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Al-Abid MA, Law C, Mor I. How to Surveil Perianal Paget's Disease: A Case Report. Cureus 2023; 15:e50282. [PMID: 38196445 PMCID: PMC10776183 DOI: 10.7759/cureus.50282] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/10/2023] [Indexed: 01/11/2024] Open
Abstract
Perianal Paget's disease (PPD) is a rare manifestation of extramammary Paget's disease. It is characterized by the presence of malignant glandular epithelial cells within the squamous epithelium. There is a well-established but poorly understood association between PPD and underlying malignancy. Due to the rarity of the disease, there are no established guidelines for treatment or surveillance of PPD. We present the unusual case of a 73-year-old woman with primary PPD without an underlying malignant lesion. The rarity of the disease renders its management and surveillance an ongoing challenge. Our case of PPD without an underlying malignancy poses the question of the most appropriate surveillance for this rare disease.
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Affiliation(s)
- Meryem A Al-Abid
- General Surgery, Royal Brisbane and Women's Hospital, Brisbane, AUS
- General Surgery, The Tweed Hospital, Gold Coast, AUS
| | - Cameron Law
- General Surgery, The Tweed Hospital, Gold Coast, AUS
- Colorectal Surgery, John Flynn Private Hospital, Gold Coast, AUS
| | - Isabella Mor
- Colorectal Surgery, The Tweed Hospital, Gold Coast, AUS
- Colorectal Surgery, John Flynn Private Hospital, Gold Coast, AUS
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Zammit AP, Srinath H, Warner R, Mor I, Clark DA. Recurrent pouch volvulus treated with robotic ventral graft pouch‐pexy. ANZ J Surg 2022; 93:1386-1387. [DOI: 10.1111/ans.18197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 11/07/2022] [Accepted: 11/24/2022] [Indexed: 12/14/2022]
Affiliation(s)
- Andrew P. Zammit
- Faculty of Medicine University of Queensland Brisbane Queensland Australia
| | - Havish Srinath
- Department of Surgery John Flynn Private Hospital Queensland Gold Coast Australia
- Department of Surgery The Tweed Hospital New South Wales Tweed Heads Australia
- Faculty of Health Sciences & Medicine Bond University Gold Coast Queensland Australia
- School of Medicine Griffith University Gold Coast Queensland Australia
| | - Ross Warner
- Department of Surgery John Flynn Private Hospital Queensland Gold Coast Australia
- Department of Surgery The Tweed Hospital New South Wales Tweed Heads Australia
- Faculty of Health Sciences & Medicine Bond University Gold Coast Queensland Australia
- School of Medicine Griffith University Gold Coast Queensland Australia
| | - Isabella Mor
- Department of Surgery John Flynn Private Hospital Queensland Gold Coast Australia
- Department of Surgery The Tweed Hospital New South Wales Tweed Heads Australia
- Faculty of Health Sciences & Medicine Bond University Gold Coast Queensland Australia
- School of Medicine Griffith University Gold Coast Queensland Australia
| | - David A. Clark
- Faculty of Medicine University of Queensland Brisbane Queensland Australia
- Department of Surgical and Perioperative Services Royal Brisbane and Women's Hospital Queensland Brisbane Australia
- Faculty of Medicine and Health University of Sydney and Surgical Outcomes Research Centre (SOuRCe) Sydney New South Wales Australia
- Department of Surgery St Vincent's Private Hospital Northside Queensland Brisbane Australia
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Peacock T, Klebe S, Barnard J, Mor I. Haematochezia: an atypical presentation of metastatic malignant pleural mesothelioma. ANZ J Surg 2022; 93:1054-1055. [PMID: 36197042 DOI: 10.1111/ans.18095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 09/18/2022] [Accepted: 09/22/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Timothy Peacock
- Department of Colorectal Surgery, The Tweed Hospital, Tweed Heads, New South Wales, Australia
| | - Sonja Klebe
- Department of Anatomical Pathology, Flinders Medical Centre, Bedford Park, South Australia, Australia
| | - Jon Barnard
- Department of Colorectal Surgery, The Tweed Hospital, Tweed Heads, New South Wales, Australia
| | - Isabella Mor
- Department of Colorectal Surgery, The Tweed Hospital, Tweed Heads, New South Wales, Australia
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Ahmadi N, Mor I, Warner R. Comparison of outcome and costs of robotic and laparoscopic right hemicolectomies. J Robot Surg 2021; 16:429-436. [PMID: 34081291 DOI: 10.1007/s11701-021-01246-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 02/20/2021] [Accepted: 04/26/2021] [Indexed: 12/22/2022]
Abstract
To compare the outcomes of patients undergoing right hemicolectomy using laparoscopic or robotic approaches and perform a cost analysis. Retrospective review of all patients undergoing elective laparoscopic and robotic right hemicolectomies at a public and private hospital in NSW/QLD from January 2015 to June 2018. Cost analysis was calculated using actual and estimated costs by the local health district. A total of 101 patients were identified. 59 (58%) had Robotic resection, of which 44 (75%) had an intra-corporeal anastomosis. There were no demographic or oncological differences between the two groups. The robotic group had a significantly earlier time to bowels opening (2 vs 4 days, p < 0.001) and shorter length of stay (3 vs 5 days, p < 0.001). The robotic group had a lower rate of ileus (2% vs 14%, p = 0.02) and complications (5% vs 33%, p = 0.006). The mean lymph node harvest was higher in the robotic group (18 vs 14, p = 0.001). The operative time was longer in the robotic group (110 vs 97 min, p = 0.021). The total instrument costs of robotic surgery were A$2565.37 compared with $1507.50 for laparoscopic surgery. The cost of bed days was A$1167.00/day. The average difference in cost of care was calculated as A$1276.13 and A$464.43 less in the robotic with intra-corporeal and extra-corporeal anastomosis, respectively. Patients have significantly faster return to bowel function and shorter length of stay after Robotic vs laparoscopic right hemicolectomy and experience fewer complications. This difference in length of stay may make robotic right hemicolectomies more cost effective.
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Affiliation(s)
- Nima Ahmadi
- Department of Colorectal Surgery, The Tweed Hospital, Powell St, Tweed Heads, NSW, 2485, Australia
| | - Isabella Mor
- Department of Colorectal Surgery, The Tweed Hospital, Powell St, Tweed Heads, NSW, 2485, Australia.,Department of Colorectal Surgery, John Flynn Private Hospital, Tugun, QLD, 4224, Australia
| | - Ross Warner
- Department of Colorectal Surgery, The Tweed Hospital, Powell St, Tweed Heads, NSW, 2485, Australia. .,Department of Colorectal Surgery, John Flynn Private Hospital, Tugun, QLD, 4224, Australia.
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Vather R, Petrushnko W, Chapman D, Sammour T, Mor I, Warner R. Factors predictive of an advanced stage of colorectal cancer at presentation - a bi-national study. Colorectal Dis 2020; 22:1538-1544. [PMID: 32421899 DOI: 10.1111/codi.15137] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 02/08/2020] [Accepted: 04/08/2020] [Indexed: 02/08/2023]
Abstract
AIM Identifying elements associated with advanced colorectal cancer (CRC) stage may inform understanding of whether advanced disease is a corollary of access to healthcare or tumour biology and in turn allow the use of targeted screening and awareness programmes. The aim of this study was to identify factors that predict advanced stage of CRC at presentation in Australia and New Zealand. METHOD This was a cross-sectional registry study sourced from the prospectively maintained Binational Colorectal Cancer Audit database of Australia and New Zealand. The primary outcome was stage as defined by the TNM system with associations drawn to demographic and perioperative variables. RESULTS In total, 25 282 separate cancers were included. Univariate analysis found younger age, treatment at a public facility, increasing American Society of Anesthesiologists (ASA) grade, more distal tumours, and less recent year of surgery to all be associated with more advanced disease; sex and presentation at a rural vs urban hospital had no bearing on this outcome. Logistic regression identified younger age (< 60 years vs > 80 years: OR 1.96; 95% CI 1.80-2.14; P = 0.002), treatment at a public vs private hospital (OR 1.21; 95% CI 1.14-1.28; P < 0.001), increasing ASA grade (ASA4 vs ASA1: OR 1.37; 95% CI 1.17-1.59, P < 0.001) and more distal tumours (mid-low rectal vs right colon tumours: OR 1.52; 95% CI 1.41-1.64; P < 0.001) to be independent predictors of nodal or metastatic disease at presentation. CONCLUSION Younger age, increasing ASA grade, more distal tumours, and treatment at a public rather than private facility are independently associated with the presence of nodal or distant CRC metastases at diagnosis.
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Affiliation(s)
- R Vather
- Colorectal Unit, Department of Surgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - W Petrushnko
- Colorectal Unit, Department of Surgery, Tweed Hospital, Tweed Heads, New South Wales, Australia
| | - D Chapman
- Department of Surgery, University of Auckland, Auckland, New Zealand
| | - T Sammour
- Colorectal Unit, Department of Surgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia.,Discipline of Surgery, Faculty of Health and Medical Science, School of Medicine, University of Adelaide, Adelaide, South Australia, Australia
| | - I Mor
- Colorectal Unit, Department of Surgery, Tweed Hospital, Tweed Heads, New South Wales, Australia
| | - R Warner
- Colorectal Unit, Department of Surgery, Tweed Hospital, Tweed Heads, New South Wales, Australia
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Chan DL, Chua D, Ravindran P, Perez Cerdeira M, Mor I. A case report of endometriosis presenting as an acute small bowel obstruction. Int J Surg Case Rep 2017; 41:17-19. [PMID: 29024840 PMCID: PMC5742011 DOI: 10.1016/j.ijscr.2017.09.024] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2017] [Accepted: 09/28/2017] [Indexed: 01/07/2023] Open
Abstract
INTRODUCTION Endometriosis is a common and benign condition that causes significant morbidity to women of childbearing age. It uncommonly affects the gastrointestinal tract and rarely manifests as an acute small bowel obstruction. PRESENTATION OF CASE A 46-year old female presented to the emergency department with signs and symptoms consistent with an acute small bowel obstruction. She had a paucity of background surgical history, having only had a laparoscopic cholecystectomy. Her CT demonstrated small bowel obstruction with a transition point in the distal ileum. Given the site of obstruction was remote from previous surgery, a high index of suspicion was maintained and early laparoscopy performed the same day. Operative findings were consistent with an endometrial stricture of the distal ileum and a formal resection was performed. DISCUSSION Endometriosis that affects the gastrointestinal tract often presents with non-specific symptoms. This is a rare case of an acute small bowel obstruction as the index symptom of endometriosis in a peri-menopausal patient. This is the first case in the literature to describe same day laparoscopy and small bowel resection of such a case and a prolonged preoperative period and misdiagnoses previously described were avoided due to clinical suspicion. CONCLUSION Endometriosis as a differential should be considered with a high index of suspicion in pre-menopausal women, particularly in patients with negligible previous surgical history. There should be a low threshold for early laparoscopy and resection of affected bowel in these patients.
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Affiliation(s)
- Daniel L Chan
- Department of Surgery, The Tweed Hospital, Tweed Heads, NSW, Australia; The Faculty of Medicine, University of New South Wales, Australia.
| | - Dorothy Chua
- Department of Surgery, The Tweed Hospital, Tweed Heads, NSW, Australia
| | - Praveen Ravindran
- Department of Surgery, The Tweed Hospital, Tweed Heads, NSW, Australia
| | | | - Isabella Mor
- Department of Surgery, The Tweed Hospital, Tweed Heads, NSW, Australia
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Vartsky D, Goldberg MB, Dangendorf V, Israelashvili I, Mor I, Bar D, Tittelmeier K, Weierganz M, Bromberger B, Breskin A. Quantitative discrimination between oil and water in drilled bore cores via Fast-Neutron Resonance Transmission Radiography. Appl Radiat Isot 2016; 118:87-94. [PMID: 27619949 DOI: 10.1016/j.apradiso.2016.08.018] [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: 02/28/2016] [Revised: 07/13/2016] [Accepted: 08/27/2016] [Indexed: 11/19/2022]
Abstract
A novel method utilizing the Fast Neutron Resonance Transmission Radiography is proposed for non-destructive, quantitative determination of the weight percentages of oil and water in cores taken from subterranean or underwater geological formations. The ability of the method to distinguish water from oil stems from the unambiguously-specific energy dependence of the neutron cross-sections for the principal elemental constituents. Monte-Carlo simulations and initial results of experimental investigations indicate that the technique may provide a rapid, accurate and non-destructive method for quantitative evaluation of core fluids in thick intact cores, including those of tight shales for which the use of conventional core analytical approaches appears to be questionable.
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Affiliation(s)
- D Vartsky
- Weizmann Institute of Science, Rehovot 76100, Israel.
| | | | - V Dangendorf
- Physikalisch-Technische Bundesanstalt (PTB), Braunschweig 38116, Germany
| | - I Israelashvili
- Weizmann Institute of Science, Rehovot 76100, Israel; Nuclear Research Center of the Negev, P.O.Box 9001, Beer Sheva, Israel
| | - I Mor
- Soreq NRC, Yavne 81800, Israel
| | - D Bar
- Soreq NRC, Yavne 81800, Israel
| | - K Tittelmeier
- Physikalisch-Technische Bundesanstalt (PTB), Braunschweig 38116, Germany
| | - M Weierganz
- Physikalisch-Technische Bundesanstalt (PTB), Braunschweig 38116, Germany
| | - B Bromberger
- Physikalisch-Technische Bundesanstalt (PTB), Braunschweig 38116, Germany
| | - A Breskin
- Weizmann Institute of Science, Rehovot 76100, Israel
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Zboray R, Mor I, Dangendorf V, Stark M, Tittelmeier K, Cortesi M, Adams R. High-frame rate imaging of two-phase flow in a thin rectangular channel using fast neutrons. Appl Radiat Isot 2014; 90:122-31. [PMID: 24709611 DOI: 10.1016/j.apradiso.2014.03.023] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [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: 01/23/2014] [Revised: 03/06/2014] [Accepted: 03/16/2014] [Indexed: 11/19/2022]
Abstract
We have demonstrated the feasibility of performing high-frame-rate, fast neutron radiography of air-water two-phase flows in a thin channel with rectangular cross section. The experiments have been carried out at the accelerator facility of the Physikalisch-Technische Bundesanstalt. A polychromatic, high-intensity fast neutron beam with average energy of 6 MeV was produced by 11.5 MeV deuterons hitting a thick Be target. Image sequences down to 10 ms exposure times were obtained using a fast-neutron imaging detector developed in the context of fast-neutron resonance imaging. Different two-phase flow regimes such as bubbly slug and churn flows have been examined. Two phase flow parameters like the volumetric gas fraction, bubble size and mean bubble velocities have been measured. The first results are promising, improvements for future experiments are also discussed.
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Affiliation(s)
- R Zboray
- Paul Scherrer Institute, PSI Villigen, CH-5232, Switzerland.
| | - I Mor
- Soreq NRC, Yavne 81800, Israel
| | - V Dangendorf
- Physikalisch-Technische Bundesanstalt (PTB), 38116 Braunschweig, Germany
| | - M Stark
- Paul Scherrer Institute, PSI Villigen, CH-5232, Switzerland
| | - K Tittelmeier
- Physikalisch-Technische Bundesanstalt (PTB), 38116 Braunschweig, Germany
| | - M Cortesi
- Paul Scherrer Institute, PSI Villigen, CH-5232, Switzerland; Swiss Federal Institute of Technology Zurich, Sonnegstrasse 3, CH-8092 Zurich, Switzerland
| | - R Adams
- Swiss Federal Institute of Technology Zurich, Sonnegstrasse 3, CH-8092 Zurich, Switzerland
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Mor I, Cheung EC, Vousden KH. Control of glycolysis through regulation of PFK1: old friends and recent additions. Cold Spring Harb Symp Quant Biol 2011; 76:211-6. [PMID: 22096029 DOI: 10.1101/sqb.2011.76.010868] [Citation(s) in RCA: 197] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Regulation of glucose metabolism is a crucial aspect of cell physiology in normal and disease conditions. Many regulatory events are involved in determining the metabolic fate of glucose and the pathways into which it is directed. The first reaction that commits glucose to the glycolytic pathway is catalyzed by the enzyme phosphofructokinase-1 (PFK-1) and is tightly regulated. One of the most potent activators of PFK-1 is fructose 2,6 bisphosphate (F2,6BP) and its cellular levels are correlated with glycolytic flux. F2,6BP is synthesized and degraded by a family of bifunctional enzymes-the 6-phosphofructo-2-kinase/fructose-2,6-bisphosphatases (PFKFB). The interplay among F2,6BP levels, the enzymes that generate and degrade it, and PFK-1 activity has important consequences for several different aspects of cell metabolism as well as for systemic metabolic conditions. TIGAR, a recently identified F2,6 bisphosphatase (F2,6BPase), could also contribute to this complexity and participate in shaping the metabolic profile of the cell.
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Affiliation(s)
- I Mor
- The Beatson Institute for Cancer Research, Garscube Estate, Glasgow G61 1BD, UK
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da Luz Moreira A, Mor I, Geisler DP, Remzi FH, Kiran RP. Laparoscopic resection for rectal cancer: a case-matched study. Surg Endosc 2010; 25:278-83. [PMID: 20585962 DOI: 10.1007/s00464-010-1174-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2009] [Accepted: 04/10/2010] [Indexed: 02/07/2023]
Abstract
INTRODUCTION The field of laparoscopic rectal cancer surgery is expanding. We compare short-term and early oncological outcomes after laparoscopic versus open resection in carefully matched rectal cancer patients. METHODS All consecutive patients undergoing elective laparoscopic resection for rectal cancer were reviewed. Laparoscopic resections were matched 1:1 to open resections by age, gender, American Society of Anesthesiologists class, body mass index, neoadjuvant chemoradiation, and type of surgery. Data were analyzed using Fisher's exact, chi-square, Wilcoxon rank-sum tests, and Kaplan-Meier estimates. P-value <0.05 was considered statistically significant. RESULTS Ninety-one rectal cancer patients with laparoscopic resection were included, 59% were male, and median age was 62 years. Conversion rate was 18.7%. Laparoscopic and open surgery had similar 30-day morbidity and mortality except wound infection, which was lower for the laparoscopic group (p = 0.02). Laparoscopic surgery had similar 30-day readmissions but shorter total length of hospital stay (5 versus 7 days, p < 0.01), time to first flatus (3 versus 4.5 days, p = 0.001), and time to first bowel movement (4 versus 5 days, p = 0.05) when compared with open surgery. The 3-year disease-free survival, local recurrence, and distant recurrence rates were also similar between the two groups. CONCLUSION Laparoscopic surgery can be safely performed for rectal cancer, with better postoperative recovery and acceptable early oncological outcomes. Results from large ongoing randomized trials with longer follow-up time are pending to better define oncologic outcomes.
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Affiliation(s)
- Andre da Luz Moreira
- Department of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, A30, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
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Joyce MR, Fazio VW, Hull TT, Church J, Kiran RP, Mor I, Lian L, Shen B, Remzi FH. Ileal pouch prolapse: prevalence, management, and outcomes. J Gastrointest Surg 2010; 14:993-7. [PMID: 20393806 DOI: 10.1007/s11605-010-1194-y] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2010] [Accepted: 03/09/2010] [Indexed: 01/31/2023]
Abstract
AIM The study aim is to review the prevalence, management, and outcomes for patients diagnosed with ileal pouch prolapse after restorative proctocolectomy. MATERIALS AND METHODS Patients were identified retrospectively from a prospectively maintained pouch database. Parameters analyzed included presenting symptoms, indications for pouch surgery, type of ileal pouch-anal anastomosis, treatment modalities, and outcomes. RESULTS Of 3,176 patients who underwent ileal pouch surgery, 11 were diagnosed with pouch prolapse (0.3%). Seven had full-thickness prolapse and four mucosal prolapse. Six were male, and five were female. Indication for index surgery was ulcerative colitis (nine patients), familial adenomatous polyposis (one patient), and colonic inertia (one patient). Median age at pouch prolapse was 34 years. Median time from index surgery to prolapse diagnosis was 2 years. Two patients with mucosal prolapse responded to conservative management; two required mucosal excisions. An abdominal approach was successful in four out of seven patients with full thickness prolapse. The three failures subsequently underwent continent ileostomy formation and prompted us to add biological mesh to future pouchpexy repairs. CONCLUSIONS Pouch prolapse is rare, and there are no obvious predisposing factors. Mucosal prolapse may be treated by stool bulking or a local perineal procedure. Full thickness prolapse requires definitive surgery and is associated with risk of pouch loss.
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Affiliation(s)
- Myles R Joyce
- Digestive Disease Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue/A30, Cleveland, OH 44195, USA
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da Luz Moreira A, Vogel JD, Baker M, Mor I, Zhang R, Fazio V. Does CT influence the decision to perform colectomy in patients with severe ulcerative colitis? J Gastrointest Surg 2009; 13:504-7. [PMID: 18979144 DOI: 10.1007/s11605-008-0732-3] [Citation(s) in RCA: 12] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2008] [Accepted: 10/14/2008] [Indexed: 01/31/2023]
Abstract
PURPOSE The purpose of this study was to evaluate the impact of abdominal computerized tomography (CT) on the decision to perform colectomy in patients with severe acute ulcerative colitis (SAC). METHODS Patients with SAC admitted to a single hospital between 2002 and 2007 were reviewed. The criteria for SAC were > or =6 bloody bowel movements per day plus fever >37.8 degrees C, pulse >90, or hemoglobin <10.5 g/dL. Study patients were given a SAC score of 2-4 based on these criteria. Clinical and laboratory parameters, medication use, abdominal X-ray, and endoscopic findings in SAC patients who did or did not have an abdominal CT were compared. Chi-squared, Fisher exact test, and Wilcoxon rank sum test were used as appropriate. RESULTS Ninety-two consecutive patients with SAC were evaluated. CT was performed in 26 (28%). The SAC score, laboratory values, abdominal X-ray, and endoscopic findings were similar in patients who did or did not have a CT. Colectomy was performed in 32 (48%) and 10 (38%) patients who did or did not have a CT, respectively (p = 0.4). The CT findings were similar in patients who required colectomy and those who did not require colectomy. In two (8%) of the patients who underwent CT, the CT findings clearly influenced the decision to perform or defer colectomy. CONCLUSION CT has a minor impact on the decision to perform colectomy in patients with severe acute ulcerative colitis.
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Affiliation(s)
- Andre da Luz Moreira
- Departments of Colon and Rectal Surgery and Abdominal Imaging, Cleveland Clinic, Cleveland, OH, USA
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Mor I, Sklan EH, Podoly E, Pick M, Kirschner M, Yogev L, Bar-Sheshet Itach S, Schreiber L, Geyer B, Mor T, Grisaru D, Soreq H. Acetylcholinesterase-R increases germ cell apoptosis but enhances sperm motility. J Cell Mol Med 2008; 12:479-95. [PMID: 18194455 PMCID: PMC3822537 DOI: 10.1111/j.1582-4934.2008.00231.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Changes in protein subdomains through alternative splicing often modify protein-protein interactions, altering biological processes. A relevant example is that of the stress-induced up-regulation of the acetylcholinesterase (AChE-R) splice variant, a common response in various tissues. In germ cells of male transgenic TgR mice, AChE-R excess associates with reduced sperm differentiation and sperm counts. To explore the mechanism(s) by which AChE-R up-regulation affects spermatogenesis, we identified AChE-R's protein partners through a yeast two-hybrid screen. In meiotic spermatocytes from TgR mice, we detected AChE-R interaction with the scaffold protein RACK1 and elevated apoptosis. This correlated with reduced scavenging by RACK1 of the pro-apoptotic TAp73, an outcome compatible with the increased apoptosis. In contrast, at later stages in sperm development, AChE-R's interaction with the glycolytic enzyme enolase-α elevates enolase activity. In transfected cells, enforced AChE-R excess increased glucose uptake and adenosine tri-phosphate (ATP) levels. Correspondingly, TgR sperm cells display elevated ATP levels, mitochondrial hyperactivity and increased motility. In human donors' sperm, we found direct association of sperm motility with AChE-R expression. Interchanging interactions with RACK1 and enolase-α may hence enable AChE-R to affect both sperm differentiation and function by participating in independent cellular pathways.
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Affiliation(s)
- I Mor
- The Silberman Institute of Life Sciences, the Hebrew University of Jerusalem, Jerusalem, Israel
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Mor I, Grisaru D, Titelbaum L, Evron T, Richler C, Wahrman J, Sternfeld M, Yogev L, Meiri N, Seidman S, Soreq H. Modified testicular expression of stress-associated "readthrough" acetylcholinesterase predicts male infertility. FASEB J 2001; 15:2039-41. [PMID: 11511515 DOI: 10.1096/fj.00-0814fje] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Male infertility is often attributed to stress. However, the protein or proteins that mediate stress-related infertility are not yet known. Overexpression of the "readthrough" variant of acetylcholinesterase (AChE-R) is involved in the cellular stress response in a variety of mammalian tissues. Here, we report testicular overexpression of AChE-R in heads, but not tails, of postmeiotic spermatozoa from mice subjected to a transient psychological stress compared with age-matched control mice. Transgenic mice overexpressing AChE-R displayed reduced sperm counts, decreased seminal gland weight, and impaired sperm motility compared with age-matched nontransgenic controls. AChE-R was prominent in meiotic phase spermatocytes and in tails, but not heads, of testicular spermatozoa from AChE-R transgenic mice. Head-localized AChE-R was characteristic of human sperm from fertile donors. In contrast, sperm head AChE-R staining was conspicuously reduced in samples from human couples for whom the cause of infertility could not be determined, similar to the pattern found in transgenic mice. These findings indicate AChE-R involvement in impaired sperm quality, which suggests that it is a molecular marker for stress-related infertility.
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Affiliation(s)
- I Mor
- Department of, Biological Chemistry, The Life Sciences Institute, The Hebrew University of Jerusalem, Jerusalem, Israel
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Mor I, Seidman S, Soreq H. Postnatal enhancement of host acetylcholinesterase in developing AChE transgenic mice. Neurosci Lett 1997. [DOI: 10.1016/s0304-3940(97)90148-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Lantsberg L, Mor I, Levy I, Khoda J. Infected hydrocele following laparoscopic appendectomy: case report. Surg Laparosc Endosc Percutan Tech 1997; 7:262. [PMID: 9194292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
In the literature, specific reported complications after laparoscopic appendectomy include bowel injury, hemorrhage, wound infection, and cecal fistula. We report the occurrence of infected hydrocele after laparoscopic appendectomy in a 20-year-old man. This complication, to our knowledge, has not yet been described in the literature.
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Affiliation(s)
- L Lantsberg
- Department of Surgery A, Soroka Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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Eliakim M, Mor I, Michaelson IC. Assessment of pharmacologic effects on the retinal circulation of hypertensive subjects by a quantitative method. Microvasc Res 1972; 4:374-83. [PMID: 4635578 DOI: 10.1016/0026-2862(72)90071-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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