Visceral Peritoneal Research Articles

Can a Sacrococcygeal Epidural of 0.25% Bupivacaine Prevent the Activation of the Sympathetic Nervous System during Feline Ovariectomy?

The ovariectomy (OVE) procedure can trigger somatosensory and visceral peritoneal nociception. Sacrococcygeal epidural (ScE) anesthesia may complement or replace systemic analgesia used for feline OVE, reducing opioid consumption and their related undesirable adverse effects and consequently reducing or completely blocking the sympathetic nervous system activation during this procedure. The present study aimed to evaluate the activation of the sympathetic nervous system resulting from adding an ScE injection of bupivacaine 0.25% (0.3 mL kg-1) in feline OVE and identify whether this translates to hemodynamic variables stability. A Parasympathetic Tone Activity (PTA) monitor was applied given that it performs analysis of heart rate variability (HRV) detecting changes in sympathetic and parasympathetic tone, making it a good tool for detecting activation of the sympathetic nervous system during the study. Two groups of animals were evaluated in five perioperative times, namely, the control group (CG) (n = 18) with systemic analgesia alone and the sacrococcygeal epidural group (ScEG) (n = 20) with 0.25% bupivacaine combined with systemic analgesia. Thirty-eight female cats were selected. All animals assigned to CG and ScEG were premedicated with dexmedetomidine (20 μg kg-1 IM) and methadone (0.2 mg kg-1 IM). General anesthesia was induced with propofol IV ad effectum and maintained with isoflurane in 100% oxygen. Heart rate, non-invasive systolic and median blood pressure, respiratory rate, and instantaneous parasympathetic tone activity were recorded. Compared to systemic analgesia alone (CG), sacrococcygeal epidural (ScEG) reduced the rise of common hemodynamic variables but did not prevent sympathetic nervous system activation.

Importance of local peritoneal involvement on the prognosis of colon cancer

Background: The implication of serous infiltration, as well as peritoneal invasion with free cells in the prognosis of colorectal cancer highlights the need to evaluate and validate diagnostic methods, allowing preoperative detection of peritoneal carcinomatosis and/or the invasion of serosal layer (pT4a). The implication of serous infiltration, as well as peritoneal invasion with free cells in the prognosis of colorectal cancer highlights the need to evaluate and validate diagnostic methods, allowing preoperative detection of peritoneal carcinomatosis and/or the invasion of serosal layer (pT4a). The objective of the study was to determine whether the peritoneal involvement (evaluated by Shepherd classification; Grade 1: Absence of peritoneal invasion, Grade 2: Peritoneal surface affected by peritumoral inflammatory infiltrate but without signs of invasion by neoplastic cells, Grade 3: Infiltration of the visceral peritoneal layer by tumor cells and Grade 4: Ulceration of the serous peritoneal surface and/or free tumor cells on the peritoneal surface) is a prognostic factor in patients with pT3 or pT4 colon cancer.

Laparoscopic Neovagina Creation by Using Modified Davydov Technique

A-21 year-old woman diagnosed with Meyer Rokitamsky Kuster Hauser syndrome has presented with a complaint of amenorrhea and failure to have vaginal penetration during coitus. On magnetic resonance imaging, bilateral rudimentary uterine remnants next to normal-appearing ovaries with absence of uterus have been detected. Laparoscopically, a 3 cm transverse incision was made pelvic peritoneum and vaginal apex to create a two-finger width opening to the blind vagina. Anterior and posterior visceral peritoneal edges have been grasped and sutured vaginally to the vaginal epithelial border. A continuous purse string stitch technique has been utilized to close the proximal part of the neovagina. The postoperative course of the patient was uneventful. The patient kept using a vaginal silicone dilatator every night for 3 months and she was allowed to have regular coital activity after then. The modified Davydov procedure is an efficient surgical technique with lower complication rates and vaginal stenosis rates.

Adenocarcinoma gástrico: revisión del TNM y de las vías de diseminación

Gastric cancer is the fifth most common cancer in the world. The most common histologic subtype is adenocarcinoma. Gastric adenocarcinomas are staged using the American Joint Committee on Cancer's 8th TNM classification. The perigastric ligaments, mesentery, omentum, and potential spaces between the parietal and visceral peritoneal linings are important structures for staging. The spread of disease is influenced by the location of the tumor within the stomach, as well as by the anatomy related to the ligaments and lymph vessels. CT is the imaging modality of choice for the preoperative clinical staging of gastric cancer, and it is essential for planning treatment. To be able to do an adequate imaging workup, radiologists need to know the different pathways through which gastric cancer can spread: lymphatic, subperitoneal, direct invasion, transperitoneal, hematogenous, and extramural venous invasion.

Post-Supravaginal Hysterectomy for Bladder Flap Hematoma in P3A0 Preterm Delivery by Cesarean Section due to Fetal Distress

Introduction: Bladder flap hematoma (BFH) is a rare complication of cesarean section (CS). BFH appears between the bladder and the lower uterine segment (LUS) when the visceral peritoneal is closed during traditional CS techniques and decreased uterine contractions. Surgery is the treatment of choice for the management of peritoneal closure in CS and the decrease in uterine contractions that cause BFH.Case Presentation: A 35-year-old G3P2A0 underwent a cesarean delivery due to fetal distress. CS was performed with the visceral peritoneal sutured as in the traditional technique. Six hours after CS, there was an increase in abdominal circumference, muscle defenses, hypotension, tachycardia, anemia, and leukocytosis. She had to undergo repeated laparotomy with acute abdomen after CS and hysterectomy because uterine atony was found.Conclusions: BFH can be caused by peritoneal closure during CS and decreased uterine contractions or uterine atony. Although there is no standard protocol for management, surgical approaches for cases with infection or bleeding and hysterectomy are performed to save the patient’s life from uterine atony.

Localized gastric mesothelioma with nodal metastasis-an exceptionally rare entity.

Localized mesothelioma is a rare disease with very few reports of presentation in visceral organs. We report a case of localized gastric mesothelioma with lymph node metastasis in a 32-year-old man without asbestos exposure. A failed attempt at resection was made before presentation at another center. He was given perioperative chemotherapy that was followed by a D2 radical subtotal gastrectomy and hyperthermic intraperitoneal chemotherapy. Histopathology showed epithelioid mesothelioma with nodal metastasis but without visceral peritoneal involvement. Cytoreductive surgery and regional chemotherapy are standard in diffuse mesothelioma. Management of localized mesothelioma is anecdotal; however aggressive surgery plays a central role with selective use of perioperative chemotherapy.

Are myoepithelial cells confined to genital coelomic sinus in the gonads of sea stars?

An ultrastructural study of the gonadal wall in 10 sea star species from the orders Forcipulatida, Paxillosida, Spinulosida, Valvatida and Velatida has shown variations in the presence of myoepithelial cells in the visceral peritoneal epithelium. These cells have only been found in the peritoneal epithelium of the gonads in Aphelasterias japonica (Forcipulatida: Asteriidae), Asterias amurensis (Forcipulatida: Asteriidae), Distolasterias nipon (Forcipulatida: Asteriidae), Diplopteraster multipes (Velatida: Pterasteridae), Luidia quinaria (Paxillosida: Ctenodiscidae), and Pteraster sp. (Velatida: Pterasteridae). Our results may shed light on the evolution of peritoneal epithelium of sea star gonads. It is probable that, initially sea stars had myoepithelial cells in visceral peritoneal epithelium of the gonads. The species from the orders Forcipulatida and Velatida have retained this plesiomorphic state, while many species from the orders Paxillosida, Spinulosida and Valvatida have lost myoepithelial cells from visceral peritoneal epithelium of their gonads.

Combined Laparoscopic-Assisted Robotic-Hysteroscopic Isthmoplasty Using Near-Infra Red Technology: A Novel Approach

<h3>Study Objective</h3> To demonstrate a surgical technique of isthmoplasty for the treatment of symptomatic caesarean scar defect. The authors present a standardised approach using combined minimally invasive techniques and Near-Infra-Red technology (NIRT) to perform the procedure in a systematic manner. <h3>Design</h3> Step-by-step oral presentation of the surgical technique. <h3>Setting</h3> Macquarie University Hospital (MUH), Australia. <h3>Patients or Participants</h3> MUH Gynaecology Clinic. <h3>Interventions</h3> A 44-years-old with three previous Caesarean sections presented with intermenstrual bleeding and pelvic pain. Transvaginal ultrasound diagnosed a grade-3 (>25mm) isthmocoele. A combined robotic-assisted-laparoscopic-hysteroscopic isthmoplasty was performed using the Da-Vinci-Xi-robot. The procedure began with hysteroscopy to explore the uterine cavity and identify the caesarean scar defect. At laparoscopy, the abdomino-pelvic cavity was explored systematically. To expose the isthmocoele, sharp dissection of the visceral peritoneal layer overlying the uterine isthmus was performed. The hysteroscopic light was directed cephalad and the laparoscopic light was then switched off to demonstrate the "Halloween sign", helping to identify the upper and lower limits of the isthmocoele. NIRT mode was then activated, the green fluorescence of the scar defect in a dark background further demarcated the surgical margins. A colpotomiser was inserted; the cup stabilised the cervix relative to the uterine body while the central cannula defined the cervical canal and aligned the defect for excision and repair. The scar tissue was excised robotically with removal of all edges of the pseudo-cavity. The myometrium was repaired in two layers with continuous barbed 2-0 suture ensuring a tension-free repair. NIRT was again activated to check for integrity of repair. <h3>Measurements and Main Results</h3> Operative time was 60 minutes. Patient was discharged same day with symptoms resolution. <h3>Conclusion</h3> Combined Laparoscopic-assisted-robotic-hysteroscopic isthmoplasty is safe and effective, giving the surgeon a comprehensive evaluation of the anatomy of the isthmocoele, and increasing the accuracy of complete resection and restoration of the anatomy. NIRT technology demarcates the resection margins and confirms complete closure of the defect.

Combined Robotic-Assisted Laparoscopic-Hysteroscopic Isthmoplasty Using Near-Infra Red Technology: A Novel Approach

<h3>Study Objective</h3> To demonstrate a surgical technique of isthmoplasty for the treatment of symptomatic caesarean scar defect. The authors present a standardised approach using combined minimally invasive techniques and Near-Infra-Red technology (NIRT) to perform the procedure in a systematic manner. <h3>Design</h3> Step-by-step Video demonstration of the surgical technique. <h3>Setting</h3> Macquarie University Hospital (MUH), Australia. <h3>Patients or Participants</h3> MUH Gynaecology Clinic. <h3>Interventions</h3> A 44-years-old with three previous Caesarean sections presented with intermenstrual bleeding and pelvic pain. Transvaginal ultrasound diagnosed a grade-3 (>25mm) isthmocoele. A combined robotic-assisted-laparoscopic-hysteroscopic isthmoplasty was performed using the Da-Vinci-Xi-robot. The procedure began with hysteroscopy to explore the uterine cavity and identify the caesarean scar defect. At laparoscopy, the abdomino-pelvic cavity was explored systematically. To expose the isthmocoele, sharp dissection of the visceral peritoneal layer overlying the uterine isthmus was performed. The hysteroscopic light was directed cephalad and the laparoscopic light was then switched off to demonstrate the "Halloween sign", helping to identify the upper and lower limits of the isthmocoele. NIRT mode was then activated, the green fluorescence of the scar defect in a dark background further demarcated the surgical margins. A colpotomiser was inserted; the cup stabilised the cervix relative to the uterine body while the central cannula defined the cervical canal and aligned the defect for excision and repair. The scar tissue was excised robotically with removal of all edges of the pseudo-cavity. The myometrium was repaired in two layers with continuous barbed 2-0 suture ensuring a tension-free repair. NIRT was again activated to check for integrity of repair. <h3>Measurements and Main Results</h3> Operative time was 60 minutes. Patient was discharged same day with symptoms resolution. <h3>Conclusion</h3> Combined robotic-assisted-laparoscopic-hysteroscopic isthmoplasty is safe and effective, giving the surgeon a comprehensive evaluation of the anatomy of the isthmocoele, and increasing the accuracy of complete resection and restoration of the anatomy. NIRT technology demarcates the resection margins and confirms complete closure of the defect.

A BRIEF HIATUS: PARAESOPHAGEAL HERNIA REPAIR COMPLICATED BY THORACIC HERNIA SAC

TOPIC: Critical Care TYPE: Fellow Case Reports INTRODUCTION: Paraesophageal herniation (PH) is the displacement of abdominal viscera, particularly the stomach, through the diaphragm into the thorax. Surgical fundoplication can infrequently lead to post-operative complications. We present a unique case of stage IV PH complicated by post-fundoplication insufflated hernia sac causing hemodynamic instability. CASE PRESENTATION: A 77-years-old woman with hypertension presented with dysuria and abdominal discomfort and was found to have hypokalemia, atrial fibrillation (AF), and pyuria. A stage IV PH was noted on computed tomography (CT). She underwent laparoscopic Nissen fundoplication for hernia repair. Postoperatively, she had worsening chest pain, dyspnea and tachycardia. CT scan revealed a large hernia sac with air-fluid level within the thorax causing cardiac shift and compression. The patient was intubated for worsening dyspnea and started on pressors for refractory hypotension. A pigtail catheter was placed under radiographic guidance into the displaced hernia sac with decompression of air and retrieval of fluid with rapid improvement in hemodynamics and cardiac shift. Fluid analysis showed low cell counts and negative cytology with yeast in culture. As tube feeds were introduced, the formulation drained through the hernia sac catheter with an elevated fluid amylase level of 895 raising concern for an esophageal leak. The patient was extubated to high-flow nasal cannula but intermittent hypotension, dyspnea, and overall failure to thrive prompted her family to pursue hospice care. DISCUSSION: PH can cause herniation of abdominal contents into the thorax causing significant morbidity with median age of presentation between 65-75 years (1). With large phrenoesophageal membrane defects, organs including stomach, spleen, and small intestine can herniate. Diagnosis is made by barium swallow, endoscopy or CT (2). Treatment for advanced, symptomatic disease refractory to medical treatment is surgical. Given the need to insufflate the peritoneal cavity, laparoscopic repair can occasionally lead to insignificant surgical emphysema and pneumomediastinum or small pneumothorax (3). However, this can infrequently cause hemodynamic instability, and to our knowledge, there is no literature reporting an inflated visceral peritoneal sac protruding into the thorax causing tension physiology as in our patient. Diagnosis is based on clinical findings of shock and imaging showing mediastinal structure compression and shift. Treatment is based on decompression and, in patients stable for surgery, resection of the hernia sac. CONCLUSIONS: Visceral peritoneal sac herniation and insufflation with air-fluid level causing tension physiology is a rare phenomenon post-PE repair that can cause significant hemodynamic instability and morbidity. Clinical exam and radiographic imaging followed by quick decompression play a key role in swift recognition and urgent treatment. REFERENCE #1: Lebenthal A, Waterford SD, Fisichella PM. Treatment and controversies in paraesophageal hernia repair. Front Surg. 2015;2:13. REFERENCE #2: Roman S, Kahrilas PJ. The diagnosis and management of hiatus hernia. BMJ. 2014;349(oct23 1):g6154-g6154. REFERENCE #3: Singhal T, Balakrishnan S, Hussain A, Grandy-Smith S, Paix A, El-Hasani S. Management of complications after laparoscopic Nissen's fundoplication: a surgeon's perspective. Ann Surg Innov Res. 2009;3:1. DISCLOSURES: No relevant relationships by Pavan Bhat, source=Web Response no disclosure on file for Robert Cole; No relevant relationships by Theodore Plush, source=Web Response

Peritoneal Metastases: Their Associated Imaging Features

Peritoneal Metastases (PM) detection remains a challenge even with modern imaging. Knowing imaging features of abnormal findings frequently associated with PM is of interest to improve PM detection. Although ascites is a common imaging finding of PM, the presence of ascites alone, even in patients with known cancer, is not enough to diagnose PM. The peritoneum should be read as an own organ with careful analysis of the ligament (e.g. falciform and hepatoduodenal ligament), the mesos and the omenta. Indirect manifestations of visceral peritoneal involvement is a segment of small bowel fixed to the parietal peritoneum, the appearance of blockage of free circulation of ascites, plurisegmental bowel obstruction and clumped bowel that is a strong predictor of diffuse involvement of the visceral peritoneum by a high grade tumor. Ovarian and umbilical metastases are frequently associated with PM in particular in digestive cancers. Moreover, ovarian metastases has been shown to be less responsive to chemotherapy than other metastases and should not be chosen as a target lesion for RECIST assessment. The presence of cardiophrenic angle lymph nodes also increases the possibility of metastatic spread in peritoneum. Finally, the most common PM mimickers include colonic diverticulum, mesenteric lymph nodes, splenosis implants, fat necrosis and postoperative changes after cytoreductive surgery and HIPEC.

S2275 All at Once: Dual Novel Diagnosis of Crohn’s Disease and Colonic Adenocarcinoma in a 22-Year-Old Man

INTRODUCTION: Colorectal cancer (CRC) is the third most commonly diagnosed cancer in the United States. Mucinous adenocarcinoma makes up 10-15% of all CRC and disproportionately affects younger adults. One study found that those aged 25 and younger who developed CRC present acutely and when compared to older adults, were diagnosed at a more advanced stage and carried a poorer prognosis.[1] Crohn’s disease frequently presents in ages 20-29 and can increase risk of CRC. CASE DESCRIPTION/METHODS: A 22 year old male with no significant past medical history presented to ED with intermittent abdominal pain, diarrhea and weight loss. Initial labs revealed leukocytosis, elevated CRP/ESR and positive fecal occult blood test. CT imaging revealed hepatic flexure stricture with dilation of the ascending colon and distal ileum with enlarged ileocolic lymph nodes (Figure 1). Colonoscopy revealed moderate stenosis at the hepatic flexure with significant inflammation and ulceration which prevented a pediatric colonscopy from traversing. Descending colon had scattered moderate inflammation. Two days following the colonoscopy, the patient developed a bowel perforation which required emergent exploratory laparotomy with open right hemicolectomy and diverting loop ileostomy. Surgical findings included terminal ileum perforation, dense stricture at the hepatic flexure with adherence to the underlying duodenum without fistula. Pathology report revealed adenocarcinoma in the ascending colon invading into the visceral peritoneal surface, with extensive lymphovascular invasion. The cancer was staged at G3pT4aN2a. The uninvolved terminal ileum revealed active inflammation consistent with Crohn’s disease. Genetic testing was only positive for polysomy of chromosome 17. He was ultimately diagnosed with mucinous adenocarcinoma with signet ring cell features in the setting of newly diagnosed Crohn’s disease (Figure 2). DISCUSSION: This is a rare case of advanced mucinous adenocarcinoma with signet ring features of the ascending colon in a 22-year-old with previously undiagnosed Crohn’s disease. This demonstrates the importance and difficulty of considering CRC in the differential when working up a young adult for GI symptoms as the newly diagnosed Crohn’s disease seemed to fit our patient’s presentation perfectly.Figure 1.: Stricture at the hepatic flexure with dilation of the ascending colon and distal ileum.Figure 2.: Signet ring cells.

Tissue-resident macrophages in omentum promote metastatic spread of ovarian cancer.

Experimental and clinical evidence suggests that tumor-associated macrophages (TAMs) play important roles in cancer progression. Here, we have characterized the ontogeny and function of TAM subsets in a mouse model of metastatic ovarian cancer that is representative for visceral peritoneal metastasis. We show that the omentum is a critical premetastatic niche for development of invasive disease in this model and define a unique subset of CD163+ Tim4+ resident omental macrophages responsible for metastatic spread of ovarian cancer cells. Transcriptomic analysis showed that resident CD163+ Tim4+ omental macrophages were phenotypically distinct and maintained their resident identity during tumor growth. Selective depletion of CD163+ Tim4+ macrophages in omentum using genetic and pharmacological tools prevented tumor progression and metastatic spread of disease. These studies describe a specific role for tissue-resident macrophages in the invasive progression of metastatic ovarian cancer. The molecular pathways of cross-talk between tissue-resident macrophages and disseminated cancer cells may represent new targets to prevent metastasis and disease recurrence.

Combined Laparoscopic-Hysteroscopic Isthmoplasty Using the Rendez-vous Technique Guided Step by Step

To demonstrate the surgical technique of Rendez-vous isthmoplasty for the treatment of symptomatic cesarean scar defect. In this video, the authors show the complete procedure in a step-by-step manner to standardize and facilitate the comprehension and performance of the procedure in a simple and safe way. Step-by-step video demonstration of the surgical technique. Private hospital in Curitiba, Paraná, Brazil. The patient is a 36-year-old woman without any comorbidities, G3 C3, and with radiologic transvaginal ultrasound diagnosis of isthmocele grade 3 (over 25 mm) identified in the superior third of the cervical canal. The main steps of combined laparoscopic-hysteroscopic isthmoplasty using the Rendez-vous technique are described in detail. A combined laparoscopic-hysteroscopic approach was performed. Under general anesthesia, the patient was placed in 0° supine decubitus, with her arms alongside her body. Operative setup included 15 mm Hg pneumoperitoneum, created using the closed Veress technique, and 4 trocars: a 10-mm trocar at the umbilicus for a 0° laparoscope, a 5-mm trocar in the right iliac fossa, a 5-mm trocar in the left iliac fossa, and a 5-mm trocar in the suprapubic area. The procedure begins after a systematic exploration of the pelvic and abdominal cavities. Step 1: Identification of key anatomic landmarks and exposure of the operation field. Step 2: By carrying out blunt and sharp dissection with cold scissors or a harmonic scalpel, the visceral peritoneal layer over the isthmus area is opened, a vesicouterine space is developed, and the bladder is pushed down at least 2 cm from the lower edge of the isthmocele. Step 3: Final Phrase: By hysteroscopic exploration of the cervical canal using the vaginoscopic approach, identification and delimitation of the isthmocele its performed by recognizing the diverticular mucosal hyperplasia, and then the hysteroscopic light is pointed directly toward the cephalic limit of the scar defect. Step 4: Laparoscopic lights are decreased in intensity and the "Halloween sign" is identified (hysteroscopic transillumination). The light of the hysteroscope is pointed to the top of the cesarean scar defect allowing the laparoscopist to identify the upper and lower edges of the scar. Step 5: Laparoscopic resection of all scar tissue, excision of all the edges of the pseudo cavity. Step 6: Adequate intracorporeal suturing technique, with a 2-layer myometrial repair using intracorporeal running and interrupted stitches of polydioxanone 2-0, is done, while ensuring preservation of the cavity by not including the endometrial tissue in the myometrial suture [1-3]. Step 7: Installation of the methylene blue dye to locate any leakage. The surgery ended without any intraoperative complications and within 60 minutes. The patient was discharged on the first day postoperatively and became pregnant 6 months after surgery, with a final C-section delivery of a healthy term newborn at 39-weeks gestational age. Combined Rendez-vous isthmoplasty is feasible, safe, and effective in experienced hands, giving the surgeon a comprehensive evaluation of the anatomy of the isthmocele, and increasing the odds of a complete resection and restoration of the anatomy [4-7]. In this patient, the procedure was uneventful, without any intra- or postoperative complications, and the symptoms were completely controlled.

Circulating osteopontin per tumor volume as a prognostic biomarker for resectable intrahepatic cholangiocarcinoma.

The role of osteopontin (OPN) in intrahepatic cholangiocarcinoma (ICC) remains controversial. This study aimed to explore the prognostic value of OPN in patients with ICC undergoing curative resection. Patients undergoing curative resection from 2005 to 2016 were identified for inclusion in this retrospective study. The expression level of OPN in tumors was measured in each of the 228 patients by immunohistochemistry. Circulating OPN in serum was tested in 124 patients by ELISA. Tumor volume was calculated according to preoperative imaging or operation record. Proliferation assay, wound healing assay, and invasion assay were performed to investigate the biological function. Low expression of OPN in tissue was associated with lymph node metastasis (P=0.009) and shorter overall survival (OS) (P=0.001). A low level of circulating OPN/volume was associated with multiple tumors (P<0.001), vascular invasion (P=0.027), visceral peritoneal perforation (P=0.001), and lymph node metastasis (P=0.002). It was also able to predict the invasive behavior, lymph node metastasis, and early recurrence with the area under the receiver operating curve (AUC) of being 0.719, 0.708 and 0.622 respectively. Patients with a low level of circulating OPN/volume had shorter OS (P=0.028) and disease-free survival (DFS) (P=0.004) and could benefit from adjuvant chemotherapy (P=0.011). Compared with negative controlled cells, ICC cell lines, which expressed more OPN, showed a decelerated proliferation rate, the weaker ability of migration and invasion, while the opposite was true for the cells expressed less OPN. MMP1, MMP10, and CXCR4 were negatively regulated by OPN. A low level of circulating OPN/volume could indicate aggressive characteristics, along with poor prognosis and efficacy of adjuvant chemotherapy in ICC patients. Over expression of OPN may inhibit phenotypes facilitating ICC metastasis by negatively regulating MMP1, MMP10, and CXCR4.

Typhlocolitis by Edwardsiella tarda in a Cow

Typhlocolitis by Edwardsiella tarda in a Cow

Study on dynamic expression profile of long non-coding RNA in peritoneal fibrosis

Objective To detect the dynamic expression of long non-coding RNA (lncRNA) in normal and peritoneal fibrosis tissue using microarray, and to discuss the relationship between lncRNA and peritoneal fibrosis. Methods Thirty male C57BL/6 mice were divided into three groups: normal group, model group for 4 weeks、model group for 6 weeks. Two model groups were injected with 4.5% peritoneal dialysis fluid (Baxter). RNA was extracted from mice’s visceral peritoneal tissue at 4 and 6 weeks after the experiment; Then the lncRNAs expression levels were detected by microarray in normal group and model groups separately; Finally the differentially expressed lncRNAs were identified by reverse transcriptase-polymerase chain reaction (RT-PCR). Results There were 857 lncRNAs differentially expressed more than 2 times in peritoneal fibrosis tissue as compared with nomal peritoneal tissue. Among them, with the prolongation of fibrosis time, 186 lncRNAs were significantly up-regulated, and 231 lncRNAs were significant down-regulated (P<0.05). Conclusion The expression profile of lncRNAs in peritoneal fibrosis tissue was changed dynamically, and the difference was significant. Suggesting that lncRNA may play a key role in peritoneal fibrosis development and occurrence. Key words: Long non-coding RNA; Peritoneal fibrosis; Microarray

Glisson's capsule cauterisation is associated with increased postoperative pain after laparoscopic cholecystectomy: a prospective case-control study.

INTRODUCTION Postoperative pain after laparoscopic cholecystectomy has three components: parietal, visceral and referred pain felt at the shoulder. Visceral peritoneal injury on the liver (Glisson's capsule) during cauterisation sometimes occurs as an unavoidable complication of the operation. Its effect on postoperative pain has not been quantified. In this study, we aimed to evaluate the association between Glisson's capsule injury and postoperative pain following laparoscopic cholecystectomy. METHODS The study was a prospective case-control of planned standard laparoscopic cholecystectomy with standardized anaesthesia protocol in patients with benign gallbladder disease. Visual analogue scale (VAS) abdominal pain scores were noted at 2 and 24 hours after the operation. One surgical team performed the operations. Operative videos were recorded and examined later by another team to detect presence of Glisson's capsule cauterisation. Eighty-one patients were enrolled into the study. After examination of the operative videos, 46 patients with visceral peritoneal injury were included in the study group, and the remaining 35 formed the control group. RESULTS VAS pain score at postoperative 2 and 24 hours was significantly higher in the study group than control (P=0.027 and 0.017, respectively). CONCLUSIONS Glisson's capsule cauterisation in laparoscopic cholecystectomy is associated with increased postoperative pain. Additional efforts are recommended to prevent unintentional cauterisation.

Reinvestigation of epithelial lining of the genital coelomic sinus in asteroids. An ultrastructural study.

Ultrastructural study of gonadal muscles in sea star, Asterina pectinifera, showed that myoepithelial cells were located only in the epithelial lining of the genital coelomic sinus. No myoepithelial cells were found in the visceral peritoneal epithelium or within connective tissue layer of the outer sac. Morphology of the myoepithelial cells in gonads of A. pectinifera varies during the reproductive cycle. During the gametogenic phase of the reproductive cycle, the myoepithelial cells get an elongated, spindle-like shape having a length of 20–30 m. In prespawning gonads, many of the myoepithelial cells form cytoplasmic extensions of 3–5 m in length, filled with myofilaments and penetrating into the underlying connective tissue of the outer sac or haemal sinus. Besides, myoepithelial cells, simultaneously anchored in the inner and outer sacs, were also observed. These changes result in development of more elaborated musculature and increase in contractility of the gonadal wall in prespawning gonads as compared to that during other stages of the reproductive cycle.

Mesenteric irritation as a means to prevent internal hernia formation after laparoscopic gastric bypass surgery

IntroductionInternal hernias (IHs) occur more frequently in laparoscopic gastric bypass (LGB) surgery than in the classic open procedure. The incidence of small bowel obstruction after LGB ranges from 1.8% and 9.7%. Some have theorized that this occurs because of decreased adhesion formation. MethodsThe mesenteric irritation technique is performed after closure of the jejunojejunal mesenteric defect with a running 2-0 silk suture. A sponge is then rubbed against the closed visceral peritoneal mesentery until petechiae are visualized on the surface of the mesentery. ResultsIn all, 338 LGBs were performed using the standard closure technique with an IH incidence of 5.3% (range 1.7% to 7.8%). When using the mesenteric irritation technique, 72 LGBs were performed with an IH rate of 1.4% (P = .13). ConclusionsMesenteric irritation is a novel technique performed with minimal additional time and no additional equipment. This technique may prove beneficial in reducing the incidence of IHs.