Search

Organoaxial gastric volvulus occurs when the stomach rotates on its longitudinal axis connecting the gastroesophageal junction to the pylorus. With that, the antrum of the stomach usually rotates in the opposite direction in rela-tion to its fundus (1). This phenomenon has often been known to be associated with diaphragmatic defects (2) Importantly, abnormal rotation of the stomach of more than 180° is a life threatening emergency that may create a closed loop ob- struction which may result in incarceration leading to strangulation, and hence, a surgical emergency. We present the case of a middle-aged female who presented with organoaxial gastric volvulus and had an associated Type IV paraesophageal hiatal hernia that was treated electively. Normally an emergent gastric volvulus is diagnosed via Borchardt’s classic triad (epigastric pain, unproductive vomiting and diffculty inserting a nasogastric tube); however in this patient the nasogastric tube (NGT) was passed into the antrum which allowed additional time for resusci-tation with fuids and other symptomatic relief.

OBJECTIVE Community Hospitals Affiliation with University Hospitals in post graduate surgical education is essential for the 2 types of training programs. Many factors affect the success of the affiliation process. Additionally, various pitfalls and challenges are encountered. The goal of this work is to study the lessons learned in 28 years successful affiliation. DESIGN/SETTING small community hospital affiliation with university program for 28 years. PARTICIPANTS surgery residency programs in small community hospital and university hospital. RESULTS successful affiliation for 28 years between community hospital and university program.

Background Oocyte cortical granules are important in the fertilization of numerous species including mammals. Relatively little is known about the composition, migration, and pre-fertilization release of mammalian oocyte cortical granules. Results Results obtained with confocal scanning laser microscopy indicated that mouse oocytes have at least two populations of cortical granules, one that bound both the lectin LCA and the antibody ABL2 and one that bound only LCA. Both types of granules were synthesized at the same time during oocyte maturation suggesting that the ABL2 antigen is targeted to specific granules by a sorting sequence. The distribution of both populations of cortical granules was then studied during the germinal vesicle to metaphase II transition. As the oocytes entered metaphase I, the first cortical granule free domain, which was devoid of both populations of cortical granules, formed over the spindle. During first polar body extrusion, a subpopulation of LCA-binding granules became concentrated in the cleavage furrow and underwent exocytosis prior to fertilization. Granules that bound ABL2 were not exocytosed at this time. Much of the LCA-binding exudate from the release at the cleavage furrow was retained in the perivitelline space near the region of exocytosis and was deduced to contain at least three polypeptides with approximate molecular weights of 90, 62, and 56 kDa. A second cortical granule free domain developed following pre-fertilization exocytosis and subsequently continued to increase in area as both, LCA and LCA/ ABL2-binding granules near the spindle became redistributed toward the equator of the oocyte. The pre-fertilization release of cortical granules did not affect binding of sperm to the overlying zona pellucida. Conclusions Our data show that mouse oocytes contain at least two populations of cortical granules and that a subset of LCA-binding cortical granules is released at a specific time (during extrusion of the first polar body) and place (around the cleavage furrow) prior to fertilization. The observations indicate that the functions of the cortical granules are more complex than previously realized and include events occurring prior to gamete membrane fusion.

Background Oocyte cortical granules are important in the fertilization of numerous species including mammals. Relatively little is known about the composition, migration, and pre-fertilization release of mammalian oocyte cortical granules.