Conservative treatment of gastric perforation after microwave ablation of a hepatocellular carcinoma: Case report.

RATIONALE: Microwave ablation (MWA) has been proven to be an efficient and safe method for local tumor control of liver tumors. Reported complications are rare, but include liver abscess, hematoma, pleural effusion, and occasional thermal injury of the adjacent colon. Intestinal perforation usually requires immediate surgical treatment to prevent generalized peritonitis and sepsis. PATIENT CONCERNS AND DIAGNOSIS: Herein, we describe a case of gastric perforation following percutaneous MWA for hepatocellular carcinoma as a bridging therapy prior to liver transplantation. INTERVENTIONS: Due to the clinical condition of the patient, conservative treatment was considered sufficient. Nine months after MWA, successful liver transplantation followed. Intraoperative findings revealed a scar in the gastric wall with tight adhesions to the liver, requiring adhesiolysis and subsequent suturing. Postoperative recovery was uneventful. OUTCOME: At present, the patient is doing well. No further gastrointestinal events occurred. LESSON: To our knowledge, this is the first report of such a complication occurring after MWA. Moreover, in this case, the gastric perforation could be treated conservatively.

Detection and tracking of anisotropic core-shell colloids.

Optical microscopy techniques with three dimensional (3D) resolution are powerful tools for the real-space imaging of the structure and dynamics of colloidal systems. While real-space imaging of spherical particles is well established, the observation of shape anisotropic particles has only recently met a lot of interest. Apart from translation, shape anisotropic particles also possess additional rotational degrees of freedom. In this manuscript, we introduce a novel technique to find the position and the orientation of anisotropic particles in 3D. It is based on an algorithm which is applicable to core-shell particles consisting of a spherical core and a shell with arbitrary shape. We demonstrate the performance of this algorithm using PMMA/PMMA (polymethyl methacrylate) core-shell ellipsoids. The algorithm is tested on artificial images and on experimental data. The correct identification of particle positions with subpixel accuracy and of their orientations with high angular precision in dilute and dense systems is shown. In addition, we developed an advanced particle tracking algorithm that takes both translational and rotational movements of the anisotropic particles into account. We show that our 3D detection and tracking technique is suitable for the accurate and reliable detection of large and dense colloidal systems containing several thousands of particles.

Anal sphincter function after total mesorectal excision is comparable to that of healthy subjects: results of a matched pair analysis.

AIM: The aim of this paper was to compare healthy subjects and patients after total mesorectal excision concerning anal resting/squeeze pressure and surface-electromyography of the sphincter. METHODS: Forty patients (9 female/31 male) after total mesorectal excision due to low or middle rectal cancer were compared to a sex-, age- and BMI-matched group of healthy volunteers by means of anorectal pull-through manometry using a microtip-transducer system and by means of endoanal surface electromyography using a bipolar plug electrode. RESULTS: Resting pressure (59.2 ± 3.1 mmHg vs. 68.3 ± 4.3 mmHg; P=0.056) and squeeze pressure (127.3 ± 3.2 mmHg vs. 128.9 ± 4.6 mmHg; P=0.78) were comparable between patients after total mesorectal excision and healthy volunteers whereas surface electromyography amplitude (9.5 ± 0.4 µV vs. 13.9 ± 0.6 µV; P=0.01) was significant lower in patients after total mesorectal excision compared to healthy subjects. Correlation between squeeze and resting pressure as well as between squeeze pressure and surface electromyography were weaker in patients after total mesorectal excision compared to healthy controls. CONCLUSION: Objective measurable sphincter pressure after total mesorectal excision seems to be comparable to that of healthy subjects whereas surface-electromyography is significant higher in healthy subjects.

Direct in vivo observations of P-selectin glycoprotein ligand-1-mediated leukocyte-endothelial cell interactions in the pulmonary microvasculature in abdominal sepsis in mice.

OBJECTIVE: P-selectin glycoprotein ligand-1 (PSGL-1) has been shown to play a significant role in septic lung injury. However, the detailed role of PSGL-1 in the pulmonary leukocyte recruitment remains elusive. We have developed a method based on intravital fluorescence microscopy of the lung microcirculation to examine the role of PSGL-1 in the extravasation process of leukocytes in septic lung damage. METHODS: Male C57BL/6 mice were treated with a control antibody or an anti-PSGL-1 antibody prior to cecal ligation and puncture (CLP). Leukocyte-endothelium interactions and microvascular hemodynamics were studied in pulmonary arterioles, capillaries and venules 4 h after CLP. RESULTS: Immunoneutralization of PSGL-1 decreased CLP-induced leukocyte rolling in pulmonary arterioles and venules significantly. Inhibition of PSGL-1 had no effect on leukocyte adhesion in venules, whereas the number of adherent leukocytes in lung arterioles and the number of trapped leukocytes in capillaries were markedly decreased. Moreover, immunoneutralization of PSGL-1 improved microvascular perfusion in the lung of septic animals. CONCLUSIONS: Taken together, these results document that PSGL-1 mediates leukocyte rolling in arterioles and venules. However, inhibition of PSGL-1 only decreases leukocyte adhesion in arterioles, suggesting that leukocyte rolling is not a prerequisite for pulmonary venular adhesion of leukocytes in sepsis. In addition, our data show that capillary trapping of leukocytes is dependent on PSGL-1 function.

Ultra-relativistic electrons in Jupiter's radiation belts.

Ground-based observations have shown that Jupiter is a two-component source of microwave radio emission: thermal atmospheric emission and synchrotron emission from energetic electrons spiralling in Jupiter's magnetic field. Later in situ measurements confirmed the existence of Jupiter's high-energy electron-radiation belts, with evidence for electrons at energies up to 20[?]MeV. Although most radiation belt models predict electrons at higher energies, adiabatic diffusion theory can account only for energies up to around 20[?]MeV. Unambiguous evidence for more energetic electrons is lacking. Here we report observations of 13.8[?]GHz synchrotron emission that confirm the presence of electrons with energies up to 50[?]MeV; the data were collected during the Cassini fly-by of Jupiter. These energetic electrons may be repeatedly accelerated through an interaction with plasma waves, which can transfer energy into the electrons. Preliminary comparison of our data with model results suggests that electrons with energies of less than 20[?]MeV are more numerous than previously believed.

Portable satellite telemedicine in practice.

The US army's first portable telemedicine unit was built in 1993 and comprised a 'ruggedized' videoconferencing unit. The unit was initially used in the United Nations' operations in Macedonia in February 1994 and subsequently in support of the Mobile Army Surgical Hospitals in Haiti, but its dimensions made it suitable only for locations where a move at short notice was unlikely. The second portable telemedicine unit comprised a PC linked to an Inmarsat B earth station through a modern. The unit allowed videoconferencing at 64 kbit/s. Three and a half years of clinical experience with both units has shown this to be quite adequate for the majority of clinical telemedicine. Portable telemedicine units have been a major benefit to medical commanders in the field.

Capillary refilling time in newborn babies: normal values.

AIM: To assess the normal values of capillary refilling time (CRT) in healthy newborn babies; to assess the effect of different nursery containers (incubator, radiant warmer, crib), phototherapy, birthweight, gestational age, size for gestational age and sex on CRT; to compare CRT at different body sites as well as to assess the variation between observers. METHODS: Healthy neonates (n = 469) of different gestational ages and different sizes for gestational age, were studied 1 to 7 days after birth. CRT was measured in four of the most suitable sites-namely, midpoints of the sternum and the forehead, the palm of the hand and the plantar surface of the heel (defined as chest, head, palm and heel, respectively). The applied pressing time was 5 seconds. CRT was measured with a manual stopwatch. RESULTS: Only the chest and the head distribution curves followed the Gaussian curve. The mean values and standard deviation of CRT in all tested nursery containers, including phototherapy for the chest, ranged from 1.82 (0.34) seconds to 2.01 (0.423) seconds, and for the head from 1.59 (0.36) seconds to 1.83 (0.31) seconds. The mean value of chest CRT was always longer than the head CRT for all parameters. Significant differences were found between different nursery containers, receivers, and non-receivers of phototherapy and between observers. No difference was found between sex, birthweight, gestational age and size for gestational age. CONCLUSIONS: The upper limit of normal for neonatal CRT was 3 seconds. Nursery containers, phototherapy, and observers produced significantly different results, but the differences were not clinically important. CRT values of the midpoints of the sternum and the forehead are the most consistent.

Extraovarian stage IV peritoneal serous papillary carcinoma presenting as an asymptomatic skin lesion--a case report and literature review.

An 81-year-old G2 P2 white female in good health with the exception of well-controlled hypertension presented to her family physician with a newly discovered lesion in the skin of the abdominal left lower quadrant. Initially, this nodule was viewed as innocuous and was followed with the expectation that it would soon resolve. Three months later, the lesion was biopsied, revealing a pattern consistent with papillary serous carcinoma from a presumed ovarian primary. CT scan revealed a pelvic mass. Subsequent laparotomy revealed a benign tubal cystadenofibroma, but otherwise normal pelvic viscera. Additional findings, however, included multiple small parietal peritoneal nodules histopathologically diagnosed as extraovarian peritoneal serous papillary carcinoma similar to the skin lesion. All gross disease was extirpated. The patient received chemotherapy as for advanced ovarian cancer.

Unexpected emergency department death: incidence, causes, and relationship to presentation and time in the department.

STUDY OBJECTIVE: To determine the incidence and causes of unexpected death in emergency department patients and its relationship to initial ED presentation. To determine if length of ED stay is directly related to unexpected death. DESIGN: Retrospective chart review of all patients dying in the study ED during a three-year period. Patients receiving CPR on admission or who had "do not resuscitate" orders were classified as expected deaths. Vital signs, level of consciousness, length of time in the ED, and cause of death were recorded for all unexpected deaths. SETTING: Five hundred sixty-six-bed medical center with an ED volume of 45,000 patients per year. PARTICIPANTS: Four hundred eleven patients were pronounced dead from 1987 to 1989, and 403 (98%) charts were available. RESULTS: Fifty-seven (14%) patients met the unexpected death criteria. Abnormal vital signs or altered level of consciousness was observed in 56 (98%) patients on presentation. Medical causes accounted for 42 (74%) of the unexpected deaths. Five (9%) surgical and ten (18%) trauma-related deaths were identified. The yearly incidence of unexpected death was 4.9 (per 10,000 ED visits) in 1987 and 4.1 in both 1988 and 1989. Average length of time in the ED before unexpected death increased during the study period (1987, 91 minutes; 1988, 110 minutes; 1989, 116 minutes). CONCLUSION: Unexpected ED death was uncommon, usually nontraumatic, and occurred in patients with evidence of significant illness. Although average length of stay in the ED increased, there was no increase in the incidence of unexpected ED death. If lengths of ED stay continue to increase, this situation will require further study.

Keratoacanthoma arising in an organoid nevus during childhood: case report and literature review.

We report an 11-year-old girl with an organoid nevus of the cheek. She represents the first report of a keratoacanthoma arising within an organoid nevus in childhood.

Microsporum nanum infection in hog farmers.

Microsporum nanum is a dermatophyte that can cause disease in both man and animals and is most frequently associated with ringworm infection in pigs. Human infections are rare in the literature. Three new cases of human M. nanum infection are reported here. Two patients had inflammatory tinea faciei and one had tinea cruris. The patients were successfully treated with clotrimazole or miconazole cream, sometimes combined with griseofulvin. All three patients were hog farmers and lived in the same small rural area. Occupational exposure is suggested as the cause of infection.

Magnitude of shear stress on the san andreas fault: implications of a stress measurement profile at shallow depth.

A profile of measurements of shear stress perpendicular to the San Andreas fault near Palmdale, California, shows a marked increase in stress with distance from the fault. The pattern suggests that shear stress on the fault increases slowly with depth and reaches a value on the order of the average stress released during earthquakes. This result has important implications for both long- and shortterm prediction of large earthquakes.

Enzymatic basis of typical X-linked icthyosis.

Steroid sulphatase activity was determined in cultured fibroblasts from 25 individuals with X-linked ichthyosis from four countries. All those with X-linked disease had markedly reduced enzyme levels compared with controls and patients with other types of ichthyosis. X-linked ichthyosis seems to be the result of a common mutation affecting the expression of steroid-sulphatase activity.