We have studied patients with recurrent varicose veins which were incompletely controlled by a thigh tourniquet. We used varicography, (a phlebogram via the varices), to detect sites of incompetence. Thirty patients (mean age 46 years) were investigated, 38 limbs being subjected to varicography and surgery. A primary operation had been performed between 3 months and 30 years earlier. A non-thrombogenic contrast medium, sodium meglumine ioxaglate 320 (Hexabix 320) was used. Metal markers were placed alongside the limb to identify the site of perforating veins on the phlebograms. The principal value of the technique was in the identification of mid-thigh perforator incompetence (MTPI) as we cannot diagnose this accurately by clinical or Doppler-ultrasound examination. Varicography demonstrated MTPI in 15/38 limbs (39%) and in only one thigh was this not confirmed at exploration. Varicography can demonstrate short saphenous incompetence and this was mainly of value in 3 patients who had previously undergone attempted short saphenous ligation; in all 3 the short saphenous vein was present and had not been ligated. The technique was less useful in demonstrating recurrence in the groin. Overall varicography influenced the operation performed in 17/38 limbs (45%), its main value being in the diagnosis of MTPI.
V aginal pessaries are effective in treating uterine prolapse but on rare occasions can cause serious complications if proper care is not taken. Case historyAn 88-year woman was referred urgently to the surgical clinic with a history of feculent vaginal discharge.Her practice nurse noticed that following an enema, it had expelled through the vagina.She also reported 6-8 weeks of constipation alternating with diarrhoea and faecal incontinence.Prior to this, her bowel habits had been normal.On examination, she was frail, but well oriented.Abdominal examination was normal.Digital rectal examination showed faecal loading and a hard object was felt in the anterior rectal wall.Speculum examination of the vagina showed faeces in the vagina along with a hard object high in the vagina, thought to be a pessary.The patient could not recollect having been fitted with a vaginal pessary.She was treated for urinary infection with antibiotics and the large bowel was cleared of faeces with regular enemas.An abdominal X-ray and a CT scan of the pelvis were obtained.She had an examination under anaesthesia.A shelf pessary was found high in the vagina with its handle eroding through the posterior fornix into the lower rectum 8 cm from the anal verge.The pessary (Fig. 1) was removed to reveal a defect in the posterior fornix of the vagina (Figs 2 and3).Colonoscopy was normal apart from the defect in the anterior wall of the rectum.There was no sign of malignancy.In view of the patient's frailty, a diverting end colostomy was performed.The patient made an uneventful recovery. CommentsSurgical repair is the definitive treatment for uterine prolapse.Elderly patients are known to tolerate vaginal
One hundred consecutive aortograms were studied to establish the efficacy of conventional arteriography in demonstrating distal vessels and the pedal arch. The standard technique was modified by using a long injection time, a large volume of contrast material (iopamidol 370), prolonged filming and multiple exposures of the feet. On the basis of these examinations each limb was classified as having aorto-iliac disease (18 limbs), superficial femoral disease (103 limbs), combined segment disease (28 limbs) or generalised disease (51 limbs). Calf and ankle arteries were seen in 196 of the 200 limbs (98%). Patency of the pedal arch was established in 184 (92%). Fourteen percent of the group of patients with combined segment disease did not have their pedal arch visualised and this group contained most of the examination failures. This modified method of aortography can demonstrate the entire arterial tree from the aorta to the foot in 92% of limbs with symptomatic chronic atherosclerotic disease. This allows the majority of peripheral vascular reconstructions to be planned and performed without the need for intra-operative arteriography.
The patient is now very well and leading a normal, active life, though the subdermal tissues in his arms and legs remain bound down and tight.Skin biopsy shows no skin atrophy or loss of appendages but some subdermal fibrosis.
Abstract Aberrant expression of repeat RNAs in pancreatic ductal adenocarcinoma (PDAC) mimics viral-like responses with implications for tumor cell state and the surrounding microenvironment. To better understand the relationship of repeat RNAs in human PDAC, we employed the NanoString CosMx™ spatial molecular imaging (SMI) platform, which utilizes a 1,000-plex RNA panel with custom repeat RNA probes targeting long interspersed nuclear element 1 (LINE-1) retrotransposon ORF1 and ORF2, HSATII satellite (SAT) repeat, and two human endogenous retroviruses (HERV-K and HERV-H) in 46 primary tumors. This analysis revealed correlations of high repeat RNA expression with alterations in the epithelial state of PDAC cells and the myofibroblast phenotype in cancer-associated fibroblasts (CAFs). The loss of cellular identity observed with dosing of extracellular vesicles (EVs) and individual repeat RNAs in PDAC and CAF cell culture models points to cell-cell intercommunication involving these viral-like elements. Differences in the PDAC and CAF response are driven by distinct innate immune signaling pathways through interferon regulatory transcription factor 3 (IRF3). Altogether, our data indicate that cell context-specific viral-like responses driven by tumor cells have broad impacts on single-cell heterogeneity within cancer cells and the pancreatic cancer microenvironment. Citation Format: Eunae You, Patrick Danaher, Chenyue Lu, Siyu Sun, Luli Zou, Ildiko Phillips, Alexandra Rojas, Natalie Ho, Yuhui Song, Michael Raabe, Katherine Xu, Peter Richieri, Hao Li, Natalie Aston, Rebecca Porter, Bidish Patel, Linda Nieman, Nathan Schurman, Briana Hudson, Khrystyna North, Sarah Church, Vikram Deshpande, Andrew Liss, Tae Kim, Yi Cui, Youngmi Kim, Benjamin Greenbaum, Martin Aryee, David Ting. Repeat RNA mediated disruption of cellular plasticity in pancreatic cancer [abstract]. In: Proceedings of the AACR Special Conference in Cancer Research: Advances in Pancreatic Cancer Research; 2024 Sep 15-18; Boston, MA. Philadelphia (PA): AACR; Cancer Res 2024;84(17 Suppl_2):Abstract nr A039.
available in those who died.The above authors have shown by CT scan that mucocoeles occurred frequently after total exclusion but clinical complications followed only when the oesophagus was grossly dilated as in achalasia.I would consider two points in the operative technique as important.The oesophagus must be divided as close to the oesophageal growth as possible and the cut ends must be securely closed with interrupted sutures after thoroughly cleansing the lumen.
Summary Small bowel perforation occurs in up to 2 percent of patients with abdominal tuberculous. Patients present with an acute abdomen. Resection of the diseased segment and 18 months treatment with anti-tuberculosis drugs is recommended.
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