Retrograde tubing as a rescue treatment for megaoesophagus: a case report

Familial dysautonomia (FD) is a genetic disease of the autonomous and sensory nervous systems. Severe gastro-oesophageal reflux is common and one of the major complications. Some patients with FD develop megaoesophagus. Oesophageal malfunction, accompanied by oesophageal food and secretion retention, results in recurrent aspiration and other severe respiratory complications. Through a traditional case report, we wish to show how reverse tubing of the oesophagus can lead to significant symptomatic improvement in these patients. Moreover, this technique can serve as an alternative treatment for other oesophageal motility disorders.

A fully 3D-printed versatile tumor-on-a-chip allows multi-drug screening and correlation with clinical outcomes for personalized medicine

Optimal clinical outcomes in cancer treatments could be achieved through the development of reliable, precise ex vivo tumor models that function as drug screening platforms for patient-targeted therapies. Microfluidic tumor-on-chip technology is emerging as a preferred tool since it enables the complex set-ups and recapitulation of the physiologically relevant physical microenvironment of tumors. In order to overcome the common hindrances encountered while using this technology, a fully 3D-printed device was developed that sustains patient-derived multicellular spheroids long enough to conduct multiple drug screening tests. This tool is both cost effective and possesses four necessary characteristics of effective microfluidic devices: transparency, biocompatibility, versatility, and sample accessibility. Compelling correlations which demonstrate a clinical proof of concept were found after testing and comparing different chemotherapies on tumor spheroids, derived from ten patients, to their clinical outcomes. This platform offers a potential solution for personalized medicine by functioning as a predictive drug-performance tool.

Rapid Classification of Sarcomas Using Methylation Fingerprint: A Pilot Study

Sarcoma classification is challenging and can lead to treatment delays. Previous studies used DNA aberrations and machine-learning classifiers based on methylation profiles for diagnosis. We aimed to classify sarcomas by analyzing methylation signatures obtained from low-coverage whole-genome sequencing, which also identifies copy-number alterations. DNA was extracted from 23 suspected sarcoma samples and sequenced on an Oxford Nanopore sequencer. The methylation-based classifier, applied in the nanoDx pipeline, was customized using a reference set based on processed Illumina-based methylation data. Classification analysis utilized the Random Forest algorithm and t-distributed stochastic neighbor embedding, while copy-number alterations were detected using a designated R package. Out of the 23 samples encompassing a restricted range of sarcoma types, 20 were successfully sequenced, but two did not contain tumor tissue, according to the pathologist. Among the 18 tumor samples, 14 were classified as reported in the pathology results. Four classifications were discordant with the pathological report, with one compatible and three showing discrepancies. Improving tissue handling, DNA extraction methods, and detecting point mutations and translocations could enhance accuracy. We envision that rapid, accurate, point-of-care sarcoma classification using nanopore sequencing could be achieved through additional validation in a diverse tumor cohort and the integration of methylation-based classification and other DNA aberrations.

Giant inguinal hernia repair using standard transverse inguinal incision with mesh. A retrospective case control study

BACKGROUND

Giant inguinal hernia (GIH) is a rare condition in the developed world, and the literature is scarce. Case reports describe different techniques in an attempt to prevent abdominal compartment syndrome (ACS). We aimed to review our experience with GIH repair.

METHOD

A retrospective review of the medical records of all consecutive patients who underwent a tension-free mesh GIH repair using a transverse inguinal incision between 2014 and 2021 at a tertiary university referral center. In brief, the technique included head-down positioning, maximal pre-incision reduction of hernia contents, and repair with mesh. Follow-up was conducted in outpatient clinic. We compared the results to a time-based open standard inguinal hernia repair group (control group).

RESULTS

During the study period, 58 patients underwent an open GIH repair with mesh without abdominal preparation. 232 patients were included in the control group. The mean surgery duration was 125.5 min in the GIH group and 84 min in the control group (p < 0.001). Bowel resection was not necessary in any case. In-hospital complication rates were 13.8% vs. 5.6% in the GIH and control groups, respectively (p = 0.045). Early complication rates (up to 30 days post-operatively) were 62.1% vs. 14.7% in the GIH and control groups, respectively (p < 0.001). Late complications rate was similar (p = 0.476). ACS and mortality were not reported. No recurrence event was reported in the GIH group.

CONCLUSION

Tension-free mesh repair for GIH using a standard transverse inguinal incision is feasible and safe and there is no need for abdominal cavity preparation. Early complications are more common than in the control group, but there were no higher rate of late or severe complications and no recurrence event.

Effect of Magnetic Resonance Imaging on Acute Surgical Treatment of Pregnant Patients: A Single Institution Study

BACKGROUND

Abdominal pathology in pregnant patients is a frequent challenge for emergency department physicians. Ultrasound is the imaging modality of choice but is inconclusive in approximately one-third of cases. Magnetic resonance imaging (MRI) is becoming increasingly available, even in acute settings. Multiple studies have defined the sensitivity and specificity of MRI in this population.

OBJECTIVES

To evaluate the use of MRI findings in pregnant patients presenting with acute abdominal complaints to the emergency department.

METHODS

This retrospective cohort study was conducted at a single institution. Data were collected on pregnant patients who underwent an MRI for acute abdominal complaints between 2010 and 2019 at a university center. Patient demographics, diagnosis at admission, ultrasound and MRI findings, and discharge diagnosis were recorded and evaluated.

RESULTS

In total, 203 pregnant patients underwent an MRI for acute abdominal complaints during the study period. MRI was found without pathology in 138 cases (68%). In 65 cases (32%), the MRI showed findings that could explain the patient's clinical presentation. Patients presenting with long-standing abdominal pain (> 24 hours), fever, leukocytosis, or elevated C-reactive protein values were at a significantly increased risk of having an acute pathology. In 46 patients (22.6%), MRI findings changed the primary diagnosis and management while in 45 patients (22.1%) MRI findings improved characterization of the suspected pathology.

CONCLUSIONS

MRI is helpful when clinical and sonographic findings are inconclusive, leading to changes in patient management in more than one-fifth of patients.

Feasibility and safety of a novel blunt tip concealed needle device for pericardial access in porcine models

BACKGROUND

Percutaneous pericardial access is the cornerstone of various procedures in clinical cardiology. The two commonly used methods utilizing large bore (LB) and smaller micropuncture (MP) needles often lead to inadvertent RV punctures. As both of these techniques push the pericardium inward, the novel blunt tip concealed needle device (BTCND) introduces the concept of bringing a small portion of the pericardium into a tube, where needle puncture and guidewire can be passed into the pericardial space all within the safety of the tube.

METHODS

The BTCND (Via One®, CardioVia, Nazareth, Israel) is a tool designed to allow for safe percutaneous subxiphoid pericardial access. In this preclinical study, a total of 18 procedures were performed in 5 female pigs. All procedures were performed under general anesthesia and under fluoroscopic guidance with a team of veterinarians and cardiac electrophysiologists. A laparoscopic camera was used to demonstrate and record the procedure. The Institutional Animal Care and Use Committees approved all preclinical experiments.

RESULTS

A total of 18 procedures were performed on five female pigs. In all procedures, the physicians safely introduced guidewire into the pericardial space. Device operation was not associated with any adverse events or bleeding, nor was any damage seen to the pericardium, the heart, or other organs during the procedure.

CONCLUSION

The result of our preclinical report demonstrates that the device is intuitive, easy to use, and effective for its intended use. Large preclinical studies are needed to validate the results of the study.

OC-002 EVALUATION OF GIANT INGUINAL HERNIA REPAIR RESULTS - A RETROSPECTIVE SINGLE INSTITUTION CASE-CONTROL PROPENSITY SCORE MATCHED STUDY

Background

Giant inguinal hernia (GIH), defined as a hernia descending below the inner-thigh midpoint in upright position, is rare. Case reports describe techniques in which the abdominal cavity is prepared and care is taken to prevent abdominal compartment syndrome (ACS). Our aim was to analyze and review our experience with GIH repair.

Methods

Retrospective single-institution, case-control, study included adults who underwent GIH repair between 2014–2021 at an university referral center. Technique included endo-tracheal intubation, head-down positioning, maximal pre-incision reduction of hernia contents, and repair with mesh. Follow-up was conducted in outpatient clinic. Results were compared to a time-based control group.

Results

During the study period, 58 patients underwent an open GIH repair with mesh without abdominal preparation. Control group included 232 patients who underwent open non-giant inguinal hernia repair (control group). Bowel resection was not necessary in any case. The in-hospital and 30-day complication rates were 17.2% and 68.9% in the GIH group, and 8.2% and 27.2%, in the control group (p=0.04, OR=2.3; and p&lt;0.001, OR=5.9, respectively). Ischemic orchitis was common in the GIH group (65.5%) compared to the control group (13.4%) (p&lt;0.001, OR=12.3). ACS, major complications and mortality were not reported. 90-day complication rates were similar. 2 cases of recurrence (0.9%) were observed in the control group.

Conclusions

Our study suggests that GIH repair is safe and feasible, and there is no need for abdominal cavity preparation. Early complications, mainly ischemic orchitis, are more common than control group, but without long-term implications and with a very low recurrence rate.

Pneumatosis Cystoides Coli Presenting as Acute Abdomen in a Patient with Complicated Behcet’s Disease: A Case Report

Patient: Male, 40-year-old

Final Diagnosis: Pneumatosis cystoides coli

Symptoms: Abdominal pain • acute abdomen • anorexia

Medication: —

Clinical Procedure: Exploratory laparotomy • ileostomy placement • right hemicolectomy

Specialty: Gastroenterology and Hepatology • Rheumatology • Surgery

Management of Pathogenic CDH1 Variant Carriers within the FREGAT Network: A multicentric Retrospective Study

OBJECTIVE

To describe the management of pathogenic CDH1 variant carriers (pCDH1vc) within the FREGAT (FRench Eso-GAsTric tumor) network. Primary objective focused on clinical outcomes and pathological findings, Secondary objective was to identify risk factor predicting postoperative morbidity (POM).

SUMMARY BACKGROUND DATA

Prophylactic Total Gastrectomy (PTG) remains the recommended option for gastric cancer risk management in pCDH1vc with however endoscopic surveillance as an alternative.

METHODS

A retrospective observational multicenter study was carried out between 2003 and 2021. Data were reported as median [interquartile range] or as counts (proportion). Usual tests were used for univariate analysis. Risk factors of overall and severe POM (i.e. Clavien-Dindo grade 3 or more) were identified with a binary logistic regression.

RESULTS

99 patients including 14 index cases were reported from 11 centers. Median survival among index cases was 12.0[7.6-16.4] months with most of them having peritoneal carcinomatosis at diagnosis (71.4%). Among the remaining 85 patients, 77 underwent a PTG (median age 34.6 [23.7 - 46.2], ASA score 1: 75%) mostly via a minimally-invasive approach (51.9%). POM rate was 37.7% including 20.8% of severe POM, with age≥ 40 years and low volume centers as predictors (P=0.030 and P=0.038). After PTG, the cancer rate on specimen was 54.5% (n=42, all pT1a) of which 59.5% had no cancer detected on preoperative endoscopy (n=25).

CONCLUSION

Among pCDH1vc, index cases carry a dismal prognosis. The risk of cancer among patients undergoing PTG remained high and unpredictable and has to be balanced with the morbidity and functional consequence of PTG.

Senolytic elimination of Cox2-expressing senescent cells inhibits the growth of premalignant pancreatic lesions

OBJECTIVE

Cellular senescence limits tumourigenesis by blocking the proliferation of premalignant cells. Additionally, however, senescent cells can exert paracrine effects influencing tumour growth. Senescent cells are present in premalignant pancreatic intraepithelial neoplasia (PanIN) lesions, yet their effects on the disease are poorly characterised. It is currently unknown whether senolytic drugs, aimed at eliminating senescent cells from lesions, could be beneficial in blocking tumour development.

DESIGN

To uncover the functions of senescent cells and their potential contribution to early pancreatic tumourigenesis, we isolated and characterised senescent cells from PanINs formed in a Kras-driven mouse model, and tested the consequences of their targeted elimination through senolytic treatment.

RESULTS

We found that senescent PanIN cells exert a tumour-promoting effect through expression of a proinflammatory signature that includes high Cox2 levels. Senolytic treatment with the Bcl2-family inhibitor ABT-737 eliminated Cox2-expressing senescent cells, and an intermittent short-duration treatment course dramatically reduced PanIN development and progression to pancreatic ductal adenocarcinoma.

CONCLUSIONS

These findings reveal that senescent PanIN cells support tumour growth and progression, and provide a first indication that elimination of senescent cells may be effective as preventive therapy for the progression of precancerous lesions.