Reconstruction of the gastric passage by a side-to-side gastrogastrostomy after failed vertical-banded gastroplasty: a case report

INTRODUCTION: Vertical-banded gastroplasty, a technique that is commonly performed in the treatment of morbid obesity, represents a nonadjustable restrictive procedure which reduces the volume of the upper stomach by a vertical stapler line. In addition, a textile or silicone band restricts food passage through the stomach. CASE PRESENTATION: A 71-year-old woman presented with a severe gastric stenosis 11 years after vertical gastroplasty. We describe a side-to-side gastrogastrostomy as a safe surgical procedure to restore the physiological gastric passage after failed vertical-banded gastroplasty. CONCLUSION: Occasionally, restrictive procedures for morbid obesity cannot be converted into an alternative bariatric procedure to maintain weight control. This report demonstrates that a side-to-side gastrogastrostomy is a feasible and safe procedure

A cervical ligamentum flavum cyst in an 82-year-old woman presenting with spinal cord compression: a case report and review of the literature

<p>Abstract</p> <p>Introduction</p> <p>We report on a very rare case of a cervical ligamentum flavum cyst, which presented with progressive myelopathy and radiculopathy. The cyst was radically extirpated and our patient showed significant recovery. A review of the relevant literature yielded seven cases.</p> <p>Case presentation</p> <p>An 82-year-old Greek woman presented with progressive bilateral weakness of her upper extremities and causalgia, cervical pain, episodes of upper extremity numbness and significant walking difficulties. Her neurological examination showed diffusely decreased motor strength in both her upper and lower extremities. Magnetic resonance imaging of her cervical spine demonstrated a large, well-demarcated cystic lesion on the dorsal aspect of her spinal cord at the C3 to C4 level, significantly compressing the spinal cord at this level, in close proximity to the yellow ligament and the C3 left lamina. The largest diameter of this lesion was 1.4 cm, and there was no lesion enhancement after the intravenous administration of a paramagnetic contrast. The lesion was surgically removed after a bilateral C3 laminectomy. The thick cystic wall was yellow and fibro-elastic in consistency, while its content was gelatinous and yellow-brownish. A postoperative cervical-spine magnetic resonance image was obtained before her discharge, demonstrating decompression of her spinal cord and dural expansion. Her six-month follow-up evaluation revealed complete resolution of her walking difficulties, improvement in the muscle strength of her arms (4+/5 in all the affected muscle groups), no causalgia and a significant decrease in her preoperative upper extremity numbness.</p> <p>Conclusion</p> <p>Cervical ligamentum flavum cysts are rare benign lesions, which should be included in the list of differential diagnosis of spinal cystic lesions. They can be differentiated from other intracanalicular lesions by their hypointense appearance on T₁-weighted and hyperintense appearance on T₂-weighted magnetic resonance images, with contrast enhancement of the cystic wall. Surgical extirpation of the cyst is required for symptom alleviation and decompression of the spinal cord. The outcome of these cysts is excellent with no risk of recurrence.</p

Shadows cast on the transition disk of HD 135344B. Multiwavelength VLT/SPHERE polarimetric differential imaging

The protoplanetary disk around the F-type star HD 135344B (SAO 206462) is in a transition stage and shows many intriguing structures both in scattered light and thermal (sub-)millimeter emission which are possibly related to planet formation processes. We study the morphology and surface brightness of the disk in scattered light to gain insight into the innermost disk regions, the formation of protoplanets, planet-disk interactions traced in the surface and midplane layers, and the dust grain properties of the disk surface. We have carried out high-contrast polarimetric differential imaging (PDI) observations with VLT/SPHERE and obtained polarized scattered light images with ZIMPOL in R- and I-band and with IRDIS in Y- and J-band. The scattered light images reveal with unprecedented angular resolution and sensitivity the spiral arms as well as the 25 au cavity of the disk. Multiple shadow features are discovered on the outer disk with one shadow only being present during the second observation epoch. A positive surface brightness gradient is observed in the stellar irradiation corrected images in southwest direction possibly due to an azimuthally asymmetric perturbation of the temperature and/or surface density by the passing spiral arms. The disk integrated polarized flux, normalized to the stellar flux, shows a positive trend towards longer wavelengths which we attribute to large aggregate dust grains in the disk surface. Part of the the non-azimuthal polarization signal in the Uphi image of the J-band observation could be the result of multiple scattering in the disk. The detected shadow features and their possible variability have the potential to provide insight into the structure of and processes occurring in the innermost disk regions.Comment: Accepted for publication in A&A, 20 pages, 15 figure

Shadows and spirals in the protoplanetary disk HD 100453

Understanding the diversity of planets requires to study the morphology and the physical conditions in the protoplanetary disks in which they form. We observed and spatially resolved the disk around the ~10 Myr old protoplanetary disk HD 100453 in polarized scattered light with SPHERE/VLT at optical and near-infrared wavelengths, reaching an angular resolution of ~0.02", and an inner working angle of ~0.09". We detect polarized scattered light up to ~0.42" (~48 au) and detect a cavity, a rim with azimuthal brightness variations at an inclination of 38 degrees, two shadows and two symmetric spiral arms. The spiral arms originate near the location of the shadows, close to the semi major axis. We detect a faint spiral-like feature in the SW that can be interpreted as the scattering surface of the bottom side of the disk, if the disk is tidally truncated by the M-dwarf companion currently seen at a projected distance of ~119 au. We construct a radiative transfer model that accounts for the main characteristics of the features with an inner and outer disk misaligned by ~72 degrees. The azimuthal brightness variations along the rim are well reproduced with the scattering phase function of the model. While spirals can be triggered by the tidal interaction with the companion, the close proximity of the spirals to the shadows suggests that the shadows could also play a role. The change in stellar illumination along the rim, induces an azimuthal variation of the scale height that can contribute to the brightness variations. Dark regions in polarized images of transition disks are now detected in a handful of disks and often interpreted as shadows due to a misaligned inner disk. The origin of such a misalignment in HD 100453, and of the spirals, is unclear, and might be due to a yet-undetected massive companion inside the cavity, and on an inclined orbit.Comment: A&A, accepte

Diagnostic Accuracy of a High-Sensitivity Cardiac Troponin Assay with a Single Serum Test in the Emergency Department.

OBJECTIVES: We sought to evaluate diagnostic accuracy of a high-sensitivity cardiac troponin I (hs-cTnI) assay for acute coronary syndromes (ACS) in the emergency department (ED). The assay has high precision at low concentrations and can detect cTnI in 96.8% of healthy individuals. METHODS: In successive prospective multicenter studies ("testing" and "validation"), we included ED patients with suspected ACS. We drew blood for hs-cTnI [Singulex Clarity® cTnI; 99th percentile, 8.67 ng/L; limit of detection (LoD), 0.08 ng/L] on arrival. Patients also underwent hs-cTnT (Roche Elecsys) testing over ≥3 h. The primary outcome was an adjudicated diagnosis of ACS, defined as acute myocardial infarction (AMI; prevalent or incident), death, or revascularization within 30 days. RESULTS: The testing and validation studies included 665 and 2470 patients, respectively, of which 94 (14.1%) and 565 (22.9%) had ACS. At a 1.5-ng/L cutoff, hs-cTnI had good sensitivity for AMI in both studies (98.7% and 98.1%, respectively) and would have "ruled out" 40.1% and 48.9% patients. However, sensitivity was lower for ACS (95.7% and 90.6%, respectively). At a 0.8-ng/L cutoff, sensitivity for ACS was higher (97.5% and 97.9%, ruling out 28.6% patients in each cohort). The hs-cTnT assay had similar performance at the LoD (24.6% ruled out; 97.2% sensitivity for ACS). CONCLUSIONS: The hs-cTnI assay could immediately rule out AMI in 40% of patients and ACS in >25%, with similar accuracy to hs-cTnT at the LoD. Because of its high precision at low concentrations, this hs-cTnI assay has favorable characteristics for this clinical application

Astrophysical false positives in direct imaging for exoplanets: a white dwarf close to a rejuvenated star

As is the case for all techniques involved in the research for exoplanets, direct imaging has to take into account the probability of so-called astrophysical false positives, which are phenomena that mimic the signature of objects we are seeking. In this work we aim to present a case of a false positive found during a direct imaging survey conducted with VLT/NACO. A promising exoplanet candidate was detected around the K2-type star HD\,8049 in July 2010.Its contrast of $\Delta H$=7.05 at 1.57 arcsec allowed us to guess the presence of a 35 \MJup companion at 50 projected AU, for the nominal system age and heliocentric distance.To check whether it was gravitationally bound to the host star, as opposed to an unrelated background object, we re-observed the system one year later and concluded a high probability of a bound system. We also used radial velocity measurements of the host star, spanning a time range of $\sim$ 30 yr, to constrain the companion's mass and orbital properties, as well as to probe the host star's spectral age indicators and general spectral energy distribution. We also obtained for the companion $U$-band imaging with EFOSC and $NIR$ spectroscopy. Combining all these information we conclude that the companion of HD\,8049 is a white dwarf (WD), with temperature $T_{eff}=18800 \pm 2100$ K and mass $M_{WD}=0.56 \pm 0.08 M_{\odot}$. The significant radial velocity trend coupled with the imaging data indicate that the most probable orbit has a semimajor axis of about 50 AU.The discrepancy between the age indicators suggested against a bona-fide young star. The moderately large level of chromospheric activity and fast rotation, mimicking the properties of a young star, might be induced by the exchange of mass with the progenitor of the WD. This example demonstrates some of the challenges in determining accurate age estimates and identifications of faint companions.Comment: 12 pages, 10 figures, 4 tables. Accepted for publication in Astronomy&Astrophysic