Notes

Decreased Likelihood of Rib Bone injuries in Pregnant Patients After Car Crashes.
Pancreatic fluid collections are a common complication of acute pancreatitis. They are classified as acute peripancreatic fluid collections and pancreatic pseudocysts. There has been an increase in the use of endoscopic ultrasound-guided drainage stents for management of these collections. As a result, complications such as stent migration are becoming more prevalent.

A 47-year-old male presented to the emergency department with upper abdominal pain, nausea and vomiting, and intermittent fevers. The patient had a known history of a pancreatic pseudocyst. He had undergone an endoscopic cyst-gastrostomy and placement of an AXIOS and Compass stents for drainage prior to the current presentation. The patient was investigated with a computed tomography (CT) scan that demonstrated acute pancreatitis, and migration of his AXIOS/Compass stent complex into the transverse colon. The patient was managed conservatively, and ultimately passed the stent through his bowel motions without issue. Follow up abdominal x-ray confirmed the passage of the stent.

Stent migration is a recognised complication of stent placement but is infrequently described for lumen-apposing metal stents like the AXIOS stent. The AXIOS stent has a dumbbell configuration designed to reduce the rate of migration compared to the original double-pigtail plastic stents. Despite this, stent migration still occurs, as in this case.

Complications of AXIOS stents can also include migration of the stent despite their specific design to prevent this. Conservative management is feasible rather than endoscopic retrieval and can be considered if there are no complicating features.
Complications of AXIOS stents can also include migration of the stent despite their specific design to prevent this. Conservative management is feasible rather than endoscopic retrieval and can be considered if there are no complicating features.A 56-year-old woman was referred to our hospital with a pathological diagnosis of squamous cell carcinoma of the cervix. We performed a re-biopsy of the vaginal mass and cervical conization. The mass was originally reported as an epithelioid MPNST after re-biopsy. Strong diffuse S-100 positivity, epithelioid morphology of the lesion, and negativity to all other immune histochemical markers confirmed the diagnosis of epithelioid MPNST. Cervical conization specimen was negative for any neoplasms.
Medial malleolar stress fractures are relatively uncommon. This report describes the successful treatment of nonunion of a medial malleolar stress fracture due to chronic lateral ankle instability.

A 13-year-old middle school student who belonged to a football club presented to our clinic with chronic medial left ankle pain lasting over a year. He had sprained his left ankle several times 6 years earlier. A plain anteroposterior ankle radiograph showed a vertical fracture line in the medial malleolus involving the epiphyseal plate, and computed tomography demonstrated the vertical fracture seen on the plain radiographs and bone sclerosis at the fracture site. We performed internal fixation for nonunion of the medial malleolar stress fracture with arthroscopic modified Broström for lateral ankle instability. SD-208 Two years after surgery, the Self-Administered Foot Evaluation Questionnaire improved in all parameters, and both the anterior drawer and varus stress tests were negative.

Early diagnosis of medial malleolar stress fracture is important for a rapid return to sports. Magnetic resonance imaging is helpful for early diagnosis. Because lateral ankle instability can cause medial malleolar stress fracture, arthroscopic modified Broström procedure is meaningful for medial malleolar stress fracture with lateral ankle instability.

Internal fixation and the arthroscopic modified Broström procedure could achieve good clinical outcomes for medial malleolar stress fractures with lateral ankle instability.
Internal fixation and the arthroscopic modified Broström procedure could achieve good clinical outcomes for medial malleolar stress fractures with lateral ankle instability.
Acute severe cholecystitis with empyema presenting as a gallbladder mass, jaundice and Mirizzi Syndrome (MS) is a complex surgical problem both diagnostically and in terms of management as it mimics both xanthogranulomatous cholecystitis (XGC) and gallbladder carcinoma.

A 48-year-old gentleman was referred to us with biliary colic and weight loss with ultrasound findings of gallstones. At subsequent follow-up he became deeply jaundiced with deranged liver function and a CT showing a gallbladder mass and dilated biliary tree. Follow-up MRCP suggested XGC and concomitant MS, but a malignant process could not be excluded. Pre-operative fine needle aspiration cytology (FNAC) at the time of percutaneous biliary drainage for his jaundice demonstrated XGC with no evidence of malignancy. Given the dense inflammation and a tense empyema at laparoscopy, he underwent a subtotal fenestrating cholecystectomy. The final histopathological diagnosis was acute cholecystitis.

Our patient likely had unrecognised acute cho to open surgery in these cases of complex inflammation.
During the last decade, a multitude of novel quantitative and semiquantitative MRI techniques have provided new information about the pathophysiology of neurological diseases. Yet, selection of the most relevant contrasts for a given pathology remains challenging. In this work, we developed and validated a method, Gated-Attention MEchanism Ranking of multi-contrast MRI in brain pathology (GAMER MRI), to rank the relative importance of MR measures in the classification of well understood ischemic stroke lesions. Subsequently, we applied this method to the classification of multiple sclerosis (MS) lesions, where the relative importance of MR measures is less understood.

GAMER MRI was developed based on the gated attention mechanism, which computes attention weights (AWs) as proxies of importance of hidden features in the classification. In the first two experiments, we used Trace-weighted (Trace), apparent diffusion coefficient (ADC), Fluid-Attenuated Inversion Recovery (FLAIR), and T1-weighted (T1w) images acquired in 904 acute/subacute ischemic stroke patients and in 6,230 healthy controls and patients with other brain pathologies to assess if GAMER MRI could produce clinically meaningful importance orders in two different classification scenarios.
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