Diaphragmatic hernia: a rare complication of hepatic ablation.

INTRODUCTION: Ablation has become an effective treatment for small hepatocellular carcinomas (HCC). Whilst ablation is a safe and effective technique, diaphragmatic injury is a rarely associated but significant complication.Case presentation: We present a case of a 67 year old patient who developed a diaphragmatic defect following microwave ablation (MWA) for HCC. The diaphragmatic defect progressed to herniation which was complicated by perforation of intrahernial large bowel. The patient was treated by emergency laparotomy and an extended right hemi-colectomy was performed. CONCLUSION: Our report adds to the current available knowledge on diaphragmatic injury following hepatic ablation and demonstrates the potential for life threatening consequences associated with this complication.

Update on the management of atrial fibrillation: anticoagulation and medical therapy.

2010 saw the introduction of dabigatran (Pradaxa; Boehringer Ingelheim Pharmaceuticals, Ridgefield, CT), following US Food and Drug Administration approval, into daily clinical practice in the United States as an alternative to Coumadin (Bristol-Myers-Squibb, New York, NY) therapy. Dronedarone (Multaq; Sanofi-Aventis, Bridgewater, NJ), originally approved for use in the United States in 2009, has seen further widespread deployment in contemporary clinical practice. Intravenous vernakalant (Cardiome Pharm, Vancouver, B.C., Canada; Merck & Co., Whitehouse Station, NJ) is being considered for approval in the United States and may serve as an alternative to current agents for safe and efficacious acute conversion from atrial fibrillation. We focus primarily on new information concerning these and other antiarrhythmic drug and anticoagulation therapies. We provide brief updates of recently published articles along with our perspective on how they will likely alter clinical practice now and in the future.