Sign Of Leakage Research Articles

Assessment of the efficacy of Handmade Vacuum-Assisted Sponge Drain for Treatment of Anastomotic leakage after Low Anterior Rectal Resection.

Anastomotic leakage is one of the major complications of colorectal surgery, which might lead to reoperation, increased hospital stays, further intervention and mortality. Vacuum-assisted closure by devices such as Endo-SPONGE® produced by (B-Braun Medical B.V.) is currently being used to treat leakage and fistula. In this study, we aimed to assess the handmade vacuum-assisted sponge drain for anastomotic leakage following low anterior resection. This prospective study included 22 patients who had undergone sponge drain placement to treat anastomotic leakage. All patients had anastomotic leaks or defects after left anterior rectal resection (LAR) without ileostomy. They were treated with neo-adjuvant chemotherapy before the surgery and then subjected to rigid recto-sigmoidoscopy for 30days following the operation. Any sign of leakage, such as perianal and pelvic pain, was immediately identified and followed up with a CT scan and another recto-sigmoidoscopy. Twenty-two patients were enrolled in this study, 12 men (54.5%) and 10 women (47.4%). All patients had received neo-adjuvant chemotherapy with an average follow-up of 22.30 ± 3.81. 75% of patients (15 cases) were successfully treated, and 17 patients (85%) underwent successful ostomy closure. Treatment failed in 5 patients (25%), including three men and two women. This study shows that handmade vacuum-assisted sponge drain is a cost-effective method of anastomotic leakage management with efficacy similar to that of Endo-SPONGE®.

Subarachnoid CSF hyperintensities at 7 tesla FLAIR MRI: A novel marker in cerebral amyloid angiopathy

BackgroundWe observed subarachnoid cerebrospinal fluid (CSF) hyperintensities at non-contrast 7-tesla (T) fluid-attenuated inversion recovery (FLAIR) MRI, frequently topographically associated with cortical superficial siderosis (cSS), in participants with cerebral amyloid angiopathy (CAA). To systemically evaluate these CSF hyperintensities we investigated their frequency and anatomical and temporal relationship with cSS on 7T and 3T MRI in hereditary Dutch-type CAA (D-CAA), sporadic CAA (sCAA), and non-CAA controls. MethodsCAA participants were included from two prospective natural history studies and non-CAA controls from a 7T study in healthy females and females with ischemic stroke. CSF hyperintensities were scored by two independent observers. ResultsWe included 38 sCAA participants (mean age 72y), 50 D-CAA participants (mean age 50y) and 44 non-CAA controls (mean age 53y, 15 with stroke). In total 27/38 (71 %, 95 %CI 56–84) sCAA and 23/50 (46 %, 95 %CI 33–60) D-CAA participants had subarachnoid CSF hyperintensities at baseline 7T. Most (96 %) of those had cSS, in 54 % there was complete topographical overlap with cSS. The remaining 46 % had ≥1 sulcus with CSF hyperintensities without co-localizing cSS. None of the healthy controls and 2/15 (13 %, 95 %CI 2–41, 100 % cSS overlap) of the stroke controls had CSF hyperintensities. In 85 % of the CAA participants CSF hyperintensities could retrospectively be identified at 3T. Of the 35 CAA participants with follow-up 7T after two years, 17/35 (49 %) showed increase and 6/35 (17 %) decrease of regional CSF hyperintensities. In 2/11 (18 %) of participants with follow-up who had baseline CSF hyperintensities without overlapping cSS, new cSS developed at those locations. ConclusionsSubarachnoid CSF hyperintensities at 7T FLAIR MRI occur frequently in CAA and are associated with cSS, although without complete overlap. We hypothesize that the phenomenon could be a sign of subtle plasma protein or blood product leakage into the CSF, resulting in CSF T1-shortening.

An energy-efficient form-stable phase change materials synthesis method to enhance thermal storage and prevent acidification of cementitious composite

• Proposed a procedural modification to prepare form-stable PCM composite. • Proposed procedure increased PCM percentage and energy efficiency of the process. • Capric Acid PCM caused acid attack when leaked into the cementitious composite. • Acidification test was recommended to prepare PCM integrated cementitious composite. • Introduced loading rate as a new factor for form shape stablized PCM composite synthesis. Integration of Form-Stable Phase change materials (FSPCM) in building construction materials has been reported to have significant potential to improve building energy efficiency and reduce emissions from this sector. Previous studies on FSPCM only focused on increasing the PCM absorption rate as the performance criteria of FSPCM without considering the energy required to produce such composites. Moreover, the existing leakage performance test used while developing FSPCM is not 100 % reliable in detecting PCM leakage in cementitious materials, which may cause an acid attack and reduce concrete strength. Therefore, this study proposed a modification of existing FSPCM synthesizing methods to improve thermal storage, minimize the embodied energy of FSPCM composites and an acidification test to detect PCM leakage. The proposed method resulted in 75 % absorption of Capric acid PCM in porous hydrophobic expanded perlite (HEP). Moreover, the thermal storage of the prepared CAHEP PCM composite was found to be higher (ΔHm = 136.9 J/g, ΔHs = 134.4 J/g) due to higher PCM absorption. The prepared CAHEP form-stable PCM composite was chemically and thermally stable as observed from a series of standard characterization tests. The loading factor (the ratio of PCM absorption and energy consumed by the process) was found to be three times the existing methods making the proposed method more energy efficient. The compressive strength of CAHEP incorporated cementitious composite and its thermal conductivity increased with increasing PCM absorption. However, at 75 % CA absorption, both the compressive strength and thermal conductivity of the cementitious composite decreased due to acid attack by leaked CA PCM as observed in the acidification test, although the standard leakage test did not show any sign of leakage. No such acid attack was observed for the paraffin PCM composite.

Conservative management of esophageal perforation following foreign body ingestion, a case report

A19 years old female presented to Shohadaye Tajrish hospital with a retrosternal chest and back pain since the day before. Chest CT showed pneumo-mediastinum, although there was no sign of contrast leakage in imaging. We decided on conservative management for the patient. Symptoms and radiologic signs were diminished after three days in the ICU. This report has discussed the importance of early diagnosis, diagnostic modalities, and management in esophageal rupture cases.

Transcatheter Dynamic Contrast-Enhanced MR Lymphangiography for Nontraumatic Lymphatic Disorders: Technical Feasibility and Imaging Findings

This study aimed to evaluate the feasibility and added value of transcatheter dynamic contrast-enhanced magnetic resonance (MR) lymphangiography for nontraumatic lymphatic disorders. Five patients (2 males and 3 females; median age, 16.0 years; range, 3–74 years) who underwent both intranodal and transcatheter dynamic contrast-enhanced MR lymphangiography for suspected nontraumatic lymphatic leakages from June 2017 to January 2020 were included in this retrospective study. The imaging findings of both dynamic contrast-enhanced MR lymphangiography techniques were assessed for the presence of chylolymphatic reflux or direct sign of leakage. Intranodal dynamic contrast-enhanced MR lymphangiography demonstrated chylolymphatic reflux into the thoracic area in 2 patients (40%) but no direct evidence of leakage in any of the 5 patients. Transcatheter dynamic contrast-enhanced MR lymphangiography revealed chylolymphatic reflux and extravasation of the contrast agent in all 5 patients (100%). In conclusion, transcatheter dynamic contrast-enhanced MR lymphangiography may reveal additional signs of reflux and extravasation even when the findings of intranodal dynamic contrast-enhanced MR lymphangiography are negative.

Management of Giant Pulmonary Artery Aneurysm with Quadricuspid Valve Stenosis

AbstractThe pulmonary artery aneurysm (PAA) is a rare disease with no well-defined guidelines about the diagnostic criteria and its management. In fact, the indications for surgical treatment and the type of surgical approach are not clear. However, in case of giant PAAs with hypertension and pulmonary valve abnormalities, surgery should be considered as an effective and safe approach to prevent dissections or ruptures. In this report, we describe a successful case of surgical repair, using a Bioconduit with a pericardial patch to recreate the pulmonary artery bifurcation in a 72-year-old male with aneurysm of the pulmonary artery (max diameter: 72 mm), associated with quadricuspid pulmonary valve stenosis and pulmonary hypertension. The procedure was uncomplicated and the follow-up computed tomography scan at 4 months showed correct positioning of the graft with no sign of contrast leakage.

Clinical application and analysis of single-port laparoscopic and thoracoscopic McKeown esophagectomy for esophageal cancer

Objective: To explore the application value of single-port laparoscopic and thoracoscopic McKeown esophagectomy for esophageal cancer. Methods: A retrospective study was conducted to collect clinical data of 34 patients with esophageal cancer who were admitted to the Department of Thoracic Surgery, the First Affiliated Hospital of Fujian Medical University, from August to November 2020. All of them, 24 males and 10 females aged from 43 to 75 with an average of (62±4) years, underwent single-port laparoscopic and thoracoscopic McKeown esophagectomy.In the thoracic part, esophageal separation and mediastinal lymph node dissection were performed with conventional 4-ports thoracoscopy in the left lateral-prone position. In the abdominal part, gastric separation and lymph node dissection were accomplished with single-port laparoscopic retrograde three-step gastric separation: firstly, the lesser omentum was dissociated, the left liver lobe was suspended with purse-string needle and thread, after that the left gastric blood vessel and lymph node was dissected; secondly, the esophageal hiatus was separated, and the gastric cardia was cut off; finally, the spleen and stomach ligaments were dissociated to complete these steps. The operation time,volume of intraoperative blood loss, time for out-of-bed activities, time of postoperative drainage tube removal,volume of thoracic drainage fluid, short-term postoperative commplications,the postoperative pathological diagnoses, the time of their discharge from hospital and results of follow-up were observed. Results: All patients underwent successfully single-port laparoscopic and thoracoscopic esophagectomy without any conversion to open surgery; the operative time of the patients was 194-285 (240±21)min, including 53-105(60±13)min for the thoracic part and 40-73(49±7)min for the abdominal part. The volume of intraoperative blood loss was 15-110(60±20) ml. The numbers of mediastinal lymph node dissected and abdominal lymph nodes harvested were 10-25(13±3), 6-16(9±3)respectively. The 34 patients resumed out-of-bed activities on the 2nd to 3rd day after the operation. The thoracic closed drainage tube and left cervical drainage were removed 2 days after the operation. The thoracic Abel drainage tube was removed 5 days after the operation. The total volume of postoperative thoracic drainage fluid was 100-500(300±100)ml. No obvious sign of anastomotic leakage, anastomotic stenosis, chylothorax or gastric emptying disorder was found after the operation. Eight cases were complicated with temporal hoarseness, and 4 patients with pneumonia which was cured by antibiotics. The mean postoperative hospital stay was 8 days(6, 8), and patients were discharged after they could take a routine semi-liquid diet. The postoperative pathological diagnoses of all patients were squamous cell carcinoma, and the postoperative pathological stage was T1-3N0-1M0. Thirty-four patients were followed up for 60 (40, 75) days after the operation. During the follow-up period, no complication or death occurred. In addition, neither recurrence nor metastasis was observed. Conclusion: Single-port laparoscopic and thoracoscopic McKeown esophagectomy for esophageal carcinoma is safe and feasible, with good short-term efficacy. Therefore we consider it an alternative minimally invasive surgery for esophageal cancer.

Motives behind the return anomaly around bonus issue announcements: the case of emerging markets

PurposeThis paper aims to examine the stock return behaviour around the bonus issue announcements in eight emerging markets for 2010–2019 by addressing the signalling, cash substitution and liquidity hypotheses.Design/methodology/approachBesides using the standard event study technique to test the presence of an anomaly, country-based regression analyses are performed. Firm-specific factors are used to understand the motive behind the anomaly observed pre- and post-announcement periods. Also, the Amihud illiquidity measure examines the liquidity hypothesis, while standardized profitability and investment ratios compare the long-run operational performance of bonus issuers to test the validity of signalling.FindingsThe findings provide evidence that abnormal returns can be detected ten days before the announcement in some countries, which is a sign of information leakage. The presence of the effect continues only in two countries after the announcement is released. The size of the bonus issue is found strongly significant in most countries, while a weak relation between abnormal return and other factors is detected. Moreover, the signalling hypothesis does not hold in the sense of long-run profitability increase, while liquidity assertion is partially presented.Research limitations/implicationsDue to an inadequate number of announcements in other emerging markets, the number of sample countries is limited by eight.Originality/valueThe research is novel regarding analyzing a wide range of emerging countries with various variables. Also, the paper is distinguished from other studies by applying multiple set of regressions under nine different event windows.

A case of acute calculous cholecystitis with contained gall bladder perforation with pericholecystic collections extending to liver parenchyma

Gall bladder perforation is a serious complication of acute cholecystitis and represents an advanced stage of the disease. Its clinical presentation is varied and can range from non-specific symptoms to acute generalized peritonitis. In many cases, GB perforation in diagnosis during exploratory laparotomy for peritonitis and with no definite source identified. The presentation of gall bladder perforation can be indistinguishable from uncomplicated acute cholecystitis. A 60 yrs. old male with no known comorbidities presented to a tertiary care hospital with diffuse pain abdomen associated with vomiting and constipation of 04 days’ duration. Clinical evaluation revealed icterus and tenderness in right hypochondrium and generalized peritonitis. Lab investigations revealed conjugated type hyperbilirubinemia and elevated serum Lipase levels and normal Amylase levels. Initial USG revealed Acute acalculous cholecystitis with normal IHBR and normal CBD. Later NCCT abdomen and MRCP were done which revealed calculous cholecystitis with sealed off GB perforation IHBR, CBD, and normal pancreas. The patient was managed non-operatively and responded well. The inflammatory reaction of the peritoneum in bile peritonitis increases the absorption of the spilled conjugated bile from the peritoneal cavity. The conjugated type hyperbilirubinemia without dilatation of the bile duct on imaging examination was the sign of bile leakage into the peritoneal cavity.

РАННИЕ ДИАГНОСТИЧЕСКИЕ КРИТЕРИИ НЕСОСТОЯТЕЛЬНОСТИ ЛИНИИ ШВОВ ЖЕЛУДКА И АНАСТОМОЗОВ ПОСЛЕ БАРИАТРИЧЕСКИХ ОПЕРАЦИЙ

Staple line and anastomotic leakage is frequent and threatening complication of bariatric surgery. Its early diagnostics is difficult, and search for new diagnostic criteria is necessary. Objective. To improve post-bariatric staple line and anastomotic leakage diagnostics by revealing new early diagnostic criteria. Materials and methods. Following hypothesis considered: postoperative stab neutrophils level is early sign of staple line and anastomotic leakage after bariatric surgery. Retrospective comparative study performed to test the hypothesis. Study group consisted of patients with staple line and anastomotic leakage in postoperative period (n=9). Control group consisted of patients with uncomplicated postoperative period (n=253). ROC-curves for stab neutrophils levels in 12 and 36 hours after surgery analyzed in both groups. The reference method was a comprehensive dynamic examination. Results. Area under the ROC-curve for stab neutrophils in 36 hours (AUC=0,613) was higher, than area under ROC-curve for stab neutrophils in 12 hours (AUC= 0,543). So stab neutrophils in 36 hours is more sensitive and specific early diagnostic criterion for staple line and anastomotic leakage. Sensitivity Se=55,56% and specificity Sp=72,13% achieved at the stab neutrophils in 36 hours after surgery level above 9%. Conclusion. As staple line and anastomotic leakage early diagnostic criterion stab neutrophils level in 36 hours after bariatric surgery has high specificity. Proposed criterion available in early postoperative period, when signs of leakage are obscured. In combination with other methods it promotes staple line and anastomotic leakage earlier diagnostics, what improve patients’ treatment results.

Tube-like preputial mucosa urethrostomy for correction of urethrorectal fistula in a young male cat

A 10-month-old cat exhibited simultaneously penile urethra obstruction and rectourethral fistula. The pubic osteotomy was a method to approach the fistula to locate the pelvic urethra opening into the rectum. Surgical correction consisted of ligation and cutting of the urethra connecting to the rectum, and a primary suture to connect the urethra to prepuce for a new opening. The tomcat catheter was placed in the urethra for a ten days-period. Ten days after the surgery, the cat was transferred to have urethrography to examine the lumen of the defective urethra, and the result showed no sign of urine leakage and stricture. After the catheter removal, the cat could urinate normally, and there was no sign of complications during urination, and no urine coming from the rectum found. In brief, this case report describes a successful urethral reconstruction for repairing the urethrorectal fistula by primary suture connecting the urethra with prepuce mucosa.

Two cases of glottic closure for refractory aspiration pneumonia after vertical partial laryngectomy

Vertical partial laryngectomy is a well-established surgical procedure for early glottic cancers with acceptable functional and oncological outcomes. However, on a long-term basis, aspiration might be a serious problem with aging. Here we presented two cases of refractory aspiration pneumonia after vertical laryngectomy. Case 1: A 76-year old gentleman with a past history of malignant lymphoma treated by chemotherapy and radiotherapy had glottic cancer, which was treated by repeated vertical partial laryngectomies. Although glottic caner had been well controlled, he started to suffer from refractory aspiration pneumonia. Since his cervical skin was very thin and hard and his general condition was poor, we employed modified Kano's method for glottic closure. Case 2: A 87-year old Japanese male had a past history of glottic cancer treated by radiotherapy and vertical partial laryngectomy. He was repeatedly hospitalized for severe aspiration pneumonia. At the age of 87, he had second primary oropharyngeal cancer. Kano's method was simultaneously performed at the time of resection of oropharyngeal cancer. Postoperative courses were uneventful without sign of leakage in both cases. The patients started oral intake 2 weeks after the surgery. They have been alive without aspiration pneumonia and takes normal diet.

Detection of oil leakage in soil by monitoring impedance using time domain reflectometry and hydraulic control system

Monitoring of petroleum contamination in soils surrounding underground storage tanks is an important issue for the effective remediation of soil and groundwater. In this study, a method for the detection of oil leakage from underground storage tanks was developed using time domain reflectometry (TDR), which has a sensible capacity for soil resistance, and a hydraulic control system. Without the hydraulic control system, TDR-measured impedance was not sensitive to the input of oil. The ability of the new system to detect diesel leakage in a sandy soil was verified by conducting leakage detection experiments. Impedance changes measured by TDR installed in the cylinder are useful as a sign of oil leakage. The sensitivity of oil leakage detection was dependent on the configuration of the hydraulic control system. The applicability of the sensor system in subsurface environment was validated by conducting oil release detection test in the sand tank. Results indicate that TDR, combined with a hydraulic control system, can be used for the detection of oil leakage from the storage tank.

Application value of closed single-port thoracoscopic and laparoscopic radical esophagectomy for esophageal cancer

Objective To investigate the application value of closed single-port thoracoscopic and laparoscopic radical esophagectomy for esophageal cancer. Methods The retrospective and descriptive study was conducted. The clinical data of a 49-year-old male patient with esophageal cancer who was admitted to the Fujian Medical University Union Hospital in November 2018 were collected. The patient underwent closed single-port thoracoscopic and laparoscopic radical esophagectomy and three-field lymph node dissection. In the thoracic part, esophageal separation and thoracic lymph node dissection were performed with closed pneumothorax, semi-lateral position and multi suspension methods. In the abdominal part, gastric separation and lymph node dissection were accomplished with lifting of liver lobe and respective separation of greater curvature and lesser curvature of stomach. The operation time, volume of intraoperative blood loss, time for out-of-bed activities, time of postoperative drainage tube removal, volume of thoracic drainage fluid, postoperative complications, postoperative pathological examination results, time for discharge from hospital and results of follow-up were observed. Follow-up using outpatient examination and telephone interview was performed to detect tumor recurrence and metastasis of patients after operation up to February 2019. Count data were described as absolute number. Results The patient underwent successfully closed single-port thoracoscopic and laparoscopic radical esophagectomy and three-field lymph node dissection. The operation time and volume of intraoperative blood loss was 310 minutes and 120 mL. The patient resumed out-of-bed activities at 2 days after operation. The abdominal drainage tube, thoracic closed drainage tube and right cervical drainage tube were removed at 2 days after operation with fasting, acid suppression, nutritional support. The thoracic Abel drainage tube and the left cervical drainage tube were removed at 5 days after operation. The volume of thoracic drainage fluid was 550 mL. No obvious sign of anastomotic leakage was found on esophageal angiography at 5 days after operation. The patient recovered well after operation without hoarseness, pulmonary infection and chylothorax. The postoperative examination result of the patient showed mid-thoracic esophageal squamous cell carcinoma (pT3N1M0G3 ⅢB stage). The patient was discharged at 8 days after operation. The patient was followed up for 3 months, and was able to engage in light physical activity. CT reexamination showed no sign of local recurrence or distant metastasis of the tumor. Conclusion Closed single-port thoracoscopic and laparoscopic radical esopahgectomy for esophageal cancer is safe and feasible, with good short-term efficacy. Key words: Esophageal neoplasms; Esophageal cancer; Radical surgery; Thoracoscopy; Laparoscopy; Single port

Dome-Shaped Macula and Foveal Neurosensory Retinal Detachment—A Case Series

Objective: To report a case series of dome-shaped macula (DSM) and serous retinal detachment (SRD). Methods: A retrospective and observational case series study was performed at two centers of ophthalmology in Rosario-Argentina from January 2016 to December 2017. Eight eyes of 5 patients diagnosed with dome-shaped macula with subfoveal hyporeflective zone seen in optical coherence tomography (OCT) were included. Best-corrected visual acuity (BCVA), OCT, fluorescein angiography (FA), differential diagnoses, clinical course and different treatments were reviewed. Results: Baseline visual acuity ranged from 20/25 to 20/200. OCT revealed that the retinal choroidal macular complex had a convex shape and exhibited foveal neurosensory retinal detachment in all cases. FA showed mild diffuse hyperfluorescence due to changes in the retinal pigment epithelium (RPE). No sign of leakage was observed. Different treatments were used, including intravitreal antiangiogenic drugs, oral spironolactone, melatonin and observation. Follow-up time was between 6 and 18 months. BCVA and OCT findings remained unchanged after different options of treatment. Conclusions: DSM is an unusual entity, which can be confused with other maculopathies that cause neurosensory retinal detachment and do not respond to different types of treatment. Hence, in our opinion, observation is a reasonable approach for this disorder.

VESICOVAGINAL FISTULA CAUSED BY CYSTOCELE: A CASE REPORT

Typical etiologies of vesicovaginal fistula (VVF) include obstructed labor, iatrogenic surgical injury, pelvic irradiation and cancer invasion. VVF caused by cystocele are very rare. To date, there are no documented cases in Japanese literature.A 74-year-old woman presented with near total incontinence. On physical examination, she was found to have severe cystocele and pressure necrosis of anterior vaginal wall, which caused partial breakdown of vaginal mucosa and VVF. She underwent vesicovaginal fistula repair using transvaginal and transabdominal approaches. Catheter drainage was performed for 10 days and postoperative cystogram showed no sign of leakage. She is currently symptom-free at 55 months.

Low-pressure bonding of monolithic SU-8 microfluidic devices

Crosslinked SU-8 is a promising material for microfluidic and bio-MEMs applications because of its excellent optical properties, chemical stability, biocompatibility and low absorption of analytes. Thus, devices made out of SU-8 are very well suited for specialized applications such as live cell imaging. However, the design of monolithic SU-8 devices is often limited because the bonding of SU-8 layers usually requires a special bonding apparatus. Here, we present a reliable and user-friendly bonding method for SU-8 layers, which eases the fabrication of 3D SU-8 microfluidic devices. The top layer and the main layer of an SU-8 channel were bonded at pressures of 1, 2, 3, 4 and 8 kPa. The resulting bonding was free of voids in all cases, and the maximum bond strength was 6.5 ± 1.9 MPa, which is sufficient for most microfluidic applications. All the devices exhibited excellent stability under flow conditions. The device bonded at the lowest applied pressure (1 kPa) was tested for 24 h under a flow shear stress of 280 dynes cm−2 and showed no sign of leakage. Thus, the presented low-pressure bonding is a promising technique to fabricate SU-8 microfluidic devices.

Biomechanical characterization of a novel ring connector for sutureless aortic anastomosis.

The surgical treatment for aortic diseases remains a challenge for any cardiac surgeon. The use of sutureless ring connector in aortic anastomosis can simplify the procedure and shorten anastomosis time. Therefore, we developed a novel device for sutureless aortic anastomosis. A series of experiments were carried out for tensile and leakproof-capacity assessments to verify the feasibility of the ring connector by using fresh swine aorta samples. In in vivo test, the ring connector was implanted in 6 swine with follow-up of 6 months. Radiographic and pathological studies of the aorta were performed. In the tensile tests, the strength was 32.7±5.9 Newton (N) in the sutureless anastomosis group, compared with 73.3±12.5 N in the control group by traditional manual suture. In the leakproof-capacity assessment, no sign of either leakage or bursting was evident at 280 mmHg of internal pressure in the aorta samples. In in vivo tests, it took 9.47±0.3 minutes for the sutureless anastomosis, compared with 15.58±1.39 minutes for hand-sewn suturing. Insertion was easy and rapid. Radiographic and pathological studies were performed at first month, third month and sixth month after surgery, each time obtained from the two swine, showed patency of the anastomosis and no signs of stenosis, blood leakage, migration or pseudoaneurysm formation, except one paralyzed swine developed of thrombo-occlusion at the site of the sutureless anastomosis. The result indicates that this novel ring connector offers considerable promise for sutureless aortic anastomosis.

Disruption of the leptomeningeal blood barrier in neuromyelitis optica spectrum disorder.

Objective:To describe leptomeningeal blood-barrier impairment reflected by MRI gadolinium-enhanced lesions in patients with aquaporin-4 immunoglobulin G (AQP4-IgG)–positive neuromyelitis optica spectrum disorder (NMOSD).Methods:A retrospective case series of 11 AQP4-IgG–positive NMOSD patients with leptomeningeal enhancement (LME) were collected from 5 centers. External neuroradiologists, blinded to the clinical details, evaluated MRIs.Results:LME was demonstrated on postcontrast T1-weighted and fluid-attenuated inversion recovery images as a sign of leptomeningeal blood-barrier disruption and transient leakage of contrast agent into the subarachnoid space in 11 patients, 6 in the brain and 6 in the spinal cord. The patterns of LME were linear or extensive and were accompanied by periependymal enhancement in 5 cases and intraparenchymal enhancement in all cases. The location of LME in the spinal cord was adjacent to intraparenchymal contrast enhancement with involvement of a median number of 12 (range 5–17) vertebral segments. At the time of LME on MRI, all patients had a clinical attack such as encephalopathy (36%) and/or myelopathy (70%) with median interval between symptom onset and LME of 12 days (range 2–30). LME occurred in association with an initial area postrema attack (44%), signs of systemic infection (33%), or AQP4-IgG in CSF (22%) followed by clinical progression. LME was found at initial clinical presentation in 5 cases and at clinical relapses leading to a diagnosis of NMOSD in 6 cases.Conclusion:This study suggests that altered leptomeningeal blood barrier may be accompanied by intraparenchymal blood-brain barrier breakdown in patients with AQP4-IgG–positive NMOSD during relapses.

Is Ultrasound a Useful Tool to Predict Severe Dengue Infection?

To study the role of ultrasound in children with dengue fever and determine its role in predicting the severity of the disease. This was a retrospective hospital based study conducted from 1(st) August 2012 to January 31(st) 2015 at a tertiary care hospital in Puducherry. Two hundred and fifty four children were admitted with dengue fever and among them non-severe dengue and severe dengue were seen in 62.6 % and 37.4% respectively. Mean age of presentation was 7.0 (3.3) years. M: F ratio was 1.2:1 Ultrasound was performed on all children with dengue fever during the critical period of illness as an early sign of plasma leakage and at the time of discharge. The diagnosis was confirmed by NS1 antigen and dengue serology. Ultrasonography showed positive findings in 156 cases (61.4%) during the critical period of illness. Ultrasound findings were analyzed using logistic regression among severe and non-severe dengue and P value of <0.05 was taken as significant. The common ultrasound findings that were significantly associated with severe dengue infection on univariate analysis were gall bladder wall thickening, ascites, pleural effusion, pericardial effusion, pericholecystic fluid, hepatomegaly, splenomegaly and mesenteric adenopathy. On multivariate analysis, gall bladder thickening and hepatomegaly were significantly associated with severe dengue infection. Gall bladder wall thickening (GBWT) with honeycombing pattern was the most specific finding in severe dengue infection in the study and significantly associated with severe thrombocytopenia (Platelet count <50,000/mm(3)). The clinical improvement coincided with resolving of the ultrasound findings at the time of discharge. Ultrasound can be used as an early predictor as well as an important prognostic sign for severe dengue infection especially during an epidemic.