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Reynolds IS, McDermott E, Liddy R, Aird JJ, Flood K, McCormack O, Geoghegan T, Brannigan AE. Acute colonic pseudo-obstruction post-cesarean section is not a benign entity: A case series and review of the literature. Int J Gynaecol Obstet 2024; 165:59-66. [PMID: 37675884 DOI: 10.1002/ijgo.15086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 08/06/2023] [Accepted: 08/17/2023] [Indexed: 09/08/2023]
Abstract
Acute colonic pseudo-obstruction (ACPO) is an infrequent occurrence after cesarean section. Anecdotal evidence suggests that the clinical course of ACPO in the obstetric setting is different to that seen in non-pregnant adult patients with ACPO secondary to alternative causes, such as systemic illnesses, the use of certain medications, and after non-abdominal surgery. The risk of progression to ischemia and perforation, as well as the need for emergency surgery, appears to be higher after cesarean section. Here we describe the clinical course of ACPO in four patients after cesarean section from our institution, followed by a review of the literature and a discussion of the important issues surrounding this condition in the postpartum time period. The findings from our cohort of patients and the reports from the medical literature support a hands-on combined approach from a group of specialists including obstetricians, surgeons, radiologists, and enterostomal therapists. Immediate imaging followed by regular observation is mandatory for any patient being managed conservatively. Early use of endoscopic decompression should be considered for patients who are not resolving with a conservative approach. Clinical signs of peritonism or radiological signs of ischemia or perforation in patients with ACPO mandate immediate surgical intervention. Appropriate postoperative care is necessary to deal with the complex physiological and psychological consequences of emergency surgery and potential stoma formation so soon after cesarean section.
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Affiliation(s)
- Ian S Reynolds
- Department of Colorectal Surgery, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Edward McDermott
- Department of Radiology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Richard Liddy
- Department of Histopathology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - John J Aird
- Department of Histopathology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Karen Flood
- Department of Obstetrics and Gynaecology, Royal College of Surgeons, Rotunda Hospital, Dublin, Ireland
| | - Orla McCormack
- Department of Upper Gastrointestinal Surgery, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Tony Geoghegan
- Department of Radiology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Ann E Brannigan
- Department of Colorectal Surgery, Mater Misericordiae University Hospital, Dublin, Ireland
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2
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Hardy NP, Mulligan N, Dalli J, Epperlein JP, Neary PM, Robertson W, Liddy R, Thorpe SD, Aird JJ, Cahill RA. Geotemporal Fluorophore Biodistribution Mapping of Colorectal Cancer: Micro and Macroscopic Insights. Curr Oncol 2024; 31:849-861. [PMID: 38392057 PMCID: PMC10887825 DOI: 10.3390/curroncol31020063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Revised: 01/20/2024] [Accepted: 01/31/2024] [Indexed: 02/24/2024] Open
Abstract
Fluorescence-guided oncology promises to improve both the detection and treatment of malignancy. We sought to investigate the temporal distribution of indocyanine green (ICG), an exogenous fluorophore in human colorectal cancer. This analysis aims to enhance our understanding of ICG's effectiveness in current tumour detection and inform potential future diagnostic and therapeutic enhancements. METHODS Fifty consenting patients undergoing treatment for suspected/confirmed colorectal neoplasia provided near infrared (NIR) video and imagery of transanally recorded and ex vivo resected rectal lesions following intravenous ICG administration (0.25 mg/kg), with a subgroup providing tissue samples for microscopic (including near infrared) analysis. Computer vision techniques detailed macroscopic 'early' (<15 min post ICG administration) and 'late' (>2 h) tissue fluorescence appearances from surgical imagery with digital NIR scanning (Licor, Lincoln, NE, USA) and from microscopic analysis (Nikon, Tokyo, Japan) undertaken by a consultant pathologist detailing tissue-level fluorescence distribution over the same time. RESULTS Significant intra-tumoural fluorescence heterogeneity was seen 'early' in malignant versus benign lesions. In all 'early' samples, fluorescence was predominantly within the tissue stroma, with uptake within plasma cells, blood vessels and lymphatics, but not within malignant or healthy glands. At 'late' stage observation, fluorescence was visualised non-uniformly within the intracellular cytoplasm of malignant tissue but not retained in benign glands. Fluorescence also accumulated within any present peritumoural inflammatory tissue. CONCLUSION This study demonstrates the time course diffusion patterns of ICG through both benign and malignant tumours in vivo in human patients at both macroscopic and microscopic levels, demonstrating important cellular drivers and features of geolocalisation and how they differ longitudinally after exposure to ICG.
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Affiliation(s)
- Niall P. Hardy
- UCD Centre for Precision Surgery, School of Medicine, UCD, D07 Y9AW Dublin, Ireland; (N.P.H.); (J.D.)
| | - Niall Mulligan
- Department of Histopathology, Mater Misericordiae University Hospital, D07 R2WY Dublin, Ireland (W.R.); (R.L.); (J.J.A.)
| | - Jeffrey Dalli
- UCD Centre for Precision Surgery, School of Medicine, UCD, D07 Y9AW Dublin, Ireland; (N.P.H.); (J.D.)
| | | | - Peter M. Neary
- Department of General and Colorectal Surgery, University Hospital Waterford, University College Cork, X91 ER8E Waterford, Ireland;
| | - William Robertson
- Department of Histopathology, Mater Misericordiae University Hospital, D07 R2WY Dublin, Ireland (W.R.); (R.L.); (J.J.A.)
| | - Richard Liddy
- Department of Histopathology, Mater Misericordiae University Hospital, D07 R2WY Dublin, Ireland (W.R.); (R.L.); (J.J.A.)
| | - Stephen D. Thorpe
- UCD School of Medicine, University College Dublin, D04 V1W8 Dublin, Ireland;
- UCD Conway Institute, University College Dublin, D04 V1W8 Dublin, Ireland
| | - John J. Aird
- Department of Histopathology, Mater Misericordiae University Hospital, D07 R2WY Dublin, Ireland (W.R.); (R.L.); (J.J.A.)
| | - Ronan A. Cahill
- UCD Centre for Precision Surgery, School of Medicine, UCD, D07 Y9AW Dublin, Ireland; (N.P.H.); (J.D.)
- Department of General and Colorectal Surgery, Mater Misericordiae University Hospital, D07 R2WY Dublin, Ireland
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Hardy NP, Epperlein JP, Dalli J, Robertson W, Liddy R, Aird JJ, Mulligan N, Neary PM, McEntee GP, Conneely JB, Cahill RA. Real-time administration of indocyanine green in combination with computer vision and artificial intelligence for the identification and delineation of colorectal liver metastases. Surg Open Sci 2023; 12:48-54. [PMID: 36936453 PMCID: PMC10017420 DOI: 10.1016/j.sopen.2023.03.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 02/26/2023] [Accepted: 03/01/2023] [Indexed: 03/06/2023] Open
Abstract
Introduction Fluorescence guided surgery for the identification of colorectal liver metastases (CRLM) can be better with low specificity and antecedent dosing impracticalities limiting indocyanine green (ICG) usefulness currently. We investigated the application of artificial intelligence methods (AIM) to demonstrate and characterise CLRMs based on dynamic signalling immediately following intraoperative ICG administration. Methods Twenty-five patients with liver surface lesions (24 CRLM and 1 benign cyst) undergoing open/laparoscopic/robotic procedures were studied. ICG (0.05 mg/kg) was administered with near-infrared recording of fluorescence perfusion. User-selected region-of-interest (ROI) perfusion profiles were generated, milestones relating to ICG inflow/outflow extracted and used to train a machine learning (ML) classifier. 2D heatmaps were constructed in a subset using AIM to depict whole screen imaging based on dynamic tissue-ICG interaction. Fluorescence appearances were also assessed microscopically (using H&E and fresh-frozen preparations) to provide tissue-level explainability of such methods. Results The ML algorithm correctly classified 97.2 % of CRLM ROIs (n = 132) and all benign lesion ROIs (n = 6) within 90-s of ICG administration following initial mathematical curve analysis identifying ICG inflow/outflow differentials between healthy liver and CRLMs. Time-fluorescence plots extracted for each pixel in 10 lesions enabled creation of 2D characterising heatmaps using flow parameters and through unsupervised ML. Microscopy confirmed statistically less CLRM fluorescence vs adjacent liver (mean ± std deviation signal/area 2.46 ± 9.56 vs 507.43 ± 160.82 respectively p < 0.001) with H&E diminishing ICG signal (n = 4). Conclusion ML accurately identifies CRLMs from surrounding liver tissue enabling representative 2D mapping of such lesions from their fluorescence perfusion patterns using AIM. This may assist in reducing positive margin rates at metastatectomy and in identifying unexpected/occult malignancies.
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Affiliation(s)
- Niall P. Hardy
- UCD Centre for Precision Surgery, School of Medicine, UCD, Dublin, Ireland
| | | | - Jeffrey Dalli
- UCD Centre for Precision Surgery, School of Medicine, UCD, Dublin, Ireland
| | - William Robertson
- Department of Histopathology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Richard Liddy
- Department of Histopathology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - John J. Aird
- Department of Histopathology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Niall Mulligan
- Department of Histopathology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Peter M. Neary
- Department of General and Colorectal Surgery, University Hospital Waterford, University College Cork, Ireland
| | - Gerard P. McEntee
- Department of Hepatobiliary, Foregut and Bariatric Surgery, Mater Misericordiae University Hospital, Dublin, Ireland
| | - John B. Conneely
- Department of Hepatobiliary, Foregut and Bariatric Surgery, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Ronan A. Cahill
- UCD Centre for Precision Surgery, School of Medicine, UCD, Dublin, Ireland
- Department of General and Colorectal Surgery, Mater Misericordiae University Hospital, Dublin, Ireland
- Corresponding author at: 47 Eccles Street, Dublin 7, Ireland. @Matersurgery
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Buckley B, Delaney F, Aird JJ, Bolster F. Pararenal malignant melanotic nerve sheath tumour: a rare tumour in an unfamiliar location. BMJ Case Rep 2022; 15:15/8/e252107. [DOI: 10.1136/bcr-2022-252107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Yang KC, Kalloger SE, Aird JJ, Lee MKC, Rushton C, Mungall KL, Mungall AJ, Gao D, Chow C, Xu J, Karasinska JM, Colborne S, Jones SJM, Schrader J, Morin RD, Loree JM, Marra MA, Renouf DJ, Morin GB, Schaeffer DF, Gorski SM. Proteotranscriptomic classification and characterization of pancreatic neuroendocrine neoplasms. Cell Rep 2021; 37:109817. [PMID: 34644566 DOI: 10.1016/j.celrep.2021.109817] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 07/16/2021] [Accepted: 09/20/2021] [Indexed: 12/13/2022] Open
Abstract
Pancreatic neuroendocrine neoplasms (PNENs) are biologically and clinically heterogeneous. Here, we use a multi-omics approach to uncover the molecular factors underlying this heterogeneity. Transcriptomic analysis of 84 PNEN specimens, drawn from two cohorts, is substantiated with proteomic profiling and identifies four subgroups: Proliferative, PDX1-high, Alpha cell-like and Stromal/Mesenchymal. The Proliferative subgroup, consisting of both well- and poorly differentiated specimens, is associated with inferior overall survival probability. The PDX1-high and Alpha cell-like subgroups partially resemble previously described subtypes, and we further uncover distinctive metabolism-related features in the Alpha cell-like subgroup. The Stromal/Mesenchymal subgroup exhibits molecular characteristics of YAP1/WWTR1(TAZ) activation suggestive of Hippo signaling pathway involvement in PNENs. Whole-exome sequencing reveals subgroup-enriched mutational differences, supported by activity inference analysis, and identifies hypermorphic proto-oncogene variants in 14.3% of sequenced PNENs. Our study reveals differences in cellular signaling axes that provide potential directions for PNEN patient stratification and treatment strategies.
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Affiliation(s)
- Kevin C Yang
- Canada's Michael Smith Genome Sciences Centre at BC Cancer, Vancouver, BC V5Z 1L3, Canada; Department of Molecular Biology and Biochemistry, Simon Fraser University, Burnaby, BC V5A 1S6, Canada
| | - Steve E Kalloger
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC V6T 1Z7, Canada; School of Population and Public Health, University of British Columbia, Vancouver, BC V6T 1Z3, Canada; Division of Anatomical Pathology, Vancouver General Hospital, Vancouver, BC V5Z 1M9, Canada; Pancreas Centre BC, Vancouver, BC V5Z 1L8, Canada
| | - John J Aird
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC V6T 1Z7, Canada; Division of Anatomical Pathology, Vancouver General Hospital, Vancouver, BC V5Z 1M9, Canada
| | - Michael K C Lee
- Division of Medical Oncology, BC Cancer, Vancouver, BC V5Z 4E6, Canada
| | - Christopher Rushton
- Department of Molecular Biology and Biochemistry, Simon Fraser University, Burnaby, BC V5A 1S6, Canada
| | - Karen L Mungall
- Canada's Michael Smith Genome Sciences Centre at BC Cancer, Vancouver, BC V5Z 1L3, Canada
| | - Andrew J Mungall
- Canada's Michael Smith Genome Sciences Centre at BC Cancer, Vancouver, BC V5Z 1L3, Canada
| | - Dongxia Gao
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC V6T 1Z7, Canada; Genetic Pathology Evaluation Centre, Vancouver, BC V6H 3Z6, Canada
| | - Christine Chow
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC V6T 1Z7, Canada; Genetic Pathology Evaluation Centre, Vancouver, BC V6H 3Z6, Canada
| | - Jing Xu
- Canada's Michael Smith Genome Sciences Centre at BC Cancer, Vancouver, BC V5Z 1L3, Canada; Department of Molecular Biology and Biochemistry, Simon Fraser University, Burnaby, BC V5A 1S6, Canada
| | | | - Shane Colborne
- Canada's Michael Smith Genome Sciences Centre at BC Cancer, Vancouver, BC V5Z 1L3, Canada
| | - Steven J M Jones
- Canada's Michael Smith Genome Sciences Centre at BC Cancer, Vancouver, BC V5Z 1L3, Canada; Department of Medical Genetics, University of British Columbia, Vancouver, BC V6T 1Z4, Canada
| | - Jörg Schrader
- Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ryan D Morin
- Canada's Michael Smith Genome Sciences Centre at BC Cancer, Vancouver, BC V5Z 1L3, Canada; Department of Molecular Biology and Biochemistry, Simon Fraser University, Burnaby, BC V5A 1S6, Canada
| | - Jonathan M Loree
- Division of Medical Oncology, BC Cancer, Vancouver, BC V5Z 4E6, Canada
| | - Marco A Marra
- Canada's Michael Smith Genome Sciences Centre at BC Cancer, Vancouver, BC V5Z 1L3, Canada; Department of Medical Genetics, University of British Columbia, Vancouver, BC V6T 1Z4, Canada
| | - Daniel J Renouf
- Pancreas Centre BC, Vancouver, BC V5Z 1L8, Canada; Division of Medical Oncology, BC Cancer, Vancouver, BC V5Z 4E6, Canada
| | - Gregg B Morin
- Canada's Michael Smith Genome Sciences Centre at BC Cancer, Vancouver, BC V5Z 1L3, Canada; Department of Medical Genetics, University of British Columbia, Vancouver, BC V6T 1Z4, Canada
| | - David F Schaeffer
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC V6T 1Z7, Canada; Division of Anatomical Pathology, Vancouver General Hospital, Vancouver, BC V5Z 1M9, Canada; Pancreas Centre BC, Vancouver, BC V5Z 1L8, Canada
| | - Sharon M Gorski
- Canada's Michael Smith Genome Sciences Centre at BC Cancer, Vancouver, BC V5Z 1L3, Canada; Department of Molecular Biology and Biochemistry, Simon Fraser University, Burnaby, BC V5A 1S6, Canada; Centre for Cell Biology, Development, and Disease, Simon Fraser University, Burnaby, BC V5A 1S6, Canada.
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Aird JJ, Steel MJ, Chow C, Ho J, Wolber R, Gilks CB, Hoang LN, Schaeffer DF. Should you repeat mismatch repair testing in cases of tumour recurrence? An evaluation of repeat mismatch repair testing by the use of immunohistochemistry in recurrent tumours of the gastrointestinal and gynaecological tracts. Histopathology 2020; 76:521-530. [DOI: 10.1111/his.14026] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 10/30/2019] [Indexed: 01/23/2023]
Affiliation(s)
- John J Aird
- Division of Anatomic Pathology Vancouver General Hospital Vancouver BC Canada
- Department of Pathology and Laboratory Medicine University of British Columbia Vancouver BC Canada
| | - Michael J Steel
- Division of Anatomic Pathology Vancouver General Hospital Vancouver BC Canada
| | - Christine Chow
- Genetic Pathology Evaluation Centre Jack Bell Research Centre Vancouver BC Canada
| | - Julie Ho
- Department of Molecular Oncology British Columbia Cancer Agency Vancouver BC Canada
| | - Robert Wolber
- Department of Laboratory Medicine and Pathology Lions Gate Hospital North Vancouver BC Canada
| | - C Blake Gilks
- Division of Anatomic Pathology Vancouver General Hospital Vancouver BC Canada
- Department of Pathology and Laboratory Medicine University of British Columbia Vancouver BC Canada
| | - Lynn N Hoang
- Division of Anatomic Pathology Vancouver General Hospital Vancouver BC Canada
- Department of Pathology and Laboratory Medicine University of British Columbia Vancouver BC Canada
| | - David F Schaeffer
- Division of Anatomic Pathology Vancouver General Hospital Vancouver BC Canada
- Department of Pathology and Laboratory Medicine University of British Columbia Vancouver BC Canada
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McNevin CS, Gleeson JP, Herlihy DB, Aird JJ, Robb WB, Kay EW, Morris PG, Grogan L, Breathnach OS. Bilateral Adrenalectomy for Metastatic Esophageal Adenocarcinoma: A Case Report. J Oncol Pract 2017; 14:47-48. [PMID: 28885880 DOI: 10.1200/jop.2017.023713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Aird JJ, Molteno ACB, Bevin TH, Sanderson G, Wynn-Williams G. Digital imaging of the human cornea in vivo with ultraviolet light. Australas Phys Eng Sci Med 2006; 29:203-5. [PMID: 16845926 DOI: 10.1007/bf03178894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
We have a developed a novel and practical method of imaging the cornea under ultraviolet (UV) light using a digital medium. Wavelengths of 336-371 nm were used to illuminate the cornea. Images were recorded using a UV Nikkor lens and a digital charged coupled device (CCD). Images obtained showed ferritin lines not visible under white light. This study concluded that 336-371 nm is comparable to shorter wavelengths for the imaging of ferritin in the cornea and that a digital image capture system was comparable to that of film.
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Affiliation(s)
- J J Aird
- Section of Ophthalmology, Department of Medical and Surgical Sciences, University of Otago Dunedin School of Medicine, New Zealand
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