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Small bowel obstruction has been noted to occur in anywhere from 1-10% of patients with a history of abdominal surgery, and in 4.7% of patients after robotic surgery, all of these studies have focused mainly on adhesions being the source of obstruction

The abdomen is unique to have two venous systems—the systemic and portal system. The systemic venous network drains directly into the inferior vena cava, whereas the portal system delivers the blood to the liver via the hepatic portal vein. The portal venous blood gets filtered through the hepatic sinusoids to enter the hepatic veins and finally the inferior vena cava. The mesenteric and splenic veins are its main tributaries but smaller veins from the stomach, pancreas, and gallbladder also contribute to this system. The portal venous system is subject to various congenital and acquired disorders, most importantly portal venous obstruction/thrombosis and portal hypertension. Proper understanding of the anatomy of the portal venous system is imperative for the diagnosis, management, and effective treatment planning of these disorders. Variant anatomy and congenital anomalies of the portal venous system are particularly important to identify in the context of consideration of liver transplantation or hepatic resections and interventional procedures like transjugular intrahepatic portosystemic shunt, portal vein embolization, etc. In this chapter, we will review the embryology and anatomy of the portal venous system, discuss its complex tributaries, and also succinctly learn about relevant anatomical and topographical variants in light of their significance prior to surgical or interventional treatments.

Assessing internal decay in tree trunks can be of crucial importance for industrial, environmental and public safety reasons [1]. To this effect, non-destructive testing (NDT) methods can provide information on the structural condition of trees with minimum intrusion. In this work, authors have analysed the capabilities of ultrasonic tomography in evaluating the internal structure of living trees, with a special focus on the identification of internal decay areas and tree bark inclusions.The presented ultrasonic tomography provides an image of the distribution of the ultrasonic velocity of propagation within the investigated section of a mature horse chestnut (Aesculus hippocastanum). This technique has proven its viability to detect fungal decomposition [2]. However, there exist some open issues with regard to: a) the coupling of the transducers to the tree, b) the anisotropy of the wood, c) the signal attenuation and the resolution of the tomographic inversion. To overcome these challenges, research is underway to explore the integration and new data-fusion strategies with other NDT methods, such as ground penetrating radar (GPR), which have proven their effectiveness within this area of endeavour [3].Within this context, data have been obtained from a “diseased” horse chestnut tree located at the Kensington Gardens – The Royal Parks – in London, UK, using two different ultrasonic equipment, i.e., the PICUS Sonic Tomograph and the Arbotom Sonic Tomograph. After compilation of data, the tree was felled and cut at the two sections where ultrasonic tomography tests were performed. In more detail, 12 sensors were arranged around the perimeter of the tree in compliance with the manufacturer’s recommendations concerning the inspection methodology (sensors installed within the bark of the tree without any intrusion to the core of the tree). The adopted methodology takes to account the shape and size of the trunk [1]. The processed data were mapped against the cut sections of the tree for validity purposes. Results presented in this abstract are part of a major ongoing research project that the authors have undertaken for the last three years. AcknowledgementsThe authors would like to express their sincere thanks and gratitude to the following trusts, charities, organisations and individuals for their generosity in supporting this project: Lord Faringdon Charitable Trust,The Schroder Foundation,Cazenove Charitable Trust,Ernest Cook Trust,Sir Henry Keswick,Ian Bond, P.F. Charitable Trust,Prospect Investment Management Limited,The Adrian Swire Charitable Trust,The John Swire 1989 Charitable Trust,The Sackler Trust,The Tanlaw Foundation, and The Wyfold Charitable Trust. We would like to thank also Ian Rodger – Royal Parks Arboricultural Manager– for providing us with the tested tree. This paper is dedicated to the memory of our colleague and friend Jonathan West, one of the original supporters of this research project. References[1] Gilbert, G.S. et al. (2016). Use of sonic tomography to detect and quantify wood decay in living trees, Applications in Plant Sciences 4(12): 1600060.[2] Bucur, V. Acoustics of Wood. CRC Press Inc., Boca Raton,Argentina (1995).[3] Alani, A.M. et al. (2019). The Use of Ground Penetrating Radar and Microwave Tomography for the Detection of Decay and Cavities in Tree Trunks. Remote Sensing 11: 2073.

262 Background: Docetaxel (DTX) is commonly used to treat metastatic prostate cancer, yet little data is available about the cost of a DTX chemotherapy episode of care (DEC) for treating mCRPC. This study analyzes DEC cost and health service utilization for men with mCRPC. Methods: We performed a claims-based analysis using Truven MarketScan and Medicare 5% sample data sets. Eligibility was required in all months of 2010 and ≥ 1 month of 2011, along with ≥ 1 2011 claim coded with prostate cancer and ≥ 1 DTX claim. Initial 2011 DECs required no DTX claim in the prior 12 months while subsequent DECs required a 60-day gap between DTX claims. DEC costs included all paid claims, except prescription drugs, from the 1st DTX claim to 30 days after the last DTX claim with early termination for death, insurance disenrollment or the end of a 24-month look-forward period. DTX drug costs were adjusted for 2011 generic DTX introduction while all other DEC costs were adjusted to 2015 using national average unit cost increase. Results: 155 commercially insured patients (COMM) and 281 Medicare patients (MDCR) were identified with 172 and 325 DECs, respectively. The average number of DTX cycles per DEC was 6.3 for COMM and 6.9 for MDCR, with 105 and 102 average days between the 1st and last infusion, respectively. The average DEC cost was $63,788 for COMM and $28,742 for MDCR with DTX drug costs contributing $13,169 (21%) and $2,588 (9%) per DEC, respectively. The average cost per DEC contributed by DTX-infusion days was $27,900 (44%) for COMM and $8,577 (30%) for MDCR. Non-DTX-infusion day costs per DEC included $10,838 (17%) for infused/injectable drugs for COMM and $7,074 (25%) for MDCR, along with $9,324 (15%) and $6,875 (24%) for inpatient admissions, respectively. 29% of COMM-DECs and 40% of MDCR-DECs had ≥ 1 inpatient admissions while 22% and 25% had ≥ 1 emergency room (ER) visit, respectively. 22% of COMM and 28% of MDCR inpatient costs and 15% of COMM and 33% of MDCR ER costs were chemotherapy related. Conclusions: Non-DTX drug costs including infusion day services, infused/injectable drugs administered on non-DTX days and inpatient admissions contributed the majority of DEC costs in COMM and MDCR mCRPC populations.

Traditional dissection teaching is being reduced in a number of medical schools, particularly in the United Kingdom. In response to this, 12 medical students from Warwick University, UK, traveled to the Island of Grenada for an intensive extracurricular dissection course at St. George's University. This course not only benefited the host university through the creation of prosections for teaching but also allowed the participants to completely immerse themselves in anatomical study, by developing their dissection skills and consolidating anatomical knowledge. We believe that similar courses could be easily implemented by other medical schools, thereby allowing future students to keep traditional dissection alive. Anat Sci Educ 2: 302–303, 2009. © 2009 American Association of Anatomists.

Melphalan-prednisone (MP) combination has been considered a standard of care for front line treatment of multiple myeloma in patients non eligible for transplant. Melphalan-prednisone-bortezomib (MPV) combination has been approved in the United States in patients non eligible for high-dose chemotherapy (HD-C) and has recently received a positive opinion from the CHMP in Europe. Melphalan-prednisone-thalidomide (MPT) was approved in Europe in patients >65 or not eligible for HD-C. There is no head-to-head trial directly comparing MPV to MPT. The objective of the current study was to compare the efficacy of MPV to MP and MPT as first line treatment of multiple myeloma in patients non eligible for transplant. Six randomized placebo controlled trials investigating the efficacy of MPT (5) and MPV (1) relative to MP were identified with a systematic literature review. The endpoints of interest were overall survival (OS), progression free survival (PFS) and overall and complete response. Relative efficacy estimates of MPT versus MP as obtained from the MPT-MP trials were combined with meta-analysis techniques and simultaneously indirectly compared with the relative efficacy of MPV versus MP from the MPV-MP trial (VISTA). This adjusted indirect comparison was performed with Bayesian fixed and random effects models. As compared to frequentist approach, Bayesian meta-analysis offers a more informative summary of the likely value of efficacy after observing the data and allows for direct probabilistic inferences. Of the three interventions compared, there was an 81% probability that MPV was the most efficacious intervention in terms of overall response and a >99% probability in terms of complete response. With MPV a patient was two times more likely to show a complete response than with MPT (Relative Risk=2.15; 95%Credible Interval (CrI): 0.99–4.45). Both MPV and MPT showed greater OS than MP (HR=0.61; 95%CrI: 0.42–0.88 and HR=0.61; 95%CrI: 0.47–0.78 respectively); the indirect comparison showed similar efficacy in terms of OS between MPV and MPT (MPV vs MPT: Hazard Ratio=1.00; 95%CrI 0.64–1.57). Both MPV and MPT also displayed greater PFS than MP (MPV versus MP: HR=0.61; 95%CrI 0.49–0.76 and MPT versus MP HR=0.51; 95%CrI 0.41–0.63 respectively) and showed similar efficacy (MPV vs MPT: HR=1.19; 95%CrI: 0.87–1.63). In this study, both MPV and MPT are more efficacious than MP in terms of response, PFS and OS. MPV is expected to result in a greater complete and overall response than MPT. No difference in OS or PFS was displayed. Further analyses will need to be undertaken once evidence base data is more mature.

Ladies and Gentlemen,—I thank you unaffectedly for the great, and, I feel, undeserved honour that you have done me in making choice of your President for the coming year.

We report on four patients in whom we observed inflation of the balloon following injection cf contrast material into the distal lumen during percutaneous transluminal coronary angioplasty. This is a rare technical problem. However, inadvertent balloon inflation may cause transient occlusion of the proximal coronary artery and in one case was associated with acute occlusion of a vessel that had been dilated. Management involves prompt deflation of the balloon.

Clinical and angiographic characteristics, procedural details and outcome were analyzed in 2,677 consecutive patients who underwent elective single-artery, single-lesion percutaneous transluminal coronary angioplasty (PTCA) between December 1980 and May 1987. Primary success was achieved in 2,479 (93%) patients. The primary success rate was significantly lower during the first period, when nonsteerable systems were used (73%), than in later periods (94%) (p less than 0.0001), when steerable and low-profile systems became available. Univariate analysis revealed the following variables as predictors of lower primary success: totally obstructed arteries (p less than 0.0001), presence of calcium in the narrowing (p = 0.002), prior myocardial infarction (p = 0.005), stenoses located in the right coronary artery (p = 0.02), narrowings between 90 and 99% in diameter (p = 0.02) and patients older than 60 years of age (p = 0.07). Multivariate analysis revealed the following 4 independent predictors of lower primary success: 100% obstruction (p less than 0.0001), calcium (p = 0.005), previous myocardial infarction (p = 0.029) and patients older than 60 years of age (p = 0.036). With present technology, single-narrowing elective PTCA can be performed with a high success rate in most patients. Although total occlusion, presence of calcium, older age and history of myocardial infarction influence the outcome unfavorably, PTCA can still be performed with acceptable primary success rates.

To the Editor: —In the editorial (The Journal, January 23, p. 278) entitled "The Trend of Veterans' Relief Legislation: State Medicine," the following sentence conveys a bad impression and should be modified: "The rewards of government service are not now generally such as to attract the type of men who seek to become physicians or to hold them after they have once entered the service." That the government services do not offer a favorable field for the professional money maker is admitted. It is not, however, admitted that "men who seek to become physicians" are not attracted to the navy (I speak for that branch of government service only) by the guaranteed (if too small) salary; by the opportunity for doing scientific work; by the generously supplied equipment; by the opportunity for travel, with its professional and cultural advantages; by the opportunity to do postgraduate work at government expense at

Several years ago the writer commenced using a bandage which he originated—so far as he knows—and which has at times been called the "Pryor bandage." METHOD OF APPLICATION. Standing in front of the patient, and holding a strip of two or three inch roller muslin bandage, two and one-half yards long, and the dressing being in place, the bandage is applied as follows: Apply the middle of the strip of bandage to patient's vertebral column at the waist. Carry ends of bandage forward about the waist. Holding the extremities taut, carry one end entirely around the other, making a "round turn" or an "elbow hitch." The result resembles an X with one of its component parts completely wrapped around the other. After twisting it as described, carry the inner extremity inside and the outer extremity outside the thigh and unite the ends with a knot, safety pin or other appliance.