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The article presents a case study of a 63 year old woman in the U.S. who was taken to the emergency department because of acute-onset epigastrc pain. She was physically examined and it shows that she has unbeatable blood pressure, peritonitis and has increased serum lactate level. The article discusses internal hernia. It also states that transomental hernia is a rare case and that the presence of small-bowel loops associated with stretched vascular pedicle indicates a sign of internal hernia.

The article presents a medical case of a 63-year-old woman with acute-onset epigastric pain who was presented to the emergency department. It mentions that physical examinations show an unstable blood pressure and peritonitis. It is stated that the patient had no history of previous or chronic illness, but past surgical history was noted with a hysterectomy.

Purpose: Assess quality metrics of modified barium swallow studies (MBSS) with and without a radiologist present during the procedure. Methods: Retrospective review of MBSS performed on adult inpatients at a tertiary care hospital 6-months pre- and post-institutional change from having to not having a radiologist present during the examination. Factors assessed included: fluoroscopy time; study duration; number of cine loops; number of images; efficiency of collimation (using a 5-point scoring system); time to final report; radiologist-speech language pathologist report disagreement; and recalls for inadequate studies. Statistical analysis was via Welch's t-test and a test of proportions for continuous and count data under the normal approximation. Results: 106 and 119 MBSS were analyzed from the radiologist present and radiologist absent periods, respectively. No statistically significant differences were found for: average fluoroscopy time (116.1 s vs. 126.9 s; P = 0.161); study duration (400.4 s vs. 417.3 s; P = 0.453); number of cine loops (9.3 vs. 10.2; P = 0.075); number of images (620.5 vs. 581.1; P = 0.350); or report disagreement. There was improved performance without the radiologist present for collimation (1.92 vs. 1.43; P = 0.003) and fewer non-diagnostic images (6.5 vs. 4.5; P = 0.001). Time to final report was longer with the radiologist absent due to more reports with significant delays. There were no repeated studies because of inadequate technique in either group. Conclusion: MBSS performed by technologists without radiologist supervision is not inferior to those performed with radiologist supervision on multiple performance measures. This supports technologist operated MBSS without radiologist supervision, while acknowledging a need to further address radiologist report time delay. [ABSTRACT FROM AUTHOR]

Purpose The study sought to assess and compare the prevalence of narrowing of the major extracranial veins in subjects with multiple sclerosis and controls, and to assess the sensitivity and specificity of magnetic resonance venography (MRV) for describing extracranial venous narrowing as it applies to the chronic cerebrospinal venous insufficiency theory, using catheter venography (CV) as the gold standard. Methods The jugular and azygos veins were assessed with time-of-flight MRV in this assessor-blinded, case-control study of subjects with multiple sclerosis, their unaffected siblings, and unrelated controls. The veins were evaluated by diameter and area, and compared with CV. Collateral vessels were also analyzed for maximal diameter, as a potential indicator of compensatory flow. Results A high prevalence of extracranial venous narrowing was demonstrated in all study groups, collectively up to 84% by diameter criteria and 90% by area, with no significant difference between the groups when assessed independently ( P = .34 and .63, respectively). There was high interobserver variability in the reporting of vessel narrowing (kappa = 0.32), and poor vessel per vessel correlation between narrowing on MRV and CV (kappa = 0.064). Collateral neck veins demonstrated no convincing difference in maximum size or correlation with jugular narrowing. Conclusion There is a high prevalence of narrowing of the major extracranial veins on MRV in all 3 study groups, with no significant difference between them. These findings do not support the chronic cerebrospinal venous insufficiency theory. Although MRV has shown a high sensitivity for identifying venous narrowing, time-of-flight imaging demonstrates poor interobserver agreement and poor specificity when compared with the gold standard CV. [ABSTRACT FROM AUTHOR]