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In recent years, most exciting inputs (MEIs) synthesized from encoding models of neuronal activity have become an established method to study tuning properties of biological and artificial visual systems. However, as we move up the visual hierarchy, the complexity of neuronal computations increases. Consequently, it becomes more challenging to model neuronal activity, requiring more complex models. In this study, we introduce a new attention readout for a convolutional data-driven core for neurons in macaque V4 that outperforms the state-of-the-art task-driven ResNet model in predicting neuronal responses. However, as the predictive network becomes deeper and more complex, synthesizing MEIs via straightforward gradient ascent (GA) can struggle to produce qualitatively good results and overfit to idiosyncrasies of a more complex model, potentially decreasing the MEI’s model-to-brain transferability. To solve this problem, we propose a diffusion-based method for generating MEIs via Energy Guidance (EGG). We show that for models of macaque V4, EGG generates single neuron MEIs that generalize better across architectures than the state-of-the-art GA while preserving the within-architectures activation and requiring 4.7x less compute time. Furthermore, EGG diffusion can be used to generate other neurally exciting images, like most exciting natural images that are on par with a selection of highly activating natural images, or image reconstructions that generalize better across architectures. Finally, EGG is simple to implement, requires no retraining of the diffusion model, and can easily be generalized to provide other characterizations of the visual system, such as invariances. Thus EGG provides a general and flexible framework to study coding properties of the visual system in the context of natural images.1

Deciphering the brain’s structure-function relationship is key to understanding the neuronal mechanisms underlying perception and cognition. The cortical column, a vertical organization of neurons with similar functions, is a classic example of primate neocortex structure-function organization. While columns have been identified in primary sensory areas using parametric stimuli, their prevalence across higher-level cortex is debated. A key hurdle in identifying columns is the difficulty of characterizing complex nonlinear neuronal tuning, especially with high-dimensional sensory inputs. Here, we asked whether area V4, a mid-level area of the macaque visual system, is organized into columns. We combined large-scale linear probe recordings with deep learning methods to systematically characterize the tuning of >1,200 V4 neurons usingin silicosynthesis of most exciting images (MEIs), followed byin vivoverification. We found that the MEIs of single V4 neurons exhibited complex features like textures, shapes, or even high-level attributes such as eye-like structures. Neurons recorded on the same silicon probe, inserted orthogonal to the cortical surface, were selective to similar spatial features, as expected from a columnar organization. We quantified this finding using human psychophysics and by measuring MEI similarity in a non-linear embedding space, learned with a contrastive loss. Moreover, the selectivity of the neuronal population was clustered, suggesting that V4 neurons form distinct functional groups of shared feature selectivity, reminiscent of cell types. These functional groups closely mirrored the feature maps of units in artificial vision systems, hinting at shared encoding principles between biological and artificial vision. Our findings provide evidence that columns and functional cell types may constitute universal organizing principles of the primate neocortex, simplifying the cortex’s complexity into simpler circuit motifs which perform canonical computations.

Background The notion of articulation in surgery has been largely synonymous with robotics. The ARTISENTIAL® instruments aim at bringing advanced articulation to laparoscopy to overcome challenges in narrow anatomical spaces. In this paper, we present first single-center results of a series of low anterior resections, performed with ARTISENTIAL®. Methods Between September 2020 and August 2021, at the Department of Surgery, St. Marienkrankenhaus Siegen, Siegen, Germany, patients with cancer of the mid- and low rectum were prospectively enrolled in a pilot feasibility study to evaluate the ARTISENTIAL® articulated instruments in performing a laparoscopic low anterior resection. Perioperative and short-term postoperative data were analyzed. Results Seventeen patients (10 males/7 females) were enrolled in this study. The patients had a median age of 66 years (range 47–80 years) and a median body mass index of 28 kg/m2 (range 23–33 kg/m2). The median time to rectal transection was 155 min (range 118–280 min) and the median total operative time was 276 min (range 192–458 min). The median estimated blood loss was 30 ml (range 5–70 ml) and there were no conversions to laparotomy. The median number of harvested lymph nodes was 15 (range 12–28). Total mesorectal excision (TME) quality was ‘good’ in all patients with no cases of circumferential resection margin involvement (R0 = 100%). The median length of stay was 9 days (range 7–14 days). There were no anastomotic leaks and the overall complication rate was 17.6%. There was one unrelated readmission with no mortality. Conclusions Low anterior resection with ARTISENTIAL® is feasible and safe. All patients had a successful TME procedure with a good oncological outcome. We will now seek to evaluate the benefits of ARTISENTIAL® in comparison with standard laparoscopic instruments through a larger study.

The purpose of this article was to provide feasibility and safety results of robotic transabdominal preperitoneal inguinal hernia repair (Robotic TAPP). We included 271 cases of robotic inguinal hernia TAPP repair using the Senhance® robotic platform from four different centers between March 2017 and March 2020. Key data points were intraoperative and postoperative complication rate, operating time, length of hospital stay, postoperative pain score and time required to get back to a daily routine that were inserted in the TransEnterix European Patient Registry for Robotic assisted Laparoscopic Procedures in Urology, Abdominal Surgery, Thoracic and Gynecologic Surgery (TRUST). We report 203 cases of unilateral and 68 cases of bilateral inguinal hernia repairs. Mean operative time was 74 ± 35 min (range 32–265 min), postoperative complications occurred in five (1.85%) cases, the intraoperative complication rate was five (1.85%). The average subjective patient-related pain score after the procedure was 3 ± 1.9 (range 1–9), length of hospital stay was 39 ± 28 h (range 4–288 h), and recovery time was 9.65 ± 8 days (range 1–36 days). Robotic inguinal hernia TAPP repair shows inspiring results. It is a safe and doable procedure. However, cost analysis should be performed in future to show the superiority over other techniques.

The foveal visual image region provides the human visual system with the highest acuity. However, it is unclear whether such a high fidelity representational advantage is maintained when foveal image locations are committed to short-term memory. Here, we describe a paradoxically large distortion in foveal target location recall by humans. We briefly presented small, but high contrast, points of light at eccentricities ranging from 0.1 to 12°, while subjects maintained their line of sight on a stable target. After a brief memory period, the subjects indicated the remembered target locations via computer controlled cursors. The biggest localization errors, in terms of both directional deviations and amplitude percentage overshoots or undershoots, occurred for the most foveal targets, and such distortions were still present, albeit with qualitatively different patterns, when subjects shifted their gaze to indicate the remembered target locations. Foveal visual images are severely distorted in short-term memory.

Responses to natural stimuli in area V4 – a mid-level area of the visual ventral stream – are well predicted by features from convolutional neural networks (CNNs) trained on image classification. This result has been taken as evidence for the functional role of V4 in object classification. However, we currently do not know if and to what extent V4 plays a role in solvingothercomputational objectives. Here, we investigated normative accounts of V4 (and V1 for comparison) by predicting macaque single-neuron responses to natural images from the representations extracted by 23 CNNs trained on different computer vision tasks including semantic, geometric, 2D, and 3D types of tasks. We found that V4 was best predicted by semantic classification features and exhibited high task selectivity, while the choice of task was less consequential to V1 performance. Consistent with traditional characterizations of V4 function that show its high-dimensional tuning to various 2D and 3D stimulus directions, we found that diverse non-semantic tasks explained aspects of V4 function beyond those captured by individual semantic tasks. Nevertheless, jointly considering the features of a pair of semantic classification tasks was sufficient to yield one of our top V4 models, solidifying V4’s main functional role in semantic processing and suggesting that V4’s affinity to 2D or 3D stimulus properties found by electrophysiologists can result from semantic functional goals.

The Electron-Ion Collider (EIC) uses crab cavities to restore the geometrical luminosity loss associated with the large crossing angle. Due to space limitations, the detector solenoid cannot be compensated locally. This paper presents the lattice design to compensate the detector solenoid effects without interfering with the crab cavities. Skew quadrupoles are employed to avoid additional crab cavities. The correction scheme is checked by beam-beam simulation.

The Electron-Ion Collider (EIC) presently under construction at Brookhaven National Laboratory will collide polarized high energy electron beams with hadron beams with design luminosities up to 1 × 1034cm−2s−1 in center mass energy range of 20-140 GeV. We studied the planned electron-proton collisions using a Particle-In-Cell (PIC) based Poisson solver in strong-strong beam-beam simulation. We observed a much larger proton emittance growth rate than in weak-strong simulation. To understand the numerical noise and its impact on strong-strong simulation results, we carried out extensive studies to identify all possible causes for artificial emittance growth and quantify their contributions. In this article, we summarize our study activities and findings. This work will help us better understand the simulated emittance growth and the limits of the PIC based strong-strong beam-beam simulation.

The notion of articulation in surgery has been largely synonymous with robotics. The ARTISENTIALBetween September 2020 and August 2021, at the Department of Surgery, St. Marienkrankenhaus Siegen, Siegen, Germany, patients with cancer of the mid- and low rectum were prospectively enrolled in a pilot feasibility study to evaluate the ARTISENTIALSeventeen patients (10 males/7 females) were enrolled in this study. The patients had a median age of 66 years (range 47-80 years) and a median body mass index of 28 kg/mLow anterior resection with ARTISENTIAL

To increase computational flexibility, the processing of sensory inputs changes with behavioural context. In the visual system, active behavioural states characterized by motor activity and pupil dilation

The foveal visual image region provides the human visual system with the highest acuity. However, it is unclear whether such a high fidelity representational advantage is maintained when foveal image locations are committed to short term memory. Here we describe a paradoxically large distortion in foveal target location recall by humans. We briefly presented small, but high contrast, points of light at eccentricities ranging from 0.1 to 12 deg, while subjects maintained their line of sight on a stable target. After a brief memory period, the subjects indicated the remembered target locations via computer controlled cursors. The biggest localization errors, in terms of both directional deviations and amplitude percentage overshoots or undershoots, occurred for the most foveal targets, and such distortions were still present, albeit with qualitatively different patterns, when subjects shifted their gaze to indicate the remembered target locations. Foveal visual images are severely distorted in short term memory.

Across animal species, sensory processing dynamically adapts to behavioral context. In the mammalian visual system, sensory neural responses and behavioral performance increase during an active behavioral state characterized by locomotion activity and pupil dilation, whereas preferred stimuli of individual neurons typically remain unchanged. Here, we address how behavioral states modulate stimulus selectivity in the context of colored natural scenes using a combination of large-scale population imaging, behavior, pharmacology, and deep neural network modeling. In visual cortex of awake mice, we identified a consistent shift of individual neuron color preferences towards ultraviolet stimuli during active behavioral periods that was particularly pronounced in the upper visual field. We found that the spectral shift in neural tuning is mediated by pupil dilation, resulting in a dynamic switch from rod-to cone-driven visual responses for constant ambient light levels. We further showed that this shift selectively enhances the discriminability of ultraviolet objects and facilitates the detection of ethological stimuli, such as aerial predators against the ultraviolet background of the twilight sky. Our results suggest a novel functional role for pupil dilation during active behavioral states as a bottom-up mechanism that, together with top-down neuromodulatory mechanisms, dynamically tunes visual representations to different behavioral demands.

Deep neural networks (DNN) have set new standards at predicting responses of neural populations to visual input. Most such DNNs consist of a convolutional network (core) shared across all neurons which learns a representation of neural computation in visual cortex and a neuron-specific readout that linearly combines the relevant features in this representation. The goal of this paper is to test whether such a representation is indeed generally characteristic for visual cortex, i.e. gener-alizes between animals of a species, and what factors contribute to obtaining such a generalizing core. To push all non-linear computations into the core where the generalizing cortical features should be learned, we devise a novel readout that reduces the number of parameters per neuron in the readout by up to two orders of magnitude compared to the previous state-of-the-art. It does so by taking advantage of retinotopy and learns a Gaussian distribution over the neuron’s receptive field po-sition. With this new readout we train our network on neural responses from mouse primary visual cortex (V1) and obtain a gain in performance of 7% compared to the previous state-of-the-art network. We then investigate whether the convolutional core indeed captures general cortical features by using the core in transfer learning to a different animal. When transferring a core trained on thousands of neurons from various animals and scans we exceed the performance of training directly on that animal by 12%, and outperform a commonly used VGG16 core pre-trained on imagenet by 33%. In addition, transfer learning with our data-driven core is more data-efficient than direct training, achieving the same performance with only 40% of the data. Our model with its novel readout thus sets a new state-of-the-art for neural response prediction in mouse visual cortex from natural images, generalizes between animals, and captures better characteristic cortical features than current task-driven pre-training approaches such as VGG16.

The purpose of this article was to provide feasibility and safety results of robotic transabdominal preperitoneal inguinal hernia repair (Robotic TAPP).We included 271 cases of robotic inguinal hernia TAPP repair using the SenhanceWe report 203 cases of unilateral and 68 cases of bilateral inguinal hernia repairs. Mean operative time was 74 ± 35 min (range 32-265 min), postoperative complications occurred in five (1.85%) cases, the intraoperative complication rate was five (1.85%). The average subjective patient-related pain score after the procedure was 3 ± 1.9 (range 1-9), length of hospital stay was 39 ± 28 h (range 4-288 h), and recovery time was 9.65 ± 8 days (range 1-36 days).Robotic inguinal hernia TAPP repair shows inspiring results. It is a safe and doable procedure. However, cost analysis should be performed in future to show the superiority over other techniques.

Despite strong evidence to the contrary in the literature, microsaccades are overwhelmingly described as involuntary eye movements. Here we show in both human subjects and monkeys that individual microsaccades of any direction can easily be triggered: (1) on demand, based on an arbitrary instruction, (2) without any special training, (3) without visual guidance by a stimulus, and (4) in a spatially and temporally accurate manner. Subjects voluntarily generated instructed “memory-guided” microsaccades readily, and similarly to how they made normal visually-guided ones. In two monkeys, we also observed midbrain superior colliculus neurons that exhibit movement-related activity bursts exclusively for memory-guided microsaccades, but not for similarly-sized visually-guided movements. Our results demonstrate behavioral and neural evidence for voluntary control over individual microsaccades, supporting recently discovered functional contributions of individual microsaccade generation to visual performance alterations and covert visual selection, as well as observations that microsaccades optimize eye position during high acuity visually-guided behavior., Microsaccades are small-amplitude, fixational eye movements that are largely thought to be involuntary. Here, the authors demonstrate that monkeys (and humans) can be easily trained to respond to a remembered target location with a volitional microsaccade, and that a population of superior colliculus neurons is selectively associated with them.

The National Synchrotron Light Source II is a third generation light source, which was constructed at Brookhaven National Laboratory. This project includes a highly-optimized 3 GeV electron storage ring, linac preinjector, and full-energy synchrotron injector. Budker Institute of Nuclear Physics built and delivered the booster for NSLS-II. The commissioning of the booster was successfully completed. This paper reviews fulfilled work by participants.

We have developed an intrinsic resonance free circular electron accelerator. This lattice could be placed in the existing RHIC tunnel and accelerate electrons from 400 MeV to 18 GeV avoiding all major polarization loss usual in such machines.

The symptoms of gastroesophageal reflux disease (GERD) are very common. Despite the fact that 40% of patients continue to suffer under conservative treatment, only approximately 1% of affected patients are operated on in Germany. Until recently, antireflux surgery was performed nearly exclusively in the form of a Nissen fundoplication or a Toupet hemifundoplication. These methods are still considered the gold standard. A new surgical minimally invasive procedure is described which treats reflux symptoms through electrical neuromodulation of the lower esophageal sphincter (LES).An electrical neuromodulator for the LES (EndoStim®, EndoStim BV, Nijmegen, The Netherlands) is implanted into the abdominal wall as a pulse generator (IPG) and connected via an electrode cable to a pair of electrodes on the lower esophageal sphincter. In our own setting, patients are selected for this procedure after extensive functional diagnostics in the context of an interdisciplinary expert conference. The patient selection, patient education, required surgical training, surgical technique, postoperative phase as well as the results, complications and side effects are described.Electrical neuromodulation is a technique that successfully provides patients with GERD with control of their reflux symptoms. The technique requires interdisciplinary patient selection, comprehensive patient education, and comprehensive surgical training. The method is not free of postoperative problems. The electrical neuromodulation of the LES should therefore be used especially in centers with high expertise in reflux therapy.

To facilitate the SAC 2015 Long Range Plan for Nuclear Science: a high-energy high-luminosity polarized Electron-Ion Collider (EIC) as the highest priority for new facility construction following the completion of FRIB. Brookhaven National Laboratory (BNL) is proposing to build a high luminosity electron-hadron collider called e-RHIC which incorporates a new electron synchrotron with the existing Relativistic Heavy Ion Collider (RHIC). A low risk conventional technology based design is being adopted for the majority of the accelerator components. The e-RHIC electron source will produce a highly polarized beam current of up to 50 mA with > 80% polarization at an energy of up to 18 GeV with a luminosity > 1034 cm-2s-1. The prototype e-RHIC beam source is currently under development at BNL and Stony Brook University. This paper presents a conceptual design of the e-RHIC machine, how polarized beam will enhance the physics program and plans to address the remaining challenges associated with the construction of e-RHIC. In order to construct a future electron ion collider with high luminosity, a high average current and high bunch charge polarized electron source is under development at Brookhaven National Laboratory. We present the R&D plan for achieving the required charge and current in the polarized eRHIC gun.. The plan involves developing a large single cathode gun to generate 5.3 nC and 6 mA polarized electrons beam. We report the progress of large cathode prototype gun development, the beam line design and plan for measuring gun charge lifetime for high bunch charge, high current operation.

Summary Hippocampal ripple oscillations likely support reactivation of memory traces that manifest themselves as temporally organized spiking of sparse neuronal ensembles. However, the network mechanisms concurring to achieve this function are largely unknown. We designed a multi-compartmental model of the CA3-CA1 subfields to generate biophysically realistic ripple dynamics from the cellular level to local field potentials. Simulations broadly parallel in vivo observations and support that ripples emerge from CA1 pyramidal spiking paced by recurrent inhibition. In addition to ripple oscillations, key coordination mechanisms involve concomitant aspects of network activity. Recurrent synaptic interactions in CA1 exhibit slow-gamma band coherence with CA3 input, thus offering a way to coordinate CA1 activities with CA3 inducers. Moreover, CA1 feedback inhibition controls the content of spontaneous replay during CA1 ripples, forming new mnemonic representations through plasticity. These insights are consistent with slow-gamma interactions and interneuronal circuit plasticity observed in vivo, suggesting a multifaceted ripple-related replay phenomenon.

Apart from stapling methods, single- or double-layer continuous hand sutures are established techniques for colonic anastomoses. It is unclear which hand suture technique has superior anastomotic safety. This randomized trial evaluated the incidence of postoperative complications depending on anastomosis technique. This multicentre randomized trial enrolled adult elective patients between February 2004 and June 2012 in four German university hospitals. Primary endpoint was incidence of clinical anastomotic leakage until 3 months postoperatively. Estimated sample size was 768 randomized patients. Main secondary endpoints were duration of anastomotic suture, postoperative morbidity and stool patterns at 3-month follow-up. Patients and postoperative outcome assessors were blinded to the group assignment. This trial is registered (NCT00996554). Due to slow recruitment, the trial was stopped prematurely. Two hundred fifty-two patients (129 to single-layer suture anastomosis (SLA), 123 to double-layer suture anastomosis (DLA)) were randomized and analysed. Nine patients (3.6 %) were lost during follow-up. Exploratory primary endpoint analysis by intention-to-treat principle showed no significant difference for clinical anastomotic leakage between suturing techniques (SLA, 4 of 129 (3.1 %) vs. DLA, 6 of 123 (4.9 %), p = 0.532). Secondary endpoint analysis showed on average a 6-min shorter suture duration for SLA than DLA (18 min (4–49) vs. 24 min (8–50), p

The National Synchrotron Light Source II at Brookhaven National Lab is a third-generation synchrotron radiation facility that has been commissioned in 2014. The facility is based on a 3 GeV electron storage ring, which will circulate 500 mA of beam current at 1 nm rad horizontal emittance. The storage ring is 792 meters in circumference and will accommodate more than 60 beamlines in the final built-out. The beamline sources range from insertion-devices located in straight sections, bending magnets or three-pole-wigglers configured in multiple branches. The NSLS-II storage ring commissioning was successfully completed in July 2014 and the facility delivered the first user light on October 23, 2014. Currently the storage ring reached 300 mA beam current and achieved 1 nm rad of horizontal emittance with 3 sets of Damping Wigglers. At this point six NSLS-II project beamlines are routinely taking photons with beam current at 150 mA. This paper reviews the NSLS-II accelerator design and commissioning experience.

The National Synchrotron Light Source II (NSLS-II) is a state of the art 3 GeV third generation light source at Brookhaven National Laboratory. During spring/ summer of 2014, the storage ring was commissioned up to 50 mA without insertion devices. In the fall of 2014, we began commissioning of the project beamlines, which included seven insertion devices on six ID ports. Beamlines IXS, HXN, CSX-1, CSX-2, CHX, SRX, and XPD-1 consist of elliptically polarized undulator (EPU), damping wigglers (DW) and in-vacuum undulators (IVU) covering from VUV to hard x-ray range. In this paper, experience with commissioning and operation is discussed. We focus on reaching storage ring performance with IDs, including injection, design emittance, compensation of orbit distortions caused by ID residual field, source point stability, beam alignment and tools for control, monitoring and protection of the ring chambers from ID radiation.

The first eight insertion devices (IDs) at the NSLS-II were commissioned during the fall run of 2014. In this paper we discuss commissioning of the synchrotron radiation protection (SRP) system and beamline frontends (FE) for the respective IDs. We describe the diagnostics utilized if FE commissioning and a procedure that was used for the alignment of the photon beam from insertion devices in the beamline frontends. Then we discuss the current status of the SRP system and operation of the commissioned frontends.

The NSLS-II is a 3rd generation light source with ultra-low beam emittance that is currently under construction at the Brookhaven National Laboratory. Because the power of the synchrotron radiation from the damping wiggler (DW) is about 64 kW, a slight mis-steer can result in severe damage to the vacuum chamber. To avoid such problems, an active interlock system is being considered. The system dumps the beam when it departs from the predefined safe window in the phase space. In this paper, we present simple geometric arguments from which we define the safe window on the basis of betatron amplitudes. This window can be applied to any DW around the ring. For the entrance of the wiggler, we obtained window of Δ x =±8.4 mm, Δ x ′=±429 μrad and Δ y =±2.1 mm, Δ y ′=±449 μrad.

HISTORY AND CLINICAL FINDINGS In a 34-year-old woman who underwent ultrasound investigation because of recurrent pyelonephritis a space-occupying lesion in the liver was an incidental finding. Computed tomography (CT) and magnetic resonance imaging (MRI) confirmed a tumour in segment I of the liver. The patient had been on contraceptives for 12 years. She had no symptoms. INVESTIGATIONS Laboratory tests, including tumour markers, were unremarkable. Diagnostic tests to exclude malignant tumour with metastases were negative (thyroid scintigraphy, mammography, coloscopy and gastroscopy). Further tests (ultrasound, coeliaco-mesentericography, hydro-CT and spiral CT, MRI) revealed a tumour, 5 x 4 x 4 cm, in segment I of the liver, most likely an adenoma. Surgical intervention was indicated by the size and questionable malignancy of the tumor. TREATMENT AND COURSE At operation a tumour was found which originated from the inferior vena cava (IVC) and displaced segment I of the liver. The tumour was resected and the venous wall reconstructed with a Goretex patch. Histological examination indicated a poorly differentiated leiomyosarcoma of the IVC. Adjuvant radiotherapy was undertaken postoperatively. There has been no evidence of recurrence after 10 months. CONCLUSIONS Leiomyosarcoma of the IVC can be mistaken, both by ultrasound and tomographic diagnostic procedures, for a tumour in segment I of the liver, especially an adenoma. A leiomyosarcoma of the IVC should be included in the differential diagnosis of an hepatic tumour that lies close to segment I of the liver.

HISTORY AND CLINICAL FINDINGS Abdominal pain developed after a bulimic binge in a 19-year-old girl with anorexia nervosa. She had unsuccessfully tried to induce vomiting. Physical examination showed no clinical sign of peritonitis, although there was diffuse abdominal tenderness on pressure. INVESTIGATIONS There was leukopenia (2200 G/l) and a raised serum lactate level (58 mg/dl). No free air was seen on a plain film of the abdomen. Abdominal sonography revealed little free fluid subhepatically. TREATMENT AND COURSE Acute respiratory impairment during investigations required emergency intubation. As bronchoscopy revealed aspiration a bronchial lavage was performed. Under gastroscopic control gastric emptying was achieved through a large gastric tube. After early improvement the patient developed the full picture of sepsis. Ultrasonography and needle puncture having revealed purulent intraabdominal fluid, a laparotomy was performed, which showed necrosis of the anterior and posterior walls of the stomach with free perforation. The greater curvature was resected. The patient slowly recovered but a relaparotomy for a subphrenic abscess became necessary on the 10th postoperative day. A year later there was free food passage, but the anorexia nervosa was unchanged. CONCLUSION A bulimic binge can become life-threatening if the stomach does not empty spontaneously. Surgical intervention is required, if the patient's condition does not improve despite gastric emptying.