Rapid pre-operative diagnosis of ileal hernia through the foramen of Winslow with multi-detector computed tomography, enabling successful laparoscopic reduction.

Internal hernias through the foramen of Winslow are extremely rare. Prompt diagnosis and early surgical reduction are vital to prevent bowel gangrene and avoid resection. We report a case of ileal hernia through the foramen of Winslow in a 48-year-old woman. She presented to the emergency department with acute epigastric pain, and rapid and definitive pre-operative diagnosis of internal hernia of ileum through the foramen of Winslow without ischaemia was made by means of multi-detector computed tomography. Emergency laparoscopic bowel reduction was performed. The postoperative course was uneventful, and the patient recovered rapidly.

Heterogeneity and phylogenetic relationships of community-associated methicillin-sensitive/resistant Staphylococcus aureus isolates in healthy dogs, cats and their owners.

AIMS: To investigate the distribution of staphylococcal enterotoxin genes (se) and the molecular features of community-associated methicillin-sensitive/resistant Staphylococcus aureus (CA-MSSA/MRSA) isolates in the nostrils of healthy pets and their owners. METHODS AND RESULTS: A total of 114 Staph. aureus isolates were identified from 1563 nasal swab samples, and CA-MRSA accounted for 20·2% (n = 23) of the total identified isolates. CA-MRSA isolates (91·3%, 21/23) harboured higher percentage of se than did CA-MSSA isolates (58·2%, 53/91) (P < 0·01), and the two highest se profiles of CA-MRSA were seb-sek-seq (42·9%, 9/21) and seb-sek-seq-sep (28·6%, 6/21). Of the MSSAs, 42·8% (39/91) were resistant to at least one antimicrobial drug and 8·8% (8/91) were multidrug resistant (MDR). We identified nine staphylocoagulase (SC) types (I-VIII and X) and three multilocus sequence types (ST59-MRSA-IV/V, ST-239-MRSA-V and ST241-MRSA-V). SC VII (23·4%, 22/94), a staphylococcal food poisoning isolate found mainly in Japan, and ST-59-MRSA-IV/V (85%, 17/20), a widespread CA-MRSA clone found mainly in Taiwan, both were the most predominant types. Phylogenetic analysis together with se and molecular characteristics obtained using pulsed-field gel electrophoresis showed that high levels of antimicrobial resistance and the se-carrying clone ST59-MRSA-IV/V-SC VII were all clustered in genogroup 5. CONCLUSIONS: The CA-MRSA clone of se-carrying-MDR-ST-59-IV/V-SC VII was identified predominantly in this study, and this clone might play a significant role in staphylococcal food poisoning in community settings. SIGNIFICANCE AND IMPACT OF THE STUDY: To our knowledge, this is the first study focussing on enterotoxin-carrying CA-MRSA/MSSA in pets and their owners, and the results support the future warnings in animal-human bond caused by CA-staphylococci in the commonwealth and the need to take cautions worldwide.

Epidemiology of shoulder impingement in upper arm sports events.

An epidemiological survey was conducted to collect data relating to the prevalence and frequency of shoulder pain and other related problems among different athletic groups that demanded vigorous upper arm activities. A questionnaire was administered on site thus ensuring that the response rate was 100 percent. Analysis of results revealed that of the 372 respondents there were 242 male (65.1 percent) and 130 female subjects (34.9 percent), with seven (1.9 percent) above the age of 40, 119 (32 percent) between the ages of 25 and 40, and 246 (66.1 percent) below 25 years of age. A total of 163 athletes (43.8 percent) indicated that they had shoulder problems, 109 (29 percent) suffering pain. Diffuse pain was indicated by 20 respondents (5.4 percent), while localized pain during movement was reported in 89 (23.9 percent). The prevalence of shoulder pain ranked highest among volley ball players (N = 28) followed by swimmers (N = 22), while badminton, basketball and tennis participants were equally affected (N = 10).