Endovascular Treatment of a Right-Sided Ureteroiliac Fistula in a Patient with a Simultaneous Left-Sided Ureteroileal Fistula

We describe an 80-year-old female with a left ureteroileal fistula and simultaneously a right ureteroiliac fistula. Her history highlights the predisposing factors of radiation, major surgery in the region, and presence of bilateral double-J-stents. She was successfully treated with an endovascular approach after being initially misdiagnosed. There seems to be an increase in reporting ureteral fistulas, however this entity remains a rare clinical condition that can lead to life-threatening situations. A fast and accurate diagnosis of an ureteroarterial fistula remains a challenge

A clinician’s guide to management of intra-abdominal hypertension and abdominal compartment syndrome in critically ill patients

This article is one of ten reviews selected from the Annual Update in Intensive Care and Emergency Medicine 2020. Other selected articles can be found online at . Further information about the Annual Update in Intensive Care and Emergency Medicine is available from http://www.springer.com/series/8901

Synchronous Laparoscopic Radical Nephrectomy Left and Contralateral Right Hemicolectomy during the Same Endoscopic Procedure

Synchronous renal cell carcinoma in patients with colorectal carcinoma is reported in various percentages ranging from 0.03 up to 4.85% (Halak et al. (2000), Capra et al. (2003)). When surgical treatment is indicated usually two separate operations are planned for resection. In open surgery, in such cases simultaneous resection is recommended if possible. Few reports have described the resection of colorectal and renal cell carcinoma in a single laparoscopic procedure. We have shown that combining left radical nephrectomy and right hemicolectomy is technically feasible, safe and that overall operative time can be limited. In our case operative time was 210 minutes, blood loss 100 milliliters, and duration of hospital stay was 8 days. Adequate port placement, preoperative scheduling, and surgical experience are essential to achieve this goal

Climate, people, fire and vegetation: new insights into vegetation dynamics in the Eastern Mediterranean since the 1st century AD

Anatolia forms a bridge between Europe, Africa and Asia and is influenced by all three continents in terms of climate, vegetation and human civilisation. Unfortunately, well-dated palynological records focussing on the period from the end of the classical Roman period until subrecent times are rare for Anatolia and completely absent for southwest Turkey, resulting in a lacuna in knowledge concerning the interactions of climatic change, human impact, and environmental change in this important region. Two well-dated palaeoecological records from the Western Taurus Mountains, Turkey, provide a first relatively detailed record of vegetation dynamics from late Roman times until the present in SW Turkey. Combining pollen, non-pollen palynomorphs, charcoal, sedimentological, archaeological data, and newly developed multivariate numerical analyses allows for the disentangling of climatic and anthropogenic influences on vegetation change. Results show changes in both the regional pollen signal as well as local soil sediment characteristics match shifts in regional climatic conditions. Both climatic as well as anthropogenic change had a strong influence on vegetation dynamics and land use. A moist environmental trend during the late-3rd century caused an increase in marshes and wetlands in the moister valley floors, limiting possibilities for intensive crop cultivation at such locations. A mid-7th century shift to pastoralism coincided with a climatic deterioration as well as the start of Arab incursions into the region, the former driving the way in which the vegetation developed afterwards. Resurgence in agriculture was observed in the study during the mid-10th century AD, coinciding with the Medieval Climate Anomaly. An abrupt mid-12th century decrease in agriculture is linked to socio-political change, rather than the onset of the Little Ice Age. Similarly, gradual deforestation occurring from the 16th century onwards has been linked to changes in land use during Ottoman times. The pollen data reveal that a fast rise in <i>Pinus</i> pollen after the end of the Beyşehir Occupation Phase need not always occur. The notion of high <i>Pinus</i> pollen percentages indicating an open landscape incapable of countering the influx of pine pollen is also deemed unrealistic. While multiple fires occurred in the region through time, extended fire periods, as had occurred during the Bronze Age and Beyşehir Occupation Phase, did not occur, and no signs of local fire activity were observed. Fires were never a major influence on vegetation dynamics. While no complete overview of post-BO Phase fire events can be presented, the available data indicates that fires in the vicinity of Gravgaz may have been linked to anthropogenic activity in the wider surroundings of the marsh. Fires in the vicinity of Bereket appeared to be linked to increased abundance of pine forests. There was no link with specifically wet or dry environmental conditions at either site. While this study reveals much new information concerning the impact of climate change and human occupation on the environment, more studies from SW Turkey are required in order to properly quantify the range of the observed phenomena and the magnitude of their impacts

Validation of less-invasive hemodynamic monitoring with Pulsioflex in critically ill patients

status: publishe