Transcatheter Arterial Embolization for Blunt Splenic Injury With Resuscitative Endovascular Balloon Occlusion of the Aorta: The Significance of Early Involvement of Radiologists.

Splenectomy is a common procedure for managing splenic injury in patients with unstable vital signs. Transcatheter arterial embolization (TAE) has emerged as a limited alternative to splenectomy, although the role of TAE can be expanded upon the stabilization of vital signs. The current case report discusses a man in his 50s, in shock after a motor vehicle accident, who was successfully stabilized using resuscitative endovascular balloon occlusion of the aorta (REBOA), followed by splenic artery embolization (SAE) instead of splenectomy, with early involvement of diagnostic and interventional radiologists from the initial stage of care. We also discuss the difficulties of SAE under REBOA and the significance of the early involvement of radiologists in trauma care.

Elective Cholecystectomy After Endoscopic Gallbladder Stenting for Acute Cholecystitis: A Propensity Score Matching Analysis.

OBJECTIVE: To investigate the influence of endoscopic gallbladder stenting (EGBS) on subsequent cholecystectomy. We retrospectively compared the surgical outcomes of EGBS, followed by elective cholecystectomy with those of immediate cholecystectomy (IC). PATIENTS AND METHODS: A total of 503 patients were included in this study. Patients who underwent EGBS as initial treatment for acute cholecystitis, followed by elective cholecystectomy, were included in the EGBS group and patients who underwent IC during hospitalization were included in the IC group. Propensity score matching analysis was used to compare the surgical outcomes. In addition, the factors that increased the amount of bleeding were examined by multivariate analysis after matching. RESULTS: Fifty-seven matched pairs were obtained after propensity matching the EGBS group and the IC group. The rate of laparoscopic cholecystectomy in the EGBS versus IC groups was 91.2% versus 49.1% ( P < 0.001). The amount of bleeding was 5 mL in the EGBS versus 188 mL in the IC group ( P < 0.001). In the EGBS and IC groups, multivariate analysis of factors associated with more blood loss revealed IC (odds ratio: 4.76, 95% CI: 1.25-20.76, P = 0.022) as an independent risk factor. CONCLUSION: EGBS as the initial treatment for acute cholecystitis and subsequent elective cholecystectomy after the inflammation has disappeared can be performed in minimally invasive procedures and safely.

Giant Adrenal Lipoma with Hemorrhage Requiring Extended Surgical Resection.

Adrenal lipoma is a rare, benign tumor, reported to account for 0.7% of primary adrenal tumors. A 69-year-old man presented with left lateral abdominal pain. Computed tomography (CT) was performed, and a huge, irregularly shaped retroperitoneal tumor of uneven internal density was identified, with the border between the tumor and the pancreas and kidney being unclear. Active hemorrhage was also depicted. The tumor consisted mainly of fat, with the exception of the hematoma; it measured 200 mm; and the boundary between it and nearby organs, such as the pancreas, was unclear. Despite angiography being performed twice, the responsible vessel was not identified. Thus, for the purpose of both diagnosis and treatment, we resected the tumor, and considering the possibility of a malignancy, such as liposarcoma, we also resected the pancreatic body and tail and the spleen. The final histopathologic diagnosis was benign adrenal lipoma with hemorrhage, with no invasion to surrounding tissue. Hemorrhage within an adrenal tumor is rare. Most adrenal lipomas are small "incidentalomas" and asymptomatic. With development of a large adrenal lipoma comes the possibility of hemorrhage along with the possibility of features suggestive of malignancy. We encountered a giant adrenal lipoma with hemorrhage and, because of the aforementioned features, performed extended surgical resection, seen in retrospect as oversurgery. The widespread use of CT has led to an increased number of reported cases of adrenal lipoma. We anticipate an accumulation of case reports, which will allow for development of an appropriate treatment algorithm.

The effects of combined elastic- and free-weight tension vs. free-weight tension on one-repetition maximum strength in the bench press.

The present study investigated the effects of training combining elastic tension, free weights, and the bench press. Eleven college-aged men (untrained) in the bench press participated in the 13-week study. The participants were first given instructions and then practiced the bench press, followed by a one-repetition maximum (1RM) test of baseline strength. Subjects were then trained in the bench press for 3 weeks to allow for the beginning of neural adaptation. After another 1RM test, participants were assigned to 1 of 2 conditions for the next 3 weeks of training: 85% Free-Weight Tension, 15% Elastic Tension (BAND), or 100% Free-Weight Tension (STAND). After 3 weeks of training and a third 1RM max test, participants switched treatments, under which they completed the final 3 weeks of training and the fourth 1RM test. Analysis via analysis of covariance revealed a significant (p ≤ 0.05) main effect for time and interaction effect for Treatment (BAND vs. STAND). Subsequent analysis via paired-samples t-test revealed the BAND condition was significantly better (p = 0.05) at producing raw gains in 1RM strength. (BAND 9.95 ± 3.7 kg vs. STAND 7.56 ± 2.8 kg). These results suggest that the addition of elastic tension to the bench press may be an effective method of increasing strength.

Reversible haptotropic shift in zirconocene-hexapentaene complexes.

Low-valent zirconocene species reacted with 1,1,6,6-tetraalkyl-1,2,3,4,5-hexapentaenes to form both 1-zirconacyclopent-3-ynes and eta2-pi-coordinated complexes according to the alkyl groups (R) and the existence of the neutral ligand (L). Haptotropic interconvertion between these two complexes was observed. It was proposed that double insertion of isocyanide into the Zr-C bond of 1-zirconacyclopent-3-ynes takes place via the isocyanide adduct of the eta2-pi-complex as an intermediate.