Inflammatory myofibroblastic tumors are lesions that most often affect young adults and children. These tumors have been found in numerous extrapulmonary sites but rarely in the stomach. It is unknown whether this process is reactive or neoplastic. They are infiltrative lesions and often extend through the gastric wall, sometimes reaching adjacent organs including the esophagus, duodenum, peritoneal cavity, spleen. pancreas, and liver. These features mimic malignancy on endoscopy and radiology. We report the ultrasound, color Doppler ultrasound, and helical computed tomographic findings of a gastric inflammatory myofibroblastic tumor with peritoneal dissemination in a young adult. To our knowledge, this is the first report of color Doppler ultrasound and helical computed tomographic findings of this rare disease entity.

Peri-prosthetic patellar fracture following resurfacing as part of total knee replacement (TKR) is an infrequent yet challenging complication. This case-control study was performed to identify clinical, radiological and surgical factors that increase the risk of developing a spontaneous patellar fracture after TKR. Patellar fractures were identified in 74 patients (88 knees) from a series of 7866 consecutive TKRs conducted between 1998 and 2009. After excluding those with a previous history of extensor mechanism realignment or a clear traumatic event, a metal-backed patella, any uncemented component or subsequent infection, the remaining 64 fractures were compared with a matched group of TKRs with an excellent outcome defined by the Knee Society score. The mean age of patients with a fracture was 70 years (51 to 81) at the time of TKR. Patellar fractures were detected at a mean of 13.4 months (2 to 84) after surgery. The incidence of patellar fracture was found to be strongly associated with the number of previous knee operations, greater pre-operative mechanical malalignment, smaller post-operative patellar tendon length, thinner post-resection patellar thickness, and a lower post-operative Insall-Salvati ratio. An understanding of the risk factors associated with spontaneous patellar fracture following TKR provides a valuable insight into prevention of this challenging complication.

The aim of this study was to compare the duration of spinal anaesthesia in obese and non-obese subjects. We also quantified the effect of body mass index (BMI) on spinal anaesthesia by comparing the median effective dose (ED50) of intrathecal hyperbaric bupivacaine required in the two cohorts. one hundred and eight patients undergoing elective total knee replacement arthroplasty under combined spinal-epidural anaesthesia were enrolled as a non-obese group (BMI <27.5 kg/m 2) or obese (o) group (BMI ≥27.5 kg/m 2). Each group was further subdivided by bupivacaine doses of 6, 7, 8, 9, 10 or 11 mg, respectively. Anaesthesia was deemed successful if a bilateral T12 sensory block occurred within 15 minutes of intrathecal drug administration and epidural supplementation was not required. The ED50 for successful anaesthesia and that for successful block of tourniquet pain were determined separately by probit regression analysis. Although the analgesic duration was prolonged with higher doses of bupivacaine in group o, the ED50 for successful anaesthesia did not differ between groups. However, the incidence of tourniquet pain was lower in group O and the ED50 for block of tourniquet pain was less in group O. This study suggests that bupivacaine dose reduction is not necessary, but analgesic duration may be prolonged in patients with higher BMI. These patients require careful consideration of spinal anaesthetic dose to minimise the risk of unnecessary prolongation of anaesthesia.