IntroductionThe hedgehog (Hh) family of proteins [1] is important in many patterning events in the developing embryo, for instance in determining digit position [2] and the development of the nervous system [3]. Hh signal transduction is highly unusual and some of its pathway components act in a rather unique manner [1]. As shown in Fig. 1A

Even 19 months after the StP-transfer for clenched fist, all operated hands could still be fully opened and there was a permanent improvement of hygiene and pain reduction.

Transanal endoscopic microsurgery (TEM) is a minimally invasive treatment modality for a variety of rectal lesions. Due to its minimally invasive nature, TEM has emerged as a safe method. Among most threatening complications are hemorrhage and peritoneal perforation. We report on two patients who demonstrated intra-abdominal free air on an erect chest X-ray after TEM procedure without other findings of a pneumoperitoneum. We hypothesize that due to the combination of elevated pressures in the retroperitoneal cavity and decreased integrity of the retroperitoneal barrier, insufflated CO2 gas can diffuse into the intraperitoneal cavity. Conservative treatment should be considered in patients with free intra-abdominal air postoperatively. However, there should be no suspicion of peritoneal entry during the procedure and the patient should be in generally good condition without severe abdominal symptoms.

No abstract