Percutaneous abscess drainage is one of the most common and rewarding procedures performed by interventional radiologists. Technical success is immediately apparent by aspiration of purulent contents and is nearly always achieved, with rates exceeding 90% in most literature studies. Clinical success is typical even for many abscesses colonized with multidrug-resistant organisms. In patients presenting with sepsis, this procedure offers an immediate and minimally invasive solution to a life-threatening condition, often resulting in defervescence and restoration of hemodynamic stability within 1 to 2 days. Although complications of abscess drainage are uncommon, radiologists should be able to recognize and treat all adverse sequelae discussed in this article.

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Carbamates are esters of substituted carbamic acids that react with acetylcholinesterase (AChE) by initially transferring the carbamoyl group to a serine residue in the enzyme active site accompanied by loss of the carbamate leaving group followed by hydrolysis of the carbamoyl enzyme. This hydrolysis, or decarbamoylation, is relatively slow, and half-lives of carbamoylated AChEs range from 4 min to more than 30 days. Therefore, carbamates are effective AChE inhibitors that have been developed as insecticides and as therapeutic agents. We show here, in contrast to a previous report, that decarbamoylation rate constants are independent of the leaving group for a series of carbamates with the same carbamoyl group. When the alkyl substituents on the carbamoyl group increased in size from N-monomethyl- to N,N-dimethyl-, N-ethyl-N-methyl-, or N,N-diethyl-, the decarbamoylation rate constants decreased by 4-, 70-, and 800-fold, respectively. We suggest that this relationship arises as a result of active site distortion, particularly in the acyl pocket of the active site. Furthermore, solvent deuterium oxide isotope effects for decarbamoylation decreased from 2.8 for N-monomethylcarbamoyl AChE to 1.1 for N,N-diethylcarbamoyl AChE, indicating a shift in the rate-limiting step from general acid-base catalysis to a likely conformational change in the distorted active site.

INTRODUCTIONTraditionally, localization of small intestine sources of obscure gastrointestinal bleeding has been a challenge. Advances in the field of endoscopy with the introduction of capsule endoscopy and radiographic imaging with computed tomography angiography and visceral angiography have facilitated more accurate visualization of the small intestine. If a bleeding lesion is identified on angiography and surgery is indicated, the use of methylene blue for enteric mapping is very effective to aid intraoperative localization of the culprit. However, when this is not an option, more invasive surgical techniques are required.PRESENTATION OF CASEWe present a new technique used in a patient with angiodysplasia of the small intestine, in where preoperative localization was done using percutaneous computed tomography (CT) guided injection of methylene blue dye. This allowed us to perform a single incision laparoscopic small intestine resection of the culprit.

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