Cholecystectomies are one of the most common surgical procedures performed in the United States, with complications being relatively common. We submit a case of a ruptured mycotic aneurysm of the hepatic artery, a complication of a recent cholecystectomy which was successfully treated with the use of transarterial thrombin.

In the presence of a normal rotator cuff, fatty infiltration increases with age. Age-related changes occur more frequently in the deltoid, verifying this muscle's potential as a standard of reference. With cuff tears, supraspinatous atrophy was disproportionate to that of the deltoid. Therefore, systematic assessment of supraspinatous muscle atrophy may be more reliable using the deltoid as a control for comparison than assessing it in isolation.

Pre-TIPS and post-TIPS volumes were measured (MIM software), and clinical data was retrospectively collected. Expected normal liver volume for patient size (ELV) was calculated using a validated formula (Vauthey et al., 2002). Results: Prior to TIPS, the cirrhotic liver volume exceeded the ELV in 15 patients (37.5%; 9M, 6F, P¼0.80). No statistically significant difference was seen in pre-TIPS MELD (mean 13.0 vs 14.2, P¼0.45) or TIPS indications between patients with measured liver volumes that were greater than ELV (ascites n¼4, bleed n¼8) or less than ELV (ascites n¼11, bleed n¼12) (P¼0.24). There was no correlation between liver volume and procedure time (r¼0.076, P¼0.65). After TIPS, surprisingly, the liver volume increased in 14 patients (35%, 10M, 4F, P¼0.60). TIPS indication was not a predictor of post-TIPS liver growth (ascites n¼4, bleed n¼7) or shrinkage (ascites n¼12, bleed n¼13) (P¼0.35). Change in portosystemic gradient was not a predictor of post-TIPS liver growth or shrinkage (median -10 vs -10 mm Hg, P¼0.83). There was no significant correlation between pre-TIPS MELD and post-TIPS liver growth or shrinkage (median 12 vs 13.5, P¼0.36). Performance of variceal embolization did not correlate with post-TIPS liver growth (P¼0.61). Conclusions: Liver volumes are used clinically to predict adequate function after surgery. We find in the cirrhotic pre-TIPS population that liver volume does not correlate with MELD and can exceed ELV for patient size. Surprisingly, liver size increased in 35% of patients post-TIPS and was not predicted by indication for TIPS, pre-TIPS MELD, change in PSG or performance of variceal embolization.

Objective: To determine, time to angiography for patients with positive gastrointestinal bleeding (GIB) on prior investigation (endoscopy [ES], nuclear medicine [NM] Tc99m red blood cells (RBC) scan, or computed tomography angiography), affects angiographic bleed identification. Materials and Methods: Visceral Angiograms performed from January 2012 to August 2017 were evaluated. Initial angiograms performed for GIB were included in the study. Exclusion criteria included recent abdominal surgery or procedure (30 days), empiric embolization (embolization without visualized active bleeding), and use of vasodilators, or subsequent angiogram. Timing and results of ES, NM Tc99m RBC scan, or computed tomography angiogram and catheter angiogram were recorded. In addition, age, gender, angiogram time, anti- platelet therapy, anti-coagulation therapy, bleed location, international normalized ratio, and units of packed RBCs received in the 24 h before catheter angiography were included in the study. Results: One hundred and seventy angiograms were included in the final analysis. Forty-three angiograms resulted in the identification of an active bleed (68.9 years, and 67.4% male). All of these patients were embolized successfully. One hundred and twenty-seven angiograms failed to identify an active bleed (70.4 years, and 49.6% male). No significance was found across the two groups with respect to time from prior positive investigation. Receiver operating characteristic analysis demonstrated that units of packed RBCs received in the preceding 24 h were correlated with positive bleed identification on catheter angiography. Conclusion: Time to angiography from prior positive investigation, including ES, NM Tc99m RBC scan, or computed tomography angiogram does not correlate with positive angiographic outcomes. Increasing units of packed RBCs administered in the 24 h before angiogram do correlate with positive angiographic findings.