Mind the gap - Small bowel obstruction due to preperitoneal herniation following laparoscopic inguinal hernia repair - A case report.

Introduction And Importance: Inguinal hernia repair is a very frequent operation in general and visceral surgery worldwide. The laparo-endoscopic approaches such as TAPP have gained increasing acceptance among specialists and many consider them as standard of care due to perioperative safety and excellent postoperative results. Knowledge of specific complications after minimally invasive inguinal hernia surgery, however, is important for the successful management of these patients.

Ordering CT pulmonary angiography to exclude pulmonary embolism: defense versus evidence in the emergency room.

Purpose: To identify reasons for ordering computed tomography pulmonary angiography (CTPA), to identify the frequency of reasons for CTPA reflecting defensive behavior and evidence-based behavior, and to identify the impact of defensive medicine and of training about diagnosing pulmonary embolism (PE) on positive results of CTPA.

Methods: Physicians in the emergency department of a tertiary care hospital completed a questionnaire before CTPA after being trained about diagnosing PE and completing questionnaires.

Results: Nine hundred patients received a CTPA during 3 years.

Effect of Q-angle on patellar positioning and thickness of knee articular cartilages.

The purpose of the present study was to investigate whether an increased quadriceps angle (Q-angle) has an effect on patellar positioning and/or the thickness of the medial and lateral tibiofemoral and patellofemoral articular cartilage and menisci, in a group of young asymptomatic individuals. These individuals were detected in a previous study with a decreased anatomical cross-sectional area of the vastus medialis and lateralis as a result of an increased Q-angle. Patellar positioning and the thickness of the articular cartilages were determined in 19 asymptomatic male individuals with high Q-angle (HQ-angle) (18.

MR motility imaging in Crohn's disease improves lesion detection compared with standard MR imaging.

Objective: To evaluate retrospectively in patients with Crohn's disease (CD) if magnetic resonance (MR) motility alterations correlate with CD typical lesions leading to an increased detection rate.

Methods: Forty patients with histologically proven CD underwent MR enterography (MRE), including coronal cine sequences (cine MRE), in addition to the standard CD MR protocol. Two blinded readings were performed with and without cine MRE.

Enhancement of liver parenchyma after injection of hepatocyte-specific MRI contrast media: a comparison of gadoxetic acid and gadobenate dimeglumine.

Purpose: To compare enhancement of liver parenchyma in MR imaging after injection of hepatocyte-specific contrast media.

Materials And Methods: Patients (n = 295) with known/suspected focal liver lesions randomly received 0.025 mmol gadoxetic acid/kg body weight or 0.

The role of the sinuses of Valsalva in aortic root flow dynamics and aortic root surgery: evaluation by magnetic resonance imaging.

Background And Aim Of The Study: Combined replacement of the aortic valve and ascending aorta using a composite graft represents the standard treatment for dilated aortic root with concomitant structural damage of the aortic valve, especially when the aortic valve cannot be preserved. Unfortunately, hemodynamic changes associated with prosthetic replacement of the aortic root have not been fully elucidated. The study aim was to compare hemodynamics within the replaced aortic root using either a prosthetic vascular graft with bulges mimicking the sinuses of Valsalva and including a stented pericardial valve, or a straight xenopericardial conduit and a stentless porcine valve.

Pretransplant pulmonary hypertension and long-term allograft right ventricular function.

Background: Graft right ventricular (RV) function is compromised directly posttransplant, especially in heart transplantation (HTx) recipients with pretransplant pulmonary hypertension (PH). Graft RV size and systolic function, and the effect of the recipient's pulmonary haemodynamics on the graft extracellular matrix are not well characterised in the patients long-term after HTx.

Aim: Comparison of RV size and systolic function in HTx recipients' long-term posttransplant stratified by the presence of pretransplant PH.

Quadriceps cross-sectional area changes in young healthy men with different magnitude of Q angle.

Knee pain and dysfunction have been often associated with an ineffective pull of the patella by the vastus medialis (VM) relative to the vastus lateralis (VL), particularly in individuals with knee joint malalignment. Such changes in muscular behavior may be attributed to muscle inhibition and/or atrophy that precedes the onset of symptoms. The aim of this study was to investigate possible effects of knee joint malalignment, indicated by a high quadriceps (Q) angle (HQ angle >15 degrees ), on the anatomic cross-sectional area (aCSA) of the entire quadriceps and its individual parts, in a group of 17 young asymptomatic men compared with a group of 19 asymptomatic individuals with low Q angle (LQ angle <15 degrees ).

Inhibition of mTOR in combination with doxorubicin in an experimental model of hepatocellular carcinoma.

Background/aims: Hepatocellular carcinoma (HCC) is resistant to chemotherapy. We reported that sirolimus, an mTOR inhibitor, has antiangiogenic properties in HCC. Since antiangiogenic therapy may enhance chemotherapy effects, we tested the antitumorigenic properties of sirolimus combined with doxorubicin in experimental HCC.

Pelvic radiography in ATLS algorithms: A diminishing role?

Background: Pelvic x-ray is a routine part of the primary survey of polytraumatized patients according to Advanced Trauma Life Support (ATLS) guidelines. However, pelvic CT is the gold standard imaging technique in the diagnosis of pelvic fractures. This study was conducted to confirm the safety of a modified ATLS algorithm omitting pelvic x-ray in hemodynamically stable polytraumatized patients with clinically stable pelvis in favour of later pelvic examination by CT scan.

Abdominal magnetic resonance imaging in small rodents using a clinical 1.5 T MR scanner.

Because of superior soft-tissue contrast compared to other imaging techniques, non-invasive abdominal magnetic resonance imaging (MRI) is ideal for monitoring organ regeneration, tissue repair, cancer stage, and treatment effects in a wide variety of experimental animal models. Currently, sophisticated MR protocols, including technically demanding procedures for motion artefact compensation, achieve an MRI resolution limit of < 100 microm under ideal conditions. However, such a high spatial resolution is not required for most experimental rodent studies.

Vascular remodeling and antitumoral effects of mTOR inhibition in a rat model of hepatocellular carcinoma.

Background/aims: Hepatocellular carcinoma (HCC) is amenable to only few treatments. Inhibitors of the kinase mTOR are a new class of immunosuppressors already in use after liver transplantation. Their antiproliferative and antiangiogenic properties suggest that these drugs could be considered to treat HCC.

Inhibition of hepatic tumor cell proliferation in vitro and tumor growth in vivo by taltobulin, a synthetic analogue of the tripeptide hemiasterlin.

Aim: To investigate the inhibitory effects of taltobulin (HTI-286), a synthetic analogue of natural hemiasterlin derived from marine sponges, on hepatic tumor growth in vitro and in vivo.

Methods: The potential anti-proliferative effects of HTI-286 on different hepatic tumor cell lines in vitro and in vivo were examined.

Results: HTI-286 significantly inhibited proliferation of all three hepatic tumor cell lines (mean IC50 = 2 nmol/L +/- 1 nmol/L) in vitro.

Stent grafting of acute hepatic artery bleeding following pancreatic head resection.

The purpose of this study was to report the potential of hepatic artery stent grafting in cases of acute hemorrhage of the gastroduodenal artery stump following pancreatic head resection. Five consecutive male patients were treated because of acute, life-threatening massive bleeding. Instead of re-operation, emergency angiography, with the potential of endovascular treatment, was performed.

The role of contrast-enhanced spiral CT imaging versus chest X-rays in surgical therapeutic concepts and thoracic aortic injury: a 29-year Swiss retrospective analysis of aortic surgery.

Background: Blunt chest trauma accounts for 90% of chest trauma in the civilian population in Europe and the United States and causes 20% of trauma-related deaths. Missed aortic injuries can rupture and lead to subsequent death of the patient.

Materials And Methods: This retrospective study compared two different imaging strategies, chest X-rays compared to additional contrast-enhanced spiral CT imaging, in patients suffering from blunt thoracic trauma.

Combined femoral and obturator neuropathy caused by synovial cyst of the hip.

A 57-year-old man with a history of severe degenerative lumbar spine disease presented with painful proximal weakness of the right leg. Clinical examination suggested a femoral and obturator neuropathy with a palpable mass in the right groin. Magnetic resonance (MR) imaging disclosed a large synovial cyst of the underlying hip joint in the extrapelvic part of the iliopsoas and external obturator muscles, with femoral and obturator nerve compression.

Use of a mechanical thrombectomy device to recanalize a subacutely occluded aortohepatic bypass after orthotopic liver transplantation.

Purpose: To report the use of a rotational thrombectomy device for recanalization of a thrombosed hepatic artery bypass graft in an orthotopic liver transplant (OLT).

Case Report: Six months after a second OLT in a 52-year-old man, an iliac conduit used for an aortohepatic bypass became occluded, interrupting arterial supply to the liver transplant. The 8-F Straub Rotarex system was used to successfully remove clot from the bypass graft, avoiding embolization to the hepatic arteries.

Estimation of central venous pressure by ultrasound.

Introduction: Increasing blood volume and cardiac output is one of the most commonly needed intervention in the primary care of traumatized and severely ill patients. Although cardiac filling pressures have severe limitations in assessing the preload, central venous pressure (CVP) is the invasive measure most frequently used in clinical practice for the assessment of volume status and cardiac preload. We combined ultrasound and tissue pressure measurement for non-invasive jugular and brachial venous pressure estimation.

Magnetic resonance imaging provides accurate and precise volume determination of the regenerating mouse liver.

Direct and repetitive noninvasive determination of the time course and the strain-specific hepatic regenerative capacity after partial hepatectomy can extend our knowledge about the basic mechanisms of liver regeneration and repair. The aim of this study was to develop a magnetic resonance (MR)-based volumetric procedure to measure the hepatic volume in the regenerating mouse liver. In Balb-C mice (n = 14), varying amounts of liver tissue were resected and MR imaging was performed 24 hours later in a 1.

Virtopsy-postmortem multislice computed tomography (MSCT) and magnetic resonance imaging (MRI) in a fatal scuba diving incident.

The body of a 44-year-old scuba diver was examined using postmortem multislice computed tomography (MSCT) and magnetic resonance imaging (MRI), and findings were verified by subsequent autopsy. The goal was to find out whether the important pathomorphological findings for the reconstruction of events and the identification of cause and manner of death could be identified using modem digital cross-sectioning techniques. The findings of a massive vital decompression with pulmonary barotrauma and lethal gas embolism were identified in the radiological images.