Mirizzi syndrome type IV associated with cholecystocolic fistula: a very rare condition- report of a case

<p>Abstract</p> <p>Background</p> <p>Mirizzi syndrome is a rare complication of prolonged cholelithiasis with presence of large, impacted gallstone into the Hartman's pouch, causing chronic extrinsic compression of common bile duct (CBD). Fistula formation between the CBD and the gallbladder may represent an outcome of that condition. According to Mirizzi's classification and Csendes's subclassification, Mirizzi syndrome type IV represents the most uncommon type (4%).</p> <p>Spontaneous biliary-enteric fistulas have also been rarely reported (1.2–5%) in a large series of cholecystectomies. Cholecystocolic fistula is the most infrequent biliary enteric fistula, causing significant morbidity and representing a diagnostic challenge.</p> <p>Case presentation</p> <p>We describe a very rare, to our knowledge, combination of Mirizzi syndrome type IV and cholecystocolic fistula. A 52 year old male, presented to our clinic complaining of episodic diarrhea (monthly episodes lasting 16 days), high temperature (38°C–39°C), right upper quadrant pain without jaundice. The definitive diagnosis was made intraoperatively. Magnetic Resonance Imaging (MRI) and Endoscopic Retrograde Cholangiopancreatography (ERCP) demonstrated the presence of Mirizzi syndrome with cholecystocolic fistula formation. The patient was operated upon, and cholecystectomy, cholecystocolic fistula excision and Roux-en-Y biliary-enteric anastomosis were undertaken with excellent post-operative course.</p> <p>Conclusion</p> <p>Appropriate biliary tree imaging with ERCP and MRI/MRCP is essential for the diagnosis of Mirizzi syndrome and its complications. Cholecystectomy, fistula excision and biliary-enteric anastomosis with Roux-en-Y loop appears to be the most appropriate surgical intervention in order to avoid damage to Calot's triangle anatomic elements. Particularly in our case, ERCP was a valuable diagnostic tool that Mirizzi syndrome type IV and cholecystocolic fistula.</p

An aluminum resist substrate for microfabrication by LIGA.

Resist substrates used in the LIGA process must provide high initial bond strength between the substrate and resist, little degradation of the bond strength during x-ray exposure, acceptable undercut rates during development, and a surface enabling good electrodeposition of metals. Additionally, they should produce little fluorescence radiation and give small secondary doses in bright regions of the resist at the substrate interface. To develop a new substrate satisfying all these requirements, we have investigated secondary resist doses due to electrons and fluorescence, resist adhesion before exposure, loss of fine features during extended development, and the nucleation and adhesion of electrodeposits for various substrate materials. The result of these studies is a new anodized aluminum substrate and accompanying methods for resist bonding and electrodeposition. We demonstrate successful use of this substrate through all process steps and establish its capabilities via the fabrication of isolated resist features down to 6 {micro}m, feature aspect ratios up to 280 and electroformed nickel structures at heights of 190 to 1400 {micro}m. The minimum mask absorber thickness required for this new substrate ranges from 7 to 15 {micro}m depending on the resist thickness

Critical Hypersonic Aerothermodynamic Phenomena

The challenges in understanding hypersonic flight are discussed and critical hypersonic aerothermodynamics issues are reviewed. The ability of current analytical methods, numerical methods, ground testing capabilities, and flight testing approaches to predict hypersonic flow are evaluated. The areas where aerothermodynamic shortcomings restrict our ability to design and analyze hypersonic vehicles are discussed, and prospects for future capabilities are reviewed. Considerable work still needs to be done before our understanding of hypersonic flow will allow for the accurate prediction of vehicle flight characteristics throughout the flight envelope from launch to orbital insertion