternotomy in congenital cardiac surgery.

OBJECTIVE: To describe a method of reducing the risk of sternal wound infection after sternotomy in children with a pre-existing tracheostomy. To report our outcomes using this method from 1 January, 2013 to 31 August, 2023. METHODS: We describe a method for temporarily occluding the tracheal stoma with a removable implant with the primary goal of reducing the risk of sternotomy wound infection by preventing soilage due to tracheostomal secretions. We then performed a retrospective review of all children who underwent temporary tracheostomal occlusion between 1 January, 2013 and 31 August, 2023 at our quaternary care children's hospital. Clinical variables were extracted from the hospital medical records. The rates of antibiotic use and minor and major complications during the period when the stoma plug was in place were recorded. RESULTS: Totally, 19 patients underwent tracheal stoma plugging prior to sternotomy and were included in our analysis. There were two cases of sternal wound infection; one case occurred while the stoma plug was in place, and one developed four days following plug removal. There was one minor complication, with one patient requiring stoma revision via serial dilation at bedside at the time of recannulation. There were no deaths. CONCLUSION: Temporary occlusion of the tracheal stoma with an impermeable plug is a viable option for reducing the risk of sternal wound infection in children with a pre-existing tracheostomy who are undergoing sternotomy.

Phylogenomic analyses of Sapindales support new family relationships, rapid Mid-Cretaceous Hothouse diversification, and heterogeneous histories of gene duplication.

Sapindales is an angiosperm order of high economic and ecological value comprising nine families, c. 479 genera, and c. 6570 species. However, family and subfamily relationships in Sapindales remain unclear, making reconstruction of the order's spatio-temporal and morphological evolution difficult. In this study, we used Angiosperms353 target capture data to generate the most densely sampled phylogenetic trees of Sapindales to date, with 448 samples and c. 85% of genera represented. The percentage of paralogous loci and allele divergence was characterized across the phylogeny, which was time-calibrated using 29 rigorously assessed fossil calibrations. All families were supported as monophyletic. Two core family clades subdivide the order, the first comprising Kirkiaceae, Burseraceae, and Anacardiaceae, the second comprising Simaroubaceae, Meliaceae, and Rutaceae. Kirkiaceae is sister to Burseraceae and Anacardiaceae, and, contrary to current understanding, Simaroubaceae is sister to Meliaceae and Rutaceae. Sapindaceae is placed with Nitrariaceae and Biebersteiniaceae as sister to the core Sapindales families, but the relationships between these families remain unclear, likely due to their rapid and ancient diversification. Sapindales families emerged in rapid succession, coincident with the climatic change of the Mid-Cretaceous Hothouse event. Subfamily and tribal relationships within the major families need revision, particularly in Sapindaceae, Rutaceae and Meliaceae. Much of the difficulty in reconstructing relationships at this level may be caused by the prevalence of paralogous loci, particularly in Meliaceae and Rutaceae, that are likely indicative of ancient gene duplication events such as hybridization and polyploidization playing a role in the evolutionary history of these families. This study provides key insights into factors that may affect phylogenetic reconstructions in Sapindales across multiple scales, and provides a state-of-the-art phylogenetic framework for further research.

Carbohydrate improves exercise capacity but does not affect subcellular lipid droplet morphology, AMPK and p53 signalling in human skeletal muscle.

KEY POINTS: Muscle glycogen and intramuscular triglycerides (IMTG, stored in lipid droplets) are important energy substrates during prolonged exercise. Exercise-induced changes in lipid droplet (LD) morphology (i.e. LD size and number) have not yet been studied under nutritional conditions typically adopted by elite endurance athletes, that is, after carbohydrate (CHO) loading and CHO feeding during exercise. We report for the first time that exercise reduces IMTG content in both central and peripheral regions of type I and IIa fibres, reflective of decreased LD number in both fibre types whereas reductions in LD size were exclusive to type I fibres. Additionally, CHO feeding does not alter subcellular IMTG utilisation, LD morphology or muscle glycogen utilisation in type I or IIa/II fibres. In the absence of alterations to muscle fuel selection, CHO feeding does not attenuate cell signalling pathways with regulatory roles in mitochondrial biogenesis. ABSTRACT: We examined the effects of carbohydrate (CHO) feeding on lipid droplet (LD) morphology, muscle glycogen utilisation and exercise-induced skeletal muscle cell signalling. After a 36 h CHO loading protocol and pre-exercise meal (12 and 2 g kg-1 , respectively), eight trained males ingested 0, 45 or 90 g CHO h-1 during 180 min cycling at lactate threshold followed by an exercise capacity test (150% lactate threshold). Muscle biopsies were obtained pre- and post-completion of submaximal exercise. Exercise decreased (P < 0.01) glycogen concentration to comparable levels (∼700 to 250 mmol kg-1 DW), though utilisation was greater in type I (∼40%) versus type II fibres (∼10%) (P < 0.01). LD content decreased in type I (∼50%) and type IIa fibres (∼30%) (P < 0.01), with greater utilisation in type I fibres (P < 0.01). CHO feeding did not affect glycogen or IMTG utilisation in type I or II fibres (all P > 0.05). Exercise decreased LD number within central and peripheral regions of both type I and IIa fibres, though reduced LD size was exclusive to type I fibres. Exercise induced (all P < 0.05) comparable AMPKThr172 (∼4-fold), p53Ser15 (∼2-fold) and CaMKIIThr268 phosphorylation (∼2-fold) with no effects of CHO feeding (all P > 0.05). CHO increased exercise capacity where 90 g h-1 (233 ± 133 s) > 45 g h-1 (156 ± 66 s; P = 0.06) > 0 g h-1 (108 ± 54 s; P = 0.03). In conditions of high pre-exercise CHO availability, we conclude CHO feeding does not influence exercise-induced changes in LD morphology, glycogen utilisation or cell signalling pathways with regulatory roles in mitochondrial biogenesis.

A systematic review and meta-analysis of disease severity and risk of recurrence in young versus elderly patients with left-sided acute diverticulitis.

Young patients are thought to have a more severe disease course and a higher rate of recurrent diverticulitis. However, these understandings are mainly based on studies with important limitations. This review aimed to clarify the true natural history of acute diverticulitis in young patients compared to elderly patients. PubMed and MEDLINE were searched for studies reporting outcomes on disease severity or recurrences in young and elderly patients with a computed tomography-proven diagnosis of acute diverticulitis. Twenty-seven studies were included. The proportion of complicated diverticulitis at presentation (21 studies) was not different for young patients (age cut-off 40-50 years) compared to elderly patients [risk ratio (RR) 1.19; 95% confidence interval 0.94-1.50]. The need for emergency surgery (11 studies) or percutaneous abscess drainage (two studies) yielded comparable results for both groups with a RR of 0.93 (95% confidence interval 0.70-1.24) and 1.65 (95% confidence interval 0.60-4.57), respectively. Crude data on recurrent diverticulitis rates (12 studies) demonstrated a significantly higher RR of 1.47 (95% confidence interval 1.20-1.80) for young patients. Notably, no association between age and recurrent diverticulitis was found in the studies that used survival analyses, taking length of follow-up per age group into account. In conclusion, young patients do not have a more severe course of acute diverticulitis. Published data on the risk of recurrent diverticulitis in young patients are conflicting, but those with the most robust design do not demonstrate an increased risk. Therefore, young patients should not be treated more aggressively nor have a lower threshold for elective surgery just because of their age.

Microplastics Can Change Soil Properties and Affect Plant Performance.

Microplastics can affect biophysical properties of the soil. However, little is known about the cascade of events in fundamental levels of terrestrial ecosystems, i.e., starting with the changes in soil abiotic properties and propagating across the various components of soil-plant interactions, including soil microbial communities and plant traits. We investigated here the effects of six different microplastics (polyester fibers, polyamide beads, and four fragment types: polyethylene, polyester terephthalate, polypropylene, and polystyrene) on a broad suite of proxies for soil health and performance of spring onion ( Allium fistulosum). Significant changes were observed in plant biomass, tissue elemental composition, root traits, and soil microbial activities. These plant and soil responses to microplastic exposure were used to propose a causal model for the mechanism of the effects. Impacts were dependent on particle type, i.e., microplastics with a shape similar to other natural soil particles elicited smaller differences from control. Changes in soil structure and water dynamics may explain the observed results in which polyester fibers and polyamide beads triggered the most pronounced impacts on plant traits and function. The findings reported here imply that the pervasive microplastic contamination in soil may have consequences for plant performance and thus for agroecosystems and terrestrial biodiversity.

Isx9 Regulates Calbindin D28K Expression in Pancreatic ß Cells and Promotes ß Cell Survival and Function.

Pancreatic ß-cell dysfunction and death contribute to the onset of diabetes, and novel strategies of ß-cell function and survival under diabetogenic conditions need to be explored. We previously demonstrated that Isx9, a small molecule based on the isoxazole scaffold, drives neuroendocrine phenotypes by increasing the expression of genes required for ß-cell function and improves glycemia in a model of ß cell regeneration. We further investigated the role of Isx9 in ß-cell survival. We find that Isx9 drives the expression of Calbindin-D28K (D28K), a key regulator of calcium homeostasis, and plays a cytoprotective role through its calcium buffering capacity in ß cells. Isx9 increased the activity of the calcineurin (CN)/cytoplasmic nuclear factor of the activated T-cells (NFAT) transcription factor, a key regulator of D28K, and improved the recruitment of NFATc1, cAMP response element-binding protein (CREB), and p300 to the D28K promoter. We found that nutrient stimulation increased D28K plasma membrane enrichment and modulated calcium channel activity in order to regulate glucose-induced insulin secretion. Isx9-mediated expression of D28K protected ß cells against chronic stress induced by serum withdrawal or chronic inflammation by reducing caspase 3 activity. Consequently, Isx9 improved human islet function after transplantation in NOD-SCID mice in a streptozotocin-induced diabetes model. In summary, Isx9 significantly regulates expression of genes relevant to ß cell survival and function, and may be an attractive therapy to treat diabetes and improve islet function post-transplantation.

Ultrasound-guided reduction of an incarcerated obturator hernia in an elderly patient.

Obturator hernia is a rare but clinically relevant cause of intestinal obstruction, usually found in elderly, thin, multiparous women. It is difficult to diagnose, leading to diagnostic delay with a high incidence of strangulation and a high mortality rate. Surgery is the only reported treatment. We report the case of an 86-year-old woman, in whom an early diagnosis of incarcerated obturator hernia was made with subsequent reduction by compression with an ultrasound transducer. When the risk of strangulation is presumed to be low, ultrasound-guided reduction of an obturator hernia is achievable and worth considering.

Effect of land-use changes on the abundance, distribution, and host-seeking behavior of Aedes arbovirus vectors in oil palm-dominated landscapes, southeastern Côte d'Ivoire.

BACKGROUND: Identifying priority areas for vector control is of considerable public health relevance. Arthropod-borne viruses (arboviruses) spread by Aedes mosquitoes are (re)emerging in many parts of the tropics, partially explained by changes in agricultural land-use. We explored the effects of land-use changes on the abundance, distribution, and host-seeking behavior of Aedes mosquitoes along a gradient of anthropogenic disturbance in oil palm-dominated landscapes in southeastern Côte d'Ivoire. METHODOLOGY: Between January and December 2014, eggs, larvae, pupae, and adults of Aedes mosquitoes were sampled in four types of macrohabitats (rainforest, polyculture, oil palm monoculture, and rural housing areas), using standard procedures (bamboo-ovitraps, metallic-ovitraps, larval surveys, and human-baited double-net traps). Immature stages were reared and adult mosquitoes identified at species level. PRINCIPAL FINDINGS: A total of 28,276 Aedes specimens belonging to 11 species were collected. No Aedes-positive microhabitat and only four specimens of Ae. aegypti were found in oil palm monoculture. The highest abundance of Aedes mosquitoes (60.9%) was found in polyculture, while the highest species richness (11 species) was observed in rainforest. Ae. aegypti was the predominant Aedes species, and exhibited high anthropophilic behavior inflicting 93.0% of total biting to humans. The biting rate of Aedes mosquitoes was 34.6 and 7.2-fold higher in polyculture and rural housing areas, respectively, compared to rainforest. Three species (Ae. aegypti, Ae. dendrophilus, and Ae. vittatus) bit humans in polyculture and rural housing areas, with respective biting rates of 21.48 and 4.48 females/person/day. Unexpectedly, all three species were also feeding during darkness. Aedes females showed bimodal daily feeding cycles with peaks at around 08:00 a.m. and 05:00 p.m. Host-seeking activities were interrupted between 11:00 a.m. and 02:00 p.m. in rural housing areas, while no such interruption was observed in polyculture. Some rainforest-dwelling Aedes species displayed little preference to feed on humans. CONCLUSIONS: In southeastern Côte d'Ivoire, the agricultural land-use/land-cover changes due to the conversion of rainforest into oil palm monocultures influence the abundance, distribution, and host-seeking behaviors of anthropophagic and non-anthropophagic Aedes vectors. As a result, there is higher risk of humans to arbovirus transmission in polyculture and rural housing areas. There is a need for integrated vector management, including landscape epidemiology and ecotope-based vector control.

In vivo biomechanical evaluation of a novel angle-stable interlocking nail design in a canine tibial fracture model.

OBJECTIVE: To compare clinical outcome and callus biomechanical properties of a novel angle stable interlocking nail (AS-ILN) and a 6 mm bolted standard ILN (ILN6b) in a canine tibial fracture model. STUDY DESIGN: Experimental in vivo study. ANIMALS: Purpose-bred hounds (n = 11). METHODS: A 5 mm mid-diaphyseal tibial ostectomy was stabilized with an AS-ILN (n = 6) or an ILN6b (n = 5). Orthopedic examinations and radiographs were performed every other week until clinical union (18 weeks). Paired tibiae were tested in torsion until failure. Callus torsional strength and toughness were statistically compared and failure mode described. Total and cortical callus volumes were computed and statistically compared from CT slices of the original ostectomy gap. Statistical significance was set at P < .05 RESULTS: From 4 to 8 weeks, lameness was less pronounced in AS-ILN than ILN6b dogs (P < .05). Clinical union was reached in all AS-ILN dogs by 10 weeks and in 3/5 ILN6b dogs at 18 weeks. Callus mechanical properties were significantly greater in AS-ILN than ILN6b specimens by 77% (failure torque) and 166% (toughness). Failure occurred by acute spiral (control and AS-ILN) or progressive transverse fractures (ILN6b). Cortical callus volume was 111% greater in AS-ILN than ILN6b specimens (P < .05). CONCLUSIONS: Earlier functional recovery, callus strength and remodeling suggest that the AS-ILN provides a postoperative biomechanical environment more conducive to bone healing than a comparable standard ILN.

[Uterine fibroids complicated by haematometra]. / Hematometra als complicatie bij uterus myomatosus.

BACKGROUND: Uterine fibroids are common, benign tumours of the myometrium. The clinical symptoms include menorrhagia, abdominal pain and subfertility. CASE DESCRIPTION: A 37-year-old black woman known to have uterine fibroids presented at the gynaecology outpatient clinic with abdominal pain. Ultrasonography and an MRI scan revealed haematometra caused by an obstructive myoma, which was drained during a hysteroscopy. The patient was subsequently treated with gonadotrophin-releasing hormone (GnRH) agonist in order to reduce the myoma. Resection of the myoma will take place sometime in the future. CONCLUSION: Haematometra is an accumulation of blood in the uterine cavity. It is a rare complication of uterine fibroids and causes abdominal pain and enlargement of the uterus. Amenorrhoea is often a finding because an adequate outflow of menstrual blood is no longer possible. The primary treatment is to drain the haematometra; a subsequent myomectomy should be performed.

Ultrasound of colon diverticulitis.

Overall, the diagnosis of diverticulitis is more reliably made by computed tomography (CT) than by ultrasound (US). However, since US is often used as a first modality in acute abdomen, it is important to be aware of the US signs of diverticulitis. Besides, in not too obese patients, US may be superior to CT. US is most useful in early, uncomplicated diverticulitis. Daily, repeated US examinations in patients with diverticulitis have taught that diverticulitis, in the majority of cases, runs a predictable and benign course. Initially, there is local wall thickening of the colon with preservation of the US layer structure. Within the inflamed diverticulum, a fecolith is present, and the diverticulum is surrounded by hyperechoic, noncompressible tissue, which represents the inflamed mesentery and omentum 'sealing off' the imminent perforation. US follow-up shows evacuation of the fecolith to the colonic lumen, with or without the transient development of a small paracolic abscess, sometimes with disintegration of the fecolith. This process of spontaneous evacuation of pus and fecolith via local weakening of the colonic wall at the level of the original diverticular neck towards the colonic lumen takes place within 1 or 2 days, rarely longer. The residual inflammatory changes remain present for several days after the evacuation, and it is not uncommon to find an empty diverticulum at first presentation. If, in such cases, patients are specifically asked for their symptoms, they invariably declare that 'the worst pain is over'. Whenever diverticulitis takes a complicated course, CT is superior to US, especially in the detection of free air, fecal peritonitis and deeply located abscesses, and in general in obese patients. Finally, US, if necessary followed by CT, has an important role in the diagnosis of alternative conditions: ureterolithiasis, pyelonephritis, perforated peptic ulcer, appendicitis, Crohn's disease, epiploic appendagitis, gynecological conditions, colonic malignancy, pancreatitis, etc. Right-sided colonic diverticulitis in many respects differs from its left-sided cousin. Diverticula of the right colon are usually congenital, solitary, true diverticula containing all bowel wall layers. The fecoliths within these diverticula are larger and the diverticular neck is wider. There is no hypertrophy of the muscularis of the right colonic wall. My observations with US and CT in 110 patients with right colonic diverticulitis clearly show that it invariably has a favorable course and never leads to free perforation or large abscesses. Although relatively rare (left:right = 15:1), it is crucial to make a correct diagnosis since the clinical symptoms of acute right lower quadrant pain may lead to an unnecessary appendectomy or even right hemicolectomy.

[Guideline on diagnosis and treatment of acute appendicitis: imaging prior to appendectomy is recommended]. / Richtlijn voor diagnostiek en behandeling van acute appendicitis. Beeldvorming vóór appendectomie aanbevolen.

Every year, over 2500 unnecessary appendectomies are carried out in the Netherlands. At the initiative of the Dutch College of Surgeons, the evidence-based guideline on the diagnosis and treatment of acute appendicitis was developed. This guideline recommends that appendectomy should not be carried out without prior imaging. Ultrasonography is the recommended imaging technique in patients with suspected appendicitis. After negative or inconclusive ultrasonography, a CT scan can be carried out. Appendectomy is the standard treatment for acute appendicitis; this can be done either by open or laparoscopic surgery. The first choice treatment of appendicular infiltrate is conservative treatment.

[Guideline on diagnosis and treatment of acute appendicitis: imaging prior to appendectomy is recommended]. / Richtlijn voor diagnostiek en behandeling van acute appendicitis: beeldvorming vóór appendectomie aanbevolen.

Every year, over 2500 unnecessary appendectomies are carried out in the Netherlands. At the initiative of the Dutch College of Surgeons, the evidence-based guideline on the diagnosis and treatment of acute appendicitis was developed. This guideline recommends that appendectomy should not be carried out without prior imaging. Ultrasonography is the recommended imaging technique in patients with suspected appendicitis. After negative or inconclusive ultrasonography, a CT scan can be carried out. Appendectomy is the standard treatment for acute appendicitis; this can be done either by open or laparoscopic surgery. The first choice treatment of appendicular infiltrate is conservative treatment.

Addressable bipartite molecular hook (ABMH): immobilized hairpin probes with sensitivity below 50 fM.

Sensitivity and specificity of nucleic acid binding probes immobilized on solid supports are essential features of microarrays. Whereas conventional biochips apply nonquenched linear probes (cDNA, oligonucleotides), hairpin structures containing a fluorophore-quencher system comprise important prerequisites required for ideal transcriptional probes. We describe here the generation of addressable bipartite molecular hook (ABMH) probes and the characterization of their performance analyzing biological and clinical samples, also in comparison to linear oligonucleotide arrays. ABMH can be immobilized subsequent to reaction with the target sequence or the reaction carried out directly with the immobilized probe; target sequences are recognized with excellent sensitivity, specificity, and a detection limit below 50 fM. Due to excellent sensitivity and specificity, ABMH represent ideal candidates for the nonamplified microarray-based detection of low abundance nucleic acids, e.g., required in diagnostic assays.

In vitro evaluation of the effect of fracture configuration on the mechanical properties of standard and novel interlocking nail systems in bending.

OBJECTIVE: To investigate the effect of fracture configuration on the mechanical properties of standard interlocking nails (ILNs) and a novel angle-stable ILN (ILNn) in bending. STUDY DESIGN: In vitro experimental study. SAMPLE POPULATION: Synthetic tibial gap fracture bone models. METHODS: Bone models, featuring a 5 or 120 mm central defect, respectively, mimicking a simple diaphyseal and a comminuted fracture involving both metaphyses, were implanted with 6 or 8 mm screwed or bolted standard ILNs (ILN6s, ILN6b, ILN8s, ILN8b, respectively) or an ILNn. Specimens were tested in 4-point bending. Construct angular deformation (AD) and slack were statistically compared (P<.05). RESULTS: With increasing gap size, standard ILN construct AD increased significantly by approximately 27% in ILN8b and by up to 105% in ILN6s. Similarly, standard ILN construct slack significantly increased by approximately 33% in ILN8b (from approximately 4.2 degrees to approximately 5.6 degrees) and by up to approximately 130% in ILN6s (from approximately 7 degrees to approximately 16 degrees). Conversely, there was no difference in the ILNn construct AD (approximately 4 degrees) regardless of gap size. ILNn AD was the lowest of all groups and occurred without slack. CONCLUSIONS: This study demonstrated that the angle-stable ILNn provided construct stability regardless of fracture configuration, whereas the intrinsic slack of standard ILNs could jeopardize construct stability in a fracture configuration involving the metaphyses. CLINICAL RELEVANCE: Use of standard ILNs may be optimal in diaphyseal fractures where circumferential nail/cortical contact could augment repair stability. Conversely, the angle-stable ILNn may represent a reliable fracture stabilization method for diaphyseal fractures as well as fractures involving the metaphyseal regions.

Long-term safety of left renal vein division and ligation to expedite complex abdominal aortic surgery.

BACKGROUND: Left renal vein division and ligation (LRVDAL) is performed to facilitate complex abdominal aortic surgery. Surgeons restore continuity of the vein due to concern that ligation could cause renal compromise or hematuria. However, we report the short and long-term safety of left renal vein division and ligation. METHOD: Between 1992 and 2007, we divided the left renal vein in 56 patients (40 males, 16 females) ages 57 to 84 (average 74-years-old) who were treated for aortic occlusive disease (9) or abdominal aortic aneurysm (47). Patients requiring concomitant renal artery reconstruction were excluded from this review. Suprarenal cross-clamp was used in 51 patients with temporary vessel-loop control of the renal arteries. Creatinine (Cr) and glomerular filtration rates (eGFR) were measured pre-, post-, and long-term after surgery. Outpatient records of all patients that had survived more than 12 months were also reviewed in order to evaluate the late effects on renal function or symptoms possibly related to LRVDAL. RESULTS: Median procedure duration was 157 (61-375) minutes. Median cross-clamp time was 16 (10-45) minutes. Median intensive care unit (ICU) and hospital length of stays were 2 (1-11) days and 7 (4-58) days, respectively. There were no deaths. There were no complications directly related to renal vein ligation. Hematuria, seen in 2 patients, was a result of traumatic insertion of a Foley catheter. Median pre-op and discharge Cr levels were 1.1 mg/dL (0.7-2.4 mg/dL) and 1.1 mg/dL (0.6-2.1 mg/dL), respectively (P < .5). Median change in Cr was 0.0 mg/dL and only increased in 14 patients (maximum increase 0.9 mg/dL). Median pre-op and discharge eGFR was 61 mL/minute (28-137 mL/minute/1.73 m2) and 67 mL/minute (32-138 mL/minute/1.73 m2), respectively (P < .5). Cr and eGFR in the 2 patients with a Cr of >2.0 mg/dL remained unchanged post-op. Only 2 patients with a Cr of <2.0 mg/dL had a post-op Cr >2.0 mg/dL and both returned to normal by day 3 post-op. Thirty-six patients have been followed for more than a year (median 34.5 months, maximum 144 months) and Cr has remained stable in all but 2 patients. These 2 patients, both with a pre-op Cr of 1.5 mg/dL, subsequently developed Cr levels of 2.1 mg/dL and 2.4 mg/dL but maintained baseline Cr levels for 25 and 34 months, respectively, before demonstrating these elevated levels which have proven to be unrelated to renal vein ligation. Hematuria and flank pain have never been recorded after discharge. CONCLUSION: Restoration of left renal vein continuity after LRVDAL may be unnecessary since renal compromise and hematuria was not encountered in this long-term analysis.

Endometriosis of the posterior cul-de-sac: clinical presentation and findings at transvaginal ultrasound.

OBJECTIVE: The purpose of our study was to evaluate the clinical findings and transvaginal ultrasound features of posterior cul-de-sac endometriosis. MATERIALS AND METHODS: A retrospective search of cases over a 13-year period was performed and yielded 25 patients with posterior cul-de-sac endometriosis. The diagnosis of posterior cul-de-sac endometriosis was confirmed by histology (n = 13), conventional barium enema (n = 13), colonoscopy (n = 8), CT (n = 8), MRI (n = 17), diagnostic laparoscopy (n = 14), and laparotomy (n = 13). All patients underwent transvaginal and abdominal ultrasound including power Doppler examination. Two radiologists working in consensus analyzed the clinical data and reviewed the imaging studies. RESULTS: All 25 patients presented with lower abdominal pain that was cyclic in six patients. Eleven patients were unintended childless. Rectal discomfort was mentioned by 17 patients, two of whom also reported rectal blood loss. At physical examination, eight patients had a palpable mass in the posterior cul-de-sac. Transvaginal ultrasound detected one or more hypoechoic masses in the posterior cul-de-sac in all 25 patients. All masses were solid, noncompressible, and localized on the serosal surface of the rectosigmoid with sparing of mucosa and submucosa. The lesions had a rounded or ovoid shape and a mean sagittal diameter of 37 mm with vascularity. The masses had a spiculated or tethering contour in 19 patients. Abdominal ultrasound detected thick-walled adnexal cysts in 11 patients, hydronephrosis in eight, and involvement of the ileocecal region in five. CONCLUSION: Patients with endometriosis of the posterior cul-de-sac frequently present with atypical noncyclic symptoms. The transvaginal ultrasound features characteristic of posterior cul-de-sac endometriosis are a solid, often spiculated, noncompressible mass near the posterior cul-de-sac that is localized at the serosal surface of the rectosigmoid, spares the mucosa and submucosa, and is vascular.

Infection of a malignant appendiceal mucocele masquerading as an appendiceal abscess: role of preoperative sonography and CT.

We report the case of a 71-year-old lady with a suspected appendiceal abscess in whom preoperative sonography and CT demonstrated an infected appendiceal mucocele. The lesion was surgically removed and final pathologic examination revealed malignancy. Correct recognition of the mucocele prevented a potentially disastrous percutaneous drainage.

[The endocannabinoid system as a novel target for the treatment of liver fibrosis]. / Le système endocannabinoïde, une nouvelle cible pour le traitement de la fibrose hépatique.

The cannabinoid system comprises specific G protein-coupled receptors (CB1 and CB2), exogenous (marijuana-derived cannabinoids) and endogenous (endocannabinoids) ligands, and a machinery dedicated to endocannabinoid synthesis and degradation. Studies over two decades have extensively documented the crucial role of the cannabinoid system in the regulation of a variety of pathophysiological conditions. However, its role in liver pathology has only been recently unravelled, probably given the low expression of CB1 and CB2 in the normal liver. We have recently demonstrated that CB1 and CB2 receptors display opposite effects in the regulation of liver fibrogenesis during chronic liver injury. Indeed, both receptors are up-regulated in the liver of cirrhotic patients, and expressed in liver fibrogenic cells. Moreover, CB1 receptors are profibrogenic and accordingly, the CB1 antagonist rimonabant reduces fibrosis progression in three experimental models. In keeping with these results, daily cannabis smoking is a risk factor for fibrosis progression in patients with chronic hepatitis C. In contrast, CB2 display antifibrogenic effects, by a mechanism involving reduction of liver fibrogenic cell accumulation. These results may offer new perspectives for the treatment of liver fibrosis, combining CB2 agonist and CB1 antagonist therapy.