Primary aorto-duodenal fistula is a rare and life-threatening cause of upper gastro-intestinal bleed. In this case report, a patient presented acutely with several episodes of haematochezia and pulseless lower limbs bilaterally. Primary aorto-duodenal fistula with peripheral vascular disease was diagnosed after an urgent CT angiogram was performed. She underwent left axillo-bifemoral bypass, resection of the fistula, Rouxen-Y gastro-jejunostomy, pyloric exclusion and controlled duodenal fistula the following day.
Aortic Diseases/*diagnosis ; Duodenal Diseases/*diagnosis ; Intestinal Fistula/*diagnosis

No abstract available.

Our recent studies have shown that co-activation of Gq and Gi proteins by 5-hydroxytryptamine (5-HT) and adrenaline show synergism in human platelet aggregation. This study was conducted to examine the mechanism(s) of synergistic interaction of 5-HT and platelet activating factor (PAF) in human platelets. We show that PAF, but not 5-HT, increased platelet aggregation in a concentration-dependent manner. However, low concentrations of 5-HT (2 microM) potentiated platelet aggregation induced by subthreshold concentration of PAF (40 nM) indicating a synergistic interaction between the two agonists and this synergism was blocked by receptor antagonists to either 5-HT or PAF. 5-HT also potentiated the effect of PAF on thromboxane A2 (TXA2) formation and phosphorylation of extracellularly regulated mitogen-activated protein kinases (ERK1/2). The synergism of 5-HT and PAF in platelet aggregation was inhibited by calcium (Ca2+) channel blockers, verapamil and diltiazem, phospholipase C (PLC) inhibitor, U73122, cyclooxygenase (COX) inhibitor, indomethacin, and MEK inhibitor, PD98059. These data suggest that synergistic effect of 5-HT and PAF on human platelet aggregation involves activation of PLC/Ca2+, COX and MAP kinase pathways.
Diltiazem/pharmacology ; Dose-Response Relationship, Drug ; Drug Synergism ; Estrenes/pharmacology ; Flavones/pharmacology ; Human ; In Vitro ; Indomethacin/pharmacology ; Kinetics ; Mitogen-Activated Protein Kinases/metabolism ; Phosphorylation/drug effects ; Platelet Activating Factor/*pharmacology ; Platelet Activation/drug effects ; Platelet Aggregation/*drug effects/physiology ; Pyrrolidinones/pharmacology ; Serotonin/*pharmacology ; Thromboxane A2/biosynthesis ; Verapamil/pharmacology

Our recent studies have shown that co-activation of Gq and Gi proteins by 5-hydroxytryptamine (5-HT) and adrenaline show synergism in human platelet aggregation. This study was conducted to examine the mechanism(s) of synergistic interaction of 5-HT and platelet activating factor (PAF) in human platelets. We show that PAF, but not 5-HT, increased platelet aggregation in a concentration-dependent manner. However, low concentrations of 5-HT (2 microM) potentiated platelet aggregation induced by subthreshold concentration of PAF (40 nM) indicating a synergistic interaction between the two agonists and this synergism was blocked by receptor antagonists to either 5-HT or PAF. 5-HT also potentiated the effect of PAF on thromboxane A2 (TXA2) formation and phosphorylation of extracellularly regulated mitogen-activated protein kinases (ERK1/2). The synergism of 5-HT and PAF in platelet aggregation was inhibited by calcium (Ca2+) channel blockers, verapamil and diltiazem, phospholipase C (PLC) inhibitor, U73122, cyclooxygenase (COX) inhibitor, indomethacin, and MEK inhibitor, PD98059. These data suggest that synergistic effect of 5-HT and PAF on human platelet aggregation involves activation of PLC/Ca2+, COX and MAP kinase pathways.
Diltiazem/pharmacology ; Dose-Response Relationship, Drug ; Drug Synergism ; Estrenes/pharmacology ; Flavones/pharmacology ; Human ; In Vitro ; Indomethacin/pharmacology ; Kinetics ; Mitogen-Activated Protein Kinases/metabolism ; Phosphorylation/drug effects ; Platelet Activating Factor/*pharmacology ; Platelet Activation/drug effects ; Platelet Aggregation/*drug effects/physiology ; Pyrrolidinones/pharmacology ; Serotonin/*pharmacology ; Thromboxane A2/biosynthesis ; Verapamil/pharmacology

Subclavian artery thrombosis is a rare complication of clavicle fractures. We reported a 20-year-old man who was admitted to the emergency room after a road traffic accident. He was a pedestrian who was initially hit by a bus and after he fell down on the road, he was run over by a car. On evaluation, he was found to have multiple facial and rib fractures, distal right humerus and right clavicle fracture. Significantly, right radial pulse was absent. After further evaluation including Doppler studies and an angiography which revealed complete obstruction of right subclavian artery just distal to its 1st portion, the patient was urgently taken to the operation room. A midclavicular fracture was adjacent to the injured vessel. We established proximal and distal control, removed damaged part. After mobilizing the subclavian artery, an end-to-end anastomosis was made. Then open reduction and internal fixation of right distal humerus was performed. The rest of the postoperative course was unremarkable. To prevent complications of subclavian artery thrombosis, different treatment modalities can be used, including anticoagulation therapy, angioplasty, stenting and bypass procedures.
Anastomosis, Surgical ; Clavicle ; injuries ; Fractures, Bone ; complications ; Humans ; Male ; Subclavian Artery ; injuries ; surgery ; Thrombosis ; etiology ; surgery ; Young Adult

OBJECTIVETracheobronchial injuries are defined as injuries involving the trachea and/or bronchi from the level of the cricoid cartilage extending up to the division of the bronchi. We present a case series with most of the tracheobronchial injuries found to be sustained after penetrating trauma.

METHODSA retrospective review was performed at the Aga Khan University, Karachi, Pakistan. From January 2004 to December 2009, 168 patients with thoracic trauma were treated, of whom 15 were recognized to have major tracheobronchial and pulmonary injuries.

RESULTSThe average age was 31 years with most of the patients being male (14:1). Among them,11 patients had penetrating trauma as the main cause of injury, 3 patients had blunt trauma from road traffic accidents, only 1 patient had combined trauma (blunt and penetrating trauma). Eight patients were diagnosed based on radiological findings. All the patients were treated surgically. Lobectomy was the most common intervention performed in 7 patients. The mortality rate was 7% (1 patient). Most patients survived with no sequelae (10 patients) while 5 survived with disability. We found that penetrating trauma was the leading cause of injury in our series. The severity of injury depends upon the weapon causing the trauma. Patients in our series had multiple injuries and required surgical management.

CONCLUSIONSTracheobronchial injuries are rare but potentially life threatening. They require quick diagnosis and management. Diagnosis tends to be difficult since there are no specialised diagnostic modalities available at present.

Adult ; Bronchi ; injuries ; Developing Countries ; Female ; Humans ; Male ; Retrospective Studies ; Trachea ; injuries

The emergence of a third wave of COVID-19 infection in Malaysia since September 2020 has led to imminent changes in public health prevention and control measures. As high as 96.2% of registered COVID-19 cases and 88.5% of confirmed deaths in Malaysia occurred during this third wave of infection. A phylogenomic study on 258 SARS-CoV-2 full genomes from February 2020-February 2021 has led to the discovery of a novel Malaysian lineage B.1.524. This lineage contains another spike mutation A701V that co-exists with the D614G spike mutation that was predominant in most of the third-wave clusters. The study provides vital genomic insights on the rapid spread of the SARS-CoV-2 variants in Malaysia in conjunction with the presence of a dominant SARS-CoV-2 lineage during the third wave of COVID-19 infection.