Sea-ice retreat suggests re-organization of water mass transformation in the Nordic and Barents Seas.

Water mass transformation in the Nordic and Barents Seas, triggered by air-sea heat fluxes, is an integral component of the Atlantic Meridional Overturning Circulation (AMOC). These regions are undergoing rapid warming, associated with a retreat in ice cover. Here we present an analysis covering 1950-2020 of the spatiotemporal variability of the air-sea heat fluxes along the region's boundary currents, where water mass transformation impacts are large. We find there is an increase in the air-sea heat fluxes along these currents that is a function of the currents' orientation relative to the axis of sea-ice change suggesting enhanced water mass transformation is occurring. Previous work has shown a reduction in heat fluxes in the interior of the Nordic Seas. As a result, a reorganization seems to be underway in where water mass transformation occurs, that needs to be considered when ascertaining how the AMOC will respond to a warming climate.

Endovascular management of renal artery aneurysm rupture in pregnancy - A case report.

INTRODUCTION: Renal artery aneurysm rupture is an extremely rare cause of acute abdominal pain and haemodynamic instability in pregnancy. Due to its rarity, the diagnosis may not be immediately considered, and therefore there is a high associated mortality rate for both mother and fetus. PRESENTATION OF CASE: We present a case of a 41-year old primigravida who presented to the obstetricians at 22 weeks' gestation with severe abdominal pain, shock and fetal loss. A bleeding renal artery aneurysm was discovered at laparotomy and radiologically coiled with sacrifice of the left kidney. Treatment of a contralateral aneurysm by autotransplantation of the remaining kidney allowed for preservation of residual renal function. DISCUSSION: Surgical acute abdominal presentations can be difficult to interpret in pregnant patients. Pregnancy is known to be a contributing risk factor for spontaneous rupture of renal artery aneurysms, an otherwise rare mode of aneurysm presentation. Prompt use of imaging to diagnose and treat non-obstetric causes of the acute abdomen should not be delayed because of perceived risks to the fetus. Endovascular arrest of aneurysmal haemorrhage may be more effect in the context of a gravid uterus than surgical management. CONCLUSION: In the shocked pregnant patient with an acute abdominal presentation, visceral artery aneurysm rupture may be comparatively more common, and should be considered in the absence of other localizing symptoms. Prompt interventional radiological treatment may be lifesaving in such cases.

Clinical and biomarker profile of trauma-induced secondary cardiac injury.

BACKGROUND: Secondary cardiac injury has been demonstrated in critical illness and is associated with worse outcomes. The aim of this study was to establish the existence of trauma-induced secondary cardiac injury, and investigate its impact on outcomes in injured patients. METHODS: Injured adult patients eligible for enrolment in the Activation of Coagulation and Inflammation in Trauma 2 study, and admitted to the intensive care unit between January 2008 and January 2010, were selected retrospectively for the study. Markers of cardiac injury (brain natriuretic peptide (BNP), heart-type fatty acid binding protein (H-FABP) and troponin I) were measured on admission, and after 24 and 72 h in blood samples from injured patients. Individual records were reviewed for adverse cardiac events and death. RESULTS: During the study period, 135 patients were enrolled (106 male, 78·5 per cent) with a median age of 40 (range 16-89) years. Eighteen patients (13·3 per cent) had an adverse cardiac event during admission and these events were not associated with direct thoracic injury. The in-hospital mortality rate was higher among the adverse cardiac event cohort: 44 per cent (8 of 18) versus 17·1 per cent (20 of 117) (P = 0·008). Raised levels of H-FABP and BNP at 0, 24 and 72 h, and troponin I at 24 and 72 h, were associated with increased adverse cardiac events. BNP levels were higher in non-survivors on admission (median 550 versus 403 fmol/ml; P = 0·022), after 24 h (794 versus 567 fmol/ml; P = 0·033) and after 72 h (1043 versus 753 fmol/ml; P = 0·036), as were admission troponin I levels. CONCLUSION: Clinical and cardiac biomarker characteristics support the existence of trauma-induced secondary cardiac injury, which is associated with death, and unrelated to direct thoracic injury.

A case series of interventional radiology in postpartum haemorrhage.

Postpartum haemorrhage (PPH) remains a significant cause of maternal morbidity and mortality in both developed and developing countries. In some instances, PPH can be anticipated and recent improvements in obstetric imaging techniques allow earlier and more reliable diagnosis of abnormalities associated with haemorrhage such as morbid placentation. However, the majority of PPH is unpredicted. Good practice notes published by the Royal College of Obstetricians and Gynaecologists state interventional radiology should be used as emergency intervention in PPH and should be considered when primary management has failed allowing arteries to be embolised to achieve haemostasis. Through collaboration between interventional radiology and maternity, appropriate guidelines need to be developed, on both emergency and elective of interventional radiology in the prevention and management of PPH. As there is mapping for neonatal services, in the future there should be consideration to develop obstetric trauma units. Maternity units which lack facilities for interventional radiology would be able to refer their cases (like placenta accreta) for safe management in units with 24 h interventional radiology services.

Role of interventional radiology in the management of morbidly adherent placenta.

The incidence of morbidly adherent placenta is rising and is directly proportional to the rate of rise of caesarean deliveries. Despite improvement in antenatal diagnosis, by accuracy of ultrasound and MRI techniques, placenta accreta is still associated with a high maternal morbidity rate. Management of pregnancies with a morbidly adherent placenta is extremely challenging and is becoming an increasingly common problem for maternity units globally. The main challenges include controlling the haemorrhage and dissection of the invaded tissues. Traditionally, these cases were managed by caesarean hysterectomy. There has now been a shift towards conservative management of placenta accreta, involving uterine and placental conservation, with the aid of interventional radiology by means of insertion of occluding balloons into appropriate vessels. We describe three cases of morbidly adherent placentas, managed at our unit where meticulous preoperative planning, multidisciplinary approach and the key role of interventional radiology led to a safe outcome for both the mother and the baby.

Rectus sheath haematoma associated with low molecular weight heparin: a case series.

A report of three cases of spontaneous rectus sheath haematoma within a 1-month period in a single hospital. The common feature was the recent treatment with low molecular weight heparin. In contrast to the perceived benign nature of the classically-described haematoma, the cases described were life-threatening and required aggressive intervention.

Spiral CT pneumocolon: applications, status and limitations.

CT pneumocolon is a promising new technique in the diagnosis and management of colon pathology. CT pneumocolon can detect (sensitivity >95%) and stage (accuracy 79%) colorectal cancer and is very accurate in the differentiation of malignant from benign colonic pathologies. It has excellent detection rates for polyps >10 mm in diameter. Several studies using 3D virtual colonoscopy have already proven its high sensitivity and specificity in polyp detection making this technique robust as a screening tool. The combined results for virtual colonoscopy, from all centres, show a sensitivity of >85% in the detection of polyps 10 mm or greater in size, 70-80% for 5-9 mm polyps and an overall specificity of 90%. CT pneumocolon is a safe, non-invasive and cost-effective method for detecting colonic carcinomas and adenomas and correctly identifying which patients need further colonoscopy. The technique is quick, well tolerated and non-operator dependent. It can also image the proximal colon when distal stenoses prevent endoscopic and barium examination. CT pneumocolon is able to identify the features and complications of inflammatory bowel disease. Further research is warranted to fully assess its impact in terms of a screening tool, acceptability, availability and cost benefit.

Dose reduction in evacuation proctography.

The goal of this study was to reduce the patient radiation dose from evacuation proctography. Ninety-eight consecutive adult patients referred for proctography to investigate difficult rectal evacuation were studied using a digital imaging system with either a standard digital program for barium examinations, a reduced dose digital program (both with and without additional copper filtration), or Video fluoroscopy. Dose-area products were recorded for each examination and the groups were compared. All four protocols produced technically acceptable examinations. The low-dose program with copper filtration (median dose 382 cGy cm2) and Video fluoroscopy (median dose 705 cGy cm2) were associated with significantly less dose than other groups (p < 0.0001). Patient dose during evacuation proctography can be reduced significantly without compromising the diagnostic quality of the examination. A digital program with added copper filtration conveyed the lowest dose.