Acute acalculous cholecystitis due to infectious causes

Acute acalculous cholecystitis (AAC) is an inflammation of the gallbladder not associated with the presence of gallstones. It usually occurs in critically ill patients but it has also been implicated as a cause of cholecystitis in previously healthy individuals. In this subgroup of patients, infectious causes comprise the primary etiology. We, herein, discuss the pathophysiological mechanisms involved in AAC, focusing on the infectious causes. AAC associated with critical medical conditions is caused by bile stasis and gallbladder ischemia. Several mechanisms are reported to be involved in AAC in patients without underlying critical illness including direct invasion of the gallbladder epithelial cells, gallbladder vasculitis, obstruction of the biliary tree, and sequestration. We emphasize that multiple pathogenic mechanisms may concurrently contribute to the development of AAC in varying degrees. Awareness of the implicated pathogens is essential since it will allow a more focused examination of the histopathological specimens. In conclusion, additional research and a high degree of clinical suspicion are needed to clarify the complex spectrum of mechanisms that are involved in the pathogenesis of AAC.     

'Waste the Waist': the development of an intervention to promote changes in diet and physical activity for people with high cardiovascular risk

Objectives. To identify an evidence‐based intervention to promote changes in diet and physical activity and adapt it for a UK primary care setting for people with high cardiovascular risk. Design. A three‐stage mixed‐methods design was used to facilitate a strategic approach to programme selection and adaptation. Method. Stage 1: Criteria for scientific quality and local appropriateness were developed for the selection/adaptation of an intervention to promote lifestyle change in people of high cardiovascular risk through (1) patient interviews, (2) a literature search to extract evidence‐based criteria for behavioural interventions, and (3) stakeholder consultation. Stage 2: Potential interventions for adaptation were identified and ranked according to their performance against the criteria developed in Stage 1. Stage 3: Intervention mapping (IM) techniques were used to (1) specify the behavioural objectives that participants would need to reach in order to attain programme outcomes, and (2) adapt the selected intervention to ensure that evidence‐based strategies to target all identified behavioural objectives were included. Results. Four of 23 potential interventions identified met the 11 essential criteria agreed by a multi‐disciplinary stakeholder committee. Of these, the Greater Green Triangle programme ( Laatikainen et al., 2007 ) was ranked highest and selected for adaptation. The IM process identified 13 additional behaviour change strategies that were used to adapt the intervention for the local context. Conclusions. IM provided a useful set of techniques for the systematic adaptation of an existing lifestyle intervention to a new population and context, and facilitated transparent working processes for a multi‐disciplinary team.     

Anatomy and Complications Following Laparoscopic Sleeve Gastrectomy: Radiological Evaluation and Imaging Pitfalls

Background  

To evaluate the post-operative gastric anatomy depicted by upper gastrointestinal gastrografin swallow studies (UGI) and report radiological work-up and management of complications following laparoscopic sleeve gastrectomy (LSG).     

Brain hemisphericity and developmental dyslexia

The present study examined the link between brain hemisphericity and dyslexia in secondary school students, using the Preference Test (PT), a widely used self-report index of preferred hemisphere thinking styles. The hypothesis was that differences would be revealed between the dyslexic group and their peers in hemispheric preference. A total of 45 secondary school students who were diagnosed with dyslexia and attended regular public schools formed the learning disabled group. A comparison group was formed of pupils who attended the same classes (N = 90), and these were matched for age and sex with dyslexics (1 dyslexic: 2 control). The results revealed that significantly more dyslexic pupils displayed a preference for a right hemisphere thinking style compared to their peers who adopted a left hemisphere thinking style. This finding is in line with the suggestion of the greater right hemisphere involvement in the expression of developmental dyslexia.     

MR urography: Anatomical and quantitative information on congenital malformations in children

Background and Aim:

Magnetic resonance urography (MRU) is considered to be the next step in uroradiology. This technique combines superb anatomical images and functional information in a single test. In this article, we aim to present the topic of MRU in children and how it has been implemented in Northern Greece so far. The purpose of this study is to demonstrate the potential of MRU in clinical practice. We focus both on the anatomical and the quantitative information this technique can offer.

Materials and Methods:

MRU was applied in 25 children (ages from 3 to 11 years) diagnosed with different types of congenital malformations. T1 and T2 images were obtained for all patients. Dynamic, contrast-enhanced data were processed and signal intensity versus time curves were created for all patients from regions of interest (ROIs) selected around the kidneys in order to yield quantitative information regarding the kidneys function.

Results:

From the slopes of these curves we were able to evaluate which kidneys were functional and from the corticomedullary cross-over point to determine whether the renal system was obstructed or not.

Conclusion:

In all 25 cases MRU was sufficient, if not superior to other imaging modalities, to establish a complete diagnosis.