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Thaveenthiran P, Bae L, Wewelwala C, Zhou K. Primary small intestine angiosarcoma mimicking Crohn's disease. BMJ Case Rep 2024; 17:e255424. [PMID: 38290985 PMCID: PMC10828878 DOI: 10.1136/bcr-2023-255424] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2024] Open
Abstract
A man in his 40s presented to an emergency department after experiencing worsening abdominal pain for 2 days. Contrast-enhanced CT of the abdomen and pelvis revealed circumferential mural thickening and luminal narrowing of the distal ileum and upstream dilatation of the small intestine, indicating small intestine obstruction. This prompted emergency laparotomy, where two lesions in the distal ileum were identified as the source of his bowel obstruction and resected. Immunohistochemistry of the resected segment revealed a primary small intestine angiosarcoma acting positively for vascular markers ERG and CD31. A subsequent positron emission tomography (PET) scan revealed positive mediastinal metastatic lymphadenopathy without organ metastases.Following his surgery, the patient recovered well and was promptly referred to an oncology unit at a specialised health centre for further treatment. Primary small intestine angiosarcoma is a rare entity in which patients present with non-specific symptoms requiring prompt tissue diagnosis to facilitate multidisciplinary management.
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Affiliation(s)
- Prasanthan Thaveenthiran
- General Surgery, Monash Health, Clayton, Victoria, Australia
- Trauma, National Trauma Research Institute, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Lily Bae
- General Surgery, Monash Health, Clayton, Victoria, Australia
| | | | - Kevin Zhou
- Radiology, Monash Health, Clayton, Victoria, Australia
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2
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Gratton R, Olaussen A, Hassan M, Thaveenthiran P, Fitzgerald MC, Mitra B. Diagnostic performance of the cardiac FAST in a high-volume Australian trauma centre. Journal of Emergency Medicine, Trauma and Acute Care 2017. [DOI: 10.5339/jemtac.2017.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Background: Cardiac injury is uncommon, but it is important to diagnose, in order to prevent subsequent complications. Extended focused assessment with sonography in trauma (eFAST) allows rapid evaluation of the pericardium and thorax. The objective of this study was to describe cardiac injuries presenting to a major trauma centre and the diagnostic performance of eFAST in detecting haemopericardium as well as broader cardiac injuries. Methods: Data of patients with severe injuries and diagnosed cardiac injuries (Injury Severity Score >12 and AIS 2008 codes for cardiac injuries) were extracted from The Alfred Trauma Registry over a four-year period from July 2010 to June 2014. The initial eFAST results were compared to those of the final diagnosis, which were determined after analysing imaging results and intraoperative findings. Results: Thirty patients who were identified with cardiac injuries met the inclusion criteria. Among these, 22 patients sustained injuries under the scope of eFAST, of which a positive eFAST scan in the pericardium was reported in 13 (59%) patients, while nine (41%) patients had a negative scan. This resulted in a sensitivity of 59% (95% CI: 36.7%–78.5%). The sensitivity of detecting any cardiac injuries was lower at 43.3% (95% CI: 26.0–62.3). Conclusions: The low sensitivities of eFAST for detecting cardiac injuries and haemopericardium demonstrate that a negative result cannot be used in isolation to exclude cardiac injuries. A high index of suspicion for cardiac injury remains essential. Adjunct diagnostic modalities are indicated for the diagnosis of cardiac injury following major trauma.
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Affiliation(s)
| | - Alexander Olaussen
- 2Department of Community Emergency Health and Paramedic Practice, Monash University, Melbourne, Australia
- 3Emergency & Trauma Centre, The Alfred Hospital, Melbourne, Australia
- 4Trauma Service, The Alfred Hospital, Melbourne, Australia
- 5National Trauma Research Institute, The Alfred Hospital, Melbourne, Australia
| | - Mariam Hassan
- 5National Trauma Research Institute, The Alfred Hospital, Melbourne, Australia
| | | | - Mark C. Fitzgerald
- 4Trauma Service, The Alfred Hospital, Melbourne, Australia
- 5National Trauma Research Institute, The Alfred Hospital, Melbourne, Australia
| | - Biswadev Mitra
- 3Emergency & Trauma Centre, The Alfred Hospital, Melbourne, Australia
- 5National Trauma Research Institute, The Alfred Hospital, Melbourne, Australia
- 6Department of Epidemiology & Preventive Medicine, Monash University, Melbourne, Australia
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Mitra B, Fitzgerald MC, Olaussen A, Thaveenthiran P, Bade-Boon J, Martin K, Smit DV, Cameron PA. Cruciform position for trauma resuscitation. Emerg Med Australas 2017; 29:252-253. [PMID: 28236379 DOI: 10.1111/1742-6723.12753] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: 10/04/2016] [Revised: 01/14/2017] [Accepted: 02/09/2017] [Indexed: 11/30/2022]
Abstract
Multiply injured patients represent a particularly demanding subgroup of trauma patients as they require urgent simultaneous clinical assessments using physical examination, ultrasound and invasive monitoring together with critical management, including tracheal intubation, thoracostomies and central venous access. Concurrent access to multiple body regions is essential to facilitate the concept of 'horizontal' resuscitation. The current positioning of trauma patient, with arms adducted, restricts this approach. Instead, the therapeutic cruciform positioning, with arms abducted at 90°, allows planning and performing of multiple life-saving interventions simultaneously. This positioning also provides a practical surgical field with improved sterility and procedural access.
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Affiliation(s)
- Biswadev Mitra
- Emergency and Trauma Centre, The Alfred Hospital, Melbourne, Victoria, Australia.,National Trauma Research Institute, The Alfred Hospital, Melbourne, Victoria, Australia.,Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,Monash Alfred Injury Network, Melbourne, Victoria, Australia
| | - Mark C Fitzgerald
- National Trauma Research Institute, The Alfred Hospital, Melbourne, Victoria, Australia.,Monash Alfred Injury Network, Melbourne, Victoria, Australia.,Trauma Service, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Alexander Olaussen
- National Trauma Research Institute, The Alfred Hospital, Melbourne, Victoria, Australia
| | | | - Jordan Bade-Boon
- Emergency and Trauma Centre, The Alfred Hospital, Melbourne, Victoria, Australia.,National Trauma Research Institute, The Alfred Hospital, Melbourne, Victoria, Australia.,Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Katherine Martin
- Trauma Service, The Alfred Hospital, Melbourne, Victoria, Australia
| | - De Villiers Smit
- Emergency and Trauma Centre, The Alfred Hospital, Melbourne, Victoria, Australia.,National Trauma Research Institute, The Alfred Hospital, Melbourne, Victoria, Australia.,Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,Monash Alfred Injury Network, Melbourne, Victoria, Australia
| | - Peter A Cameron
- Emergency and Trauma Centre, The Alfred Hospital, Melbourne, Victoria, Australia.,National Trauma Research Institute, The Alfred Hospital, Melbourne, Victoria, Australia.,Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,Monash Alfred Injury Network, Melbourne, Victoria, Australia
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Mitra B, Rau TF, Surendran N, Brennan JH, Thaveenthiran P, Sorich E, Fitzgerald MC, Rosenfeld JV, Patel SA. Plasma micro-RNA biomarkers for diagnosis and prognosis after traumatic brain injury: A pilot study. J Clin Neurosci 2017; 38:37-42. [PMID: 28117263 DOI: 10.1016/j.jocn.2016.12.009] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [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: 05/29/2016] [Revised: 11/13/2016] [Accepted: 12/26/2016] [Indexed: 11/16/2022]
Abstract
Prediction of post-concussive syndrome after apparent mild traumatic brain injury (TBI) and subsequent cognitive recovery remains challenging, with substantial limitations of current methods of cognitive testing. This pilot study aimed to determine if levels of micro ribonucleic acids (RNAs) circulating in plasma are altered following TBI, and if changes to levels of such biomarkers over time could assist in determination of prognosis after TBI. Patients were enrolled after TBI on presentation to the Emergency Department and allocated to three groups: A - TBI (physical trauma to the head), witnessed loss of consciousness, amnesia, GCS=15, a normal CT Brain and a recorded first pass after post-traumatic amnesia (PTA) scale; B TBI, witnessed LOC, amnesia, GCS=15, a normal CT brain and a PTA scale test fail and: C - TBI and initial GCS <13 on arrival to the ED. Venous blood was collected at three time points (arrival, day 5 and day 30). Isolation of cell-free total RNA was then assayed using a custom miRNA PCR array. Two micro-RNAs, mir142-3p and mir423-3p demonstrated potential clinical utility differentiating patients after mild head injury into those at greater risk of developing amnesia and therefore, post-concussive syndromes. In addition, these miRNA demonstrated a decrease in expression over time, possibly indicative of brain healing after the injury. Further evaluation of these identified miRNA markers with larger patient cohorts, correlation with clinical symptoms and analysis over longer time periods are essential next steps in developing objective markers of severity of TBI.
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Affiliation(s)
- Biswadev Mitra
- Emergency & Trauma Centre, The Alfred Hospital, Australia; National Trauma Research Institute, The Alfred Hospital, Australia; Department of Epidemiology & Preventive Medicine, Monash University, Australia.
| | - Thomas F Rau
- Department of Biomedical and Pharmaceutical Sciences, University of Montana, Missoula, MT, USA
| | - Nanda Surendran
- National Trauma Research Institute, The Alfred Hospital, Australia
| | - James H Brennan
- Emergency & Trauma Centre, The Alfred Hospital, Australia; National Trauma Research Institute, The Alfred Hospital, Australia
| | | | | | - Mark C Fitzgerald
- National Trauma Research Institute, The Alfred Hospital, Australia; Trauma Service, The Alfred Hospital, Australia
| | - Jeffrey V Rosenfeld
- Department of Surgery, Monash University, Melbourne, Australia; Department of Neurosurgery, The Alfred Hospital, Melbourne, Australia; Department of Surgery, F. Edward Hébert School of Medicine, Uniformed Services University of The Health Sciences, Bethesda, MD, USA
| | - Sarjubhai A Patel
- Department of Biomedical and Pharmaceutical Sciences, University of Montana, Missoula, MT, USA
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Olaussen A, Thaveenthiran P, Fitzgerald MC, Jennings PA, Hocking J, Mitra B. Prediction of critical haemorrhage following trauma: A narrative review. Journal of Emergency Medicine, Trauma and Acute Care 2016. [DOI: 10.5339/jemtac.2016.3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Introduction: Traumatic haemorrhagic shock can be difficult to diagnose. Models for predicting critical bleeding and massive transfusion have been developed to aid clinicians. The aim of this review is to outline the various available models and report on their performance and validation. Methods: A review of the English and non-English literature in Medline, PubMed and Google Scholar was conducted from 1990 to September 2015. We combined several terms for i) haemorrhage AND ii) prediction, in the setting of iii) trauma. We included models that had at least two data points. We extracted information about the models, their developments, performance and validation. Results: There were 36 different models identified that diagnose critical bleeding, which included a total of 36 unique variables. All models were developed retrospectively. The models performed with variable predictive abilities–the most superior with an area under the receiver operating characteristics curve of 0.985, but included detailed findings on imaging and was based on a small cohort. The most commonly included variable was systolic blood pressure, featuring in all but five models. Pattern or mechanism of injury were used by 16 models. Pathology results were used by 15 models, of which nine included base deficit and eight models included haemoglobin. Imaging was utilised in eight models. Thirteen models were known to be validated, with only one being prospectively validated. Conclusions: Several models for predicting critical bleeding exist, however none were deemed accurate enough to dictate treatment. Potential areas of improvement identified include measures of variability in vital signs and point of care imaging and pathology testing.
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Affiliation(s)
- Alexander Olaussen
- 2Emergency & Trauma Centre, The Alfred Hospital, Melbourne, Australia
- 5Monash School of Medicine, Monash University, Australia
- 3Trauma Service, The Alfred Hospital, Melbourne, Australia
- 4National Trauma Research Institute, The Alfred Hospital, Melbourne, Australia
- 1Department of Community Emergency Health and Paramedic Practice, Monash University, Melbourne, Australia
| | - Prasanthan Thaveenthiran
- 4National Trauma Research Institute, The Alfred Hospital, Melbourne, Australia
- 5Monash School of Medicine, Monash University, Australia
| | - Mark C. Fitzgerald
- 3Trauma Service, The Alfred Hospital, Melbourne, Australia
- 4National Trauma Research Institute, The Alfred Hospital, Melbourne, Australia
| | - Paul A. Jennings
- 1Department of Community Emergency Health and Paramedic Practice, Monash University, Melbourne, Australia
- 2Emergency & Trauma Centre, The Alfred Hospital, Melbourne, Australia
- 6College of Health and Biomedicine, Victoria University, Melbourne, Australia
| | - Jessica Hocking
- 2Emergency & Trauma Centre, The Alfred Hospital, Melbourne, Australia
| | - Biswadev Mitra
- 2Emergency & Trauma Centre, The Alfred Hospital, Melbourne, Australia
- 4National Trauma Research Institute, The Alfred Hospital, Melbourne, Australia
- 7Department of Epidemiology & Preventive Medicine, Monash University, Australia
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Maller JJ, Thaveenthiran P, Thomson RH, McQueen S, Fitzgerald PB. Volumetric, cortical thickness and white matter integrity alterations in bipolar disorder type I and II. J Affect Disord 2014; 169:118-27. [PMID: 25189991 DOI: 10.1016/j.jad.2014.08.016] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Revised: 06/25/2014] [Accepted: 08/10/2014] [Indexed: 01/07/2023]
Abstract
BACKGROUND Bipolar disorder (BD) is a debilitating psychiatric disorder affecting millions of people worldwide with mean time to diagnosis estimated to be at least 10 years. Whilst many brain imaging studies have compared those with BD to controls, few have attempted to investigate differences between BD Type I and II and matched controls. METHODS Thirty-one patients with BD (16 Type I and 15 Type II) and 31 matched healthy controls were MRI brain scanned with conventional T1-weighted and diffusion tensor imaging methods. RESULTS There was significantly reduced regional brain volume and thickness among the BD subjects, but also between BD Type I when compared to Type II. White matter integrity also differed between the groups and BD severity correlated significantly with regional brain volume and thickness. LIMITATIONS Future investigations will consider length of time each BD patient had been diagnosed with BD, as well as assessing controls for family history of psychiatric illness, specifically BD. Similarly, genetic assessment will be conducted as well. CONCLUSIONS These findings suggest that there are not only regional brain volumetric, thickness and white matter integrity differences between BD and matched controls, but also between those with BD Type I and Type II, such that reduced regional brain volume may underlie BD Type I whereas white matter integrity is more altered in BD Type II.
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Affiliation(s)
- Jerome J Maller
- Monash Alfred Psychiatry Research Centre, The Alfred & Monash University Central Clinical School, Melbourne Victoria, Australia.
| | - Prasanthan Thaveenthiran
- Monash Alfred Psychiatry Research Centre, The Alfred & Monash University Central Clinical School, Melbourne Victoria, Australia
| | - Richard H Thomson
- Monash Alfred Psychiatry Research Centre, The Alfred & Monash University Central Clinical School, Melbourne Victoria, Australia
| | - Susan McQueen
- Monash Alfred Psychiatry Research Centre, The Alfred & Monash University Central Clinical School, Melbourne Victoria, Australia
| | - Paul B Fitzgerald
- Monash Alfred Psychiatry Research Centre, The Alfred & Monash University Central Clinical School, Melbourne Victoria, Australia
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