ABSTRACT
INTRODUCTION: Despite reported poor sensitivity and specificity, plain abdominal radiographs have a role in the investigation of suspected appendicitis. PRESENTATION OF CASE: We report a case of a previously healthy 47 year old man, who presented with sudden onset abdominal pain associated with a raised temperature. He gave a short history of pain around the umbilicus, which radiated to his right iliac fossa over a period of hours. On examination his abdomen was soft with rebound tenderness in the right iliac fossa. Investigations revealed white cell count 11.2×109/L, CRP 4mg/L and normal haemoglobin, renal and liver function tests. An inflamed appendix was visible with thickened walls on a plain abdominal radiograph and was confirmed during laparoscopic appendectomy and subsequent histology. He made good recovery and was discharged. DISCUSSION: Prominent appendiceal wall and air in the appendix has been described in the literature as a CT finding that can distinguish appendicitis from other differential diagnoses and here we present a case of diagnosis of appendicitis on a plain abdominal radiograph showing this sign which to the best of our knowledge is rarely seen on abdominal films. CONCLUSION: Careful assessment of plain abdominal films in suspected appendicitis is encouraged not just for exclusion of other causes of pain but also in the possible detection of an inflamed appendix.
ABSTRACT
BACKGROUND: Endothelin-1 stimulates Gq protein-coupled receptors to promote proliferation in dividing cells or hypertrophy in terminally differentiated cardiomyocytes. In cardiomyocytes, endothelin-1 rapidly (within minutes) stimulates protein kinase signaling, including extracellular-signal regulated kinases 1/2 (ERK1/2; though not ERK5), with phenotypic/physiological changes developing from approximately 12 h. Hypertrophy is associated with changes in mRNA/protein expression, presumably consequent to protein kinase signaling, but the connections between early, transient signaling events and developed hypertrophy are unknown. RESULTS: Using microarrays, we defined the early transcriptional responses of neonatal rat cardiomyocytes to endothelin-1 over 4 h, differentiating between immediate early gene (IEG) and second phase RNAs with cycloheximide. IEGs exhibited differential temporal and transient regulation, with expression of second phase RNAs within 1 h. Of transcripts upregulated at 30 minutes encoding established proteins, 28 were inhibited >50% by U0126 (which inhibits ERK1/2/5 signaling), with 9 inhibited 25-50%. Expression of only four transcripts was not inhibited. At 1 h, most RNAs (approximately 67%) were equally changed in total and polysomal RNA with approximately 17% of transcripts increased to a greater extent in polysomes. Thus, changes in expression of most protein-coding RNAs should be reflected in protein synthesis. However, approximately 16% of transcripts were essentially excluded from the polysomes, including some protein-coding mRNAs, presumably inefficiently translated. CONCLUSION: The phasic, temporal regulation of early transcriptional responses induced by endothelin-1 in cardiomyocytes indicates that, even in terminally differentiated cells, signals are propagated beyond the primary signaling pathways through transcriptional networks leading to phenotypic changes (that is, hypertrophy). Furthermore, ERK1/2 signaling plays a major role in this response.
