Necrotic Parts Research Articles

Acute Intrathoracic Stomach: Complicated Paraesophageal Hernia associated with Distal Gastrointestinal Obstruction. Report of Two Cases and Review

The intrathoracic or upside-down stomach (UDS) is associated with the risk of incarceration and volvulus, which can be complicated by acute gastric obstruction and strangulation, leading to sepsis. Two cases of complicated UDS are reported, with a review of the relevant literature, to highlight the diagnostic challenges and management of this devastating condition. Two case reports are presented and the literature from 1995 to the present is reviewed regarding the etiology, incidence, presentation, diagnosis and treatment of complicated large paraesophageal hernia (PEH) and acute UDS. Two patients with cases of known large PEH and severe comorbidities, a man aged 88 years (case I) and a woman aged 78 years (case II), underwent emergency operation for volvulus and strangulation of UDS, after intense resuscitation. Case I had a prepyloric lesion revealed by gastroscopy. Case II also had an incarcerated abdominal incisional hernia producing bowel obstruction, and was in septic shock. X-ray and CT of the chest and abdomen helped the diagnosis of complicated PEH. Operative findings: In Case I, the entire stomach was found in the mediastinum with volvulus and distal ischemia; distal gastrectomy, gastrojejunostomy, cruroraphy and fundopexy were performed. In Case II, after freeing the incarcerated viable bowel, UDS was identified in the mediastinum, with ischemic antrum and necrotic, ruptured gastric fundus; total gastrectomy was performed with esophageal and duodenal stapling, and a feeding jejunostomy was constructed. Both patients were transferred intubated to the intensive care unit (ICU). Case I was extubated on day 4 and discharged on day 28; histology revealed antral ischemia and obstructive prepyloric pT2 adenocarcinoma. Case II was never stabilized, and died 50 hours after surgery; histology demonstrated gastric necrosis. Obstructive conditions distal to large PEHs may cause life-threatening complications in the contents of the hernial sac. In patients who are in unstable condition, with complicated large PEH or UDS with gastric compromise, emergency open surgery is required for reduction and resection of the necrotic parts of the stomach and possibly other organs. In other patients, who respond well to resuscitation after endoscopic gastric decompression, semi-urgent or early elective repair may be programmed.

Experimental approaches for agro-ecological management of black leaf streak in dry and humid tropical conditions

Black leaf streak (BLS), caused by the phytopathogenic fungus Pseudocercospora fijiensis, leads to leaf necrosis and often to a substantial reduction in fruit yield. It also causes the fruit to ripen early by reducing the time between harvest and the beginning of natural ripening, called green life (GL). The usual method of control is by spraying fungicides, but this type of management is challenged worldwide due to the high costs, regulation of products, environmental concerns and the development of resistance. Integrated pest control is an alternative management method based on the combination of agronomic practices that can slow down the development of the epidemic, and limit damage to the fruit. Two experiments were conducted in the Dominican Republic and Martinique, to evaluate the performance of an innovative prototype cropping system with no chemical control. This system is based on optimal growth management, to reduce stress and enhance the leaf emission rate, combined with the systematic removal of necrotic parts of the leaves, which strongly limits ascopore sporulation and reduces the effect of BLS on GL. Depending on the conditions and cycles, the reduction in bunch weight with the prototype system versus chemical control ranged from O to 15%. Bananas were harvested at the same physiological age in the prototype and in the control. The bananas harvested from plants with as low as zero leaves left at harvest retained a good aptitude for conservation, with up to 40 days of GL, on average. The limited impact on fruit weight observed suggests that physiological compensation phenomena through remobilization of resources inside the plant (stem, bunch, suckers) occur. Above all, the removal of necrotic leaves prevented a significant negative effect on early fruit ripening when the bananas were harvested at the correct physiological age, and enabled export of the fruit despite the small number of leaves remaining on the plant at harvest. These results offer perspectives for the development and transfer of alternative practices to chemical control.

Automatic detection and segmentation of brain metastases on multimodal MR images with a deep convolutional neural network

Stereotactic treatments are today the reference techniques for the irradiation of brain metastases in radiotherapy. The dose per fraction is very high, and delivered in small volumes (diameter <1 cm). As part of these treatments, effective detection and precise segmentation of lesions are imperative. Many methods based on deep-learning approaches have been developed for the automatic segmentation of gliomas, but very little for that of brain metastases. We adapted an existing 3D convolutional neural network (DeepMedic) to detect and segment brain metastases on MRI. At first, we sought to adapt the network parameters to brain metastases. We then explored the single or combined use of different MRI modalities, by evaluating network performance in terms of detection and segmentation. We also studied the interest of increasing the database with virtual patients or of using an additional database in which the active parts of the metastases are separated from the necrotic parts. Our results indicated that a deep network approach is promising for the detection and the segmentation of brain metastases on multimodal MRI.

Magnetic resonance imaging: dynamic contrast enhancement and diffusion-weighted imaging to identify malignant cervical lymph nodes

ObjectiveTo examine the potential of two magnetic resonance imaging (MRI) techniques-dynamic contrast enhancement (DCE) and diffusion-weighted imaging (DWI)-for the detection of malignant cervical lymph nodes.Materials and MethodsUsing DCE and DWI, we evaluated 33 cervical lymph nodes. For the DCE technique, the maximum relative enhancement, relative enhancement, time to peak enhancement, wash-in rate, wash-out rate, brevity of enhancement, and area under the curve were calculated from a semi-quantitative analysis. For the DWI technique, apparent diffusion coefficients (ADCs) were acquired in the region of interest of each lymph node. Cystic or necrotic parts were excluded. All patients underwent neck dissection or node biopsy. Imaging results were correlated with the histopathological findings. None of the patients underwent neoadjuvant treatment before neck dissection.ResultsRelative enhancement, maximum relative enhancement, and the wash-in rate were significantly higher in malignant lymph nodes than in benign lymph nodes (p < 0.009; p < 0.05; and p < 0.03, respectively). The time to peak enhancement was significantly shorter in the malignant lymph nodes (p < 0.02). In the multivariate analysis, the variables identified as being the most capable of distinguishing between benign and malignant lymph nodes were time to peak enhancement (sensitivity, 73.7%; specificity, 69.2%) and relative enhancement (sensitivity, 89.2%; specificity, 69.2%).ConclusionAlthough DCE was able to differentiate between benign and malignant lymph nodes, there is still no consensus regarding the use of a semi-quantitative analysis, which is difficult to apply in a clinical setting. Low ADCs can predict metastatic disease, although inflammatory processes might lead to false-positive results.

Investigation of Regional Blood-Brain Barrier Integrity and Cerebral Efflux Transporter Function in Patients with Neuroepithelial Tumors by Means of [11C] Tariquidar Pet

At the human blood-brain barrier (BBB) high levels of efflux transporters, such as P-glycoprotein (ABCB1) and breast cancer resistance protein (ABCG2), are expressed, which restrict the brain distribution of many drugs. The pharmacological treatment of brain tumors is often hampered by the impermeability of the BBB to anticancer drugs. It has been shown that the BBB may become disrupted in central necrotic parts of high-grade gliomas, leading to higher drug concentrations as compared to tumor-free brain tissue. In this study [11C]tariquidar, a drug-like radiotracer, which is subject to efflux transport by ABCB1 and ABCG2 at the human BBB, is used to study regional BBB integrity and cerebral efflux transporter function in patients with neuroepithelial tumors of the central nervous system (CNS). Seven patients diagnosed with a neuroepithelial tumor and elected for neurosurgery underwent a 60-min dynamic [11C]tariquidar brain PET scan and simultaneous arterial blood sampling. Four regions of interest (tumor, tumor rim, contralateral as well as ipsilateral tumor-free brain area) were delineated on MR-co-registered PET images. Logan graphical analysis was used to estimate the total distribution volume (VT) as a parameter of [11C]tariquidar distribution from blood to different brain regions. In all patients, brain distribution of [11C]tariquidar was very low, which was consistent with ABCB1/ABCG2-mediated efflux transport at the BBB. There were no significant differences in [11C]tariquidar VT values between tumor tissue and tumor-free tissue and between the central part of the tumor and the tumor rim. In 4 patients, VT values were lower in tumor tissue as compared to contralateral tumor-free brain tissue (-89% ± 78%, range: -22% to -200%). In 3 patients, VT values were higher in tumor tissue as compared with contralateral tumor-free brain tissue (+27% ± 14%, range: +13% to +40%). We found no significant differences in distribution of [11C]tariquidar to tumor tissue and tumor-free tissue, which argues against a major BBB disruption in these patients and suggests that anticancer drugs transported by ABCB1 and ABCG2, may not reach the tumor tissue in sufficiently high and therapeutically effective concentrations.

Osseoscopy: Direct Visualization to Assist Core Decompression and Debridement of Necrotic Bone Defects

Free vascularized fibular grafting after core decompression and debridement of necrotic lesions is an effective surgical treatment of avascular necrosis of the femoral head. A technical challenge encountered in performing this procedure is ensuring adequate debridement of necrotic parts while preserving healthy bone. A previously described method accomplishes this indirectly using radioactive contrast media and fluoroscopy, increasing the risk of radiation exposure. We propose a surgical technique using standard arthroscopic equipment to visualize inside the femoral head, facilitating precise and accurate debridement without additional radiation exposure.

Tumor Infiltration in Enhancing and Non-Enhancing Parts of Glioblastoma: A Correlation with Histopathology.

PurposeTo correlate histopathologic findings from biopsy specimens with their corresponding location within enhancing areas, non-enhancing areas and necrotic areas on contrast enhanced T1-weighted MRI scans (cT1).Materials and MethodsIn 37 patients with newly diagnosed glioblastoma who underwent stereotactic biopsy, we obtained a correlation of 561 1mm3 biopsy specimens with their corresponding position on the intraoperative cT1 image at 1.5 Tesla. Biopsy points were categorized as enhancing (CE), non-enhancing (NE) or necrotic (NEC) on cT1 and tissue samples were categorized as “viable tumor cells”, “blood” or “necrotic tissue (with or without cellular component)”. Cell counting was done semi-automatically.ResultsNE had the highest content of tissue categorized as viable tumor cells (89% vs. 60% in CE and 30% NEC, respectively). Besides, the average cell density for NE (3764 ± 2893 cells/mm2) was comparable to CE (3506 ± 3116 cells/mm2), while NEC had a lower cell density with 2713 ± 3239 cells/mm2. If necrotic parts and bleeds were excluded, cell density in biopsies categorized as “viable tumor tissue” decreased from the center of the tumor (NEC, 5804 ± 3480 cells/mm2) to CE (4495 ± 3209 cells/mm2) and NE (4130 ± 2817 cells/mm2).DiscussionThe appearance of a glioblastoma on a cT1 image (circular enhancement, central necrosis, peritumoral edema) does not correspond to its diffuse histopathological composition. Cell density is elevated in both CE and NE parts. Hence, our study suggests that NE contains considerable amounts of infiltrative tumor with a high cellularity which might be considered in resection planning.

Genetic Mapping and Characterization of Lethal Necrotic Mutants in Rice (&amp;lt;i&amp;gt;Oryza sativa&amp;lt;/i&amp;gt; L.)

The spread of tissue necrosis leads to plant death. We isolated 18 lethal necrotic mutants induced in rice (Oryza sativa L.) by gamma-irradiation. The necrotic lethality among the 18 mutants was controlled by single recessive genes designated necrotic lethality1 (nec1) to nec18. These mutants display pale-green leaves from the third-leaf stage and leaf-tip necrosis, which spreads to the whole plant, killing it. Genetic mapping and histochemical analysis of the lethal necrotic mutants were conducted. At least four independent loci on chromosomes 2 and 4 controlled necrotic lethality. Therefore, the genetic causes of lethal necrosis vary among mutant stocks. Histochemical analysis at 12 days after sowing showed that H2O2 accumulated in the necrotic parts of leaves, and that cell death occurred throughout the leaf. Mutants for early necrotic lethality (2O2 accumulation throughout the third leaf. Mutants for late necrotic lethality (>35 days to lethality) were characterized by the incomplete spread of H2O2 accumulation within the third leaf.

Value of spectral CT-based quantitative analysis in differential diagnosis of liver cancer and liver abscess

Objective: To investigate the value of spectral CT-based quantitative analysis in the differential diagnosis of liver cancer and liver abscess. Methods: A total of 70 patients with space-occupying lesions in the liver(45 with liver cancer and 25 with liver abscess)underwent spectral CT scans to obtain spectral images in the arterial phase and portal venous phase. The solid constituents of lesions and the iodine and water concentrations in necrotic or cystic parts of lesions, normal hepatic tissue, and abdominal aorta in the arterial phase and portal venous phase were measured, and the normalized iodine concentration(NIC)and lesion-to-normal hepatic tissue ratio(LNR)of iodine concentration were calculated. The two samples t-test and the receiver operating characteristic(ROC)curve analysis were performed for the quantitative indices above. Results: The patients with liver cancer had higher NIC and LNR in solid constituents in the arterial phase than those with liver abscess(NIC: 0.15±0.06 mg/ml vs 0.14±0.02 mg/ml, P > 0.05; LNR: 2.78±0.65 vs 1.45±0.88, P < 0.001). The patients with liver abscess had significantly higher NIC and LNR in solid constituents in the portal venous phase than those with liver cancer(NIC: 0.65±0.08 mg/ml vs 0.52±0.08 mg/ml, P≤0.001; LNR: 1.22±0.23 vs 0.95±0.15, P≤0.001). There were no significant differences in NIC in the arterial phase or NIC and LNR in the portal venous phase in necrotic or cystic parts of lesions between the patients with liver cancer and liver abscess(P > 0.05). The optimal quantitative value for the differential diagnosis of liver cancer and liver abscess was LNR in arterial phase, and the cut-off value of 1.53 had a sensitivity of 100% and a specificity of 92%. Conclusion: Quantitative iodine concentration analysis in spectral CT imaging has a certain value in the differential diagnosis of liver cancer and liver abscess and can improve the accuracy of diagnosis.

Margin Reduction Based on Comparison of Histopathology With Delineations on CT, MRI, and FDG-PET in Laryngeal and Hypopharyngeal Cancer

Tumor delineation is one of the weakest links in the radiation therapy (RT) treatment chain. The margin needed to determine the clinical target volume (CTV) is also questionable. In order to improve treatment, more insight into the errors made by delineation is needed. In this study, gross tumor volume (GTV) delineations on computed tomography (CT), magnetic resonance imaging (MRI), and the automatic segmentation on 18fluorodeoxyglucose positron emission tomography (FDG-PET) of laryngeal and hypopharyngeal squamous cell carcinoma are validated on histopathology. Twenty-one patients were included with a laryngeal (n=14) or hypopharyngeal (n=7) tumor (T3/T4). Before total laryngectomy/partial pharyngectomy, CT, MRI (T1weighted and T2-weighted), and FDG-PET images were made in RT positioning mask. The GTV was delineated in consensus by 3 experienced observers on CT and MRI. FDG-PET was delineated semi-automatically using a Gaussian mixed model based threshold. Tumor has been delineated by a pathologist on whole-mount hematoxylin and eosin stained (HE) histopathologic sections (intersections of approximately 3 mm) and afterwards digitized and reconstructed to a 3 dimensional specimen. This 3D specimen was then registered to the imaging prior to laryngectomy. The GTVs were compared with the histopathologic-based tumor delineation in 3 dimensions, including the microscopic extension. The margin around the GTV needed to ensure 95% coverage of the histopathologically determined tumor surface, was 3 mm (SD 2), 4 mm (SD 2) and 4 mm (SD 2) for CT, MRI and FDG-PET, respectively. In the semi-automatic delineation of FDG-PET, for 1 case a margin of 9 mm was needed, probably due to large necrotic parts in the tumor. The part of the tumor included in the GTV (sensitivity) amounted to 86% (SD 9), 80% (SD 11) and 79% (SD 11) for CT, MRI and FDG-PET, respectively, while the overestimation of the tumor volume amounted to 87% (SD 45), 62% (SD 33) and 50% (SD38). The positive predictive value (PPV), on CT, MRI, and FDG-PET was found to be 53% (SD 14), 59% (SD 13), and 66% (SD 15), respectively. In order to cover 95% of the histopathologic tumor surface, including the HE-determined microscopic extension, the margin added to the GTVs needed to be 6-7 mm (average margin + 1.5 times SD). This margin indicates that the standard clinical target volume (CTV) margin of 10 mm could be reduced. FDG-PET has the highest PPV; therefore semi-automatic delineation of FDG-PET can be used as an initial delineation of the GTV. This delineation must be reviewed by a physician and, if necessary, modified based on additional information from high resolution CT or MRI.

Harmonic Contrast-Enhanced Endoscopic Ultrasonography forthe Guidance of Fine-Needle Aspiration in Solid Pancreatic Masses.

Purpose The global accuracy of fine-needle aspiration guided by endoscopic ultrasound (EUS-FNA) for pancreatic adenocarcinoma is about 85 %. The use of contrast agents during EUS to highlight vessels and the necrotic parts of pancreatic masses may improve biopsy guidance. Our aim was to assess whether the guidance of FNA by harmonic contrast-enhanced endoscopic ultrasound (CH-EUS) would increase diagnostic accuracy relative to conventional EUS-FNA in the same pancreatic masses. Patients and Methods In a prospective study, EUS-FNA was performed in patients with pancreatic masses on CT scan, followed by harmonic CH-EUS using SonoVue. A second cluster of CH-EUS-FNA was performed on contrast-enhanced images. The final diagnosis was based on the results of EUS-FNA and surgery, or the findings after 12 months' follow-up. Results The final diagnosis was adenocarcinoma (n = 35), chronic pancreatitis (n = 10), or other (n = 6). The diagnostic accuracy based on core histology was 78.4 % for EUS-FNA and 86.5 % for CH-EUS-FNA (p = 0.35). The accuracy increased to 94 % when the two methods' results were combined. The two false-negative EUS-FNA cases were correctly appreciated by CH-EUS. Neither core histology size nor the presence of necrosis was significant for the true-positive diagnosis of malignancy. Conclusion CH-EUS-FNA had an insignificant incremental effect on diagnostic accuracy compared with conventional EUS-FNA in our small group. The presence of necrosis did not influence the results of CEUS-FNA. Qualitative assessment of the contrast uptake within the lesion was useful in false-negative EUS-FNA cases.

Phytophthora cinnamomi – nowy patogen borówki wysokiej w Polsce

Summary Phytophthora cinnamomi was isolated from necrotic roots and stem parts of blueberry with aboveground symptoms of chlorosis and reddening of leaves, defoliation, dieback of branches, growth stunting and crown and root rot. The species was also detected from substratum of diseased plants. Other species including Alternaria alternata, Botrytis cinerea and Fusarium avenaceum were isolated rarely. The species isolates from highbush blueberry and cranberry colonized stem parts, roots and leaf blades of host plant. Necrosis spread much faster on inoculated stem parts than blueberry roots. In greenhouse trials isolate from high blueberry was more pathogenic than that from cranberry.

Pediatric deep burns caused by hot incense ashes during 2014 Spring Festival in Fuyang city, China.

The Chinese people in Fuyang city, a northwest city of Anhui Province, are accustomed to burning incense at home for blessing during the Spring Festival. Their children, especially toddlers, like playing around the burning incense and are at risk of burning by hot incense ashes. The purpose of this study was to describe the unique cause and clinical characteristics of pediatric deep burns caused by hot incense ashes during 2014 Spring Festival. Twelve consecutive children admitted to our Burn Center and Fuyang People's Hospital during 2014 Spring Festival, with burn injuries caused by hot incense ashes which were epidemiologically studied retrospectively. Data on age, gender, size, depth and site of burn, incidence by day, number of operation, hospital stay, and causes of burns were collected. All patients came from Fuyang city. Of the 12 patients, the average age was 2.17 years, with a range of 1-6. The boy-to-girl ratio was 2: 1. The mean total burn surface area (TBSA) was 5.83%, and 91.67% of the children sustained full-thickness burn. Hands were the most common parts of the body to be injured. Dry necrosis developed in 14 fingers of 3 patients. January 31, 2014, the first day of the Chinese New Year, was the time of highest incidence. Six patients (50%) required surgical intervention while the number of operations including escharectomy, excision, skin grafting, or amputation of necrotic fingers, per patient was 2. A total of 14 fingers were amputated of the necrotic parts. All children survived and mean length of hospital stay of the patients was 20 days. Hot incense ashes cause serious injuries to children in Fuyang city during the Spring Festival. Preventive programs should be directed towards high risk groups to reduce the incidence of this burn.

Cancer and inflammation: differentiation by USPIO-enhanced MR imaging

To assess ultrasmall superparamagnetic iron oxide particles (USPIO) -enhanced MR imaging for the differentiation of malignant from benign, inflammatory lesions. In this study, approved by the local animal care committee, VX2 carcinoma and intramuscular abscesses were implanted into the hind thighs of New Zealand White rabbits. MR imaging was performed pre contrast and serially for 24 h after the injection of USPIO. MR findings were compared with histopathologic results based on Prussian blue stains for the presence of iron. Twenty-four hours after the Ferumoxtran-injection, no changes were observed in VX2 carcinomas, whereas a mean reduction of the contrast-to-noise ratio (CNR) of approximately 90 % was noticed in abscesses as well as in necrotic tumors. On histopathologic examination, abscess and necrotic parts of the tumor were found to include iron-containing monocytes demonstrating that the reduction in CNR was caused by USPIO-tagged monocytes. Our results prove the ability of USPIO-enhanced MRI to differentiate benign, inflammatory from malignant lesions.

NI-72 * CORRELATION OF VOLUMETRICAL ANALYSES DERIVED FROM 18FET-PET AND MRI WITH OUTCOME IN GLIOBLASTOMA PATIENTS

AIM: Both MRI and PET have been increasingly used for monitoring treatment response and adjustment of therapeutic strategies in glioma. The purpose of the currentstudy was to elucidate a possible prognostic influence of the initial tumor volume derived both from 18FET-PET as well as MRI on outcome in de-novo glioblastoma (GBM) patients. PATIENTS AND METHODS: 71 patients with newly diagnosed GBM who received 18FET-PET and MRI prior to microsurgery/biopsy and subsequent radio/chemotherapy according to the EORTC/NCIC protocolwere analysed. After co-registration, volumetrical analysis was performed on MRI and 18FET-PET data. Biological tumor volume (BTV) was defined on 18FET-PET using brain-to tumor ratio of 1.6. For MRI,T2/FLAIR as well as Gd-enhanced T1-weighted sequences with and without necrotic parts were correspondingly obtained in each patient. Correlation of initial tumor volume on each image modality with overall survival and progression free survival was performed. Log rank test was used for statistical analysis. RESULTS: Volumetrical analyses revealed the following distribution pattern: FLAIR volume > BTV1.6 >Gd-enhanced T1 volume with necrosis >Gd-enhanced T1 volume without necrosis. Patients with smaller BTV1.6 experienced longer OS and PFS (p= 0.01/0.03), while Gd-enhanced T1-weighted MRI without necrosis was the only MRI parameter associated with an improved OS and PFS (p = 0.03/p = 0.05). CONCLUSION: Biological tumor volume as determined by 18FET-PET and Gd-enhanced T1 volume without necrosis are associated with outcome in GBM. BTV seems to surmount volumetry obtained by conventional MRI techniques in depicting vital tumor tissue. This research was in part supported by Deutsche Krebshilfe/GGN/ 70-3163-Wi 3

Mo1451 The Contrast Enhanced Endoscopic Ultrasound Increases the Diagnostic Accuracy of the Fine Needle Aspiration in Pancreatic Masses

The global accuracy of fine needle aspiration endoscopic ultrasound (EUS-FNA) for pancreatic adenocarcinoma is about 85%. The contrast agents during EUS may highlight the vessels and the necrotic parts of the pancreatic masses, but their incremental role in diagnosis is not known.

Septic shock with tension fecothorax as a delayed presentation of a gunshot diaphragmatic rupture.

Diaphragmatic rupture (DR) after thoracoabdominal trauma has a reported rate of 0.8% to 5% and up to 30% of diaphragmatic hernias are accompanied with delayed diagnosis. The DR occurs after high-energy blunt or penetrating (stab or gunshot wounds) trauma. The purpose of this article is to analyze the DR, its clinical presentation, complications and possible causes of the delay in diagnosis, whilst recording a rare interesting case. A 44-year old moribund male with a fifteen years history of paraplegia, came to the emergency department with a clinical presentation of extremely severe respiratory distress. Chest X-ray showed the colon present in the left hemithorax. The onset of symptoms was 48 hours before, resulting in hemodynamic instability and severe sepsis condition. Emergency left thoracotomy and laparotomy were carried out. A rupture of the left hemidiaphragm was found as well as intrathoracic presence of colon, incarcerated and perforated, feces and omentum, also incarcerated and necrotic. There were dense adhesions between the ectopic viscera and the thoracic structures. The necrotic parts of the colon and the omentum were mobilized, and then resected. The viable parts of the colon were laboriously reintroduced into the intraperitoneal cavity. We conclude that early diagnosis is crucial to the morbidity and mortality after DR. The course and the kinetic energy of bullets determine the extent of the wound and the size of the DR. The diagnosis of rupture of the diaphragm after penetrating trauma is sometimes difficult and delay can lead to life threatening complications.

Septal perforation and bilateral partial middle turbinate necrosis after bilateral sphenopalatine artery ligation

To report previously unreported complications of bilateral sphenopalatine artery ligation. We present the case of a 45-year-old man who underwent bilateral sphenopalatine artery ligation to control intractable posterior epistaxis. After four months, he re-presented with nasal obstruction and crusting. Examination under general anaesthesia showed posterior septal perforation and bilateral necrosis of the lower parts of the middle turbinates. The necrotic parts were excised. The patient had no more complaints. Following sphenopalatine artery occlusion, ischaemic necrosis is a potential risk in anatomical areas that receive their only arterial supply from this artery. The staging of bilateral sphenopalatine artery occlusion needs to be studied.

Invited Review: The preterm pig as a model in pediatric gastroenterology

At birth, the newborn mammal undergoes a transition from a sterile uterine environment with a constant nutrient supply, to a microbe-rich environment with intermittent oral intake of complex milk nutrients via the gastrointestinal tract (GIT). These functional challenges partly explain the relatively high morbidity and mortality of neonates. Preterm birth interrupts prenatal organ maturation, including that of the GIT, and increases disease risk. Exemplary is necrotizing enterocolitis (NEC), which is associated closely with GIT immaturity, enteral feeding, and bacterial colonization. Infants with NEC may require resection of the necrotic parts of the intestine, leading to short bowel syndrome (SBS), characterized by reduced digestive capacity, fluid loss, and dependency on parenteral nutrition. This review presents the preterm pig as a translational model in pediatric gastroenterology that has provided new insights into important pediatric diseases such as NEC and SBS. We describe protocols for delivery, care, and handling of preterm pigs, and show how the immature GIT responds to delivery method and different nutritional and therapeutic interventions. The preterm pig may also provide a sensitive model for postnatal adaptation of weak term piglets showing high mortality. Attributes of the preterm pig model include close similarities with preterm infants in body size, organ development, and many clinical features, thereby providing a translational advantage relative to rodent models of GIT immaturity. On the other hand, the need for a sow surgical facility, a piglet intensive care unit, and clinically trained personnel may limit widespread use of preterm pigs. Studies on organ adaptation in preterm pigs help to identify the physiological basis of neonatal survival for hypersensitive newborns and aid in defining the optimal diet and rearing conditions during the critical neonatal period.

Cancer and inflammation: Differentiation by USPIO‐enhanced MR imaging

To assess ultrasmall superparamagnetic iron oxide particles (USPIO) -enhanced MR imaging for the differentiation of malignant from benign, inflammatory lesions. In this study, approved by the local animal care committee, VX2 carcinoma and intramuscular abscesses were implanted into the hind thighs of New Zealand White rabbits. MR imaging was performed pre contrast and serially for 24 h after the injection of USPIO. MR findings were compared with histopathologic results based on Prussian blue stains for the presence of iron. Twenty-four hours after the Ferumoxtran-injection, no changes were observed in VX2 carcinomas, whereas a mean reduction of the contrast-to-noise ratio (CNR) of approximately 90% was noticed in abscesses as well as in necrotic tumors. On histopathologic examination, abscess and necrotic parts of the tumor were found to include iron-containing monocytes demonstrating that the reduction in CNR was caused by USPIO-tagged monocytes. Our results prove the ability of USPIO-enhanced MRI to differentiate benign, inflammatory from malignant lesions.