Iatrogenic Bile Duct Injury Associated with Anomalies of the Right Hepatic Sectoral Ducts: A Misunderstood and Underappreciated Problem

Although laparoscopic cholecystectomy (LC) has been widely accepted as the standard of care, it continues to have a higher complication rate than open cholecystectomy. Bile duct injury with LC has often been attributed to surgical inexperience, but it is also clear that aberrant bile ducts are present in a significant number of patients who sustain biliary injuries during these procedures. We present three cases of right sectoral hepatic duct injuries which occurred during LC and provide a discussion of the conditions which are likely to lead to these injuries, as part of a strategy to prevent them

Management of Enteropathy-Associated T-Cell Lymphoma: An Algorithmic Approach

Perforation of the small intestine is the most lethal complication following induction chemotherapy for enteropathy-associated T-cell lymphoma (EATL). We report a case of EATL with a near perforated jejunal ulcer, and suggest a novel approach towards its management. Surgical resection followed by aggressive chemotherapy should limit chemotherapy-associated gastrointestinal toxicity, thus allowing patients to receive adequate dose and duration of chemotherapy. The presented case highlights potential benefits of surgical intervention prior to chemotherapy for EATL

The Page Kidney Phenomenon Secondary to a Traumatic Fall

Page kidney is a rare phenomenon of hyperreninemic hypertension caused by compression of the renal parenchyma. It has been reported in healthy individuals after blunt abdominal or flank trauma, and in patients after invasive nephrological interventions. We present a case of acute on chronic renal failure and Page kidney phenomenon in an elderly male after a traumatic fall, who underwent effective medical management until spontaneous recovery to baseline was observed. A brief discussion on the Page kidney phenomenon is provided with a suggested algorithmic approach towards the management of this process

An artificial neural network-based snow cover predictive modeling in the higher Himalayas

With trends indicating increase in temperature and decrease in winter precipitation, a significant negative trend in snow-covered areas has been identified in the last decade in the Himalayas. This requires a quantitative analysis of the snow cover in the higher Himalayas. In this study, a nonlinear autoregressive exogenous model, an artificial neural network (ANN), was deployed to predict the snow cover in the Kaligandaki river basin for the next 30 years. Observed climatic data, and snow covered area was used to train and test the model that captures the gross features of snow under the current climate scenario. The range of the likely effects of climate change on seasonal snow was assessed in the Himalayas using downscaled temperature and precipitation change projection from — HadCM3, a global circulation model to project future climate scenario, under the A1B emission scenario, which describes a future world of very rapid economic growth with balance use between fossil and non-fossil energy sources. The results show that there is a reduction of 9% to 46% of snow cover in different elevation zones during the considered time period, i.e., 2011 to 2040. The 4700 m to 5200 m elevation zone is the most affected area and the area higher than 5200 m is the least affected. Overall, however, it is clear from the analysis that seasonal snow in the Kaligandaki basin is likely to be subject to substantial changes due to the impact of climate change

Agenesis of the Dorsal Pancreas and its Association With Pancreatic Tumors.

Morphogenesis of the pancreas is a complex process; nevertheless, congenital anomalies are rare. At embryogenesis, the pancreas develops from the endoderm-lined dorsal and ventral buds of the duodenum. The ventral bud gives rise to the lower head and uncinate process of the pancreas; whereas, the dorsal bud gives rise to the upper head, isthmus, body, and tail of the pancreas. Rarely, developmental failure of the dorsal pancreatic bud at embryogenesis results in the agenesis of the dorsal pancreas--neck, body, and tail. Even rarer is the association of pancreatic tumors with agenesis of the dorsal pancreas. In addition to citing our case, we provide a comprehensive review on agenesis of the dorsal pancreas and its association with pancreatic tumors

Peripheral Artery Leiomyosarcoma.

Vascular leiomyosarcomas are extremely rare tumors and represent only 0.001% of all malignancies. Venous leiomyosarcomas occur five times more often than arterial ones, with 50% of them originating in the inferior vena cava (IVC). Arterial leiomyosarcomas are most commonly encountered in the great vessels with less than 50% of them occurring in the peripheral circulation. A total of only seven cases of arterial leiomyosarcomas involving the femoral artery have been reported in literature to date. We report a case of an arterial leiomyosarcoma involving the profunda femoris artery, and provide a comprehensive review on peripheral arterial leiomyosarcomas-distribution, clinical presentation, radiological and histological diagnosis, staging, and treatment

Chronic Diaphragmatic Hernia: A Delayed Problem Requiring Urgent Response

Chronic diaphragmatic hernia (CDH) repair presents a unique challenge as several surgical techniques have been described, yet no standard procedure currently exists. The authors describe a trans- abdominal, tension-free prosthetic repair of a large CDH and review other approaches. (non-author abstract

Assessment of Climate Change Impact on Reservoir Inflows Using Multi Climate-Models under RCPs—The Case of Mangla Dam in Pakistan

Assessment of climate change on reservoir inflow is important for water and power stressed countries. Projected climate is subject to uncertainties related to climate change scenarios and Global Circulation Models (GCMs). This paper discusses the consequences of climate change on discharge. Historical climatic and gauging data were collected from different stations within a watershed. Bias correction was performed on GCMs temperature and precipitation data. After successful development of the hydrological modeling system (SWAT) for the basin, streamflow was simulated for three future periods (2011–2040, 2041–2070, and 2071–2100) and compared with the baseline data (1981–2010) to explore the changes in different flow indicators such as mean flow, low flow, median flow, high flow, flow duration curves, temporal shift in peaks, and temporal shifts in center-of-volume dates. From the results obtained, an overall increase in mean annual flow was projected in the basin under both RCP 4.5 and RCP 8.5 scenarios. Winter and spring showed a noticeable increase in streamflow, while summer and autumn showed a decrease in streamflow. High flows were predicted to increase, but median flow was projected to decrease in the future under both scenarios. Flow duration curves showed that the probability of occurrence of high flow is likely to be more in the future. It was also noted that peaks were predicted to shift from May to July in the future, and the center-of-volume date of the annual flow may vary from −11 to 23 days in the basin, under both RCP 4.5 and RCP 8.5. As a whole, the Mangla basin will face more floods and less droughts in the future due to the projected increase in high and low flows, decrease in median flows and greater temporal and magnitudinal variations in peak flows. These outcomes suggest that it is important to consider the influence of climate change on water resources to frame appropriate guidelines for planning and management

Krukenberg Tumor: Metastasis of Meckel\u27s Diverticular Adenocarcinoma to Ovaries.

A 56-year-old female presented with abdominal pain, weight loss and fatigue. Computed tomography revealed an abdominopelvic mass and ascites. At surgery she had carcinomatosis and bilateral ovarian metastases arising from a cancer in a Meckel\u27s diverticulum. Histology identified the primary to be a signet-ring cell adenocarcinoma within the Meckel\u27s with ovarian metastases. This is the first report of a Krukenberg tumor from a Meckel\u27s diverticulum. A discussion of malignancies within a Meckel\u27s diverticulum is provided