ABSTRACT
Gastroduodenal intussusception is a rare presentation in adults. A mass lesion in the stomach typically acts as a lead point that invaginates into the pylorus and duodenum causing intussusception. In a subset of these cases, episodic symptoms of obstruction occur because of intermittent prolapse of the lesion, termed "ball-valve syndrome." We present a 73-year-old woman with intermittent abdominal pain and nausea who was discovered to have gastroduodenal intussusception secondary to a large prolapsing fundic adenoma through the pylorus and into the duodenum. The case highlights this rare complication from gastric lesions along with the importance of surgical intervention for definitive management.
ABSTRACT
Intestinal transplant is an uncommon treatment of intestinal failure that has provided many patients with reduced morbidity and mortality. However, there are associated risks, including an increased risk of cancer, such as posttransplant lymphoproliferative disorder and solid-organ malignancy. Here, we report a unique case of primary jejunal adenocarcinoma presenting initially only with axillary lymphadenopathy in a patient with recurrent posttransplant lymphoproliferative disorder after multiple solid-organ transplants, including small intestine and 2 renal transplants.
ABSTRACT
Esophageal fistula to the respiratory tract and mediastinum is a well-described complication from esophageal malignancies. Spinal-esophageal fistula (SEF) on the other hand is a much rarer complication that has only been reported in few instances. Here, we report a unique case of fatal spinal-esophageal fistula with an associated pneumocephalus in an 83-year-old woman with metastatic esophageal squamous cell carcinoma.
ABSTRACT
Background and study aims Argon plasma coagulation (APC) is an effective and safe modality for many gastrointestinal conditions requiring hemostasis and/or ablation. However, it can be quite costly. A potentially more cost-effective alternative is snare-tip spray coagulation (SC). This study aimed to determine whether SC would be a safe and effective alternative to APC using an ex-vivo model. Methods Using two resected porcine stomach, 36 randomized gastric areas were ablated for 2 seconds with either APC at 1.0âL/min 20âW (APC20) and 1.4âL/min 40âW (APC40) or SC with Effect 2 60âW (SC60) and 80âW (SC80) from 3âmm. Extent of tissue injury was then analyzed histopathologically. Results The mean coagulation depth was 790â±â159âµm and 825â±â467âµm for SC60 (nâ=â9) and SC80 (nâ=â8), respectively. This was compared to 539â±â151âµm for APC20 (nâ=â8) and 779â±â267âµm for APC40 (nâ=â9). Mean difference (MD) in coagulation depth between SC60 and APC40 was 12âµm (95â% confidence interval [CI], -191 to 214 µm; P â=â0.91) and was 47âµm (95â%CI, -162 to 255 µm; P â=â0.81) between SC80 and APC40.âThere was a greater depth of injury with APC40 (MD, 240 µm; 95â%CI, 62 to 418âµm; P â=â0.04) and with SC60 (MD, 252âµm; 95â%CI, 141 to 362âµm; P â=â0.004) when compared to APC20. Mean cross-sectional area of coagulation was 2.39â±â0.852 mm² for SC60 and 2.54â±â1.83âmm² for SC80 compared to 1.22â±â0.569 mm² for APC20 and 1.99â±â0.769âmm² for APC40.âSeventy-eight percent reached the muscularis mucosa (MM) and 11â% the submucosa in the SC60 group compared to 50â% and 38â% in SC80 and 56â% and 11â% in APC40, respectively. Thirty-eight percent of APC20 specimens reached the MM. The muscularis propria was unaffected. Conclusions This small ex-vivo study suggests that SC60 and SC80 may be safe alternatives to APC40 with comparable coagulation depths and area effects.
ABSTRACT
The RET receptor tyrosine kinase (RTK) contributes to kidney and nervous system development, and is implicated in a number of human cancers. RET is expressed as two protein isoforms, RET9 and RET51, with distinct interactions and signaling properties that contribute to these processes. RET isoforms are internalized from the cell surface into endosomal compartments in response to glial cell line-derived neurotropic factor (GDNF) ligand stimulation but the specific mechanisms of RET trafficking remain to be elucidated. Here, we used total internal reflection fluorescence (TIRF) microscopy to demonstrate that RET internalization occurs primarily through clathrin coated pits (CCPs). Activated RET receptors colocalize with clathrin, but not caveolin. The RET51 isoform is rapidly and robustly recruited to CCPs upon GDNF stimulation, while RET9 recruitment occurs more slowly and is less pronounced. We showed that the clathrin-associated adaptor protein complex 2 (AP2) interacts directly with each RET isoform through its AP2 µ subunit, and is important for RET internalization. Our data establish that interactions with the AP2 complex promote RET receptor internalization via clathrin-mediated endocytosis but that RET9 and RET51 have distinct internalization kinetics that may contribute to differences in their biological functions.