Colonic Hemostatic Clip Causing Perforated Acute Appendicitis.

Teaching Point: The advantages of CT over other imaging techniques for the diagnosis of acute appendicitis in adults include the ability to identify foreign bodies that may be involved.

A case of reversed intestinal rotation revealed by volvulus in adult: anatomo-radiological correlations.

We report a case of reversed rotation (RR) of the midgut, the rarest form of intestinal malrotation (IMR), revealed by a chronic volvulus, in a 42-year-old woman presenting with episodes of abdominal pain occurring after heavy meals. The complete preoperative diagnosis was obtained by contrast-enhanced computed tomography (CT). Classical signs of volvulus were associated with typical findings of RR comprising an unusual position of the third duodenum in front of the mesenteric vessels and a very unusual location of the transverse colon behind these vessels. Complete absence of fixation of the right colon allowed secondary volvulus. A detailed reminder of the embryology of IMR and RR is presented.

Intravesical Protrusion of a Pedunculated Colonic Polyp through a Sigmoido-Vesical Fistula Caused by Diverticulitis.

Teaching Point: Sigmoid diverticulitis may cause colo-vesical fistula from which intravesical protrusion of a pedunculated colonic polyp is an exceptional event that should not be regarded as a bladder cancer.

Acute massive congestive ischaemic colitis related to inferior mesenteric arteriovenous malformation.

We report a very rare case of acute congestive ischaemic colitis of the left colon caused by brutal decompensation of an uncommon arteriovenous malformation (AVM) in the territory of the inferior mesenteric artery (IMA) in a 45-year-old male patient. The patient presented with severe abdominal pain in the left iliac fossa and abundant mucoid stools. The diagnosis of congestive colitis was made by optical colonoscopy but the full diagnosis of the responsible AVM in the IMA territory was made by contrast-enhanced multidetector CT scan combined with colour Doppler ultrasound. Two successive attempts at selective embolization failed to resolve the symptoms and finally, extensive surgery was necessary. The complete imaging findings of the case are presented and the characteristic features of uncommon AVMs and fistulas of the IMA territory are briefly reviewed.

Small bowel obstruction caused by peritoneal immunoglobulin g4-related disease mimicking carcinomatosis: case report.

We hereby report a case of diffuse pelvic peritoneal involvement by immunoglobulin G4-related disease (IgG4-RD). Numerous pelvic masses and nodules showing delayed enhancement on enhanced abdominal CT were found to congregate in the pelvic organs of a 57-year-old female presenting with intestinal subocclusion. The differentiation between peritoneal IgG4-RD and pelvic peritoneal carcinomatosis was only made by histopathology and immunohistochemistry performed after surgical resection. Autoimmune pancreatitis represents the historical prototype of IgG4-RD, but the spectrum of manifestations involving various organs has expanded during the last decade. In this report, we shortly review this clinical entity.

Focal parietal necrosis of the sigmoid due to atypical neuroleptics: a case report.

We present the case of a 26-year-old man with schizoid personality disorder who suffered from a very focal and transparietal necrosis of the sigmoid after an overdose of atypical neuroleptics. This is a singular, rather unknown and potentially lethal side effect of these drugs. The physiopathology of this complication is multifactorial.

Extra-abdominal lumbar abscesses caused by retroperitoneal gastrointestinal perforations through the lumbar triangle of Petit: report of two cases diagnosed by CT.

Extra-abdominal abscesses of gastrointestinal origin developing within the lumbar subcutaneous tissues are extremely rare. We report two cases of retroperitoneal bowel perforation presenting spontaneously at admission with a lumbar abscess trespassing the lumbar triangle of Petit, a classical "locus of minus resistencia" of the posterior abdominal wall. The first case was caused by perforation of a retrocecal appendicitis--being concomitantly responsible of a necrotizing fasciitis of the thigh--and in the second case perforation was caused by left colonic diverticulitis. In both cases, the full diagnosis was made with abdominal CT. The patients were threatened by a two-step surgical approach comprising a direct posterior percutaneous drainage of the abscess followed by classical laparotomy.

A rigid dinuclear ruthenium(II) complex as an efficient photoactive agent for bridging two guanine bases of a duplex or quadruplex oligonucleotide.

The rigid dinuclear [(tap)(2)Ru(tpac)Ru(tap)(2)](4+) complex (1) (TAP=1,4,5,8-tetraazaphenanthrene, TPAC=tetrapyridoacridine) is shown to be much more efficient than the mononuclear bis-TAP complexes at photodamaging oligodeoxyribonucleotides (ODNs) containing guanine (G). This is particularly striking with the G-rich telomeric sequence d(T(2)AG(3))(4). Complex 1, which interacts strongly with the ODNs as determined by surface plasmon resonance (SPR) and emission anisotropy experiments, gives rise under illumination to the formation of covalent adducts with the G units of the ODNs. The yield of photocrosslinking of the two strands of duplexes by 1 is the highest when the G bases of each strand are separated by three to four base pairs. This corresponds with each Ru(tap)(2) moiety of complex 1 forming an adduct with the G base. This separation distance of the G units of a duplex could be determined thanks to the rigidity of complex 1. On the basis of results of gel electrophoresis, mass spectrometry, and molecular modelling, it is suggested that such photocrosslinking can also occur intramolecularly in the human telomeric quadruplex d(T(2)AG(3))(4).

Oxidizing Ru(II) complexes as irreversible and specific photo-cross-linking agents of oligonucleotide duplexes.

Oxidizing polyazaaromatic Ru(II) complexes containing two TAP ligands (TAP = 1,4,5,8-tetraazaphenanthrene) are able under illumination to cross-link irreversibly the two strands of an oligonucleotide (ODN) duplex by covalent bond formation. The cross-linking proceeds by two successive absorptions of a photon. An adduct of the metallic complex on a guanine (G) base of one ODN strand is first photoproduced, followed by a second photoaddition of the same Ru species to a G base of the complementary strand, provided that the two G moieties are separated by 0 or 1 base pair. These two processes lead to the cross-linking of the two strands. Such a photo-cross-linking is easily detected with [Ru(TAP)(2)(phen)](2+) (1; phen = 1,10-phenanthroline) and [Ru(HAT)(2)(phen)](2+) (2; HAT = 1,4,5,8,9,12-hexaazatriphenylene), whereas it is not observed with [Ru(TAP)(2)TPAC](2+) (3; TPAC = tetrapyridoacridine) at the same level of loading of the duplex by 3. With a concentration of 3 similar to that of 1 and 2, when the loading of the duplex by 3 is much more important than with 1 and 2, the photo-cross-linking with 3 can thus also be observed. As 3 intercalates its TPAC ligand into the base pairs stack, its mobility is restricted in the duplex. In contrast, 1 and 2 can adopt different geometries of interaction, which probably facilitate the photo-cross-linking.

Effects of protonation on the spectroscopic properties of tetrapyridoacridine (TPAC) mono- and dinuclear Ru(II) complexes in their ground and (3)MLCT excited states.

The spectroscopic behavior of mono- and dinuclear Ru(II) complexes (P, T, PP and TT, Figure 1) that contain the extended planar ligand tetrapyrido[3,2-a:2',3'-c:3' ',2' '-h:2' '',3' ''-j]acridine (TPAC) and either 1,10-phenanthroline (phen) or 1,4,5,8-tetraazaphenanthrene (tap) as ancillary ligands is examined in water and as a function of the pH. These four complexes luminesce in aqueous solution. The analyses of the data in absorption lead to the pKa values in the ground state, and the data in emission show that the excited 3MLCT states are much more basic than the ground state. When the complex contains tap ligands (T and TT), a decrease in pH transforms the luminescent excited basic form into another luminescent excited protonated species, which emits more bathochromically. In contrast, with phen ancillary ligands (P and PP), the protonated excited state does not luminesce. The rate constant of first protonation of the 3MLCT state is diffusion controlled, except for the dinuclear PP complex, whose protonation takes place on the nitrogen of the acridine motif. For P, in which the protonation process is the fastest, it would take place on the nitrogen atoms of the nonchelated phen moiety of the TPAC ligand. These results allow also us to gain information on the localization of the excited electron in the 1MLCT state populated upon absorption as well as in the relaxed 3MLCT emissive state. Moreover as these complexes are interesting for their study with DNA, it can be concluded from these data that a portion of the excited species in interaction with DNA will be protonated.

Optically active Ru(II) complexes with a chiral Tröger's base ligand and their interactions with DNA.

Three stereoisomers of a Ru(II) complex bearing a chiral bis-phenanthroline Tröger's base analogue, TBphen2 (1), have been isolated from the reaction of the enantiomerically pure precursor complex Lambda- (or Delta-) cis-[Ru(phen)2(py)2]2+ (phen=1,10-phenanthroline, py=pyridine) with the racemic mixture of 1. Each stereoisomer of [Ru(phen)2TBphen2]2+ (2) has been characterized by 1H NMR and CD spectroscopy. Electrochemical studies revealed that the redox properties of 2 are not influenced by the stereochemistry, however, the electrochemical oxidation of the metallic center is irreversible because of the diazocine bridge of the TBphen2 ligand. Steady-state emission measurements in the presence of calf thymus DNA showed that the DNA binding of [Ru(phen)2TBphen2]2+ depends on the stereoisomer and is mainly controlled by the absolute configuration of the metal center of the complex. The affinity constant for the stereoisomer Delta-S-2 is 10(2) higher than that for Lambda-S-2 and rac-[Ru(phen)3]2+.

Repair of bicuspid aortic valves in patients with aortic regurgitation.

BACKGROUND: Bicuspid aortic valve regurgitation can be caused by a defect in the valve itself or by dysfunction of one or more components of the aortic root complex. A successful repair thus requires correction of all aspects of the problem simultaneously. We review our experience addressing both the valve and the aortic root when correcting bicuspid valve regurgitation. METHODS AND RESULTS: Between 1996 and 2004, we treated 68 patients for aortic regurgitation. Thirty patients had isolated aortic regurgitation, and 38 had an associated ascending aortic aneurysm. All patients were treated using a standardized and integrated surgical technique, which included resection of the median raphe or leaflet plication, subcommissural annuloplasty, reinforcement of the leaflet free edge, and sinotubular junction plication. In the 38 patients with proximal aortic dilatation, reimplantation or remodeling of the aortic root was performed. Immediate postoperative echocardiography showed grade < or = 1 aortic regurgitation in all patients. Three patients nonetheless needed an early re-operation because of recurrent regurgitation. No hospital mortality was observed. At a mean follow-up of 34 months after surgery, all patients were in New York Heart Association (NYHA) class 1 or 2. Two patients needed a re-operation (23 and 92 months, respectively). Echocardiographic follow-up showed no progression of the regurgitation in 58 surviving patients. Four patients progressed to grade 2 regurgitation. CONCLUSIONS: Our data indicate that regurgitant bicuspid aortic valves, whether alone or in association with a proximal aortic dilatation, can be repaired successfully provided that both the valve and the aortic root problems are treated simultaneously.

Enantioselective luminescence quenching of DNA light-switch [Ru(phen)2dppz]2+ by electron transfer to structural homologue [Ru(phendione)2dppz]2+.

The quenching of the luminescence of [Ru(phen)(2)dppz](2+) by structural homologue [Ru(phendione)(2)dppz](2+), when both complexes are bound to DNA, has been studied for all four combinations of Delta and Lambda enantiomers. Flow linear dichroism spectroscopy (LD) indicates similar binding geometries for all the four compounds, with the dppz ligand fully intercalated between the DNA base pairs. A difference in the LD spectrum observed for the lowest-energy MLCT transition suggests that a transition, potentially related to the final localization of the excited electron to the dppz ligand in [Ru(phen)(2)dppz](2+), is overlaid by an orthogonally polarized transition in [Ru(phendione)(2)dppz](2+). This would be consistent with a low-lying LUMO of the phendione moiety of [Ru(phendione)(2)dppz](2+) that can accept the excited electron from [Ru(phen)(2)dppz](2+), thereby quenching the emission of the latter. The lifetime of excited Delta-[Ru(phen)(2)dppz](2+) is decreased moderately, from 664 to 427 ns, when bound simultaneously with the phendione complex to DNA. The 108 ns lifetime of opposite enantiomer, Lambda-[Ru(phen)(2)dppz](2+), is only shortened to 94 ns. These results are consistent with an average rate constant for electron transfer of approximately 1.10(6) s(-1) between the phenanthroline- and phendione-ruthenium complexes. At binding ratios close to saturation of DNA, the total emission of the two enantiomers is lowered equally much, but for the Lambda enantiomer, this is not paralleled by a decrease in luminescence lifetime. A binding isotherm simulation based on a generalized McGhee-von Hippel approach shows that the Delta enantiomer binds approximately 3 times stronger to DNA both for [Ru(phendione)(2)dppz](2+) and [Ru(phen)(2)dppz](2+). This explains the similar decrease in total emission, without the parallel decrease in lifetime for the Lambda enantiomer. The simulation also does not indicate any significant binding cooperativity, in contrast to the case when Delta-[Rh(phi)(2)bipy](3+) is used as quencher. The very slow electron transfer from [Ru(phen)(2)dppz](2+) to [Ru(phendione)(2)dppz](2+), compared to the case when [Rh(phi)(2)phen](3+) is the acceptor, can be explained by a much smaller driving free-energy difference.