BackgroundDespite decreasing sheath diameter, access site bleeding and vascular complications are still a major concern in transfemoral aortic valve implantation (TAVI), and may increase morbidity and even increase mortality. The aim was to compare safety of arterial closure in transfemoral TAVI with two different principles, pre-suture with ProGlide and collagen plug closure with Manta.ResultsSeventy-six patients treated with ProGlide and 75 with Manta were analysed. The endpoints were 1: access site vascular complications and 2: non-planned vascular or endovascular surgery at the puncture site. Complications occurred in 2 (2.7%) ProGlide and in 8 (10.7%) Manta cases, p = 0.047. During the learning phase there were no significant differences. In the established phase there was one event (2%) in the ProGlide group, compared to 6 endpoints (12.0%), p = 0.047, in the Manta group.Unplanned surgery or intervention was seen in two (2.7%) ProGlide and in 7 (9.3%) Manta patients, p = ns. There were no significant differences during the learning phase. In established use, endpoints occurred more frequently in patients treated with the Manta device (12%), than in patients treated with the ProGlide (2%), p = 0.047.ConclusionThe ProGlide presuture closure device was associated with significantly lower rates of vascular complications and lower rates of surgery and interventions compared to the collagen plug Manta system.Trial registrationThe data were collected from Internal quality control registry on treatment of patients with valvular heart disease with or without coronary artery disease, No 2014/17280, Oslo University Hospital, Ullevål.

De Garengeot's hernia is quite rare and is a femoral hernia that contains a vermiform appendix and can present as a painful, tender swelling or an asymptomatic lump. We present the case of a 70-year-old patient who presented to our surgical unit after being referred for diagnostic imaging of an asymptomatic groin lump which was found to be a De Garengeot's hernia. She had an open repair of her femoral hernia and laparoscopic appendicectomy. Her post-operative stay was uneventful. De Garengeot's hernia is rare; however, imaging is usually required to make a diagnosis preoperatively. Management is usually surgical with simultaneous repair of the femoral hernia and appendicectomy.

Caecal volvulus is a rare cause of intestinal obstruction, with the bascule subtype accounting for <10% of all cases of caecal volvulus. It is associated with significant morbidity and mortality if left undiagnosed. We present the case of a 58-year-old female who presented to our surgical department with symptoms of intestinal obstruction. She had various radiological investigations, which supported the diagnosis of a caecal volvulus of the bascule subtype. She was subsequently managed surgically and had a right hemicolectomy and ileocolic anastomosis. Her recovery was uneventful and she was discharged within 1 week of having her operation. Fortunately, caecal volvulus of the bascule subtype is rarely encountered; however, clinicians need to be aware of its presentation and subsequent management options so that clinical outcomes are improved.

The aim of this work is to define the basis for design guidelines that will minimise the risk of exposure from airborne organisms in hospital isolation rooms. This research employs an algorithm that combines an understanding of the interaction between the room airflow and the ultra violet (UV) system. The airflow in such a room is complex and therefore cannot easily be accounted for by existing design guidance. The main findings were firstly, the mean lifetime of the ventilated particles does not reduce in proportion with increasing ventilation rate. Secondly, an increase in the ventilation rate reduces the effectiveness of ultra violet germicidal irradiation (UVGI) with only a limited increase in the number of particles that are ventilated. Finally, there is a social benefit attached to this project from the point of view of helping people who are vulnerable as well as reducing their risk of being exposed to possible tuberculosis infection. The significance of these findings is to provide the engineer and the architect with an essential tool to ensure good design practice. It is also important to ensure that the methodology can be applicable to most isolation room uses.

We report a case of typhoid rhabdomyolysis with acute renal failure and acute pancreatitis in a 23-year-old Vietnamese male who was admitted to the intensive care unit with a 15-day history of fever followed by severe abdominal pain. On examination, the patient was febrile and his abdomen was diffusely tender. Serum creatinine was 533 micromol/L, pancreatic amylase 1800 U/L and lipase 900 U/L; the myoglobin blood level was high, which is associated with significant myoglobinuria. Blood, urine and stool culture yielded Salmonella enterica serovar typhi, which was sensitive to ceftriaxon, ampicillin and ciprofloxacin. Ceftriaxon was initiated for a total of 14 days. Subsequently, the patient maintained a good urine output with improved renal parameters and accordingly was discharged. In this report, we review the literature and discuss the pathogenesis of the disease thoroughly.