Biliary disease and cholecystectomy after initiation of elexacaftor/ivacaftor/tezacaftor in adults with cystic fibrosis

Individuals with cystic fibrosis (CF) have an increased risk for gallbladder abnormalities and biliary tract disease, but the reported incidence of these manifestations of CF varies widely in the literature. With the approval of elexacaftor/tezacaftor/ivacaftor (ELX/TEZ/IVA), increasing numbers of CF patients have been initiated on highly effective cystic fibrosis transmembrane regulator (CFTR) modulator therapy. While elevations in hepatic panel are known potential side effects of CFTR modulators, there have been no published cases of biliary disease or acute cholecystitis attributed to these medications. In this case series, we describe seven patients at two adult CF centers with biliary colic shortly after initiation with ELX/TEZ/IVA, six of whom required cholecystectomy.     

Global Forum of Cancer Surgeons: Cancer Surgery During the COVID-19 Pandemic: Impact and Lessons Learned

Annals of Surgical Oncology - The purpose of this article is to summarize the opinions of the surgical oncology leaders from the Global Forum of Cancer Surgeons (GFCS) about the global impact of...     

Rapid and reversible enhancement of blood–brain barrier permeability using lysophosphatidic acid

The present study characterizes the effects of lysophosphatidic acid (LPA) on blood–brain barrier (BBB) permeability focusing specifically on the time of onset, duration, and magnitude of LPA-induced changes in cerebrovascular permeability in the mouse using both magnetic resonance imaging (MRI) and near infrared fluorescence imaging (NIFR). Furthermore, potential application of LPA for enhanced drug delivery to the brain was also examined by measuring the brain accumulation of radiolabeled methotrexate. Exposure of primary cultured brain microvessel endothelial cells (BMECs) to LPA produced concentration-dependent increases in permeability that were completely abolished by clostridium toxin B. Administration of LPA disrupted BBB integrity and enhanced the permeability of small molecular weight marker gadolinium diethylenetriaminepentaacetate (Gd-DTPA) contrast agent, the large molecular weight permeability marker, IRdye800cwPEG, and the P-glycoprotein efflux transporter probe, Rhodamine 800 (R800). The increase in BBB permeability occurred within 3 minutes after LPA injection and barrier integrity was restored within 20 minutes. A decreased response to LPA on large macromolecule BBB permeability was observed after repeated administration. The administration of LPA also resulted in 20-fold enhancement of radiolabeled methotrexate in the brain. These studies indicate that administration of LPA in combination with therapeutic agents may increase drug delivery to the brain.     

Reconstruction of chest wall defects following extirpative surgery

Reconstructive procedures following chest wall resection pose a special surgical challenge. With modern surgical technique, a wide range of reconstructive options are at the surgeon's disposal and, hence it is imperative that the appropriate procedure be selected in a given patient. A total of 64 patients underwent resection of malignant chest wall tumors at the Tata Memorial Hospital. The technique of preference at our institution for reconstruction of full-thickness chest wall defects uses a combination of autogenous fascia lata and Marlexmesh. We present our experience with chest wall reconstruction following extirpative surgery in these patients. © Wiley-Liss, Inc.     

Magnetic resonance angiography in the management of aneurysmal subarachnoid haemorrhage: a study of 51 cases

We report preliminary experience with the use of magnetic resonance angiography (MRA) in the assessment of intracranial aneurysms. The aims of the study were to confirm that aneurysms could be detected and to assess the quality of the images with a view to early surgery if clinically indicated. We studied 51 patients with recent spontaneous subarachnoid haemorrhage with MRA, using a three-dimensional time-of-flight technique. The results of MRA were subsequently confirmed on intra-arterial digital subtraction angiography (IA-DSA) for anatomical correlation, and were considered satisfactory in 38 patients (74.5 %). In 20 patients early surgical obliteration of their aneurysm was possible on the MRA results without recourse to IA-DSA. A total of 37 aneurysms were identified in 32 patients, while the remaining 6 patients did not have an aneurysm. MRA was misinterpreted in 4 patients (7.9 %), and in 9 other patients (17.6 %) MRA was unsatisfactory due to movement artefacts. Received: 1 September 1994 Accepted: 12 May 1995     

Amnioinfusion in thick meconium

Objective : There are conflicting reports regarding the results of amnioinfusion in the management of meconium passagein utero. This study was done to evaluate transcervical amnioinfusion for meconium stained amniotic fluid during labour.Methods : 196 women at term in early labour with meconium were randomized to receive either transcervical intrapartum amnioinfusion with saline (96) or routine obstetrical care (100). Transcervical amnioinfusion of one liter saline infused over 30–45 minutes. End points were relief of decelerations, incidence of vaginal delivery, presence of meconium below the neonatal cords, and X-ray evidence of meconium aspiration.Results : Amnioinfusion resulted in relief of decelerations in 75% of cases as compared to 7% in the control group. Eighty-eight percent of patients delivered vaginally as compared to 58% in the control group (p<0.001). Neonatal outcome was significantly better in the infusion group. The incidence of meconium below the vocal cords was reduced from 48% to 17% (p<0.004) using amnioinfusion with positive X-rays for meconium aspiration in only 12.5% versus 26% (p<0.5).Conclusions : We concluded that transcervical intrapartum amnioinfusion is a safe, simple and inexpensive technique that reduces operative intervention and improves neonatal outcome, and is of tremendous relevance in developing countries.