Free Intra-Abdominal Air without Peritoneal Perforation after TEM: A Report of Two Cases

Transanal endoscopic microsurgery (TEM) is a minimally invasive treatment modality for a variety of rectal lesions. Due to its minimally invasive nature, TEM has emerged as a safe method. Among most threatening complications are hemorrhage and peritoneal perforation. We report on two patients who demonstrated intra-abdominal free air on an erect chest X-ray after TEM procedure without other findings of a pneumoperitoneum. We hypothesize that due to the combination of elevated pressures in the retroperitoneal cavity and decreased integrity of the retroperitoneal barrier, insufflated CO(2) gas can diffuse into the intraperitoneal cavity. Conservative treatment should be considered in patients with free intra-abdominal air postoperatively. However, there should be no suspicion of peritoneal entry during the procedure and the patient should be in generally good condition without severe abdominal symptoms

Restricting digital sites of dissent: commercial social media and free expression

The widespread use of commercial social media platforms by protesters and activists has enhanced protest mobilisation and reporting but it has placed social media providers in the intermediary role as facilitators of dissent and has thereby created new challenges. Companies like Google and Facebook are increasingly restricting content that is published on or distributed through their platforms; they have been subject to obstruction by governments; and their services have been at the core of large-scale data collection and surveillance. This article analyses and categorises forms of infrastructure-based restrictions on free expression and dissent. It shows how private intermediaries have been incorporated into state-led content policies; how they set their own standards for legitimate online communication and intervene accordingly; and how state-based actions and commercial self-regulation intersect in the specific area of online surveillance. Based on a broad review of cases, it situates the role of social media in the wider trend of the privatisation of communications policy and the complex interplay between state-based regulation and commercial rule-making

TWO PATIENTS WITH X CHROMOSOME DUPLICATION: dupXp AND dupXq

ABSTRACT Structural abnormalities of the X chromosome may lead to different phenotypes, depending on the chromosome region affected. We report phenotypic findings of two patients who had X chromosome duplications. One had a menstrual irregularity, a low hairline, cubitus valgus and suffered from dyslexia. The other had multiple congenital anomalies, severe mental-motor retardation and intractable epilepsy. The karyotypes were 46,X,dup(X) (p11.3p21) and 46,X,dup(X)(q13q25) respectively

Physical constraints on the non-dimensional absorption coefficients of compressional and shear waves for viscoelastic cylinders.

International audienceBackgroundNormalized absorption coefficients for the longitudinal and shear waves in viscoelastic (polymer-type) materials, extracted from non-fictional experimental data showed anomalous effects, such as the generation of a negative radiation force (NRF) in plane progressive waves, negative energy absorption and extinction efficiencies and a scattering enhancement, not in agreement with energy conservation.ObjectiveThe objective of this work is directed towards analyzing those anomalies from the standpoint of energy conservation. Physical conditions which demonstrate that the ratio of the normalized absorption coefficients cannot be of arbitrary value but depends on the ratio of the square of the compressional and shear wave speeds, are established and discussed.MethodThe necessary physical condition for the validity of the linear viscoelastic (VE) model for any passive (i.e. that does not generate energy) polymeric cylinder with an ultrasonic absorption of hysteresis-type submerged in a non-viscous fluid requires that the absorption efficiency be positive (Qabs > 0) since there are no active radiating sources inside the core material. This condition imposes restrictions on the values attributed to the normalized absorption coefficients for the compressional and shear-wave wavenumbers for each partial-wave mode n. The forbidden values produce anomalous/unphysical NRF, negative absorption and extinction efficiencies, as well as an enhancement of the scattering efficiency using plane progressive waves, not in agreement with energy conservation.ResultsBased on the partial wave series expansion method in cylindrical coordinates, numerical results for the radiation force, extinction, absorption and scattering energy efficiencies assuming plane progressive wave incidence are performed for three VE polymer cylinders immersed in a non-viscous host liquid (i.e. water) with particular emphasis on the shear-wave absorption coefficient, the dimensionless size parameter ka (where k is the wavenumber and a is the radius of the cylinder) and the partial-wave mode number n. Physical and mathematical conditions are established for the non-dimensional absorption coefficients of the longitudinal and shear waves for a cylinder (i.e. the 2D case) in terms of the sound velocities in the VE material. The physical condition for the spherical 3D case is also noted.ConclusionFor passive materials, the physical conditions must be always satisfied to allow accurate computations of the acoustic radiation force, torque, and energy absorption, extinction and scattering efficiencies for VE cylinders having a hysteresis type of absorption (such as polymers and plastics), and submerged in a non-viscous fluid. The physical conditions must be always satisfied regardless of the shape of the incident field. They also serve to validate and verify experimental data for VE materials and test the accuracy of related numerical computations

Uretero-iliac artery fistula: a diagnostic and therapeutic challenge.

Uretero-Iliac artery fistulas (UAFs) are very uncommon in urological practice. The rarity of this clinical entity may lead to a delayed or missed diagnosis which can result in life-threatening consequences. We present a case of a right ureteric and right external iliac artery fistula, its presentation, diagnosis, and management along with the review of the literature

Extrapontine Myelinolysis-Induced Parkinsonism in a Patient with Adrenal Crisis

Background. Extrapontine myelinolysis (EPM) has been well described in the presence of rapid correction of hyponatremia. It is seldom reported with adrenal insufficiency. We report a unique case where a patient developed EPM as a result of adrenal insufficiency where the brain MRI revealed symmetrical lesion in the basal ganglia with pallidal sparing. Case Report. A 30-year-old gentleman with panhypopituitarism developed adrenal crisis, hyponatremia, and hyponatremic encephalopathy. Seven days after the rapid correction of hyponatremia, he developed parkinsonism and neuropsychiatric symptoms. MRI showed extrapontine myelinolysis without central pontine myelinolysis. Conclusion. Extrapontine myelinolysis without central pontine myelinolysis is rare and should raise a concern of associated adrenal insufficiency in the right clinical setting. Rapid correction of hyponatremia particularly in steroid-deficient states should be avoided as it can predispose to extrapontine myelinolysis. Magnetic resonance imaging is very helpful in supporting the diagnosis of EPM