Focused opening of the sylvian fissure for microsurgical management of MCA aneurysms.

Background: A wide sylvian opening, with either a proximal or distal start, has been standard for microsurgical management of middle cerebral artery (MCA) aneurysms. However, extensive sylvian dissection is potentially associated with increased incidence of iatrogenic injury to the brain and neurovascular structures. The aim of the present study was to describe the technique of focused opening of the sylvian fissure for microsurgical management of MCA aneurysms with additional tips on handling difficulties which may be encountered with this technique.

Arteriovenous fistula formations: key to vascular surgical training.

Purpose: To highlight missed training opportunities in daycase surgery for trainees to acquire competency in vascular anastomosis by performing arteriovenous fistula (AVF) formations.

Methods: Operative Room Management Information System records were reviewed for AVF procedures in daycase and general theatres at a UK Foundation Trust between 2007 and 2012. Data collected included procedure, procedure time (PT), patient length of stay (LOS), readmissions within 30 days of procedure and lead and assistant surgeons involved.

7 Tesla MRI with a transmit/receive loopless antenna and B1-insensitive selective excitation.

Purpose: Use of external coils with internal detectors or conductors is challenging at 7 Tesla (T) due to radiofrequency (RF) field (B1 ) penetration, B1 -inhomogeneity, mutual coupling, and potential local RF heating. The present study tests whether the near-quadratic gains in signal-to-noise ratio and field-of-view with field-strength previously reported for internal loopless antennae at 7T can suffice to perform MRI with an interventional transmit/receive antenna without using any external coils.

Methods: External coils were replaced by semi-rigid or biocompatible transmit/receive loopless antennae requiring only a few Watts of peak RF power.

Endoscopic management of paediatric antrochoanal polyp: our experience.

Antrochoanal polyp is a benign polypoid lesion arising from the oedematous mucosa of the maxillary sinus and extending through the maxillary ostium into the nose. In children, it constitutes 33% of all nasal polyps. Surgery is the usual treatment for antrochoanal polyps.

Efavirenz induced acute liver failure requiring liver transplantation in a slow drug metaboliser.

Highly active antiretroviral therapy has revolutionised HIV management. However, many of these drugs are potentially hepatotoxic. Here, we report the first adult case of efavirenz induced acute liver failure successfully treated by liver transplantation.

Quantification of human high-energy phosphate metabolite concentrations at 3 T with partial volume and sensitivity corrections.

Practical noninvasive methods for the measurement of absolute metabolite concentrations are key to the assessment of the depletion of myocardial metabolite pools which occurs with several cardiac diseases, including infarction and heart failure. Localized MRS offers unique noninvasive access to many metabolites, but is often confounded by nonuniform sensitivity and partial volume effects in the large, poorly defined voxels commonly used for the detection of low-concentration metabolites with surface coils. These problems are exacerbated at higher magnetic field strengths by greater radiofrequency (RF) field inhomogeneity and differences in RF penetration with heteronuclear concentration referencing.

Coinfection with hepatitis C virus and schistosomiasis: fibrosis and treatment response.

Aim: To assess whether schistosomiasis coinfection with chronic hepatitis C virus (HCV) influences hepatic fibrosis and pegylated-interferon/ribavirin (PEG-IFN/RIB) therapy response.

Methods: This study was designed as a retrospective analysis of 3596 chronic HCV patients enrolled in the Egyptian National Program for HCV treatment with PEG-IFN/RIB. All patients underwent liver biopsy and anti-schistosomal antibodies testing prior to HCV treatment.

Clinical and laboratory features and natural history of seronegative hepatitis in a nontransplant centre.

Background: Seronegative hepatitis is a recognized cause of liver failure requiring transplantation. The aetiology is unknown, but might relate to an unidentified virus or immune dysregulation. There are few data on seronegative hepatitis presenting to nontransplant centres.

A new, more accurate classification of middle cerebral artery aneurysms: computed tomography angiographic study of 1,009 consecutive cases with 1,309 middle cerebral artery aneurysms.

Background: Classification of middle cerebral artery (MCA) aneurysms is sometimes difficult because the identification of the main MCA bifurcation, the key for accurate classification of MCA aneurysms, is inconsistent and somewhat subjective.

Objective: To use the meeting point of the M1 and M2 trunks as an objective, generally accepted, and angiographically evident hallmark for identification of MCA bifurcation and more accurate classification of MCA aneurysms.

Methods: We reviewed the computed tomographic angiography data of 1009 consecutive patients with 1309 MCA aneurysms.

Improving access to treatment for patients with chronic hepatitis C through outreach.

Background: Chronic hepatitis C infection (HCV) is common in injecting drug users and is a major cause of liver disease. Antiviral treatment can 'cure' HCV, but is frequently associated with side effects and requires regular monitoring. Non-attendance at hospital appointments is frequent.

Daycase hernia surgery: a missed training opportunity.

Introduction: Traditionally uncomplicated elective hernia operations were performed by surgical trainees; allowing them to develop key competencies and skills transferable to emergency hernia surgery. Daycase surgical units (DCU) are increasingly accommodating operations that traditionally contributed to operating lists in general elective theatres. We aim to assess whether DCU could help improve training in hernia surgery.

Denoising MRI using spectral subtraction.

Improving the signal-to-noise-ratio (SNR) of magnetic resonance imaging (MRI) using denoising techniques could enhance their value, provided that signal statistics and image resolution are not compromised. Here, a new denoising method based on spectral subtraction of the measured noise power from each signal acquisition is presented. Spectral subtraction denoising (SSD) assumes no prior knowledge of the acquired signal and does not increase acquisition time.

p38α inhibits liver fibrogenesis and consequent hepatocarcinogenesis by curtailing accumulation of reactive oxygen species.

Most hepatocellular carcinomas (HCC) develop in the context of severe liver fibrosis and cirrhosis caused by chronic liver inflammation, which also results in accumulation of reactive oxygen species (ROS). In this study, we examined whether the stress-activated protein kinase p38α (Mapk14) controls ROS metabolism and development of fibrosis and cancer in mice given thioacetamide to induce chronic liver injury. Liver-specific p38α ablation was found to enhance ROS accumulation, which appears to be exerted through the reduced expression of antioxidant protein HSP25 (Hspb1), a mouse homolog of HSP27.

Internal hernias: a brief review.

Hernias are very familiar to a core surgical trainee in the setting of clinics and the surgical assessment unit. By definition, a hernia is an abnormal protrusion of a viscus from one compartment to another. In clinic, they are visible lumps, exhibiting a cough reflex often with a well definable history making them readily identifiable.

MRI pyschophysics: an experimental framework relating image quality to diagnostic performance metrics.

Purpose: To determine the minimal image quality needed to preserve diagnostic performance relative to arthroscopy in the knee.

Materials And Methods: Synthetic noise was added to images from clinical MRI scans (three-dimensional SPACE pulse sequence; Siemens) from five patients who had undergone knee MRI with arthroscopic follow-up, resulting in 25 simulated sets of images with standardized signal-to-noise ratios (SNRs) of 1, 2, 5, 10, or 20. All cases were scored by four musculoskeletal radiologists progressing from low to high SNR and grading all cartilage surfaces, major ligaments and menisci on a 5-point scale.

Management of aneurysms at the origin of duplicated middle cerebral artery: series of four patients with review of the literature.

Objective: To review the management of aneurysms arising at the origin of a duplicated middle cerebral artery (DMCA), which is an extremely rare entity.

Methods: Four patients with internal carotid artery-DMCA aneurysms are presented, and 24 previously published cases are reviewed.

Results: Of the 28 internal carotid artery-DMCA aneurysms, 17 were ruptured, and 11 were unruptured.

Can thoracic paravertebral block replace thoracic epidural block in pediatric cardiac surgery? A randomized blinded study.

To compare the outcomes of thoracic epidural block with thoracic paravertebral block for thoracotomy in pediatric patients. A prospective double-blind study. 60 pediatric patients aged 1-24 months, ASA II, III scheduled for thoracotomy were randomly allocated into two groups.

Multigenerational epigenetic adaptation of the hepatic wound-healing response.

We investigated whether ancestral liver damage leads to heritable reprogramming of hepatic wound healing in male rats. We found that a history of liver damage corresponds with transmission of an epigenetic suppressive adaptation of the fibrogenic component of wound healing to the male F1 and F2 generations. Underlying this adaptation was less generation of liver myofibroblasts, higher hepatic expression of the antifibrogenic factor peroxisome proliferator-activated receptor γ (PPAR-γ) and lower expression of the profibrogenic factor transforming growth factor β1 (TGF-β1) compared to rats without this adaptation.

HLA-DQB1* alleles and genetic susceptibility to type 1 diabetes mellitus.

Aim: To determine human leukocyte antigen (HLA)-DQB1 allele association with susceptibility to type 1 diabetes (T1D) and to clinical and laboratory findings.

Methods: This study was conducted on 85 unrelated Egyptian children with T1D recruited consecutively from the Pediatric Diabetes Endocrinology outpatients Clinic; Mansoura University Children's Hospital, Egypt. Patient mean follow up period was 2.

Percutaneous endoscopic treatment of foraminal and extraforaminal disc herniation at the L5-S1 level.

Background: Microsurgery of foraminal and extraforaminal disc herniation at the L5-S1 level remains a challenge because of the limited access by a high iliac crest, the sacral ala, large transverse processes of L5 and hidden disc fragments lateral to the zygapophyseal joint. Our aim was to present the outcome of percutaneous endoscopic lumbar discectomy (PELD) of these lateral and far lateral disc herniations at the L5-S1 level using the newly described foraminal retreat technique in a group of patients with similar preoperative diagnostic studies.

Methods: A total of 22 patients, 13 males and 9 females, with foraminal and extraforaminal lumbar disc herniation at the L5-S1 level were treated by applying the PELD between September 2004 and April 2010.

The future developments in hepatology: no need for a jaundiced view.

There have been major advances in the diagnosis and management of all forms of liver disease since the British Society of Gastroenterology first came into existence 75 years ago. In this review some of the exciting developments that are likely to enter into routine clinical practice over the next 5 years are highlighted. It is suggested that some critical changes need to take place in UK hepatology over the next decade to ensure that the management of liver disease in this country continues to be among the best in the world.