Perforation with extravasation of barium is a rare complication of contrast enema examination of the large bowel with a high associated mortality rate. The experience of performing a re-laparotomy in a patient previously exposed to barium peritonitis is even less common. We describe an elderly male patient with a Hartmann's procedure performed a year previously, presenting with peritonitis following barium enema evaluation of the proximal colon via an end descending colon stoma. Emergency laparotomy, segmental bowel resection and liberal peritoneal toilet resulted in a satisfactory outcome. The patient had a subsequent successful reversal of his Hartmann's procedure nine months later despite the presence of dense barium induced adhesions. This potentially preventable iatrogenic complication is discussed in this report, which is supplemented by a brief review of the English literature.
Barium Sulfate/administration & dosage ; Barium Sulfate/*adverse effects ; Colon ; Colostomy ; Enema/*adverse effects ; *Iatrogenic Disease ; Peritonitis/*chemically induced

AIMTo review the outcomes of eyes with neovascular age-related macular degeneration (AMD) treated with photodynamic therapy (PDT) with verteporfin and intravitreal triamcinolone acetonide injection.

MATERIALS AND METHODSWe retrospectively reviewed the outcomes of consecutive eyes with neovascular AMD that received an intravitreal triamcinolone injection within 1 week of their first PDT and had at least 6 months of follow-up. Eyes were retreated with PDT at 3-month intervals if angiographic leakage was present.

RESULTSTwenty-six eyes from 24 patients were identified. The mean visual acuity at baseline was 20/118 (median 20/112). The mean visual acuity decreased to 20/138 at 9 months (P = 0.24, n = 15) and to 20/174 at 12 months (P = 0.23, n = 8). The change in visual acuity from baseline was not statistically significant at any time point. The mean central foveal thickness by OCT measured 342 microm at baseline and decreased to 296 microm at 12 months (P = 0.31). Sixty-two per cent of eyes required no additional PDT at 12 months. Nineteen per cent of 26 eyes had a rise in intraocular pressure that was controlled with topical medication alone.

CONCLUSIONPhotodynamic therapy with verteporfin combined with intravitreal triamcinolone injection in the treatment of neovascular AMD may be superior to PDT alone by decreasing visual loss and reducing the number or retreatments.

Age Factors ; Aged ; Choroidal Neovascularization ; Female ; Humans ; Macular Degeneration ; drug therapy ; therapy ; Male ; Photochemotherapy ; Photosensitizing Agents ; therapeutic use ; Porphyrins ; therapeutic use ; Retrospective Studies ; Treatment Outcome ; Triamcinolone ; therapeutic use

BACKGROUND: Use of antidepressant medications has been linked to detrimental impacts on bone mineral density and osteoporosis; however, the cellular basis behind these observations remains poorly understood. The effect does not appear to be homogeneous across the whole class of drugs and may be linked to affinity for the serotonin transporter system. In this study, we hypothesized that antidepressants have a class- and dose-dependent effect on mesenchymal stem cell (MSC) differentiation, which may affect bone metabolism. METHODS: Human MSCs (hMSCs) were committed to differentiate when either adipogenic or osteogenic media was added, supplemented with five increasing concentrations of amitriptyline (0.001–10 µM), venlafaxine (0.01–25 µM), or fluoxetine (0.001–10 µM). Alizarin red staining (mineralization), alkaline phosphatase (osteoblastogenesis), and oil red O (adipogenesis) assays were performed at timed intervals. In addition, cell viability was assessed using a MTT. RESULTS: We found that fluoxetine had a significant inhibitory effect on mineralization. Furthermore, adipogenic differentiation of hMSC was affected by the addition of amitriptyline, venlafaxine, and fluoxetine to the media. Finally, none of the tested medications significantly affected cell survival. CONCLUSIONS: This study showed a divergent effect of three antidepressants on hMSC differentiation, which appears to be independent of class and dose. As fluoxetine and amitriptyline, but not venlafaxine, affected both osteoblastogenesis and adipogenesis, this inhibitory effect could be associated to the high affinity of fluoxetine to the serotonin transporter system.
Adipogenesis ; Alkaline Phosphatase ; Amitriptyline ; Antidepressive Agents ; Bone Density ; Cell Survival ; Fluoxetine ; Humans ; Mesenchymal Stromal Cells ; Metabolism ; Miners ; Osteoblasts ; Osteoporosis ; Serotonin Plasma Membrane Transport Proteins ; Venlafaxine Hydrochloride

PURPOSE: This study is intended to understand the sensitometric charac teristics and the emulsion properties of the commercially available CEA TVS film in comparison with the Kodak X-Omat V film. MATERIAL AND METHODS: For this purpose, we have formulated an analytic expression of the characteristic curves for x-ray film exposed to mixed radiation of electrons, photons, and visible light. This mathematical expression was developed based on reaction-rate and target-hit theories. Unlike previous expressions, it relates optical density to emulsion properties such as grain size and silver bromide content. We have also developed a quantity which characterizes the film response to visible light relative to that to photons and electrons. This quantity could be expressed as a function of grain area. Thus, we have developed mathematical expressions and quantities with which the emulsion properties of the films can be revealed based on the sensitometric characteristics. Demonstrating the use of this analytical study, we exposed CEA and Kodak verification films to the mixed radiation of electrons, photons, and visible light, and interpreted the experimental results accordingly. RESULTS: We have demonstrated that: (1) the saturation density increases as the silver bromide content increases, (2) the time required to reach the threshold dose (to which the film begins to respond) when films are exposed to visible light decreases as the grain size increases, and (3) the CEA film contains more silver bromide, whereas the Kodak film contains larger grains. These findings were supported by the data provided by the manufacturers afterward. CONCLUSION: This study presented an analytical and experimental basis for understanding the response of X-ray film with respect to the emulsion properties.
Edible Grain ; Light ; Photons ; Silver ; X-Ray Film

The hepatic lobule is divided into three zones along the portal-central vein axis. Hepatocytes within each zone exhibit a distinctive gene expression profile that coordinates their metabolic compartmentalization. The zone-dependent heterogeneity of hepatocytes has been hypothesized to result from the differential degree of exposure to oxygen, nutrition and gut-derived toxins. In addition, the gradient of Wnt signaling that increases towards the central vein seen in rodent models is believed to play a critical role in shaping zonation. Furthermore, hepatic zonation is coupled to the site of the homeostatic renewal of hepatocytes. Despite its critical role, the regulatory mechanisms that determine the distinctive features of zonation and its relevance to humans are not well understood. The present study first conducted a comprehensive zone-dependent transcriptome analysis of normal human liver using laser capture microdissection. Upstream pathway analysis revealed the signatures of host responses to gut-derived toxins in the periportal zone, while both the canonical Wnt pathway and the xenobiotic response pathway govern the perivenular zone. Furthermore, we found that the hypoxic environment of the perivenular zone promotes Wnt11 expression in hepatocytes, which then regulates unique gene expression via activation of the non-canonical Wnt pathway. In summary, our study reports the comprehensive zonation-dependent transcriptome of the normal human liver. Our analysis revealed that the LPS response pathway shapes the characteristics of periportal hepatocytes. By contrast, the perivenular zone is regulated by a combination of three distinct pathways: the xenobiotic response pathway, canonical Wnt signaling, and hypoxia-induced noncanonical Wnt signaling.