Herniation of the caecum and ascending colon through the foramen of Winslow: a case report and review

Approximately 5% of intestinal obstruction cases are caused by internal herniation. Caecal herniation through the foramen of Winslow is considered a rare event. The management of caecal herniation remains challenging due to the lack of literature highlighting this pathology. A 66-year-old woman was admitted with a 24-hour history of epigastric pain radiating to the back. The pain was associated with nausea and vomiting of gastric contents. On examination, the abdomen was soft with mild tenderness but no signs of peritonism or distension. The abdominal x-ray and a computed tomography were in keeping with caecal volvulus and confirmed that the caecum was not in the right iliac fossa. In a midline laparotomy procedure, the ileum, caecum and ascending colon were noted to be herniating into the foramen of Winslow. A right hemicolectomy with a handsewn anastomosis was performed. The foramen of Winslow was not closed. No postoperative complications occurred. A literature review showed a lack of similar cases with no agreed management consensus. The laparotomy approach is comparable to the laparoscopic approach and no caecal herniation recurrence after open/laparoscopic surgical procedures were identified. Awareness of caecal herniation allows early diagnosis and timely surgical management is needed in prevent patient morbidity and mortality.

The first case of the Reveal LINQ™ Insertable Cardiac Monitor implanted in a child in Malta

BACKGROUND

The Reveal LINQ™Insertable Cardiac Monitor (ICM) or Implantable Loop recorder (ILR), is a miniaturized, subcutaneous, single lead, electrocardiographic monitoring device which has been extensively used in the differential diagnosis of unexplained syncope and palpitations in adults.

PATIENT DESCRIPTION

We describe an asymptomatic 20-month-old boy, noted to have incidental bradycardia on routine examination and in whom Holter monitoring revealed complete heart block (CHB). Over 1 year, the longest recorded pause lengthened from 1.8 seconds to 3.6 seconds.

RESULTS

The Reveal LINQ™ ICM was inserted for long-term monitoring of the CHB. The device will record the electrocardiogram (ECG) continuously for up to 3 years, freezing in its memory any significant arrhythmic events. This will enable the diagnosis of the longest pauses, confirm whether they are lengthening over time and assist with the decision of pacemaker implantation.

CONCLUSION

The Reveal LINQ™ ICM is much smaller than the conventional loop recorder and has been shown to be ideal for close monitoring of asymptomatic yet potentially dangerous arrhythmias in young children.

Lead and other metals in gestational hypertension

OBJECTIVES

To identify any effects that lead, calcium, magnesium, and zinc may have on the development of gestational hypertension.

METHODS

Third-trimester 110 normotensive and 33 gestational hypertension cases were assayed for various metal levels, using standard techniques, including atomic absorption spectrometry.

RESULTS

Gestational hypertension cases showed significantly higher blood lead levels than normotensives. No differences were noticed regarding calcium (ionized and total), magnesium, and zinc levels. Blood lead was significantly related with blood pressure, even after correcting for the body mass indices and age. Blood pressure levels showed no relation to the other analyzed metals. However, the lead:ionized calcium ratio showed a stronger association with blood pressure, than lead alone. Blood lead showed a significant negative relationship with ionized calcium, but none with the other metals.

CONCLUSIONS

Blood lead evidently influenced blood pressure increments and gestational hypertension development. This implies that all efforts should be made to reduce the population's exposure.

Evaluation of environmental levels and biological impact of TBT in Malta (central Mediterranean)

Chemical monitoring for butyltins in bulk seawater, surface microlayer and superficial sediments determined that the two main local sources of marine contamination by tributyltin (TBT) compounds in Malta are ship-repairing dockyards and marinas. In bulk seawater, TBT values ranged from below the detection limit of 5 ng Sn l(-1) to 300 ng Sn l(-1); in sediments derived from the most polluted areas, TBT concentrations as high as 1500 ng Sn g(-1) were measured. At TBT levels found in local harbours, several sublethal biological responses are possible and were observed, including a significant reduction in MFO enzyme system activities of fish; digestive cell atrophy in the oyster Ostrea edulis; and induction of imposex in the snail Hexaplex trunculus. The latter two responses are evident at TBT concentrations below the environmental quality standard (20 ng TBT l(-1)). The ecological implications of these results are discussed and it is concluded that exposure of marine organisms to TBT in local harbours may be expected to lead to a reduction in the long-term survival of a number of such organisms. For these reasons, both the use of TBT-based antifouling paints for pleasure boats as well as drydock practices need to be controlled by appropriate regulations and their enforcement.

Improvements in immunostaining samples embedded in methacrylate: localization of microtubules and other antigens throughout developing organs in plants of diverse taxa

Microtubules are important in plant growth and development. Localizing microtubules in sectioned material is advantageous because it allows any tissue of interest to be studied and it permits the positional relations of the cells within the organ to be known. We describe here a method that uses semi-thin (0.5-2 μm) sections of material embedded in butyl-methylmethacrylate, to which 10 mM dithiothreitol was added. After removing the embedding material and using indirect immunofluorescence staining, we obtain clear images of microtubules, actin microfilaments, callose and pulse-fed bromodeoxyuridine. This method works on the root tissues of Arabidopsis thaliana(L.) Heynh, Pinus radiataD. Don, Zamia furfuraceaAit., Azolla pinnataR. Br. and on sporophytic tissues of Funaria hygrometricaHedw. In general, most of the cells in the organs studied are successfully stained. Using this method, we find that interphase meristematic cells in all of these species have microtubules not only in the usual cortical array but also throughout their cytoplasm. The presence of the calcium chelator ethylene glycol-bis(β-aminoethyl ether)N,N,N',N'-tetraacetic acid EGTA in fixation buffers led to some tissue damage, and did not enhance the preservation of microtubules. The common assumption that EGTA-containing buffers stabilize plant microtubules during fixation appears unwarranted.

Pethidine blood concentrations at time of birth

Pethidine levels in maternal and fetal blood were estimated at birth after variable periods of intramuscular administration--delivery intervals in forty pregnant women. The results suggest that maternal--fetal equilibrium occurs at a fast rate with a regression coefficient initially of 0.54. There appeared to be a tendency towards trapping of the drug in the fetal circulation resulting in a rise in the regression coefficient after 3 h reaching 0.85. The pharmacokinetics and the clinical significance of these observations are discussed.

Rearrangements of Microtubules Involved in Establishing Cell Division Planes Start Immediately after DNA Synthesis and Are Completed just before Mitosis

This work concerns an aspect of spatial regulation of cell division, the development of the preprophase band (PPB) of microtubules. The PPB is significant in plant development because its position in the dividing cell indicates where the new cell wall will be inserted[mdash]an important site for control of histogenesis. We have categorized and determined the durations of stages in the development of PPBs, and have established their timing relative to the S-, G2-, and mitotic phases of the cell cycle. Roots of wheat seedlings were supplied with bromodeoxyuridine in continuous and pulse-chase treatments. Cells that were in the S-phase were identified and changes in their microtubule arrays were monitored by double immunolabeling. PPB initiation was detectable as early as the end of the S-phase as a narrowing of the preceding interphase array of microtubules. Development continued throughout G2 to a mature, narrow PPB, which existed only briefly and then eroded during the transition to the prophase mitotic spindle. The microtubule rearrangements of PPB development showed that preparation of the future site and plane of division in higher plant cells begins just after DNA replication and is completed just before mitosis.