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The occurrence of spontaneous bladder rupture during labor or the postpartum period after an uncomplicated vaginal delivery is exceedingly uncommon. However, we encountered a case involving spontaneous bladder rupture, which resulted in the development of localized fluid collections in the abdomen after an uncomplicated vaginal delivery. In this instance, the absence of typical peritonitis symptoms, such as abdominal pain or tenderness, and the lack of typical urological symptoms, including haematuria, dysuria, and anuria, coupled with the absence of clinical manifestations of puerperal sepsis, the absence of microbial presence in the ascitic fluid, and the patient’s symptomatic amelioration following antibiotic therapy, contributed to a delay in identifying the bladder rupture. The initial management entailed the use of a percutaneous drain, followed by surgical correction of the rupture through laparotomy. This case underscores the necessity of considering intraperitoneal bladder rupture as a plausible diagnosis in cases of enclosed ascitic fluid with multiple partitions following childbirth. Additionally, it prompts considering non-surgical management for substantial intraperitoneal bladder ruptures in asymptomatic patients.

Background Around 5% of patients with cirrhosis of the liver develop hepatic hydrothorax (HH). For patients with refractory HH (RHH), transjugular intrahepatic portosystemic shunt (TIPS) has been investigated in small studies. Hence, the present meta-analysis aimed to summarize the current data on the outcome of TIPS in patients with RHH.

Uterine artery pseudoaneurysm (UAP) following abdominal hysterectomy is an uncommon complication. However, it can cause life-threatening bleeding, necessitating early diagnosis and intervention. Imaging is vital in its prompt diagnosis and aids in planning interventions. Here, we describe a case of recurrent massive per-vaginal bleeding from a left UAP developed following total abdominal hysterectomy and bilateral salpingo-oophorectomy. Bleeding was successfully managed with percutaneous ultrasound-guided glue (N-butyl cyanoacrylate) injection into the aneurysmal sac. The patient is doing well without any recurrent bleeding.

Abstract Materials with field-tunable polarization are of broad interest to condensed matter sciences and solid-state device technologies. Here, using hydrogen (H) donor doping, we modify the room temperature metallic phase of a perovskite nickelate NdNiO3 into an insulating phase with both metastable dipolar polarization and space-charge polarization. We then demonstrate transient negative differential capacitance in thin film capacitors. The space-charge polarization caused by long-range movement and trapping of protons dominates when the electric field exceeds the threshold value. First-principles calculations suggest the polarization originates from the polar structure created by H doping. We find that polarization decays within ~1 second which is an interesting temporal regime for neuromorphic computing hardware design, and we implement the transient characteristics in a neural network to demonstrate unsupervised learning. These discoveries open new avenues for designing ferroelectric materials and electrets using light-ion doping.

Background: Wunderlich syndrome is an uncommon entity characterized by spontaneous, nontraumatic renal bleeding into the subcapsular and perirenal regions. The most frequent benign tumor, angiomyolipoma, is the most common cause of Wunderlich syndrome.Case presentation: We report a case of Wunderlich syndrome in angiomyolipoma. Intratumoral pseudoaneurysm arising from feeders of an accessory renal artery supplying the lower pole of the kidney was selectively embolized. Rarely does a sporadic renal angiomyolipoma develop a giant pseudoaneurysm.Conclusion: Transarterial embolization is imperative to control the bleeding or as a preventative measure to reduce the risk of intralesional pseudoaneurysm rupture. When vascular interventional facilities are unavailable, surgery may be necessary.

Biliary fistula and bile leak are known complications following hepatobiliary surgery, trauma, and percutaneous biliary interventions. In the case of an isolated biliary system with a prolonged indwelling percutaneous transhepatic biliary drainage (PTBD) catheter, a biliary-cutaneous fistula (BCF) may develop after catheter blockage or its accidental slippage. Due to the absence of internal drainage, secreted bile flows through the matured PTBD tract to form a fistula. If left untreated, chronic BCF will result in malabsorption, infection, and delayed wound healing. Here, we report a case of left-sided BCF following prolonged PTBD for Bismuth type II cholangiocarcinoma (metastatic disease), which was initially managed by bile duct ablation using N-butyl cyanoacrylate. The patient further needed fistulous tract embolization to obliterate the BCF.

The metal-insulator transition is well-known phenomenon in condensed-matter physics but the mechanisms driving the insulating state can vary from system to system and so understanding the underlying physics is complex. Here, the authors investigate electronic structure of single crystalline, Ca-doped NdNiO3 using synchrotron measurements and DFT calculations, illuminating the importance of bond disproportionation in the observed properties.

Hepatic arterioportal fistula (APF) in the setting of cirrhosis may aggravate the preexisting portal hypertension and its complications. Cirrhotic patients undergo various percutaneous invasive procedures and are at risk of developing an APF. These should be diagnosed early and should be treated accordingly at the earliest when indicated. Presently embolization is the treatment of choice with coil embolization as the most commonly used method. We describe four cases from our institute with a history of liver parenchymal disease and were found to have acquired APF on imaging. These were successfully managed with transarterial embolization with resolution or improvement in their clinical symptoms on follow-up. The present case series and review emphasize the importance of APF in the setting of liver parenchymal disease and the role of early diagnosis and therapeutic intravascular interventions.

Abstract Background Retroperitoneal nodal metastasis in a primary testicular tumor is not uncommon and usually presents as solid or solid-cystic nodal masses. A completely cystic appearance with fluid attenuation or fluid signal intensity on computed tomography (CT) and magnetic resonance imaging (MRI), respectively, is an uncommon presentation. There are many case reports of different types of cystic retroperitoneal masses; however, to our knowledge, metastatic retroperitoneal cystic masses showing fluid attenuation/fluid signal intensity on CT/ MRI secondary to primary testicular seminoma masquerading as cystic lymphangioma has been rarely reported in the medical literature. Our case report reports a case of a metastatic retroperitoneal cystic mass in a known case of testicular seminoma patient, which was misdiagnosed as cystic lymphangioma initially based on imaging. Case presentation A 55-year-old—patient presented to our hospital with abdominal pain, which was on and off in character. The patient underwent routine ultrasound abdomen, CT and MRI, which revealed multiple cystic lesions in the retroperitoneum. Initially, a provisional diagnosis of cystic lymphangioma was made based on the utterly cystic nature of the lesion and the presence of calcification. However, fine-needle aspiration cytology (FNAC) confirmed the metastatic origin of the lesion and was strengthened by the previous clinical history of orchidectomy. Conclusion The treatment strategy for cystic retroperitoneal masses varies depending on the cause and its nature, so differentiation between the cystic masses is essential. Metastasis should also be kept in the differentials in all cystic retroperitoneal masses. Moreover, clinical history and FNAC can assist in making the correct diagnosis.

The surgical relevance of Makuuchi ligament (inferior vena cava ligament) has been less explored, especially in pediatric population. With the advent of major hepatectomies and liver transplantation indicated for various malignancies and metabolic conditions in children, knowledge about IVC ligament seems essential, in terms of its draining vessels, contained hepatic tissue and close relation with caudate lobe. Herein, we present a 2 years old female child diagnosed with hepatoblastoma (PRE-Treatment-EXTent of tumor II and POST-Treatment EXTent of tumor II) (PRETEXT II, and POSTTEXT II), with tumor involving right hepatic vein, who underwent right hepatectomy. Intraoperatively, after liver mobilization, we encountered a long IVC ligament, in the form of a broad membranous ligament bridging the left and right sides of caval groove encircling IVC completely. With the help of Cavitron Ultrasonic Aspirator (CUSA) and fine Ligaclips, the IVC ligament was meticulously ligated before tumor handling, preventing any major intraoperative bleeding, bile leak and possible tumor spread. Segments V-VIII were resected out to complete a formal anatomical right hepatectomy. The child was shifted to intensive care unit (ICU) on ventilator for postoperative recovery and care. Postoperatively, we did not encounter any signs of hepatic failure and the subhepatic drain output was persistently minimal without any bleed or bile leak.

Introduction: Infectious disease is an important contributor to disability and death in Sickle Cell Haemoglobinopathy (SCH). India has a high burden of Tuberculosis (TB) and SCH is widespread among residents in and around Burla, Odisha. This was the first attempt to find the prevalence of SCH in active cases of TB in Indian adults. Aim: To estimate the prevalence of SCH in TB and to evaluate the demographic and clinicoradiological presentation of TB in patients with SCH in a subset of Indian population. Materials and Methods: A cross-sectional study was conducted from October 2010 to September 2012 in Department of Pulmonary Medicine of VSSMC, Burla, Odisha, India. The primary inclusion criterion was patients with TB and SCH. Demographic characteristics, clinical, radiological, microbiological and histopathology data were collected. Statistical analysis was done using Statistical Package of the Social Sciences (SPSS) 18.0. Association between categorical data was calculated using Chi-square test and Fisher’s exact test. A p-value of

Paracentesis is a routinely performed low-risk daycare procedure most commonly performed in patients with cirrhosis. Although uncommon, devastating bleeding complications may occur, particularly in patients with coagulopathy. Hence to avoid any such complication, it is important for the intervention radiologists, as well as clinicians, particularly beginners, to have basic knowledge of the major anterior abdominal wall arteries, their course, and their sonographic appearance. Here, we briefly describe the relevant abdominal wall anatomy and sonographic planes to use for paracentesis.

Heterostructure engineering provides an efficient way to obtain several emergent phases of LaNiO3, as demonstrated in recent studies. In this work, a new class of short-periodic superlattice, consisting of LaNiO3 and EuNiO3, has been grown by pulsed laser interval deposition to investigate the effect of structural symmetry mismatch on the electronic and magnetic behaviors. Using synchrotron-based soft and hard x-ray resonant scattering experiments, we have found that these heterostructures undergo simultaneous electronic and magnetic transitions. Most importantly, LaNiO3 within these artificial structures exhibits a new antiferromagnetic, charge ordered insulating phase, which may be a potential candidate to achieve high temperature superconductivity.

Hepatic vein recanalization in Budd–Chiari syndrome may require procedural modification if the endovascular approach fails. Sharp recanalization using the stiff end of a guidewire or a thin Chiba needle remains an effective technique in difficult-to-cross hepatic vein stricture. Of note, this technique requires utmost precaution to avoid catastrophic hemorrhage. The present case describes the successful recanalization of the middle hepatic vein using a 21-gauge Chiba needle through the percutaneous transhepatic route.

Background Preoperative magnetic resonance imaging (MRI) has an important role in the management and prognostication of parotid gland tumors. We aim to evaluate the role of multiparametric MRI in differentiating the major subgroup of parotid tumors.