Perforation of an Adjustable Gastric Banding Connecting Tube into distal Transverse Colon with Intra-luminal Migration

Laparoscopic adjustable gastric banding (LAGB) is one of the most common bariatric procedures performed in Europe and Australia. Major post-operative complications are limited but once they occur, prompt diagnosis and treatment are mandatory. LAGB complications are related either to the port and the connecting tube, such as infection or tubing disconnection and migration, or to the band, such as slippage, pouch dilatation, or intra-gastric migration. We report a case of intra-colonic migration of the connecting tube occurring 4 years after gastric banding placement in a patient otherwise asymptomatic.     

2007年度自贡市第四人民医院细菌耐药性分析

目的了解近年来医院细菌耐药情况,为临床合理使用抗菌药物提供可靠的依据。方法根据原始数据统计各类抗菌药物对革兰阳性杆菌和革兰阴性杆菌的敏感率和耐药率排序。结果第四季度与前三季度相比,革兰阴性杆菌对药物敏感率下降总指数为25.10,比较稳定,革兰阳性杆菌敏感率下降总指数为123.00;在19种进行敏感性试验的药品中,敏感性下降的药品15种,敏感性下降10%以上的药品8种,占标本总数的42%。结论细菌的耐药性呈逐年上升趋势。通过统计分析抗菌药物使用情况,比较临床标本细菌菌种分布及细菌对药物的敏感性变化,依据抗菌药物指导原则对抗菌药物使用合理性进行评价,可以促进合理用药。     

Do we know all there is to know about Familial Adenomatous Polyposis?

Familial Adenomatous Polyposis (FAP) and Attenuated FAP (AFAP) are caused by a germline mutation in the Adenomatous polyposis coli (APC) gene. Recently, a new pathway characterized by a biallelic mutation in the MYH gene, with a recessive model of inheritance was discovered for this inherited syndrome. This report describes a Tunisian patient with an attenuated FAP phenotype, presenting seven colon polyps and an adenocarcinoma but no detectable germline mutations in the FAP target genes. A well known somatic mutation was found in the APC mutation cluster region (MCR). This case shows that further studies are needed to fully understand all the pathways of the FAP syndrome.     

Cyclosporin and plasma exchange in thrombotic thrombocytopenic purpura: long-term follow-up with serial analysis of ADAMTS13 activity

We hypothesized that cyclosporin (CSA) as adjunct to plasma exchange (PE) improves the efficacy of PE in idiopathic thrombotic thrombocytopenic purpura (TTP) via suppression of the antibody inhibitor of ADAMTS13. Our preliminary findings with CSA and PE as the upfront treatment of TTP suggested that the addition of CSA to PE significantly decreased the exacerbation (disease recurrence within 30 d of the last PE) rates compared to a cohort that received corticosteroids and PE as their upfront therapy of TTP. We present an updated analysis with long-term follow-up of 18 patients with idiopathic TTP treated with concurrent CSA and PE with analysis of serial measurements of ADAMTS13 activity, antigen and inhibitor concentration in the context of clinical outcome data. Overall, 16/18 (89%) patients achieved remission, similar to historical remission rates in idiopathic TTP with PE with only one patient suffering an exacerbation. Clinical responses correlated with improvements in ADAMTS13 activity and suppression of the antibody inhibitor of ADAMTS13. These data suggest that the efficacy of CSA is at least in part related to its suppression of the antibody inhibitor of ADAMTS13 and a subsequent improvement in ADAMTS13 activity and antigen.     

Incorporating covariates in mapping heterogeneous traits: a hierarchical model using empirical Bayes estimation

Complex genetic traits are inherently heterogeneous, i.e., they may be caused by different genes, or non-genetic factors, in different individuals. So, for mapping genes responsible for these diseases using linkage analysis, heterogeneity must be accounted for in the model. Heterogeneity across different families can be modeled using a mixture distribution by letting each family have its own heterogeneity parameter denoting the probability that its disease-causing gene is linked to the marker map under consideration. A substantial gain in power is expected if covariates that can discriminate between the families of linked and unlinked types are incorporated in this modeling framework. To this end, we propose a hierarchical Bayesian model, in which the families are grouped according to various (categorized) levels of covariate(s). The heterogeneity parameters of families within each group are assigned a common prior, whose parameters are further assigned hyper-priors. The hyper-parameters are obtained by utilizing the empirical Bayes estimates. We also address related issues such as evaluating whether the covariate(s) under consideration are informative and grouping of families. We compare the proposed approach with one that does not utilize covariates and show that our approach leads to considerable gains in power to detect linkage and in precision of interval estimates through various simulation scenarios. An application to the asthma datasets of Genetic Analysis Workshop 12 also illustrates this gain in a real data analysis. Additionally, we compare the performances of microsatellite markers and single nucleotide polymorphisms for our approach and find that the latter clearly outperforms the former.     

Aortic endocarditis complicated with a large ventricular septal defect and septic pulmonary embolism

BACKGROUND: Infectious complications of the aortic valve can lead to severe cardiac failure and widespread contiguous lesions by the involvement of subaortic structures such as aorto-left ventricular discontinuity, destruction of the aortic ring, aortic abscesses, true or false aneurysms and shunts. AIM: Report a new case of a large ventricular septal defect due to infection. CASE REPORT: Abnormal communications occurring during acute aortic valve endocarditis are rare but they are very serious complications. We report a case of a 58 year-old-man, referred to our hospital with the diagnosis of aortic endocarditis with complicating root abscesses, acquired ventricular septal defect (VSD) and pulmonary septic embolism. Surgery was indicated and the whole procedure was performed through the aortic root. The patient underwent a radical resection of the abscesses, reconstruction of the aortic ring, closure of the ventricular septal defect and prosthetic replacement of the aortic valve. The immediate postoperative course was marked by persistent sepsis. Transoesophageal echocardiography showed vegetation's in the right side of the patch without signs of dehiscence. The outcome was fatal due to hemodynamic collapse. CONCLUSION: The authors would like to select and analyze some weaknesses of their procedure like using only the transaortic access that often limits exposure of possible right-side lesions, not removing the pulmonary obstruction and using an important amount of foreign material to reconstruct subvalvular lesions.     

Prognostic value of the immunohistochemical expression of: Ki67, p53, PCNA and Bcl2 in the superficial tumors of the bladder

AIM: To study a serie of superficial tumors of the bladder and to assess the prognostic significance of p53, Ki67, PCNA and bcl2 in these tumors. METHODS: We studied 59 bladder tumors: 43 pTa and 16 pT1. All Patients had cystoscopy 3 months after the resection and tumors that did not recur had a minimum follow up of 5 years. RESULTS: Age more than 65 years (p = 0,001), multifocality (p=0,022) and tumoral size > or = 3 cm (p = 0,022) were correlated with the recurrence. The expression of p53 was correlated with the recurrence in the year following the tumoral resection (p = 0,035). That of of Ki67 was correlated with the histological grade (p = 0,03) and stage (p=0,002). CONCLUSION: Our results suggest to practise regular endoscopic controls during the first year following the resection of the primitive tumor if it expresses p53. The immunohistochemical expression of Ki67 being correlated with the grade, this marker could help to better classify the tumors of intermediate grade.