The Internet, Apps, and the Anesthesiologist.

Modern anesthesia continues to be impacted in new and unforeseen ways by digital technology. Combining portability and versatility, mobile applications or "apps" provide a multitude of ways to enhance anesthetic and peri-operative care. Research suggests that the uptake of apps into anesthetic practice is becoming increasingly routine, especially amongst younger anesthetists brought up in the digital age.

British Society of Echocardiography Departmental Accreditation Standards 2019 with input from the Intensive Care Society.

This article sets out a summary of standards for departmental accreditation set by the British Society of Echocardiography (BSE) Departmental Accreditation Committee. Full accreditation standards are available at www.bsecho.

Sport Sampling Is Associated With Improved Landing Technique in Youth Athletes.

Background: Sport sampling is recommended to promote fundamental movement skill acquisition and physical activity. In contrast, sport specialization is associated with musculoskeletal injury risk, burnout, and attrition from sport. There is limited evidence to support the influence of sport sampling on neuromuscular control, which is associated with injury risk, in youth athletes.

Very late rupture of a post-traumatic abdominal aortic pseudoaneurysm.

Post-traumatic abdominal aortic pseudoaneurysms remain a rare yet severe complication of aortic injuries and may present many years later. Clinical presentations vary, from the traditional aneurysmal symptoms of abdominal and/or back pain with or without a pulsatile mass, to a fatal rupture. We present the case of a man aged 42 years, with a history of blunt abdominal trauma 14 years ago, presenting with symptoms of non-specific lower abdominal pain and a recent history of straining due to constipation.

A case of hepatopulmonary syndrome.

Unlabelled: This report presents the case of a 42-year-old man with liver cirrhosis who presents with breathlessness. Initial investigations are unable to explain his persistent hypoxia and a diagnosis of hepatopulmonary syndrome is considered. Saline contrast echocardiography is utilised in confirming the diagnosis.

Vein graft aneurysms following popliteal aneurysm repair are more common than we think.

True infrainguinal vein graft aneurysms are reported infrequently in the literature. We sought to identify the true incidence of these graft aneurysms after popliteal aneurysm repair and identify factors which may increase the risk of such aneurysms developing. Using a prospectively compiled database, we identified patients who underwent a popliteal aneurysm repair between January 1996 and January 2011 at a single district general hospital.

Multilevel bypass grafting: is it worth it?

Background: Traditionally, multilevel arterial disease has been treated with an inflow procedure only but simultaneous multilevel bypass graft procedures have been attempted. However, these procedures are potentially high risk. We report our single-center experience of performing multilevel bypass grafts over the last 15 years.

An incidental peri-adrenal cystic lesion.

A 50-year-old man was found to have an incidental peri-adrenal cystic lesion on CT imaging which was removed laparoscopically. Histological examination showed a cystic structure composed of respiratory and cuboidal-type epithelium with underlying smooth muscle, cartilage and seromucinous glands. The differential diagnosis for such a lesion includes bronchogenic cyst or teratoma differentiated.

Functionally uni-leaflet mitral valves in a family: a case series.

Functionally uni-leaflet mitral valves are extremely rare. In severe cases, they are considered incompatible with life beyond the neonatal period. We present a case series of three adults with almost complete absence of the posterior mitral valve leaflet and who are asymptomatic, with no more than mild mitral regurgitation.

Newton's Law to the rescue: therapeutic effects of gravity aiding the management of a migratory venous foreign body--a case report.

The management of intravascular metallic foreign bodies (FB) can be difficult and challenging. We report a case of a migrating FB, initially within the femoral vein which subsequently migrated to the intrahepatic vena-cava. Following a change of posture, the metallic FB moved with gravity against the normal venous blood flow to the left renal vein.

Steal phenomenon in the lower limb: presentation of a case with osseous metastases secondary to renal cell carcinoma and review of the literature.

Renal cell carcinoma is reported to have potent angiogenic activity with a high microvascular density in both primary and metastatic sites compared with other adenocarcinomas. Angiogenesis can lead to the formation of abnormal arteriovenous shunts that can, in patients with peripheral vascular disease, result in worsening of the degree of ischaemia by producing a vascular steal-like phenomena. Nevertheless, steal phenomena secondary to malignancies are extremely rare.

Angiotensin II receptor antagonists in chronic heart failure: where do they fit?

Heart failure is a common and disabling condition with a dismal prognosis. Inhibition of the renin-angiotensin-aldosterone system (RAAS) with angiotensin converting enzyme (ACE) inhibitors has proven to be a valuable therapeutic strategy in this condition, with well-proven morbidity and mortality benefits. Nonetheless, ACE inhibitors provide incomplete blockade of the RAAS and also inhibit the degradation of bradykinin.

Assessing exercise capacity, quality of life and haemodynamics in heart failure: do the tests tell us the same thing?

Background: The objective measurement of exercise tolerance is an important component of heart failure trials. The use of laboratory-based treadmill exercise testing has attracted criticism, however, as being unrepresentative of patients' true capabilities.

Aim: To examine the relationships between tests of exercise capacity, quality of life and haemodynamics in patients with stable symptomatic heart failure.