Outcome of Endoscopic Cerebrospinal Fluid Rhinorrhoea Repair: An Institutional Study

Abstract

Cerebrospinal fluid Rhinorrhoea is caused by an abnormal open communication between the subarachnoid space and the nasal cavity. The most common anatomic sites of such abnormal communication are found in the anterior skull base, namely, ethmoid roof, olfactory groove, roof of the sphenoid sinus and the posterior wall of the frontal sinus. It can be classified into traumatic or spontaneous. Spontaneous leaks are associated with highest recurrence rates following surgical repair. The repair of CSF Rhinorrhoea has rapidly evolved over the past 30 years. Prior to the advent of the endoscopic approach, craniotomy was used for repairs which carried a variable success rate and morbidity. The purpose of our study was to ascertain the outcome after Transnasal Endoscopic Repair of spontaneous CSF leaks. This was a prospective study conducted at the Department of ENT at Safdarjung Hospital, New Delhi between January 2015 and June 2016. The study comprised of eleven patients who presented with the complaint of watery nasal discharge and were diagnosed to have spontaneous CSF Rhinorrhoea. Proper clinical examination, nasal endoscopy and biochemical and cytological analysis of nasal secretions of the patient was done. High Resolution Computed Tomography and MRI scans of the nose and paranasal sinuses were done to identify precise location of CSF leak and the size of fistula. CT cisternography was done wherever required. Fistula was repaired via Transnasal endoscopic approach in a multi layered underlay fashion. Out of all eleven patients with spontaneous CSF leaks, most common site of leak was from left cribriform area. Four patients (36.36%) were found to have meningoencephalocele. No associated intracranial lesion was found and all patients did not have any benign intracranial hypertension. Our success rate of endoscopic repair on first attempt was 100% with recurrence in 1 patient after 4 months of repair. Endoscopic repair of CSF rhinorrhoea is safe and effective, with a very low complication rate. It has almost completely replaced the older open techniques. Accurate localization of leak site followed by multilayered closure of dural defect appear to be essential for successful endoscopic repair.

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Subclinical Changes in Deceased Donor Kidney Proteomes are Associated with 12-month Allograft Function Posttransplantation – a Preliminary Study

Background Cerebral injury during Donation after Brain Death (DBD) may induce systemic damage affecting long-term kidney function posttransplantation. Conventional evaluation of donor organ quality as a triage for transplantation is of limited utility. Methods We compared donor kidneys yielding opposing extremes of the continuum of posttransplantation outcomes by several common kidney biopsy evaluation techniques including Kidney Donor Profile Index (KDPI) and Remuzzi scoring, and analysed tissue from a minimal sample cohort using Label-Free Quantitation (LFQ) mass spectrometry. Further assessment of the proteomic results was performed by orthogonal quantitative comparisons of selected key proteins by immunoblotting. Results We show that common evaluation techniques of kidney biopsies were not predictive for posttransplantation outcomes. In contrast, despite the limited cohort size, the proteomic analysis was able to clearly differentiate between kidneys yielding extreme posttransplantation outcome differences. Pathway analysis of the proteomic data suggested that outcome-related variance in protein abundance associated with profibrotic, apoptosis and antioxidant proteins. Immunoblotting confirmation further supported this observation. Conclusions We present preliminary data indicating that there is scope for existing evaluation approaches to be supplemented by the analysis of proteomic differences. Furthermore, the observed outcome-related variance in a limited cohort was supported by immunoblotting and is consistent with mechanisms previously implicated in the development of injury and cytoprotection in kidney transplantation. This is an open access article distributed under the Creative Commons Attribution License 4.0 (CCBY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. + Equal contribution ◊ Equal contribution Corresponding Author: Dr. Maria Kaisar (maria.kaisar@nds.ox.ac.uk), Nuffield Department of Surgical Sciences, University of Oxford, Oxford, OX3 7LJ, United Kingdom AUTHORSHIP PAGE Authorship: MK, BMK and RJP designed this study. MK, AZ, NW as members of the National Management Team and the QUOD Steering Committee participated in the establishment of the QUOD biobank. RJP is the Coordinator of the QUOD consortium. Clinical evaluation of samples was performed by MK. Sample preparation for proteomic study was performed by MK, MLT and HH. Mass spectrometric analysis was performed by MLT and HH. Mass spectrometric data was processed and searched by MK and MLT. Statistical analysis of proteomic quantitation was performed by MK and PDC. Immunoblotting was performed by LvD. Remuzzi scoring was performed by AK. The paper was written by MK, PDC, BMK and RJP with input from the other authors. Disclosure: The authors declare no conflicts of interest Funding: This work was supported by research funding from NHS Blood and Transplant Trust Fund TF031 and Oxford Transplant Foundation award to M.K., a John Fell Fund 133/075 and Wellcome Trust grant 097813/Z/11/Z to B.M.K. and COPE FP7 grant award to R.J.P. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Survival from a 75% TBSA thermal injury complicated by bowel ischemia presenting with pneumatosis intestinalis

Abstract

Thermal injury is associated with an increased risk of abdominal complications such as ischemia, infarction and pneumatosis intestinalis (PI). PI is characterized by gas in the intestinal wall and, when diagnosed it can signify the presence of a life-threatening condition. We present a case of a patient who survived 75% total body surface area burns complicated by ischemic bowel that initially presented as extensive PI. This patient was emergently taken to the operating room and underwent a subtotal colectomy and small bowel resection for ischemic bowel. Prompt diagnosis and successful management of the underlying condition ultimately contributed to the patient's survival. The presence of peritonitis or abdominal distension, portomesenteric venous gas and lactic acidosis should prompt immediate surgical intervention in the post-burn period.

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Adenocarcinoma of jejunum

Abstract

Although gastrointestinal malignancy is still the major concern of health problems in Worldwide and Thailand, but small intestinal malignancy is extremely rare. The location of small intestinal malignancy is duodenum (73.6%), jejunum (13.2%) and ileum (13.2%). The diagnosing of small intestinal malignancy usually delays due to inaccessible of esophagogastroduodenoscopy especially jejunum and ileum causing poor prognostic outcomes. We reported our case of jejunal adenocarcinoma.

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Poorly differentiated signet ring cell carcinoma of pancreas masquerading as chronic pancreatitis

Abstract

Pancreatic cancer is typically arises in the context of inflammation, and a surrounding area of pancreatitis is often present within the tumor microenvironment. Signet ring cell carcinoma (SRCC) is a rare variant of pancreatic adenocarcinoma. Pathologically, it presents either as single cells or loose clusters masquerading in the background of pancreatitis. Sampling of these inflammatory cells during biopsy can result in the incorrect diagnosis of pancreatitis. We report a case of SRCC of the pancreas which the diagnosis of cancer was delayed because multiple biopsies revealed only inflammatory changes with no obvious evidence of malignancy. This case highlights the fact that negative results with endoscopic ultrasound fine needle aspiration in SRCC can be misleading. A cancer diagnosis should still be considered despite findings of inflammatory pancreatitis if the clinical presentation is concerning for cancer (mass on CT scan).

https://ift.tt/2MC1hhT

Age is nothing but a number: radical en bloc resection of colon adenocarcinoma with abdominal wall reconstruction in an 81 year old

Abstract

Colon adenocarcinoma is a common neoplasm, which rarely presents with full thickness invasion through the abdominal wall. Aggressive treatment is often reserved for younger patients, with many surgeons opting to consider elderly patients as non-operative candidates, especially in the setting of diffuse disease. We report a case of radical resection of a colon cancer, with full thickness abdominal wall invasion in an 81-year-old female. The patient presented with gradual abdominal swelling over multiple months. She had a CT scan revealing a mass eroding through her abdominal wall, up to the skin. Operative resection with adjuvant chemotherapy was chosen as therapy because the patient had no co-morbidities. The patient underwent en bloc resection of the abdominal wall with right hemicolectomy and resection of all structures attached to the mass. The patient has been disease free for 24 months and has had return to her baseline activities of daily living.

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Foreign body granuloma treatment with 22‐MHz ultrasound‐guided corticoid infiltration

Journal of Cosmetic Dermatology, EarlyView.


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