ABSTRACT
Pericardioesophageal fistula is an uncommon, yet serious complication that can occur after left atrial ablation for cardiac arrhythmias. Timing of this complication is variable; however, it has been reported to occur from a week to over a month post-ablation. The incidence of this complication after ablation is <0.05%; however with increasing rates of left atrial ablations, early recognition is imperative. Nonspecific symptoms, including chest pain, dysphagia, and fever, can indicate the presence of a fistula within the first month after ablation. Early drainage with subsequent definitive treatment is key to limiting morbidity. Here we report four cases of pericardioesophageal fistula all occurring ~1 month post-ablation, with two patients surviving after prompt diagnosis and surgical treatment. Successful treatment in these two cases was achieved with fistula takedown and intercostal muscle flap interposition and esophageal stenting.
ABSTRACT
Esophageal adenoid cystic carcinoma is a rare cancer that is a challenge to treat because the tumor often invades local structures. Complete resection with grossly negative margins is key to disease-free survival. We describe a case in which the esophageal tumor invaded a significant portion of the posterior trachea, making a tracheal resection with primary anastomosis impossible. Therefore, to resect the tumor completely, we performed a laparoscopic esophagectomy and posterior tracheal resection with tracheoplasty using a rotational flap while the patient was on venovenous extracorporeal membrane oxygenation.
Subject(s)
Carcinoma, Adenoid Cystic , Esophageal Neoplasms , Laparoscopy , Humans , Esophagectomy , Trachea/surgery , Trachea/pathology , Carcinoma, Adenoid Cystic/surgeryABSTRACT
The induction of interferon beta (IFNB1) is a key event in the antiviral immune response. We studied the role of transcriptional noise in the regulation of the IFNB1 locus in primary cultures of human dendritic cells (DCs), which are important 'first responders' to viral infection. In single cell assays, IFNB1 mRNA expression in virus-infected DCs showed much greater cell-to-cell variation than that of a housekeeping gene, another induced transcript and viral RNA. We determined the contribution of intrinsic noise by measuring the allelic origin of transcripts in each cell and found that intrinsic noise is a very significant part of total noise. We developed a stochastic model to investigate the underlying mechanisms. We propose that the surprisingly high levels of IFNB1 transcript noise originate from the complexity of IFNB1 enhanceosome formation, which leads to a range up to many minutes in the differences within each cell in the time of activation of each allele.
