BACKGROUND Upper gastrointestinal fishbone microperforations are rare and not commonly reported in medical literature.Despite the increasing use of computer tomography(CT)imaging and the employment of the Alvardo crit...BACKGROUND Upper gastrointestinal fishbone microperforations are rare and not commonly reported in medical literature.Despite the increasing use of computer tomography(CT)imaging and the employment of the Alvardo criteria,misdiagnosis of acute appendicitis can still occur.We report the rare case of an elderly Chinese gentleman who had a fish-bone induced microperforation of the duodenum that closely mimicked the symptoms of acute appendicitis.CASE SUMMARY This 79-year-old man presented with migratory lower abdominal pain that localized at his periumbilical region and right lower quadrant.He had associated pyrexia,general malaise and was noted to have an elevated white cell count.CT investigations initially revealed a distended appendix which was resected laparoscopically but showed no obvious signs of gross inflammation.The patient then deteriorated clinically and had increased oxygen requirements immediately after the surgery.This prompted further investigations.A further review of his CT scan revealed a fine fishbone microperforation in the distal duodenum associated with retroperitoneal abscess formation and seepage extending into the right lower quadrant.He was then started on broad spectrum intravenous antibiotics and subsequently underwent a laparotomy 12 h later to manage the obscure aetiology and to drain the abscess.The post-operative course was uneventful and he was discharged 11 d later including a 2-d stay in the intensive care unit.CONCLUSION This case offers an insight into a potential mimic of acute appendicitis and the diagnostic difficulties experienced in such presentations.展开更多
BACKGROUND Post-colonoscopy colorectal cancer(CRC)rates for patients with inflammatory bowel disease(IBD)are unacceptably high.During colonoscopy,an intravenous fluorescent anti-c-MET probe may improve endoscopic dete...BACKGROUND Post-colonoscopy colorectal cancer(CRC)rates for patients with inflammatory bowel disease(IBD)are unacceptably high.During colonoscopy,an intravenous fluorescent anti-c-MET probe may improve endoscopic detection of lesions.However,c-MET expression in IBD lesions is poorly defined,limiting translational studies.AIM To comprehensively define c-MET expression in sporadic and IBD-associated colorectal carcinogenesis.METHODS c-MET expression was immunohistochemically assessed in 319 formalin-fixed paraffin-embedded tissue specimens,colonoscopically or surgically retrieved between 1994-2017.Tissue included:30 normal colorectal biopsies,30 hyperplastic polyps(HP),31 sessile serrated lesions(SSL),55 tubular/tubulovillous adenomas with low(TA-LGD,n=32)or high grade dysplasia(TA-HGD,n=23),26 sporadic(s)-CRCs,16 quiescent IBD biopsies,11 active/inflamed IBD biopsies,18 IBDassociated dysplastic lesions(IBD-dys),and 102 IBD-CRCs.Expression was scored by two independent observers as:0=absent,1=weak,2=moderate or 3=strong.Mann-Whitney U and Kruskal-Wallis tests were used to assess significance.RESULTS Positive epithelial cytoplasmic and membranous c-MET expression was observed in all tissues,indicating there is ubiquitous expression in the colorectum.c-MET expression was weak in normal colonic epithelium compared with each of the sporadic colonic lesions,including TA-LGD(P<0.001),TA-HGD(P=0.004),HP(P<0.001),SSL(P<0.001),and s-CRC(P<0.001).Specifically,in sporadic(non-IBD)lesions,expression was stronger in TA-LGD compared with normal mucosa(P<0.001),and stronger in s-CRC compared with TA-HGD(P=0.004).However,there was no significant difference between TA-LGD and TA-HGD(P=0.852).Further,there was no difference in c-MET expression between HP and SSL(P=0.065).In IBD,expression was weaker in quiescent colonic mucosa compared with inflamed colonic mucosa(P<0.001).There was no difference between inflamed colonic mucosa and IBD-dys(P=0.512)or IBD-CRC(P=0.296).However,expression was stronger in IBD-dys(P<0.001)and IBD-CRC(P<0.001)compared with quiescent IBD colonic mucosa.CONCLUSION The characterisation of c-MET expression suggest that an intravenous probe may improve the endoscopic detection of lesions in both non-IBD patients and IBD patients with quiescent disease.展开更多
Dear Editor, The COVID-19 pandemic has brought about the development of novel vaccines at a rapid pace. The Astra Zeneca(AZ) COVID-19 adenovirus vector vaccine has been associated with thrombotic complications, the mo...Dear Editor, The COVID-19 pandemic has brought about the development of novel vaccines at a rapid pace. The Astra Zeneca(AZ) COVID-19 adenovirus vector vaccine has been associated with thrombotic complications, the most serious of which includes cerebral venous sinus thrombosis.展开更多
Background Hyponatraemia often occurs after subarachnoid haemorrhage(SAH).However,its clinical significance and optimal management are uncertain.We audited the screening,investigation and management of hyponatraemia a...Background Hyponatraemia often occurs after subarachnoid haemorrhage(SAH).However,its clinical significance and optimal management are uncertain.We audited the screening,investigation and management of hyponatraemia after SAH.Methods We prospectively identified consecutive patients with spontaneous SAH admitted to neurosurgical units in the United Kingdom or Ireland.We reviewed medical records daily from admission to discharge,21 days or death and extracted all measurements of serum sodium to identify hyponatraemia(<135 mmol/L).Main outcomes were death/dependency at discharge or 21 days and admission duration>10 days.Associations of hyponatraemia with outcome were assessed using logistic regression with adjustment for predictors of outcome after SAH and admission duration.We assessed hyponatraemia-free survival using multivariable Cox regression.Results 175/407(43%)patients admitted to 24 neurosurgical units developed hyponatraemia.5976 serum sodium measurements were made.Serum osmolality,urine osmolality and urine sodium were measured in 30/166(18%)hyponatraemic patients with complete data.The most frequently target daily fluid intake was>3 L and this did not differ during hyponatraemic or non-hyponatraemic episodes.26%(n/N=42/164)patients with hyponatraemia received sodium supplementation.133(35%)patients were dead or dependent within the study period and 240(68%)patients had hospital admission for over 10 days.In the multivariable analyses,hyponatraemia was associated with less dependency(adjusted OR(aOR)=0.35(95%CI 0.17 to 0.69))but longer admissions(aOR=3.2(1.8 to 5.7)).World Federation of Neurosurgical Societies grade I-III,modified Fisher 2-4 and posterior circulation aneurysms were associated with greater hazards of hyponatraemia.Conclusions In this comprehensive multicentre prospective-adjusted analysis of patients with SAH,hyponatraemia was investigated inconsistently and,for most patients,was not associated with changes in management or clinical outcome.This work establishes a basis for the development of evidence-based SAH-specific guidance for targeted screening,investigation and management of high-risk patients to minimise the impact of hyponatraemia on admission duration and to improve consistency of patient care.展开更多
Breast cleavage is defined by the International Federation of Associations of Anatomists(IFAA),as the space present between a woman’s breasts.The width of the inter-mammary cleft is defined by the distance between th...Breast cleavage is defined by the International Federation of Associations of Anatomists(IFAA),as the space present between a woman’s breasts.The width of the inter-mammary cleft is defined by the distance between the points of attachment of the breast tissue to the periosteal tissue.[1-3].展开更多
文摘BACKGROUND Upper gastrointestinal fishbone microperforations are rare and not commonly reported in medical literature.Despite the increasing use of computer tomography(CT)imaging and the employment of the Alvardo criteria,misdiagnosis of acute appendicitis can still occur.We report the rare case of an elderly Chinese gentleman who had a fish-bone induced microperforation of the duodenum that closely mimicked the symptoms of acute appendicitis.CASE SUMMARY This 79-year-old man presented with migratory lower abdominal pain that localized at his periumbilical region and right lower quadrant.He had associated pyrexia,general malaise and was noted to have an elevated white cell count.CT investigations initially revealed a distended appendix which was resected laparoscopically but showed no obvious signs of gross inflammation.The patient then deteriorated clinically and had increased oxygen requirements immediately after the surgery.This prompted further investigations.A further review of his CT scan revealed a fine fishbone microperforation in the distal duodenum associated with retroperitoneal abscess formation and seepage extending into the right lower quadrant.He was then started on broad spectrum intravenous antibiotics and subsequently underwent a laparotomy 12 h later to manage the obscure aetiology and to drain the abscess.The post-operative course was uneventful and he was discharged 11 d later including a 2-d stay in the intensive care unit.CONCLUSION This case offers an insight into a potential mimic of acute appendicitis and the diagnostic difficulties experienced in such presentations.
基金support of NHS Research Scotland via NHS Lothian。
文摘BACKGROUND Post-colonoscopy colorectal cancer(CRC)rates for patients with inflammatory bowel disease(IBD)are unacceptably high.During colonoscopy,an intravenous fluorescent anti-c-MET probe may improve endoscopic detection of lesions.However,c-MET expression in IBD lesions is poorly defined,limiting translational studies.AIM To comprehensively define c-MET expression in sporadic and IBD-associated colorectal carcinogenesis.METHODS c-MET expression was immunohistochemically assessed in 319 formalin-fixed paraffin-embedded tissue specimens,colonoscopically or surgically retrieved between 1994-2017.Tissue included:30 normal colorectal biopsies,30 hyperplastic polyps(HP),31 sessile serrated lesions(SSL),55 tubular/tubulovillous adenomas with low(TA-LGD,n=32)or high grade dysplasia(TA-HGD,n=23),26 sporadic(s)-CRCs,16 quiescent IBD biopsies,11 active/inflamed IBD biopsies,18 IBDassociated dysplastic lesions(IBD-dys),and 102 IBD-CRCs.Expression was scored by two independent observers as:0=absent,1=weak,2=moderate or 3=strong.Mann-Whitney U and Kruskal-Wallis tests were used to assess significance.RESULTS Positive epithelial cytoplasmic and membranous c-MET expression was observed in all tissues,indicating there is ubiquitous expression in the colorectum.c-MET expression was weak in normal colonic epithelium compared with each of the sporadic colonic lesions,including TA-LGD(P<0.001),TA-HGD(P=0.004),HP(P<0.001),SSL(P<0.001),and s-CRC(P<0.001).Specifically,in sporadic(non-IBD)lesions,expression was stronger in TA-LGD compared with normal mucosa(P<0.001),and stronger in s-CRC compared with TA-HGD(P=0.004).However,there was no significant difference between TA-LGD and TA-HGD(P=0.852).Further,there was no difference in c-MET expression between HP and SSL(P=0.065).In IBD,expression was weaker in quiescent colonic mucosa compared with inflamed colonic mucosa(P<0.001).There was no difference between inflamed colonic mucosa and IBD-dys(P=0.512)or IBD-CRC(P=0.296).However,expression was stronger in IBD-dys(P<0.001)and IBD-CRC(P<0.001)compared with quiescent IBD colonic mucosa.CONCLUSION The characterisation of c-MET expression suggest that an intravenous probe may improve the endoscopic detection of lesions in both non-IBD patients and IBD patients with quiescent disease.
文摘Dear Editor, The COVID-19 pandemic has brought about the development of novel vaccines at a rapid pace. The Astra Zeneca(AZ) COVID-19 adenovirus vector vaccine has been associated with thrombotic complications, the most serious of which includes cerebral venous sinus thrombosis.
基金JJML is supported by a Wellcome Trust Fellowship Grant(214145/Z/18/Z)MTCP is supported by a Cancer Research UK Brain Tumour Centre of Excellence Award(C157/A27589).
文摘Background Hyponatraemia often occurs after subarachnoid haemorrhage(SAH).However,its clinical significance and optimal management are uncertain.We audited the screening,investigation and management of hyponatraemia after SAH.Methods We prospectively identified consecutive patients with spontaneous SAH admitted to neurosurgical units in the United Kingdom or Ireland.We reviewed medical records daily from admission to discharge,21 days or death and extracted all measurements of serum sodium to identify hyponatraemia(<135 mmol/L).Main outcomes were death/dependency at discharge or 21 days and admission duration>10 days.Associations of hyponatraemia with outcome were assessed using logistic regression with adjustment for predictors of outcome after SAH and admission duration.We assessed hyponatraemia-free survival using multivariable Cox regression.Results 175/407(43%)patients admitted to 24 neurosurgical units developed hyponatraemia.5976 serum sodium measurements were made.Serum osmolality,urine osmolality and urine sodium were measured in 30/166(18%)hyponatraemic patients with complete data.The most frequently target daily fluid intake was>3 L and this did not differ during hyponatraemic or non-hyponatraemic episodes.26%(n/N=42/164)patients with hyponatraemia received sodium supplementation.133(35%)patients were dead or dependent within the study period and 240(68%)patients had hospital admission for over 10 days.In the multivariable analyses,hyponatraemia was associated with less dependency(adjusted OR(aOR)=0.35(95%CI 0.17 to 0.69))but longer admissions(aOR=3.2(1.8 to 5.7)).World Federation of Neurosurgical Societies grade I-III,modified Fisher 2-4 and posterior circulation aneurysms were associated with greater hazards of hyponatraemia.Conclusions In this comprehensive multicentre prospective-adjusted analysis of patients with SAH,hyponatraemia was investigated inconsistently and,for most patients,was not associated with changes in management or clinical outcome.This work establishes a basis for the development of evidence-based SAH-specific guidance for targeted screening,investigation and management of high-risk patients to minimise the impact of hyponatraemia on admission duration and to improve consistency of patient care.
文摘Breast cleavage is defined by the International Federation of Associations of Anatomists(IFAA),as the space present between a woman’s breasts.The width of the inter-mammary cleft is defined by the distance between the points of attachment of the breast tissue to the periosteal tissue.[1-3].
