Acute abdomen from chylous peritonitis: a surgical diagnosis. Case report and literature review.

Acute accumulation of chyle in the peritoneal cavity is a rare event (less than 100 cases are described in the literature) and is to be distinguished from chylous ascites, which is characteristically chronic. It is frequently idiopathic, and diagnosis is usually made at laparotomy, whenever signs of acute peritonitis impose it. Peritoneal toilette and drainage are the only treatment required, and the prognosis is excellent. We describe the case of a 69-year-old man who underwent emergency surgery for acute peritonitis. Approximately 0.5 liters of chyle were found free in the peritoneal cavity at laparoscopic exploration, without any important underlying pathological condition apart from a blood vessel congestion in the bowel resembling angiomatosis. Laparotomic conversion, peritoneal toilette and drainage, with postoperative low-fat diet, were the pursued treatments. Two years after discharge, chemistry and clinics are normal, without evidence of associated disease or recurrence.

Acute thrombosis of abdominal aorta and hypercoagulable disorders.

Acute abdominal aortic occlusion (AAAO) is a rare, life threatening condition, which usually occurs in elderly patients, causing challenging management issues. In patients who have no cardiac or vascular disease this catastrophic event is very rare and is due to hypercoagulable disorders. This study reviews the literature on AAAO in hypercoagulable states in the light of our experience on a case of an acute thrombosis of nonaneurysmal, nonatherosclerotic abdominal aorta in a female patient with protein S deficiency and Sjögren's syndrome and her younger brother, which was found to have atherosclerotic involvement of distal aorta and elevation in homocysteine levels. Because of a misleading clinical presentation, the diagnosis was delayed and conservative treatment failed. Both were successfully treated with emergency aorto-bifemoral grafting. Other cases of arterial thrombosis and hypercoagulable disorders were found in first-degree relatives. Our experience and the review of the literature suggest that the interaction between host and environment factors can lead to acute thrombosis of the non-pathologic abdominal aorta; not only classic hypercoagulability disorders, but also immunologic, metabolic, toxicological cofactors can be involved. Delay in diagnosis is frequent and may not influence the prognosis, but does not allow conservative therapy. Prognosis depends mainly on pathologic cofactors that require detection and appropriate treatment in order to prevent complications and recurrences.

ST14A cells have properties of a medium-size spiny neuron.

The ST14A cell line was previously derived from embryonic day 14 rat striatal primordia by retroviral transduction of the temperature-sensitive SV40 large T antigen. We showed that cell division and expression of nestin persists at 33 degrees C, the permissive temperature, whereas cell division ceases, nestin expression decreases, and MAP2 expression increases at the nonpermissive temperature of 39 degrees C. In this study, we further characterized the cells and found that they express other general and subtype-specific neuronal characteristics. ST14A cells express enolase and beta III-tubulin. Furthermore, they express the striatal marker DARPP-32, which is up-regulated upon differentiation of the cells by growth in serum-free medium. Stimulation with dopamine, the D2-dopamine receptor agonist quinpirole, or the D1-dopamine receptor agonist SKF82958 results in phosphorylation of CREB. Treatment of the cells with a mixture of reagents which stimulate the MAPK and adenylyl cyclase pathways radically changes the morphology of the ST14A cells. The cells develop numerous neurite-like appearing processes which stain with beta III-tubulin. Moreover, under these conditions, intracellular injection of rectangular depolarizing current stimuli elicits overshooting action potentials with a relatively fast depolarization rate when starting from a strongly hyperpolarized membrane potential. Taken together, these data imply that the ST14A cell line displays some of the characteristics of a medium-size spiny neuron subtype and provides a new tool to elucidate the pathways and molecules involved in medium-size spiny neuron differentiation and disease.

A mini-invasive technique for axillary lymphadenectomy in early breast cancer: a study of 15 patients.

Axillary lymphadenectomy is the major cause of morbidity reported in breast surgery, but remains the gold standard in breast cancer staging procedures. The aim of this study was to evaluate if endoscopic lymphadenectomy, preceded by fat suction, could reduce morbidity and hospitalization, giving better aesthetic results, while conserving the same oncologic radicality as the traditional open technique. We studied 15 cases of breast cancer with tumour diameter < or = 25 mm, N0. The subjects underwent endoscopic lymphadenectomy. We removed an average of 15.5 node/patient, the volume of lymphorrea was 580 ml, the drainage was kept up for 5 days, the mean length of hospitalization was 6 days. One seroma (4.6%) was found. No shoulder restriction has been reported and aesthetic results were excellent. The follow-up will demonstrate if this technique can reduce the incidence of lymphoedema.