Gastrointestinal bleeding of obscured origin due to cystic artery pseudoaneurysm.

Cystic artery pseudoaneurysm is a rare condition, which usually arises from the complication of gallstone disease. Patients may present with Quinke's triad (epigastric pain, obstructive jaundice, and gastrointestinal bleeding). The results can be fatal if present with a ruptured pseudoaneurysm. We report a patient who presented with upper gastrointestinal bleeding, and later diagnosis was confirmed with a computer tomography scan of the abdomen and a three-vessel angiogram. Endovascular intervention was attempted. Although it failed, the patient was eventually cured with an open cholecystectomy.

Clinical applications of high-intensity focused ultrasound.

Ultrasound has been developed for therapeutic use in addition to its diagnostic ability. The use of focused ultrasound energy can offer a non-invasive method for tissue ablation, and can therefore be used to treat various solid tumours. High-intensity focused ultrasound is being increasingly used in the treatment of both primary and metastatic tumours as these can be precisely located for ablation. It has been shown to be particularly useful in the treatment of uterine fibroids, and various solid tumours including those of the pancreas and liver. High-intensity focused ultrasound is a valid treatment option for liver tumours in patients with significant medical co-morbidity who are at high risk for surgery or who have relatively poor liver function that may preclude hepatectomy. It has also been used as a form of bridging therapy while patients awaiting cadaveric donor liver transplantation. In this article, we outline the principles of high-intensity focused ultrasound and its clinical applications, including the management protocol development in the treatment of hepatocellular carcinoma in Hong Kong by performing a search on MEDLINE (OVID), EMBASE, and PubMed. The search of these databases ranged from the date of their establishment until December 2015. The search terms used were: high-intensity focused ultrasound, ultrasound, magnetic resonance imaging, liver tumour, hepatocellular carcinoma, pancreas, renal cell carcinoma, prostate cancer, breast cancer, fibroids, bone tumour, atrial fibrillation, glaucoma, Parkinson's disease, essential tremor, and neuropathic pain.

Case Report of Relay Liver Transplantation With Graft Infected With Hepatitis B Virus.

Reuse of liver graft for transplantation is extremely uncommon. We report the 1st case of reuse of liver graft from a recipient who had hepatitis B virus (HBV) infection, 11 years after the 1st transplantation. Our relay liver transplantation challenged conventional thinking because of late reuse of graft in the presence of HBV infection. Moreover, both the 1st and the 2nd donors were of advanced age. The key questions were whether the liver graft could be reused safely, especially in the setting of HBV infection, and technical concerns during organ procurement and implantation. The absence of HBV replication was confirmed with negative hepatitis B surface antigen and undetectable serum HBV DNA in the 2nd donor. Based on our experience in managing HBV infection after liver transplantation, we were confident that the adequately suppressed HBV infection in the donor would not jeopardize graft function and that the graft would be able to withstand another ischemia-perfusion injury to continue to function well in our recipient.

Rare cause of jaundice in a post liver transplant patient.

A hepatitis B virus carrier suffering from acute flare of chronic hepatitis B infection underwent deceased-donor liver transplantation. He was put on the immunosuppressive agent tacrolimus. On routine follow-up, he was found to have abnormal liver function. Computed tomography scan of the abdomen did not show any dilatation of the biliary system. Liver biopsy showed scattered microabscesses, and a microgranuloma was detected. Endoscopic retrograde cholangiography was performed and a biliary anastomotic stricture (BAS) was noted. In addition, the Chinese liver fluke, Clonorchis sinensis, was discovered. Balloon dilatation and stenting were performed. The patient was given a course of praziquantel. His liver function improved and normalized. We present the case of a liver transplant recipient with cholangitis caused by C. sinensis infestation and infection and biliary obstruction resulting from BAS.

Conservative management of delayed retrograde type A aortic dissection after successful hybrid endovascular repair of distal arch aneurysm.

Retrograde Type A aortic dissection following successful endovascular treatment of thoracic aortic disease is not uncommon. We report a case where the primary pathology was distal aortic arch aneurysm without dissection, and the retrograde type A dissection occurred four months after successful hybrid endovascular management with right to left carotid bypass and stent-graft with a Cook Zenith device. As the patient was not medically fit for sternotomy and repair of Type A aortic dissection, progress was monitored with serial CT scans. This case demonstrates that delayed retrograde type A dissection can occur even in cases when there was no previous aortic dissection, and that in selective patients who are poor candidates for major aortic surgery, a conservative approach can be adopted.

Marked improvement in China's maternal and child health. Surveys and data.

PIP: China's Ministry of Public Health has had a national network in place since 1990 to monitor maternal mortality and the mortality of children under five in the 30 provinces, autonomous regions, and municipalities of China's mainland. The major causes of death for children under age 5 are pneumonia, suffocation at birth, early birth, and diarrhea. A bulletin released by the Ministry in August 1996 indicates that maternal and child health care in the country have improved considerably. In 1995, the maternal mortality rate (MMR) in the monitored regions was 61.9/100,000, significantly lower than the 94.7/100,000 rate in 1989. The infant mortality rate (IMR) in 1995 was 36.4/1000 compared to 50.19/1000 in 1991, and 1995 under-five mortality was 44.5/1000 compared to 61.0/1000 in 1991. Mortality rates are higher in rural areas, where the most marked declines in mortality over the period were also observed. The Chinese Government has committed itself to reducing the mortality rate of infants and children under age 5 by one third from the 1991 level by 2000. Finally, survey data from nine cities on the physical growth of children indicate that in 1995, children under age 7 all grew taller and heavier than those of the same age group in previous periods.^ieng