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Background: Blunt and penetrating liver trauma is common and often presents major diagnostic and management problems. Methods: A literature review was undertaken to determine the current consensus on investigation and management strategies. Results: The liver is the most frequently injured organ following abdominal trauma. Immediate assessment with ultrasound has replaced diagnostic peritoneal lavage in the resuscitation room, but computerised tomography remains the gold standard investigation. Nonoperative management is preferred in stable patients but laparotomy is indicated in unstable patients. Damage control techniques such as perihepatic packing, hepatotomy plus direct suture, and resectional debridement are recommended. Major complex surgical procedures such as anatomical resection or atriocaval shunting are now thought to be redundant in the emergency setting. Packing is also recommended for the inexperienced surgeon to allow control and stabilisation prior to transfer to a tertiary centre. Interventional radiological techniques are becoming more widely used, particularly in patients who are being managed nonoperatively or have been stabilised by perihepatic packing. Conclusions: Management of liver injuries has evolved significantly throughout the last two decades. In the absence of other abdominal injuries, operative management can usually be avoided. Patients with more complex injuries or subsequent complications should be transferred to a specialist centre to optimise final outcome. [ABSTRACT FROM AUTHOR]

Hypoxia-inducible factor (HIF) is central in coordinating many of the transcriptional adaptations to hypoxia. Composed of a heterodimer of α and β subunits, the α subunit is rapidly degraded in normoxia, leading to inactivation of the hypoxic response. Many models for a molecular oxygen sensor regulating this system have been proposed, but an important finding has been the ability to mimic hypoxia by chelation or substitution of iron. A key insight has been the recognition that HIF-α is targeted for degradation by the ubiquitin-proteasome pathway through binding to the von Hippel-Lindau tumour suppressor protein (pVHL), which forms the recognition component of an E3 ubiquitin ligase complex leading to ubiquitylation of HIF-α. Importantly, the classical features of regulation by iron and oxygen availability are reflected in regulation of the HIF-α /p VHL interaction. It has recently been shown that HIF-α undergoes an iron- and oxygen-dependent modification before it can interact with pVHL, and that this results in hydroxylation of at least one prolyl residue (HIF-1α, Pro 564). This modification is catalysed by an enzyme termed HIF-prolyl hydroxylase (HIF-PH), and compatible with all previously described prolyl-4-hydroxylases HIF-PH also requires 2-oxoglutarate as a cosubstrate. The key position of this hydroxylation in the degradation pathway of HIF-α, together with its requirement for molecular dioxygen as a co-substrate, provides the potential for HIF-PH to function directly as a cellular oxygen sensor. However, the ability of these enzyme(s) to account for the full range of physiological regulation displayed by the HIF system remains to be defined. [ABSTRACT FROM AUTHOR]

Dissection of the descending aorta post coarctation repair in a patient with Turner's syndrome has rarely been described. A 45-year-old woman with Turner's syndrome had repair of coarctation by resection and interposition graft. Her postoperative course was uneventful. Chest X-ray two months postoperatively showed a hematoma in the proximal descending aorta, and a CT scan confirmed dissection distal to the coarctation repair, which was treated medically. Subsequent CT scanning one year later showed the hematoma resolving with no increase in the diameter of the dissected segment. [ABSTRACT FROM AUTHOR]

A patient was referred for coronary artery bypass reoperation. The right internal mammary artery (RIMA) was anastomosed to the left anterior descending artery (LAD) and a left radial artery graft (RA) was sequentially anastomosed to the posterior descending artery (PDA) and left ventricular branches (LVB) of the right coronary artery (RCA). The patent proximal stump of an occluded saphenous vein graft was used as an interposition segment to lengthen the RA graft, thereby avoiding the need for a further anastomosis on the ascending aorta.