Detecting bone lesions in X-ray under diverse acquisition conditions

Purpose

The diagnosis of primary bone tumors is challenging as the initial complaints are often non-specific. The early detection of bone cancer is crucial for a favorable prognosis. Incidentally, lesions may be found on radiographs obtained for other reasons. However, these early indications are often missed. We propose an automatic algorithm to detect bone lesions in conventional radiographs to facilitate early diagnosis. Detecting lesions in such radiographs is challenging. First, the prevalence of bone cancer is very low; any method must show high precision to avoid a prohibitive number of false alarms. Second, radiographs taken in health maintenance organizations (HMOs) or emergency departments (EDs) suffer from inherent diversity due to different X-ray machines, technicians, and imaging protocols. This diversity poses a major challenge to any automatic analysis method.

Approach

We propose training an off-the-shelf object detection algorithm to detect lesions in radiographs. The novelty of our approach stems from a dedicated preprocessing stage that directly addresses the diversity of the data. The preprocessing consists of self-supervised region-of-interest detection using vision transformer (ViT), and a foreground-based histogram equalization for contrast enhancement to relevant regions only.

Results

We evaluate our method via a retrospective study that analyzes bone tumors on radiographs acquired from January 2003 to December 2018 under diverse acquisition protocols. Our method obtains 82.43% sensitivity at a 1.5% false-positive rate and surpasses existing preprocessing methods. For lesion detection, our method achieves 82.5% accuracy and an IoU of 0.69.

Conclusions

The proposed preprocessing method enables effectively coping with the inherent diversity of radiographs acquired in HMOs and EDs.

A Deep-Learning Approach to Spleen Volume Estimation in Patients with Gaucher Disease

The enlargement of the liver and spleen (hepatosplenomegaly) is a common manifestation of Gaucher disease (GD). An accurate estimation of the liver and spleen volumes in patients with GD, using imaging tools such as magnetic resonance imaging (MRI), is crucial for the baseline assessment and monitoring of the response to treatment. A commonly used method in clinical practice to estimate the spleen volume is the employment of a formula that uses the measurements of the craniocaudal length, diameter, and thickness of the spleen in MRI. However, the inaccuracy of this formula is significant, which, in turn, emphasizes the need for a more precise and reliable alternative. To this end, we employed deep-learning techniques, to achieve a more accurate spleen segmentation and, subsequently, calculate the resulting spleen volume with higher accuracy on a testing set cohort of 20 patients with GD. Our results indicate that the mean error obtained using the deep-learning approach to spleen volume estimation is 3.6 ± 2.7%, which is significantly lower than the common formula approach, which resulted in a mean error of 13.9 ± 9.6%. These findings suggest that the integration of deep-learning methods into the clinical routine practice for spleen volume calculation could lead to improved diagnostic and monitoring outcomes.

Why did glutamate, GABA, and melatonin become intercellular signalling molecules in plants?

Intercellular signalling is an indispensable part of multicellular life. Understanding the commonalities and differences in how signalling molecules function in two remote branches of the tree of life may shed light on the reasons these molecules were originally recruited for intercellular signalling. Here we review the plant function of three highly studied animal intercellular signalling molecules, namely glutamate, γ-aminobutyric acid (GABA), and melatonin. By considering both their signalling function in plants and their broader physiological function, we suggest that molecules with an original function as key metabolites or active participants in reactive ion species scavenging have a high chance of becoming intercellular signalling molecules. Naturally, the evolution of machinery to transduce a message across the plasma membrane is necessary. This fact is demonstrated by three other well-studied animal intercellular signalling molecules, namely serotonin, dopamine, and acetylcholine, for which there is currently no evidence that they act as intercellular signalling molecules in plants.

Automatic measurements of fetal intracranial volume from 3D ultrasound scans

Three-dimensional fetal ultrasound is commonly used to study the volumetric development of brain structures. To date, only a limited number of automatic procedures for delineating the intracranial volume exist. Hence, intracranial volume measurements from three-dimensional ultrasound images are predominantly performed manually. Here, we present and validate an automated tool to extract the intracranial volume from three-dimensional fetal ultrasound scans. The procedure is based on the registration of a brain model to a subject brain. The intracranial volume of the subject is measured by applying the inverse of the final transformation to an intracranial mask of the brain model. The automatic measurements showed a high correlation with manual delineation of the same subjects at two gestational ages, namely, around 20 and 30 weeks (linear fitting R2(20 weeks) = 0.88, R2(30 weeks) = 0.77; Intraclass Correlation Coefficients: 20 weeks=0.94, 30 weeks = 0.84). Overall, the automatic intracranial volumes were larger than the manually delineated ones (84 ± 16 vs. 76 ± 15 cm3; and 274 ± 35 vs. 237 ± 28 cm3), probably due to differences in cerebellum delineation. Notably, the automated measurements reproduced both the non-linear pattern of fetal brain growth and the increased inter-subject variability for older fetuses. By contrast, there was some disagreement between the manual and automatic delineation concerning the size of sexual dimorphism differences. The method presented here provides a relatively efficient way to delineate volumes of fetal brain structures like the intracranial volume automatically. It can be used as a research tool to investigate these structures in large cohorts, which will ultimately aid in understanding fetal structural human brain development.

De-identification procedures for magnetic resonance images and the impact on structural brain measures at different ages

Surface rendering of MRI brain scans may lead to identification of the participant through facial characteristics. In this study, we evaluate three methods that overwrite voxels containing privacy‐sensitive information: Face Masking, FreeSurfer defacing, and FSL defacing. We included structural T1‐weighted MRI scans of children, young adults and older adults. For the young adults, test–retest data were included with a 1‐week interval. The effects of the de‐identification methods were quantified using different statistics to capture random variation and systematic noise in measures obtained through the FreeSurfer processing pipeline. Face Masking and FSL defacing impacted brain voxels in some scans especially in younger participants. FreeSurfer defacing left brain tissue intact in all cases. FSL defacing and FreeSurfer defacing preserved identifiable characteristics around the eyes or mouth in some scans. For all de‐identification methods regional brain measures of subcortical volume, cortical volume, cortical surface area, and cortical thickness were on average highly replicable when derived from original versus de‐identified scans with average regional correlations >.90 for children, young adults, and older adults. Small systematic biases were found that incidentally resulted in significantly different brain measures after de‐identification, depending on the studied subsample, de‐identification method, and brain metric. In young adults, test–retest intraclass correlation coefficients (ICCs) were comparable for original scans and de‐identified scans with average regional ICCs >.90 for (sub)cortical volume and cortical surface area and ICCs >.80 for cortical thickness. We conclude that apparent visual differences between de‐identification methods minimally impact reliability of brain measures, although small systematic biases can occur.

Changes in the intracranial volume from early adulthood to the sixth decade of life: A longitudinal study

Normal brain-aging occurs at all structural levels. Excessive pathophysiological changes in the brain, beyond the normal one, are implicated in the etiology of brain disorders such as severe forms of the schizophrenia spectrum and dementia. To account for brain-aging in health and disease, it is critical to study the age-dependent trajectories of brain biomarkers at various levels and among different age groups. The intracranial volume (ICV) is a key biological marker, and changes in the ICV during the lifespan can teach us about the biology of development, aging, and gene X environment interactions. However, whether ICV changes with age in adulthood is not resolved. Applying a semi-automatic in-house-built algorithm for ICV extraction on T1w MR brain scans in the Dutch longitudinal cohort (GROUP), we measured ICV changes. Individuals between the ages of 16 and 55 years were scanned up to three consecutive times with 3.32±0.32 years between consecutive scans (N = 482, 359, 302). Using the extracted ICVs, we calculated ICV longitudinal aging-trajectories based on three analysis methods; direct calculation of ICV differences between the first and the last scan, fitting all ICV measurements of individuals to a straight line, and applying a global linear mixed model fitting. We report statistically significant increase in the ICV in adulthood until the fourth decade of life (average change +0.03%/y, or about 0.5 ml/y, at age 20), and decrease in the ICV afterward (-0.09%/y, or about -1.2 ml/y, at age 55). To account for previous cross-sectional reports of ICV changes, we analyzed the same data using a cross-sectional approach. Our cross-sectional analysis detected ICV changes consistent with the previously reported cross-sectional effect. However, the reported amount of cross-sectional changes within this age range was significantly larger than the longitudinal changes. We attribute the cross-sectional results to a generational effect. In conclusion, the human intracranial volume does not stay constant during adulthood but instead shows a small increase during young adulthood and a decrease thereafter from the fourth decade of life. The age-related changes in the longitudinalmeasure are smaller than those reported using cross-sectional approaches and unlikely to affect structural brain imaging studies correcting for intracranial volume considerably. As to the possible mechanisms involved, this awaits further study, although thickening of the meninges and skull bones have been proposed, as well as a smaller amount of brain fluids addition above the overall loss of brain tissue.

Dividing the Archaeal Way: The Ancient Cdv Cell-Division Machinery

Cell division in most prokaryotes is mediated by the well-studied fts genes, with FtsZ as the principal player. In many archaeal species, however, division is orchestrated differently. The Crenarchaeota phylum of archaea features the action of the three proteins, CdvABC. This Cdv system is a unique and less-well-studied division mechanism that merits closer inspection. In vivo, the three Cdv proteins form a composite band that contracts concomitantly with the septum formation. Of the three Cdv proteins, CdvA is the first to be recruited to the division site, while CdvB and CdvC are thought to participate in the active part of the Cdv division machinery. Interestingly, CdvB shares homology with a family of proteins from the eukaryotic ESCRT-III complex, and CdvC is a homolog of the eukaryotic Vps4 complex. These two eukaryotic complexes are key factors in the endosomal sorting complex required for transport (ESCRT) pathway, which is responsible for various budding processes in eukaryotic cells and which participates in the final stages of division in Metazoa. There, ESCRT-III forms a contractile machinery that actively cuts the membrane, whereas Vps4, which is an ATPase, is necessary for the turnover of the ESCRT membrane-abscission polymers. In contrast to CdvB and CdvC, CdvA is unique to the archaeal Crenarchaeota and Thaumarchaeota phyla. The Crenarchaeota division mechanism has often been suggested to represent a simplified version of the ESCRT division machinery thus providing a model system to study the evolution and mechanism of cell division in higher organisms. However, there are still many open questions regarding this parallelism and the division mechanism of Crenarchaeota. Here, we review the existing data on the role of the Cdv proteins in the division process of Crenarchaeota as well as concisely review the ESCRT system in eukaryotes. We survey the similarities and differences between the division and abscission mechanisms in the two cases. We suggest that the Cdv system functions differently in archaea than ESCRT does in eukaryotes, and that, unlike the eukaryotic case, the Cdv system's main function may be related to surplus membrane invagination and cell-wall synthesis.

Mapping out Min protein patterns in fully confined fluidic chambers

The bacterial Min protein system provides a major model system for studying reaction-diffusion processes in biology. Here we present the first in vitro study of the Min system in fully confined three-dimensional chambers that are lithography-defined, lipid-bilayer coated and isolated through pressure valves. We identify three typical dynamical behaviors that occur dependent on the geometrical chamber parameters: pole-to-pole oscillations, spiral rotations, and traveling waves. We establish the geometrical selection rules and show that, surprisingly, Min-protein spiral rotations govern the larger part of the geometrical phase diagram. Confinement as well as an elevated temperature reduce the characteristic wavelength of the Min patterns, although even for confined chambers with a bacterial-level viscosity, the patterns retain a ~5 times larger wavelength than in vivo. Our results provide an essential experimental base for modeling of intracellular Min gradients in bacterial cell division as well as, more generally, for understanding pattern formation in reaction-diffusion systems.

DOI:http://dx.doi.org/10.7554/eLife.19271.001

Some proteins can spontaneously organize themselves into ordered patterns within living cells. One widely studied pattern is made in a rod-shaped bacterium called Escherichia coli by a group of proteins called the Min proteins. The pattern formed by the Min proteins allows an E. coli cell to produce two equally sized daughter cells when it divides by ensuring that the division machinery correctly assembles at the center of the parent cell. These proteins move back and forth between the two ends of the parent cell so that the levels of Min proteins are highest at the ends and lowest in the middle. Since the Min proteins act to inhibit the assembly of the cell division machinery, this machinery only assembles in locations where the level of Min proteins is at its lowest, that is, at the middle of the cell.

When Min proteins are purified and placed within an artificial compartment that contains a source of chemical energy and is covered by a membrane similar to the membranes that surround cells, they spontaneously form traveling waves on top of the membrane in many directions along to surface. It is not clear how these waves relate to the oscillations seen in E. coli. Caspi and Dekker now analyze the behavior of purified Min proteins inside chambers of various sizes that are fully enclosed by a membrane.

The results show that in narrow chambers, Min proteins move back and forth (i.e. oscillate) from one side to the other. However, in wider containers the wave motion is more common. In containers of medium width the Min proteins rotate in a spiral fashion. Caspi and Dekker propose that the spiral rotations are the underlying pattern formed by Min proteins and that the back and forth motion is caused by spirals being cut short. In other words, if a spiral cannot form because the compartment is too small then the back and forth motion emerges. Similarly, Caspi and Dekker propose that the waves emerge in larger containers when multiple spirals come together.

These findings suggest that the different patterns that Min proteins form in bacterial cells and artificial compartments arise from different underlying mechanisms. The next step will be to investigate other differences in how the patterns of Min proteins form in E. coli and in artificial compartments.

DOI:http://dx.doi.org/10.7554/eLife.19271.002

Octanol-assisted liposome assembly on chip

Liposomes are versatile supramolecular assemblies widely used in basic and applied sciences. Here we present a novel microfluidics-based method, octanol-assisted liposome assembly (OLA), to form monodisperse, cell-sized (5-20 μm), unilamellar liposomes with excellent encapsulation efficiency. Akin to bubble blowing, an inner aqueous phase and a surrounding lipid-carrying 1-octanol phase is pinched off by outer fluid streams. Such hydrodynamic flow focusing results in double-emulsion droplets that spontaneously develop a side-connected 1-octanol pocket. Owing to interfacial energy minimization, the pocket splits off to yield fully assembled solvent-free liposomes within minutes. This solves the long-standing fundamental problem of prolonged presence of residual oil in the liposome bilayer. We demonstrate the unilamellarity of liposomes with functional α-haemolysin protein pores in the membrane and validate the biocompatibility by inner leaflet localization of bacterial divisome proteins (FtsZ and ZipA). OLA offers a versatile platform for future analytical tools, delivery systems, nanoreactors and synthetic cells.

Deformation of filamentous Escherichia coli cells in a microfluidic device: a new technique to study cell mechanics

The mechanical properties of bacterial cells are determined by their stress-bearing elements. The size of typical bacterial cells, and the fact that different time and length scales govern their behavior, necessitate special experimental techniques in order to probe their mechanical properties under various spatiotemporal conditions. Here, we present such an experimental technique to study cell mechanics using hydrodynamic forces in a microfluidic device. We demonstrate the application of this technique by calculating the flexural rigidity of non-growing Escherichia coli cells. In addition, we compare the deformation of filamentous cells under growing and non-growing conditions during the deformation process. We show that, at low forces, the force needed to deform growing cells to the same extent as non-growing cells is approximately two times smaller. Following previous works, we interpret these results as the outcome of the difference between the elastic response of non-growing cells and the plastic-elastic response of growing cells. Finally, we observe some heterogeneity in the response of individual cells to the applied force. We suggest that this results from the individuality of different bacterial cells.

Synthetic mimic of selective transport through the nuclear pore complex

The nuclear pore complex is a large protein channel present universally in eukaryotic cells. It generates an essential macromolecular separation between the nucleus and cytoplasm. The transport mechanism relies on recognition of molecular cargos by receptor proteins, and on specific interaction between the receptors and the pores. We present a chemical mimic of this "receptor-mediated" transport using modified nanoporous membrane filters, polyisopropylacrylamide as the carrier molecule, or receptor, and single-stranded DNA as the cargo. We show that a complex of ssDNA and polyisopropylacrylamide diffuses faster through the modified pores than does the bare ssDNA, in spite of the larger size of the complex. The mobile polymer thus acts as a soluble receptor to usher a macromolecular cargo specifically through the pores.

Space-time super-resolution

We propose a method for constructing a video sequence of high space-time resolution by combining information from multiple low-resolution video sequences of the same dynamic scene. Super-resolution is performed simultaneously in time and in space. By "temporal super-resolution," we mean recovering rapid dynamic events that occur faster than regular frame-rate. Such dynamic events are not visible (or else are observed incorrectly) in any of the input sequences, even if these are played in "slow-motion." The spatial and temporal dimensions are very different in nature, yet are interrelated. This leads to interesting visual trade-offs in time and space and to new video applications. These include: 1) treatment of spatial artifacts (e.g., motion-blur) by increasing the temporal resolution and 2) combination of input sequences of different space-time resolutions (e.g., NTSC, PAL, and even high quality still images) to generate a high quality video sequence. We further analyze and compare characteristics of temporal super-resolution to those of spatial super-resolution. These include: How many video cameras are needed to obtain increased resolution? What is the upper bound on resolution improvement via super-resolution? What is the temporal analogue to the spatial "ringing" effect?

Budding and tubulation in highly oblate vesicles by anchored amphiphilic molecules

We studied local budding and tubulation induced in highly oblate lipid vesicles by the anchoring of either polymers having a hydrophilic backbone and grafted hydrophobic anchor groups, or by oleoyl-coenzyme A, an amphiphilic molecule important in lipid metabolism. The dynamics of bud formation, shrinkage, and readsorption is consistent with an induced spontaneous curvature coupled with local amphiphile diffusion on the membrane. We report a novel metastable state prior to bud readsorption.

Detoxification centers: who's in the revolving door?

Data from 443,812 admissions to publicly funded detoxification centers in Massachusetts (fiscal year 1984 to fiscal year 1996) were analyzed to assess changes in the population served. Substantial increases in admissions of women, African Americans, and Hispanics were apparent. Mean age at admission declined and unemployment increased. A 25% decline in admissions reporting alcohol use was coupled with a twofold increase in reported cocaine use and a fourfold increase in heroin use. Detoxification services have evolved. The older, white, male alcoholic is no longer the primary consumer. Policy initiatives (e.g., increased services for women) and the changing epidemiology of drugs abuse (e.g., increased access to heroin) contributed to the changing population served in detoxification centers.

Secondary V(D)J rearrangements and B cell receptor-mediated down-regulation of recombination activating gene-2 expression in a murine B cell line

It has recently become clear that recombination of Ig genes is not restricted to B cell precursors but that secondary rearrangements can also occur under certain conditions in phenotypically immature bone marrow and peripheral B cells. However, the nature of these cells and the regulation of secondary V(D)J recombination in response to B cell receptor (BCR) stimulation remain controversial. In the present study, we have analyzed secondary light chain gene rearrangements and recombination activating gene (RAG) expression in the surface IgM+, IgD- murine B cell line, 38C-13, which has previously been found to undergo kappa light chain replacement. We find that 38C-13 cells undergo spontaneous secondary Vkappa-Jkappa and RS rearrangements in culture, with recombination occurring on both productive and nonproductive alleles. Both 38C-13 cells and the Id-negative variants express the RAG genes, indicating that the presence of RAG does not depend on activation via the 38C-13 BCR. Moreover, BCR cross-linking in 38C-13 cells leads to a rapid and reversible down-regulation of RAG2 mRNA. Therefore, 38C-13 cells resemble peripheral IgM+, IgD- B cells undergoing light chain gene rearrangement and provide a possible in vitro model for studying peripheral V(D)J recombination.

Relationship of child loss to psychiatric and functional impairment in resettled Cambodian refugees

One hundred sixty eight respondents, recruited from a community of resettled Cambodian refugees in Massachusetts, were interviewed for a study of trauma, physical and emotional health, and functioning. Of the 161 respondents who have ever had any children, 70 parents (43%) reported the death of between one and six of their children. Child loss was positively associated with health-related concerns, a variety of somatic symptoms, and culture-bound conditions of emotional distress. No relationship was found with conventional psychiatric symptoms of depression and posttraumatic stress disorder. Parents whose children died were performing most routine daily activities and participating in social activities to a similar and even greater extent than were parents who did not lose children. Nevertheless, child loss was strongly associated with a perception of health-related limitation in both physical functioning and social activities. Further research on the prevalence of child loss and its impact on long-term adjustment in survivors of mass trauma is indicated.

The effects of passive anti-viral immunotherapy in AKR mice: II. Susceptibility to B cell lymphomagenesis

Prevention of high frequency spontaneous T cell lymphoma development in AKR mice by mAb 18-5 treatment was shown to involve inhibition of the recombinant Class I MCF virus formation and elimination of the early occurring potential lymphoma cells (PLCs). A low B cell lymphoma incidence (16% at a mean latency of 540 days) and a low level of PLCs (yielding 12% B cell lymphoma development following lymphoid cell transfer) was observed in mAb 18-5 treated mice (in contrast to a high PLC level in thymectomized AKR mice that could be experimentally triggered to progress to overt CD5+ B cell lymphomas). Administration of anti CD8 mAb or IL-4 to 12-month-old mAb 18-5 pre-treated mice only slightly increased B cell lymphoma incidence (up to 30-40%). Exposure to split-dose irradiation resulted in 26% B cell lymphomas at a 250 day mean latency. The phenotypes of the B lymphomas developing in mAb 18-5 treated mice were: B220+ (14.8+, 6B2+), 6C3+, Mac2+, CD5-. Most lymphomas expressed l-a and surface IgM, pointing to their mature B cell characteristics. Moreover, in some of the lymphomas, high levels of IgM production and secretion were determined. A comparison of the morphological characteristics (based on light and ultrastructure microscopy) of CD5+ and CD5- B cell lymphomas developing in AKR mice indicated marked differences. Analysis of the IgH locus of representative CD5- B lymphomas showed an identical pattern of IgH rearrangement in some tumors (similar to previous findings among CD5+ lymphomas). The virological analysis of the CD5- B cell lymphomas (similar to those observed in the CD5+ B cell lymphomas of AKR origin) showed that their development did not require formation of the pathogenic MCF recombinant viruses. The differences observed between the CD5+ and CD5- B cell lymphomas developing in AKR mice (following prevention of spontaneous T cell lymphomagenesis) may be due to their origin of different B cell precursors or from B cells at different levels of differentiation.

Light chain loss and reexpression leads to idiotype switch. Surrogate light chains are probably responsible for this process

The murine B-lymphocyte cell line 38C-13 is characterized by several cell surface markers typical for an early stage of B-cell differentiation. Cells of this cell line possess cell surface membrane IgM molecules composed of mu and kappa polypeptide chains. They also produce "surrogate" or "pseudo" light chains (psi L) coded by the lambda 5 and VpreB genes. Variants of the 38C-13 cell line which do not synthesize kappa chains can be isolated from the 38C-13 population by the use of anti-idiotype antibodies in vivo and in vitro. In some kappa chain-deficient variant cell lines, cells which have regained surface IgM expression but have lost the original idiotype specificity, can be isolated. This idiotype switch is probably due to a secondary rearrangement of the kappa gene. In the kappa chain-deficient variant cells, the mu chains assemble with the surrogate light chains but the assembled IgM-like molecules are not expressed on the cell surface. It is suggested that surrogate light chains play an important role in the induction of kappa gene rearrangement but that surface expression of mu-psi L complexes is not required for this process.

[Annulo-aortic ectasia]

Aortic regurgitation due to annular aortic ectasia was diagnosed in a 29-year-old woman with heart failure. The primary pathology of this disease is cystic medial necrosis of the ascending aorta with aneurysm formation and dilation of the aortic valve annulus. In successful surgical correction, the ascending aorta was replaced by a dacron prosthesis, the aortic valve by a prosthetic disc valve and the coronary arteries were reimplanted into the aortic graft.

Surgical treatment of post-infarction ventricular septal defect without concomitant myocardial revascularization

Twenty one patients suffering from rupture of the ventricular septum (RVS) following acute myocardial infarction were operated upon between 1982-1985. Eighteen patients were operated upon urgently within 9.3 +/- 2.1 hours following diagnosis of RVS. In all, RVS occurred during the first infarction. None had concomitant myocardial revascularization. There were twelve operative survivors for an operative mortality of 42.5%. Two patients died 6 and 9 months postoperatively. All survivors are in functional class I, during a follow-up period of 14 to 56 months. The need for urgent repair of RVS is stressed and the value of concomitant coronary artery bypass is discussed.

The significance of bundle branch block in the immediate postoperative electrocardiograms of patients undergoing coronary artery bypass

Three hundred sixteen consecutive patients undergoing coronary artery bypass were studied for postoperative electrocardiographic conduction disturbances. Fifty-five of these 316 patients had postoperative bundle branch block (Group 1). This group had a higher incidence of left main coronary stenosis, together with previous inferior myocardial infarction, than patients without postoperative conduction disturbances (Group 2). Perioperative myocardial infarction, low cardiac output, and death were significantly more common in Group 1 than in Group 2: 7.3% versus 1.9% for perioperative myocardial infarction, 16.4% versus 2.7% for low cardiac output, and 5.5% versus 0.8% for death. Analysis of the type of conduction disturbances indicates that the presence of a new complete left bundle branch block postoperatively in a patient undergoing coronary artery bypass is a sign of intraoperative myocardial damage. This damage is potentially lethal, especially in a patient with left main coronary stenosis and previous inferior myocardial infarction.

Successful repair of concomitant tear of the interventricular septum and right ventricular free wall after acute myocardial infarction

Early repair of acute rupture of the ventricular septum after myocardial infarction is now the procedure of choice accepted by most centers. Rupture of the right ventricular free wall is rare and usually is accompanied by tamponade. The finding of coincidental right ventricular free wall rupture and acute ventricular septal defect following myocardial infarction and their successful repair are discussed in the following report.

Rupture of splenic abscess through the diaphragm

Splenic abscess is an uncommon disease that has a high mortality rate if not treated surgically. With the aid of new diagnostic tools, such as ultrasonography, scanning and computerized axial tomography, it is possible to diagnose the entity antemortem. Even though it often has a nontypical clinical course, it may overlap other systemic diseases. We describe an unusual case of splenic abscess with rare complications, the operation and the outcome.