Background: Surgical mortality data are collected routinely in high-income countries, yet virtually no low-or middle-income countries have outcome surveillance in place. The aim was prospectively to collect worldwide mortality data following emergency abdominal surgery, comparing findings across countries with a low, middle or high Human Development Index (HDI).Methods: This was a prospective, multicentre, cohort study. Self-selected hospitals performing emergency surgery submitted prespecified data for consecutive patients from at least one 2-week interval during July to December 2014. Postoperative mortality was analysed by hierarchical multivariable logistic regression.

ObjectiveTo develop recommendations that can be used as guidance for standardized approach regarding indications, patient preparation, sequences acquisition, interpretation and reporting of magnetic resonance imaging (MRI) for diagnosis and grading of pelvic floor dysfunction (PFD).MethodsThe technique included critical literature between 1993 and 2013 and expert consensus about MRI protocols by the pelvic floor-imaging working group of the European Society of Urogenital Radiology (ESUR) and the European Society of Gastrointestinal and Abdominal Radiology (ESGAR) from one Egyptian and seven European institutions. Data collection and analysis were achieved in 5 consecutive steps. Eighty-two items were scored to be eligible for further analysis and scaling. Agreement of at least 80 % was defined as consensus finding.ResultsConsensus was reached for 88 % of 82 items. Recommended reporting template should include two main sections for measurements and grading. The pubococcygeal line (PCL) is recommended as the reference line to measure pelvic organ prolapse. The recommended grading scheme is the “Rule of three” for Pelvic Organ Prolapse (POP), while a rectocele and ARJ descent each has its specific grading system.ConclusionThis literature review and expert consensus recommendations can be used as guidance for MR imaging and reporting of PFD.Key points • These recommendations highlight the most important prerequisites to obtain a diagnostic PFD-MRI. • Static, dynamic and evacuation sequences should be generally performed for PFD evaluation. • The recommendations were constructed through consensus among 13 radiologists from 8 institutions.

Background: Stroke is a common neurological disorder that is encountered in most hospitals in both developed and developing countries. This two-year study was designed to show the characteristics of the problem at the King Fahad Hospital, Hofuf, Saudi Arabia. Patients and Method: This was a prospective study of all Saudi stroke patients admitted to the medical wards in the study period. All patients were assessed individually by one of the two available neurologists. Data was collected on pre-designed protocol, and analysis was performed using tables and figures, and EpiInfo ® computer software. Results: The 329 Saudi patients studied fulfilled the criteria for stroke. The male:female ratio of the patients was 1:1, and their ages ranged between 42 and 92 years (mean 62.8±11.1) for males, and between 20 and 100 years (mean 59.6±15.4) for females. The relative frequencies of stroke subtypes were ischemic infarcts (79%), of which 46% were lacunar infarcts, intracerebral hemorrhage (18.8%), and subarachnoid hemorrhage (2.2%). The most common risk factor was concomitant hypertension with diabetes mellitus (40.4%), hypertension alone (24.9%), diabetes alone (11.6%), atrial fibrillation (5.8%), other cardiac factors (5.5%), transient ischemic attack (TIA) and prior stroke (2.1% each), and smoking (1.8%). No risk factor was detected in 5.8% of the patients. The overall inhospital mortality was 10.0%, with a significant male preponderance. Conclusion: This study demonstrated that stroke is a common neurological condition in the Al-Hassa region of the Kingdom. The male:female ratio was dissimilar from that observed in other parts of Saudi Arabia. The study also showed that hypertension with diabetes constituted a potent risk factor. Sickle cell anemia was not found to be a risk factor. The case fatality was low and both the incidence and mortality showed seasonal preference. We believe that there is a need to establish a Stroke Register at the King Fahad Hospital at Hofuf for the Al-Hassa region.

Combined analysis of static and dynamic MR images of patients with pelvic floor dysfunction allowed identification of certain structural abnormalities with specific dysfunctions.

CMEThis article is available for CME credit. See www.arrs.org for more information.OBJECTIVE. There has been no uniformity of opinion concerning the structures supporting the female urethra. Therefore, the aims of this prospective study were to define precisely the female urethral support structures at cadaveric anatomic dissection and histologic examination and to determine which of these structures can be detected on MRI of cadaveric specimens and of healthy volunteers.SUBJECTS AND METHODS. Dissection of seven formalin-preserved cadavers (age at death, 25-50 years; no parity history available) was performed by a professor of anatomy to explore the anatomy of the urethral supporting ligaments and was followed by MRI of the cadaveric specimens with ligamentous markers in place and then by histologic analysis of the dissected ligaments. MRI of 17 healthy nulliparous women (age range, 20-35 years; mean age, 25.5 years) was then performed using T2-weighted, dual turbo spin-echo, balanced fast-field echo, and STIR sequences. A standardized grid system that allowed us to record structural observations on sequentially numbered axial MR images was used by a radiologist who then applied a 4-point grading scale to assess ligament visibility. Three authors-one radiologist, one anatomist, and one urologist-then compared the appearance of each ligament seen in a cadaveric specimen with its appearance on MR images of the same cadaver and on MR images of volunteers.RESULTS. At cadaveric dissection we identified ventral and dorsal urethral ligaments. The ventral urethral ligaments included the pubourethral ligaments, which were found to consist of three separate components coursing anteroposterior from the bladder neck to the pubic bone; the periurethral ligament; and the paraurethral ligaments. Dorsal to the urethra, a slinglike ligament, which we believe should be named the "suburethral ligament," was identified. This ligament had a distinct plane of cleavage from the anterior vaginal wall. The MRI findings in the volunteers correlated with the MRI and gross anatomic findings in the cadavers. The proximal pubourethral, periurethral, paraurethral, and suburethral ligaments had visibility scores of 3 (moderately visible) or 4 (easily visible) on MRI in 47%, 65%, 47%, and 53% of volunteers, respectively.CONCLUSION. Our results present evidence that may help resolve previous controversies regarding the MR appearance of the ventral urethral ligaments and that better define the course of the ligament dorsal to the urethra, the suburethral ligament. We hope that this detailed anatomic information about the structures involved in continence may lead eventually to improvements in the treatments for women with stress urinary incontinence. F Downloaded from www.ajronline.org by 117.253.101.235 on 10/09/15 from IP address 117.253.101.235.

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In pelvic floor dysfunction (PFD), magnetic resonance imaging of the pelvic floor supporting system from a functional point of view allows radiologists to recognize and classify the types of defects in each supporting structure (namely, the urethral supporting system, the vaginal supporting system, and the anal sphincter complex). Combined analysis of both the static and dynamic images of patients reporting stress urinary incontinence and pelvic organ prolapse has revealed a close relationship between certain anatomical defects in the pelvic organ support system and specific PFD. Because of the consistency and reproducibility of this relationship, radiologists can accurately identify and report the underlying structural defects, allowing clinicians to individually tailor surgical techniques for each patient. This is important because even those patients presenting with the same clinical symptoms may have different underlying structural derangement or abnormalities that may warrant a different treatment plan or approach. In view of the reported high rate of dysfunction recurrence after surgical treatment and clinicians' desire for a test that can pinpoint each patient's structural and anatomical defects, this approach provides the necessary scientific evidence on which best clinical practice can be based, and the data-reporting system used for analysis provides a tool for accurately planning reconstructive surgery, reducing the risk of surgical failure, dysfunction recurrence, and reoperation. With the improved radiological evidence made possible by combined image analysis, clinicians can now have the documentation that they need to plan more effective procedures and thus produce better outcomes. This review focuses on the MRI anatomy of the pelvic floor from a functional point of view and from the urogynecological side of floor dysfunction (UI and POP), adopting a problem-oriented approach. The first section of this article provides the basic essential anatomical information about the pelvic floor and briefly reviews the pathophysiology and clinical features of SUI and POP. The second portion details the vital role of the radiologist in obtaining accurate images for the clinician to use in planning reconstructive surgery. In addition, it includes case examples, illustrating how to report MRI findings systematically and comprehensively on both the static and dynamic images, using a recently developed integrated MRI analytical approach from a purely functional point of view that may enhance radiologists' interaction with clinicians and bridges the gap between radiology and surgery.