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1. ECLAPTE: Effective Closure of LAParoTomy in Emergency-2023 World Society of Emergency Surgery guidelines for the closure of laparotomy in emergency settings

Author

Frassini, S, Cobianchi, L, Fugazzola, P, Biffl, W, Coccolini, F, Damaskos, D, Moore, E, Kluger, Y, Ceresoli, M, Coimbra, R, Davies, J, Kirkpatrick, A, Di Carlo, I, Hardcastle, T, Isik, A, Chiarugi, M, Gurusamy, K, Maier, R, Segovia Lohse, H, Jeekel, H, Boermeester, M, Abu-Zidan, F, Inaba, K, Weber, D, Augustin, G, Bonavina, L, Velmahos, G, Sartelli, M, Di Saverio, S, Ten Broek, R, Granieri, S, Dal Mas, F, Fare, C, Peverada, J, Zanghi, S, Vigano, J, Tomasoni, M, Dominioni, T, Cicuttin, E, Hecker, A, Tebala, G, Galante, J, Wani, I, Khokha, V, Sugrue, M, Scalea, T, Tan, E, Malangoni, M, Pararas, N, Podda, M, De Simone, B, Ivatury, R, Cui, Y, Kashuk, J, Peitzman, A, Kim, F, Pikoulis, E, Sganga, G, Chiara, O, Kelly, M, Marzi, I, Picetti, E, Agnoletti, V, De'Angelis, N, Campanelli, G, de Moya, M, Litvin, A, Martinez-Perez, A, Sall, I, Rizoli, S, Tomadze, G, Sakakushev, B, Stahel, P, Civil, I, Shelat, V, Costa, D, Chichom-Mefire, A, Latifi, R, Chirica, M, Amico, F, Pardhan, A, Seenarain, V, Boyapati, N, Hatz, B, Ackermann, T, Abeyasundara, S, Fenton, L, Plani, F, Sarvepalli, R, Rouhbakhshfar, O, Caleo, P, Ho-Ching Yau, V, Clement, K, Christou, E, Castillo, A, Gosal, P, Balasubramaniam, S, Hsu, J, Banphawatanarak, K, Pisano, M, Adriana, T, Michele, A, Cioffi, S, Spota, A, Catena, F, Ansaloni, L, Frassini S., Cobianchi L., Fugazzola P., Biffl W. L., Coccolini F., Damaskos D., Moore E. E., Kluger Y., Ceresoli M., Coimbra R., Davies J., Kirkpatrick A., Di Carlo I., Hardcastle T. C., Isik A., Chiarugi M., Gurusamy K., Maier R. V., Segovia Lohse H. A., Jeekel H., Boermeester M. A., Abu-Zidan F., Inaba K., Weber D. G., Augustin G., Bonavina L., Velmahos G., Sartelli M., Di Saverio S., Ten Broek R. P. G., Granieri S., Dal Mas F., Fare C. N., Peverada J., Zanghi S., Vigano J., Tomasoni M., Dominioni T., Cicuttin E., Hecker A., Tebala G. D., Galante J. M., Wani I., Khokha V., Sugrue M., Scalea T. M., Tan E., Malangoni M. A., Pararas N., Podda M., De Simone B., Ivatury R., Cui Y., Kashuk J., Peitzman A., Kim F., Pikoulis E., Sganga G., Chiara O., Kelly M. D., Marzi I., Picetti E., Agnoletti V., De'Angelis N., Campanelli G., de Moya M., Litvin A., Martinez-Perez A., Sall I., Rizoli S., Tomadze G., Sakakushev B., Stahel P. F., Civil I., Shelat V., Costa D., Chichom-Mefire A., Latifi R., Chirica M., Amico F., Pardhan A., Seenarain V., Boyapati N., Hatz B., Ackermann T., Abeyasundara S., Fenton L., Plani F., Sarvepalli R., Rouhbakhshfar O., Caleo P., Ho-Ching Yau V., Clement K., Christou E., Castillo A. M. G., Gosal P. K. S., Balasubramaniam S., Hsu J., Banphawatanarak K., Pisano M., Adriana T., Michele A., Cioffi S. P. B., Spota A., Catena F., Ansaloni L., Frassini, S, Cobianchi, L, Fugazzola, P, Biffl, W, Coccolini, F, Damaskos, D, Moore, E, Kluger, Y, Ceresoli, M, Coimbra, R, Davies, J, Kirkpatrick, A, Di Carlo, I, Hardcastle, T, Isik, A, Chiarugi, M, Gurusamy, K, Maier, R, Segovia Lohse, H, Jeekel, H, Boermeester, M, Abu-Zidan, F, Inaba, K, Weber, D, Augustin, G, Bonavina, L, Velmahos, G, Sartelli, M, Di Saverio, S, Ten Broek, R, Granieri, S, Dal Mas, F, Fare, C, Peverada, J, Zanghi, S, Vigano, J, Tomasoni, M, Dominioni, T, Cicuttin, E, Hecker, A, Tebala, G, Galante, J, Wani, I, Khokha, V, Sugrue, M, Scalea, T, Tan, E, Malangoni, M, Pararas, N, Podda, M, De Simone, B, Ivatury, R, Cui, Y, Kashuk, J, Peitzman, A, Kim, F, Pikoulis, E, Sganga, G, Chiara, O, Kelly, M, Marzi, I, Picetti, E, Agnoletti, V, De'Angelis, N, Campanelli, G, de Moya, M, Litvin, A, Martinez-Perez, A, Sall, I, Rizoli, S, Tomadze, G, Sakakushev, B, Stahel, P, Civil, I, Shelat, V, Costa, D, Chichom-Mefire, A, Latifi, R, Chirica, M, Amico, F, Pardhan, A, Seenarain, V, Boyapati, N, Hatz, B, Ackermann, T, Abeyasundara, S, Fenton, L, Plani, F, Sarvepalli, R, Rouhbakhshfar, O, Caleo, P, Ho-Ching Yau, V, Clement, K, Christou, E, Castillo, A, Gosal, P, Balasubramaniam, S, Hsu, J, Banphawatanarak, K, Pisano, M, Adriana, T, Michele, A, Cioffi, S, Spota, A, Catena, F, Ansaloni, L, Frassini S., Cobianchi L., Fugazzola P., Biffl W. L., Coccolini F., Damaskos D., Moore E. E., Kluger Y., Ceresoli M., Coimbra R., Davies J., Kirkpatrick A., Di Carlo I., Hardcastle T. C., Isik A., Chiarugi M., Gurusamy K., Maier R. V., Segovia Lohse H. A., Jeekel H., Boermeester M. A., Abu-Zidan F., Inaba K., Weber D. G., Augustin G., Bonavina L., Velmahos G., Sartelli M., Di Saverio S., Ten Broek R. P. G., Granieri S., Dal Mas F., Fare C. N., Peverada J., Zanghi S., Vigano J., Tomasoni M., Dominioni T., Cicuttin E., Hecker A., Tebala G. D., Galante J. M., Wani I., Khokha V., Sugrue M., Scalea T. M., Tan E., Malangoni M. A., Pararas N., Podda M., De Simone B., Ivatury R., Cui Y., Kashuk J., Peitzman A., Kim F., Pikoulis E., Sganga G., Chiara O., Kelly M. D., Marzi I., Picetti E., Agnoletti V., De'Angelis N., Campanelli G., de Moya M., Litvin A., Martinez-Perez A., Sall I., Rizoli S., Tomadze G., Sakakushev B., Stahel P. F., Civil I., Shelat V., Costa D., Chichom-Mefire A., Latifi R., Chirica M., Amico F., Pardhan A., Seenarain V., Boyapati N., Hatz B., Ackermann T., Abeyasundara S., Fenton L., Plani F., Sarvepalli R., Rouhbakhshfar O., Caleo P., Ho-Ching Yau V., Clement K., Christou E., Castillo A. M. G., Gosal P. K. S., Balasubramaniam S., Hsu J., Banphawatanarak K., Pisano M., Adriana T., Michele A., Cioffi S. P. B., Spota A., Catena F., and Ansaloni L.

Abstract

Laparotomy incisions provide easy and rapid access to the peritoneal cavity in case of emergency surgery. Incisional hernia (IH) is a late manifestation of the failure of abdominal wall closure and represents frequent complication of any abdominal incision: IHs can cause pain and discomfort to the patients but also clinical serious sequelae like bowel obstruction, incarceration, strangulation, and necessity of reoperation. Previous guidelines and indications in the literature consider elective settings and evidence about laparotomy closure in emergency settings is lacking. This paper aims to present the World Society of Emergency Surgery (WSES) project called ECLAPTE (Effective Closure of LAParoTomy in Emergency): the final manuscript includes guidelines on the closure of emergency laparotomy.

Published
2023

2. ECLAPTE: Effective Closure of LAParoTomy in Emergency-2023 World Society of Emergency Surgery guidelines for the closure of laparotomy in emergency settings.

Author

Frassini, S., Cobianchi, L., Fugazzola, P., Biffl, W.L., Coccolini, F., Damaskos, D., Moore, E.E., Kluger, Y., Ceresoli, M., Coimbra, R., Davies, J., Kirkpatrick, A., Carlo, I. Di, Hardcastle, T.C., Isik, A., Chiarugi, M., Gurusamy, K., Maier, R.V., Segovia Lohse, H.A., Jeekel, H., Boermeester, M.A., Abu-Zidan, F., Inaba, K., Weber, D.G., Augustin, G., Bonavina, L., Velmahos, G., Sartelli, M., Saverio, S. Di, Broek, R.P.G ten, Granieri, S., Mas, F. Dal, Farè, C.N., Peverada, J., Zanghì, S., Viganò, J., Tomasoni, M., Dominioni, T., Cicuttin, E., Hecker, A., Tebala, G.D., Galante, J.M., Wani, I., Khokha, V., Sugrue, M., Scalea, T.M., Tan, E.C.T.H., Malangoni, M.A., Pararas, N., Podda, M., Simone, B. De, Ivatury, R., Cui, Y., Kashuk, J., Peitzman, A., Kim, F., Pikoulis, E., Sganga, G., Chiara, O., Kelly, M.D., Marzi, I., Picetti, E., Agnoletti, V., De'Angelis, N., Campanelli, G., Moya, M. de, Litvin, A., Martínez-Pérez, A., Sall, I., Rizoli, S., Tomadze, G., Sakakushev, B., Stahel, P.F., Civil, I., Shelat, V., Costa, D., Chichom-Mefire, A., Latifi, R., Chirica, M., Amico, F., Pardhan, A., Seenarain, V., Boyapati, N., Hatz, B., Ackermann, T., Abeyasundara, S., Fenton, L., Plani, F., Sarvepalli, R., Rouhbakhshfar, O., Caleo, P., Ho-Ching Yau, V., Clement, K., Christou, E., Castillo, A.M.G., Gosal, P.K.S., Balasubramaniam, S., Hsu, J., Banphawatanarak, K., Pisano, M., Adriana, T., Michele, A., Cioffi, S.P.B., Spota, A., Catena, F., Ansaloni, L., Frassini, S., Cobianchi, L., Fugazzola, P., Biffl, W.L., Coccolini, F., Damaskos, D., Moore, E.E., Kluger, Y., Ceresoli, M., Coimbra, R., Davies, J., Kirkpatrick, A., Carlo, I. Di, Hardcastle, T.C., Isik, A., Chiarugi, M., Gurusamy, K., Maier, R.V., Segovia Lohse, H.A., Jeekel, H., Boermeester, M.A., Abu-Zidan, F., Inaba, K., Weber, D.G., Augustin, G., Bonavina, L., Velmahos, G., Sartelli, M., Saverio, S. Di, Broek, R.P.G ten, Granieri, S., Mas, F. Dal, Farè, C.N., Peverada, J., Zanghì, S., Viganò, J., Tomasoni, M., Dominioni, T., Cicuttin, E., Hecker, A., Tebala, G.D., Galante, J.M., Wani, I., Khokha, V., Sugrue, M., Scalea, T.M., Tan, E.C.T.H., Malangoni, M.A., Pararas, N., Podda, M., Simone, B. De, Ivatury, R., Cui, Y., Kashuk, J., Peitzman, A., Kim, F., Pikoulis, E., Sganga, G., Chiara, O., Kelly, M.D., Marzi, I., Picetti, E., Agnoletti, V., De'Angelis, N., Campanelli, G., Moya, M. de, Litvin, A., Martínez-Pérez, A., Sall, I., Rizoli, S., Tomadze, G., Sakakushev, B., Stahel, P.F., Civil, I., Shelat, V., Costa, D., Chichom-Mefire, A., Latifi, R., Chirica, M., Amico, F., Pardhan, A., Seenarain, V., Boyapati, N., Hatz, B., Ackermann, T., Abeyasundara, S., Fenton, L., Plani, F., Sarvepalli, R., Rouhbakhshfar, O., Caleo, P., Ho-Ching Yau, V., Clement, K., Christou, E., Castillo, A.M.G., Gosal, P.K.S., Balasubramaniam, S., Hsu, J., Banphawatanarak, K., Pisano, M., Adriana, T., Michele, A., Cioffi, S.P.B., Spota, A., Catena, F., and Ansaloni, L.

Abstract

Contains fulltext : 296003.pdf (Publisher’s version ) (Open Access), Laparotomy incisions provide easy and rapid access to the peritoneal cavity in case of emergency surgery. Incisional hernia (IH) is a late manifestation of the failure of abdominal wall closure and represents frequent complication of any abdominal incision: IHs can cause pain and discomfort to the patients but also clinical serious sequelae like bowel obstruction, incarceration, strangulation, and necessity of reoperation. Previous guidelines and indications in the literature consider elective settings and evidence about laparotomy closure in emergency settings is lacking. This paper aims to present the World Society of Emergency Surgery (WSES) project called ECLAPTE (Effective Closure of LAParoTomy in Emergency): the final manuscript includes guidelines on the closure of emergency laparotomy.

Published
2023

3. Evidence of Altered Guinea Pig Ventricular Cardiomyocyte Protein Expression and Growth in Response to a 5 min in vitro Exposure to H2O2

Author

Seenarain, V., Viola, H.M., Ravenscroft, G., Casey, T.M., Lipscombe, R.J., Ingley, E., Laing, N.G., Bringans, S.D., Hool, L.C., Seenarain, V., Viola, H.M., Ravenscroft, G., Casey, T.M., Lipscombe, R.J., Ingley, E., Laing, N.G., Bringans, S.D., and Hool, L.C.

Abstract

Oxidative stress and alterations in cellular calcium homeostasis are associated with the development of cardiac hypertrophy. However, the early cellular mechanisms for the development of hypertrophy are not well understood. Guinea pig ventricular myocytes were exposed to 30 μ H2O 2 for 5 min followed by 10 units/mL catalase to degrade the H 2O2, and effects on protein expression were examined 48 h later. Transient exposure to H2O2 increased the level of protein synthesis more than 2-fold, assessed as incorporation of [ 3H]leucine (n = 12; p < 0.05). Cell size was increased slightly, but there was no evidence of major cytoskeletal disorganization assessed using fluorescence microscopy. Changes in the expression of individual proteins were assessed using iTRAQ protein labeling followed by mass spectrometry analysis (LC-MALDI-MSMS); 669 proteins were identified, and transient exposure of myocytes to H2O2 altered expression of 35 proteins that were predominantly mitochondrial in origin, including TCA cycle enzymes and oxidative phosphorylation proteins. Consistent with changes in the expression of mitochondrial proteins, transient exposure of myocytes to H2O 2 increased the magnitude of the mitochondrial NADH signal 10.5 ± 2.3% compared to cells exposed to 0 μH2O2 for 5 min followed by 10 units/mL catalase (n = 8; p < 0.05). In addition, metabolic activity was significantly increased in the myocytes 48 h after transient exposure to H2O2, assessed as formation of formazan from tetrazolium salt. We conclude that a 5 min exposure of ventricular myocytes to 30 μ H2O2 is sufficient to significantly alter protein expression, consistent with the development of hypertrophy in the myocytes. Changes in mitochondrial protein expression and function appear to be early sequelae in the development of hypertrophy.

Published
2010

4. Characterisation of changes in the cardiac proteome after transient exposure of myocytes to hydrogen peroxide

Author

Seenarain, V., Viola, H., Ingley, E., Casey, T., Lipscombe, R., Hool, L., Seenarain, V., Viola, H., Ingley, E., Casey, T., Lipscombe, R., and Hool, L.

Abstract

We have shown previously that exposure of guinea pig ventricular myocytes to 30 μM hydrogen peroxide (H2O2) for 5 min followed by 10 U/ml catalase to degrade the H2O2 results in a persistent increase in superoxide production by the mitochondria. This leads to a 2-fold increase in protein synthesis measured as [3H] leucine incorporation. We characterised the effect of a transient exposure of cardiac myocytes to H2O2 on the proteome. Myocytes were exposed to 0 μM or 30 μM H2O2 for 5 min followed by 10U/ml catalase. Protein was extracted, labelled with iTRAQ reagents and the peptides were analysed by LC–MALDI-TOF/TOF mass spectrometry and identified against SwissProt and Ludwig NR databases. More than 900 proteins were identified. Transient exposure of the myocytes to H2O2 resulted in altered expression of 62 proteins. 40% of proteins identified with altered expression were mitochondrial. Consistent with our in vitro data, mitochondria complex I and complex III subunit expression was upregulated while downregulation of complex IV and ATP synthase subunits suggested compromised ATP production. We also detected an increase in sarcomere associated proteins including Troponin C, Tropomyosin I alpha isoform 6 and Myosin light chain 2 and 3. Prohibitin was downregulated and calcireticulin expression was upregulated, consistent with promotion of cellular growth. We are currently validating the findings with in vitro functional studies in the myocytes. These data suggest that transient exposure to cardiac myocytes is sufficient to significantly alter expression of proteins and provides insight into early mechanisms of development of cardiac hypertrophy.

Published
2009

5. Retrospective comparison of outcomes of patients undergoing omental patch versus falciform patch repair of perforated peptic ulcers.

Author

Seenarain V, Wilson T, Fletcher DR, and Foster AJ

Subjects
Humans, Retrospective Studies, Omentum, Australia, Postoperative Complications surgery, Treatment Outcome, Laparoscopy methods, Duodenal Ulcer surgery, Peptic Ulcer Perforation surgery
Abstract

Background: The omental patch repair is the gold standard for the repair of perforated peptic ulcers. This can be performed open or laparoscopically. However, in the event of non-viable or inadequate omentum available at the time of surgery the falciform ligament has been reportedly used to as an alternative. Nonetheless, evidence for its safety is scant. This study aims to determine differences in patient outcomes when comparing the two repair techniques., Methods: Following ethics approval, patients who underwent surgical repair of perforated peptic ulcers using omental or falciform patch repair, between 1 January 2010 and 31 December 2017, across all three Western Australian tertiary hospital services and at least 18 years of age were included. Data were collected by reviewing medical records of included patients., Results: Three hundred twenty-nine patients who underwent either open or laparoscopic repairs were included. Thirty-seven patients had falciform repairs and were mostly ASA of 2 compared to 292 patients receiving omental patch repair who were mostly ASA 3. Falciform patch repairs were more commonly used in duodenal ulcer perforations. There were no statistically significant differences in patient outcomes between the omental patch and falciform ligament groups. This included post-operative intra-abdominal sepsis, return to theatre, post-operative ICU admission, inpatient mortality, 30-day readmission and ulcer healing on follow-up gastroscopy., Conclusions: This study demonstrates safety, efficacy and similar outcomes for patients receiving the falciform ligament patch repair compared with omental patch repair., (© 2023 The Authors. ANZ Journal of Surgery published by John Wiley & Sons Australia, Ltd on behalf of Royal Australasian College of Surgeons.)

Published
2024
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6. Correction: ECLAPTE: Effective Closure of LAParoTomy in Emergency-2023 World Society of Emergency Surgery guidelines for the closure of laparotomy in emergency settings.

Author

Frassini S, Cobianchi L, Fugazzola P, Biffl WL, Coccolini F, Damaskos D, Moore EE, Kluger Y, Ceresoli M, Coimbra R, Davies J, Kirkpatrick A, Di Carlo I, Hardcastle TC, Isik A, Chiarugi M, Gurusamy K, Maier RV, Segovia Lohse HA, Jeekel H, Boermeester MA, Abu-Zidan F, Inaba K, Weber DG, Augustin G, Bonavina L, Velmahos G, Sartelli M, Di Saverio S, Ten Broek RPG, Granieri S, Dal Mas F, Farè CN, Peverada J, Zanghì S, Viganò J, Tomasoni M, Dominioni T, Cicuttin E, Hecker A, Tebala GD, Galante JM, Wani I, Khokha V, Sugrue M, Scalea TM, Tan E, Malangoni MA, Pararas N, Podda M, De Simone B, Ivatury R, Cui Y, Kashuk J, Peitzman A, Kim F, Pikoulis E, Sganga G, Chiara O, Kelly MD, Marzi I, Picetti E, Agnoletti V, De'Angelis N, Campanelli G, de Moya M, Litvin A, Martínez-Pérez A, Sall I, Rizoli S, Tomadze G, Sakakushev B, Stahel PF, Civil I, Shelat V, Costa D, Chichom-Mefire A, Latifi R, Chirica M, Amico F, Pardhan A, Seenarain V, Boyapati N, Hatz B, Ackermann T, Abeyasundara S, Fenton L, Plani F, Sarvepalli R, Rouhbakhshfar O, Caleo P, Ho-Ching Yau V, Clement K, Christou E, Castillo AMG, Gosal PKS, Balasubramaniam S, Hsu J, Banphawatanarak K, Pisano M, Toro A, Michele A, Cioffi SPB, Spota A, Catena F, and Ansaloni L

Published
2023
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7. ECLAPTE: Effective Closure of LAParoTomy in Emergency-2023 World Society of Emergency Surgery guidelines for the closure of laparotomy in emergency settings.

Author

Frassini S, Cobianchi L, Fugazzola P, Biffl WL, Coccolini F, Damaskos D, Moore EE, Kluger Y, Ceresoli M, Coimbra R, Davies J, Kirkpatrick A, Di Carlo I, Hardcastle TC, Isik A, Chiarugi M, Gurusamy K, Maier RV, Segovia Lohse HA, Jeekel H, Boermeester MA, Abu-Zidan F, Inaba K, Weber DG, Augustin G, Bonavina L, Velmahos G, Sartelli M, Di Saverio S, Ten Broek RPG, Granieri S, Dal Mas F, Farè CN, Peverada J, Zanghì S, Viganò J, Tomasoni M, Dominioni T, Cicuttin E, Hecker A, Tebala GD, Galante JM, Wani I, Khokha V, Sugrue M, Scalea TM, Tan E, Malangoni MA, Pararas N, Podda M, De Simone B, Ivatury R, Cui Y, Kashuk J, Peitzman A, Kim F, Pikoulis E, Sganga G, Chiara O, Kelly MD, Marzi I, Picetti E, Agnoletti V, De'Angelis N, Campanelli G, de Moya M, Litvin A, Martínez-Pérez A, Sall I, Rizoli S, Tomadze G, Sakakushev B, Stahel PF, Civil I, Shelat V, Costa D, Chichom-Mefire A, Latifi R, Chirica M, Amico F, Pardhan A, Seenarain V, Boyapati N, Hatz B, Ackermann T, Abeyasundara S, Fenton L, Plani F, Sarvepalli R, Rouhbakhshfar O, Caleo P, Ho-Ching Yau V, Clement K, Christou E, Castillo AMG, Gosal PKS, Balasubramaniam S, Hsu J, Banphawatanarak K, Pisano M, Adriana T, Michele A, Cioffi SPB, Spota A, Catena F, and Ansaloni L

Subjects
Humans, Laparotomy adverse effects, Suture Techniques adverse effects, Reoperation adverse effects, Abdominal Wound Closure Techniques adverse effects, Incisional Hernia etiology
Abstract

Laparotomy incisions provide easy and rapid access to the peritoneal cavity in case of emergency surgery. Incisional hernia (IH) is a late manifestation of the failure of abdominal wall closure and represents frequent complication of any abdominal incision: IHs can cause pain and discomfort to the patients but also clinical serious sequelae like bowel obstruction, incarceration, strangulation, and necessity of reoperation. Previous guidelines and indications in the literature consider elective settings and evidence about laparotomy closure in emergency settings is lacking. This paper aims to present the World Society of Emergency Surgery (WSES) project called ECLAPTE (Effective Closure of LAParoTomy in Emergency): the final manuscript includes guidelines on the closure of emergency laparotomy., (© 2023. The Author(s).)

Published
2023
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8. Diagnosis and surgical repair of delayed tracheal perforation post thyroidectomy in context of previous cranio-spinal radiotherapy - A case report.

Author

Seenarain V, Trivedi A, Flukes S, and Tjhin WE

Abstract

Introduction and Importance: This is the first case of delayed tracheal perforation post total thyroidectomy in the context of previous radiotherapy to the neck. Such a presentation can be easily misdiagnosed and managed as a seroma at significant risk to the patient, as the latter had no precipitating factors and cardiorespiratory compromise. There are nineteen previously described cases of delayed tracheal injury post thyroidectomy of variable severity and variable intervention., Case Presentation: A 51-year-old man presented with non-tender anterior neck surgical emphysema initially diagnosed on bedside ultrasound and plain X-ray, 22 days following total thyroidectomy and central neck dissection. His background was significant for childhood acute lymphoblastic leukaemia requiring chemotherapy and cranio-spinal radiotherapy. He underwent total thyroidectomy, for multiple bilateral thyroid nodules found on cranio-spinal MRI surveillance concerning for follicular neoplasm. There were significant amount of adhesions tethering the thyroid secondary to prior radiotherapy but no tracheal injury intra-operatively., Clinical Discussion: At presentation, no source of air leak was identified on Computer Tomography. He failed conservative management. During surgical exploration, a 2 mm tracheal perforation at the right cricothyroid joint was closed with the right sternothyroid muscle due to the proximity of the perforation with the recurrent right laryngeal nerve. Tisseel was applied over the repair. He recovered without further complications., Conclusion: Sudden onset neck swelling post thyroidectomy in the context of significant scaring from radiotherapy, should raise the suspicion of surgical emphysema in the neck patients and confirmed with plain x-ray. Such patients should have multidisciplinary tertiary care., (Crown Copyright © 2022. Published by Elsevier Ltd. All rights reserved.)

Published
2022
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10. Random colonic biopsies in macroscopically normal colonoscopies: is there any benefit? A two-centre audit of current practice.

Author

Seenarain V, Idrees M, Mogridge J, Sinha A, and Thompson A

Subjects
Adult, Biopsy, Humans, Intestinal Mucosa, Western Australia epidemiology, Colon, Colonoscopy
Abstract

Background: Recent guidelines from the British Society of Gastroenterology published in April 2018, recommended performing random colonic biopsies (RCB) in endoscopically normal colonic mucosa when investigating chronic diarrhoea in adults to rule out microscopic colitis; however, cost effectiveness was not accounted for due to poor evidence base. There is now more evidence that RCBs are of low yield and of significant cost., Methods: A two-centre audit of current practice was conducted at Rockingham General Hospital and Fremantle Hospital in Western Australia, aiming to determine the yield of RCB in macroscopically normal mucosa for microscopic colitis, from 1 January 2009 to 30 June 2018, with comparisons of practice and results between gastroenterologists and general surgeons. Variability in the indications (diarrhoea and non-diarrhoea indications) for RCBs was determined and the cost of consumables, additional endoscopy time and histopathology analysis were calculated., Results: A total of 872 normal colonoscopies with RCBs were included; 48.7% of colonoscopies with RCB were for diarrhoea. Only 1.5% of RCBs were positive for microscopic colitis; 3.1% of patients with diarrhoea had microscopic colitis. Only one patient received pharmacologial treatment as a result of the test. The calculated cost per positive diagnosis of microscopic colitis was $10 862.42., Conclusion: RCBs from normal colonic mucosa have poor yield and are costly. Local guidelines should be updated, so RCBs are performed only in patients with a high degree of suspicion of an organic cause of chronic diarrhoea., (© 2020 Royal Australasian College of Surgeons.)

Published
2020
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11. Testicular Infarction: A Rare Complication after Endovascular Abdominal Aortic Aneurysm Repair.

Author

Seenarain V, Quick M, Weerasuriya A, and Min Then GC

Subjects
Aortic Aneurysm, Abdominal diagnostic imaging, Arterial Occlusive Diseases diagnostic imaging, Arterial Occlusive Diseases physiopathology, Collateral Circulation, Humans, Infarction diagnostic imaging, Infarction physiopathology, Male, Middle Aged, Regional Blood Flow, Aortic Aneurysm, Abdominal surgery, Arterial Occlusive Diseases etiology, Blood Vessel Prosthesis Implantation adverse effects, Endovascular Procedures adverse effects, Infarction etiology, Testis blood supply
Published
2019
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12. Evidence of altered guinea pig ventricular cardiomyocyte protein expression and growth in response to a 5 min in vitro exposure to H(2)O(2).

Author

Seenarain V, Viola HM, Ravenscroft G, Casey TM, Lipscombe RJ, Ingley E, Laing NG, Bringans SD, and Hool LC

Subjects
Analysis of Variance, Animals, Cell Size, Down-Regulation, Female, Guinea Pigs, Heart Ventricles cytology, Heart Ventricles drug effects, Isotope Labeling, Leucine metabolism, Male, Microscopy, Confocal, Mitochondria metabolism, Myocytes, Cardiac cytology, Myocytes, Cardiac drug effects, NAD metabolism, Oxidative Stress drug effects, Proteome drug effects, Proteome metabolism, Cardiomegaly metabolism, Heart Ventricles metabolism, Hydrogen Peroxide pharmacology, Myocytes, Cardiac metabolism
Abstract

Oxidative stress and alterations in cellular calcium homeostasis are associated with the development of cardiac hypertrophy. However, the early cellular mechanisms for the development of hypertrophy are not well understood. Guinea pig ventricular myocytes were exposed to 30 microM H(2)O(2) for 5 min followed by 10 units/mL catalase to degrade the H(2)O(2), and effects on protein expression were examined 48 h later. Transient exposure to H(2)O(2) increased the level of protein synthesis more than 2-fold, assessed as incorporation of [(3)H]leucine (n = 12; p < 0.05). Cell size was increased slightly, but there was no evidence of major cytoskeletal disorganization assessed using fluorescence microscopy. Changes in the expression of individual proteins were assessed using iTRAQ protein labeling followed by mass spectrometry analysis (LC-MALDI-MSMS); 669 proteins were identified, and transient exposure of myocytes to H(2)O(2) altered expression of 35 proteins that were predominantly mitochondrial in origin, including TCA cycle enzymes and oxidative phosphorylation proteins. Consistent with changes in the expression of mitochondrial proteins, transient exposure of myocytes to H(2)O(2) increased the magnitude of the mitochondrial NADH signal 10.5 +/- 2.3% compared to cells exposed to 0 microM H(2)O(2) for 5 min followed by 10 units/mL catalase (n = 8; p < 0.05). In addition, metabolic activity was significantly increased in the myocytes 48 h after transient exposure to H(2)O(2), assessed as formation of formazan from tetrazolium salt. We conclude that a 5 min exposure of ventricular myocytes to 30 microM H(2)O(2) is sufficient to significantly alter protein expression, consistent with the development of hypertrophy in the myocytes. Changes in mitochondrial protein expression and function appear to be early sequelae in the development of hypertrophy.

Published
2010
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