We conclude by stating that this case of emphysematous gastritis, due to gastric ulcers, would have no difference in outcome if treated medically instead of surgically. Historically, patients with emphysematous gastritis warranted surgical intervention. More recently, case reports of emphysematous gastritis are favoring conservative management. The consensus still remains that there is no standard approach for these patients and most patients in extremis are undergoing surgical intervention.

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Although Weed & Flexner [1933] have confirmed the earlier findings of Becht [1920] that the venous pressure in the torcular is uninfluenced by variations in the subarachnoid pressure, Wright [1938] has found that changes in venous pressure can readily be brought about by varying the subarachnoid pressure.He measured the venous pressure in the posterior part of the superior longitudinal sinus. A slight rise in the venous pressure was observed when the subarachnoid pressure was first raised; this, however, fell rapidly to a low level and remained there as long as the raised subarachnoid pressure was maintained. In another series of experiments, Wright [1938] studied the effect of a gradual rise in subarachnoid pressure on the rate of blood flow through the superior longitudinal sinus. A decrease in blood flow was observed when the pressure was first raised with a progressive reduction until complete cessation occurred, when the subarachnoid pressure exceeded the systolic arterial pressure. Astudy has been made in the following experiments of the effect of variations in subarachnoid pressure on the venous pressure in the superior longitudinal sinus and in the torcular of the dog. EXPERIMENTAL PROCEDURE Difficulty in obtaining dogs owing to the war conditions has made little selection possible; diseased and grossly undernourished animals, however, were always rejected. The subarachnoid pressure was measured with a needle in the cisterna magna. Variations in pressure were effected and maintained in the manner already described in earlier publications [Bedford, 1935[Bedford, , 1936. The highest pressure employed in these experiments was 500 mm. normal saline solution and the lowest 0 mm. normal saline solution. The venous pressure in the superior longitudinal sinus was recorded in the following way.

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Background and Objectives:Synthetic mesh reinforcement during laparoscopic hiatal hernia repair (LHHR) reduces recurrence. Biologically derived mesh is also associated with reduced recurrence. Urinary bladder matrix (UBM), a biologically derived extracellular matrix mesh, has shown clinical success. We wanted to determine the safety and efficacy of LHHR with porcine UBM reinforcement.Methods:This retrospective, single-surgeon study reviewed clinical data on patients who underwent LHHR from August 2009 through May 2014, with diaphragmatic reinforcement with porcine UBM mesh. Primary outcomes were (1) recurrence—a >2-cm defect above the diaphragm at 3 months; (2) intra- and postoperative complications; (3) pre- and postoperative esophageal reflux (GERD) or dysphagia; and (4) cessation of proton pump inhibitor (PPI).Results:Sixty-two patients who had LHHR with UBM mesh were studied (mean age, 62 years, 53 women, mean body mass index 32.7 kg/m2) Before surgery 98% had GERD, 19% had dysphagia, and 98% were on PPI. Postoperative UGIS was performed on 66% 3 months after surgery, and 19% had a recurrence of >2 cm; 56% remained on PPI, and 16% (P < .001) remained symptomatic. Dysphagia improved in 75% (P = .05). No intraoperative complications were recorded. One postoperative mortality occurred secondary to an unrelated cardiac event.Conclusions:UBM mesh was effective and safe for LHHR. In addition to reducing the rate of recurrence compared to unreinforced primary repair, the properties of UBM, including site-specific constructive tissue remodeling, may add benefits over other biologic products. This study represents an evaluation of UBM mesh in a large cohort of patients who underwent LHHR.

Apocrine breast carcinoma is a rare subtype of the invasive ductal carcinoma and accounts for as little as 0.3–1% of all breast cancers. It is usually positive for human epidermal growth factor receptor 2 (HER-2) and negative for both estrogen receptor and progesterone receptor. Here we present an exceptionally rare case of apocrine breast carcinoma that is a triple receptor negative with metastases and to our knowledge this is the first published case. This is a significant finding because it implies that the tumor would not respond to the typical hormonal agents. This case highlights the need for studies to elucidate better treatment strategies for these types of patients.

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