Transvenous endovascular repair of symptomatic type II endoleak following endovascular repair of a ruptured common iliac aneurysm with arteriovenous fistula.

Arteriovenous fistula (AVF) is an uncommon presentation of ruptured aortoiliac aneurysm (rAIA). Symptomatic persistence of an AVF fed by a type II endoleak after endovascular aneurysm repair (EVAR) for rAIA is rare, with little in the literature to guide practice. We present a novel transvenous approach to treatment of symptomatic type II endoleak after EVAR for rAIA with AVF. A transvenous approach avoids complex arterial access and the need for stenting in the venous system. This technique should be considered in patients with persistent AVF after EVAR with ongoing symptomatic type II endoleak.

Reducing inflow occlusion, occlusion duration and blood loss during hepatic resections.

BACKGROUND: To assess the changes in blood loss during hepatic resection with improved haemostatic devices such as a bipolar sealing device and a topical haemostatic agent. METHODS: This retrospective clinical study of prospectively collected data will assess hepatic resections performed by a single surgeon between 2005 and 2013, with the introduction of the two haemostatic techniques in 2009. RESULTS: A total of 371 hepatic resections (214 from 2005 to 2008 and 157 from 2009 to 2013) were included in this study. Compared with the conventional hepatic resection (2005-2008), the use of haemostatic techniques (2009-2013) significantly reduced the need for inflow occlusion (OR: 0.37, 95% CI: 0.24-0.57, P < 0.001), overall occlusion time (20.8 min versus 25.9 min, P = 0.04) and transfusion requirement (4.6% versus 12%, OR: 0.35, 95% CI: 0.14-0.90, P = 0.02). Mean overall blood loss was reduced post-2009; however, the decrease was not statistically different (401.3 mL versus 470.8 mL, P = 0.27). Subgroup analysis revealed that blood loss was more than halved post-2009 compared with pre-2009 for patients who received pre-operative chemotherapy (324.6 mL versus 738.5 mL, P = 0.005). CONCLUSION: The use of a bipolar sealing device and a topical haemostatic agent reduces the need for inflow occlusion, overall occlusion time and transfusions in all patients compared with conventional hepatic resections.

Evidence based exercise - clinical benefits of high intensity interval training.

BACKGROUND: Aerobic exercise has a marked impact on cardiovascular disease risk. Benefits include improved serum lipid profiles, blood pressure and inflammatory markers as well as reduced risk of stroke, acute coronary syndrome and overall cardiovascular mortality. Most exercise programs prescribed for fat reduction involve continuous, moderate aerobic exercise, as per Australian Heart Foundation clinical guidelines. OBJECTIVE: This article describes the benefits of exercise for patients with cardiovascular and metabolic disease and details the numerous benefits of high intensity interval training (HIIT) in particular. DISCUSSION: Aerobic exercise has numerous benefits for high-risk populations and such benefits, especially weight loss, are amplified with HIIT. High intensity interval training involves repeatedly exercising at a high intensity for 30 seconds to several minutes, separated by 1-5 minutes of recovery (either no or low intensity exercise). HIT is associated with increased patient compliance and improved cardiovascular and metabolic outcomes and is suitable for implementation in both healthy and 'at risk' populations. Importantly, as some types of exercise are contraindicated in certain patient populations and HIIT is a complex concept for those unfamiliar to exercise, some patients may require specific assessment or instruction before commencing a HIIT program.

Meniscal tear - presentation, diagnosis and management.

BACKGROUND: Medial and lateral knee joint menisci serve to transfer load and absorb shock, aid joint stability and provide lubrication. The meniscus is the most commonly injured structure in the knee joint. Imaging techniques such as magnetic resonance imaging may be warranted but are no substitute for thorough clinical history and examination. OBJECTIVE: This article outlines the aetiology, presentation, diagnosis (both clinical and radiographic) and management of these important injuries. DISCUSSION: Magnetic resonance imaging can confirm clinical concern for meniscal tear, review intra- and extra-articular anatomical structures and exclude alternative diagnoses. Meniscal tears can be assessed arthroscopically for stability and vascularity. Even partial meniscectomy may lead to osteoarthritis. On the basis of the findings, treatment can be considered in terms of four Rs: Rest and Rehabilitate the patient (with physiotherapy), and if the patient is not improving on Review, Refer to an orthopaedic surgeon. New experimental surgical techniques seek to replace damaged tissue. These include meniscal allograft transplantation, biosynthetic scaffolds, growth factor and gene therapy, or a combination of these.