Congenital peritoneal encapsulation: A review and novel classification system.

Congenital peritoneal encapsulation (CPE) is a very rare, congenital condition characterised by the presence of an accessory peritoneal membrane which encases a variable extent of the small bowel. It is unclear how CPE develops, however it is currently understood to be a result of an aberrant adhesion in the peritoneal lining of the physiological hernia in foetal mid-gut development. The condition was first described in 1868, and subsequently there have been only 45 case reports of the phenomenon. No formal, systematised review of CPE has yet been performed, meaning the condition remains poorly understood, underdiagnosed and mismanaged. Diagnosis of CPE remains clinical with important adjuncts provided by imaging and diagnostic laparoscopy. Two thirds of patients present with abdominal pain, likely secondary to sub-acute bowel obstruction. A fixed, asymmetrical distension of the abdomen and differential consistency on abdominal palpation are more specific clinical features present in approximately 10% of cases. CPE is virtually undetectable on plain imaging, and is only detected on 40% of patients with computed tomography scan. Most patients will undergo diagnostic laparotomy to confirm the diagnosis. Management of CPE includes both medical management of the critically-unstable patient and surgical laparotomy, partial peritonectomy and adhesiolysis. Prognosis following prompt surgical treatment is excellent, with a majority of patients being symptom free at follow up. This review summarises the current literature on the aetiology, diagnosis and treatment of this rare disease. We also introduce a novel classification system for encapsulating bowel diseases, which may distinguish CPE from the commoner, more morbid conditions of abdominal cocoon and encapsulating peritoneal sclerosis.

The inferior mesenteric artery arising as a persistence of the ventral longitudinal anastomosis: A rare anatomical variation

Routine dissection of an 82-year-old cadaver demonstrated the inferior mesenteric artery arising from two roots: one from the coeliac trunk, and the other from the superior mesenteric artery. There was no discrete connection between the inferior mesenteric artery and the aorta. This variant artery gave off its characteristic branches, including left colic and sigmoidal branches.This can be explained as an abnormal persistence of the ventral longitudinal anastomotic channel. Furthermore, an understanding of the breadth of variations of mesenteric vasculature is essential to surgeons and proceduralists of the gastro-intestinal tract, and may have implications in cancer, retroperitoneal and endovascular surgery

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Gender and age based differences in behavioural patterns following anterior cruciate ligament injury.

ACL injury can be clinically diagnosed prior to imaging, and therefore understanding any symptomatology differences between age-groups and genders is critical. Data gathered from 341 patients with ACL injuries over six years showed no gender-based difference in ability to continue playing sport post-injury. Fewer males required crutches (37.2% vs. 49.5%, p = 0.04) and more males returned to sports prior to treatment (24.4% vs. 14.1%, p = 0.04). There was no age based difference in play continuation post-injury, however more elderly patients fell post-injury (<30 y: 91.9%, 30 y 83.8%, p = 0.02). Therefore, there are few differences in behavioural patterns following ACL injury based on age or sex.

Peritoneal encapsulation as a cause of chronic recurrent abdominal pain in a young male.

This case report describes an otherwise well 20-year-old male who presented to hospital with vague, long-standing abdominal symptoms and was found to have peritoneal encapsulation.

A short-term follow-up study of a surgeon-customised fully-coated hydroxyapatite femoral stem using a nation-wide joint registry.

OBJECTIVE: To compare revision rates between otherwise-identical fully-coated and proximally-coated hydroxyapatite (HA) femoral stems using a nation-wide registry. METHODS: 249 proximally-coated stems (50 µm HA) and 225 fully-coated stems (100 µm HA and 50 µm titanium) were followed over a mean of 34.9 and 23.2 months respectively. RESULTS: Four proximally-coated (rate: 1.61%) and five fully-coated stem revisions (rate: 2.20%) were reported, with no statistical difference between groups (p = 1.0, OR 0.90, 95% CI 0.20-3.97). Registry data showed no difference in performance between fully-coated and proximally-coated stems nationwide (rate: 2.22%, p = 0.82). CONCLUSION: There is no statistical difference in survival between fully-coated and proximally-coated HA prostheses in the short-term.

Reproductive Hormones and Longitudinal Change in Bone Mineral Density and Incident Fracture Risk in Older Men: The Concord Health and Aging in Men Project.

The objectives of this study were to examine relationships between baseline levels of reproductive hormones in older men and (1) change in bone mineral density (BMD) over 5 years and (2) incident fractures over an average of 6 years' follow-up. A total of 1705 men aged 70 years and older from the Concord Health and Ageing in Men Project (CHAMP) study were assessed at baseline (2005-2007), 2 years follow-up (2007-2009), and 5 years follow-up (2010-2013). At baseline, testosterone (T), dihydrotestosterone (DHT), estradiol (E2), and estrone (E1) were measured by liquid chromatography-tandem mass spectrometry (LC-MS/MS), and sex hormone-binding globulin (SHBG), luteinizing hormone (LH), and follicle-stimulating hormone (FSH) by immunoassay. Hip BMD was measured by dual X-ray absorptiometry (DXA) at all three time-points. Fracture data were collected at 4-monthly phone calls and verified radiographically. Statistical modeling was by general estimating equations and Cox model regression. Univariate analyses revealed inverse associations for serum SHBG, FSH, and LH and positive association for E1 but not DHT or E2 with BMD loss at the hip across the three time points. Serum levels of SHBG (ß = -0.071), FSH (ß = -0.085), LH (ß = -0.070), and E1 (ß = 0.107) remained significantly associated with BMD loss in multivariate-adjusted models; however, we were unable to identify any thresholds for accelerated BMD loss according to reproductive steroids. Incident fractures (all, n = 171; hip, n = 44; and nonvertebral, n = 139) were all significantly associated with serum SHBG, FSH, and LH levels in univariate models but none remained significantly associated in multivariate-adjusted model. Serum T, DHT, E2, and E1 levels were not associated with incident fractures in univariate or multivariate-adjusted analyses. In older men, lower serum SHBG, FSH, and LH and higher E1 levels protected against loss of BMD without increasing fracture rate. This means these reproductive variables may be considered as novel biomarkers of bone health during male aging.