By laparoscopic approach, the nature of Denonvilliers' fasciae in male and female patients can be better defined and facilitates more precise laparoscopic total mesorectal excision for rectal cancer.

Based on the controllable surgical complications and minimal invasiveness in the current patient series, laparoscopic TME is shown to be technically feasible and can be recommended for patients with advanced lower rectal cancer requiring preoperative CCRT using bevacizumab as the additional therapeutic agent.

Teaching NeuroImages: Spontaneous tension pneumo-hydrocephalus may be related to otitis media and temporal bony defect A 39-year-old woman with recurrent left otitis media presented with the sensation of fluid flowing in the head, headache, mild dyslexia, and disequilibrium for 2 weeks. She reported no head trauma and had a normal neurologic examination. Head CT (figure, A) showed intraventricular pneumocephalus and a focal low-density lesion with air-fluid level in the left posterior temporal region. Brain MRI showed minimal enhancement and no restriction of diffusion, and thus did not suggest an abscess (figure, B). CT of petrous pyramids demonstrated a small bone defect at the left posterior temporal bone, which was considered a possible point of entry for air (figure, C).1 CSF culture was negative. Lumbar puncture to release intracranial pressure and antibiotic therapy resulted in full recovery without surgical intervention. AUTHOR CONTRIBUTIONSDr. Yu: drafting/revising the manuscript, study concept and design, acquisition of data. Dr. Peng: drafting the manuscript, interpretation of data. Dr. Cheng: revising the manuscript, analysis of data. Dr. How: drafting/revising the manuscript, study supervision. STUDY FUNDINGNo targeted funding reported. DISCLOSUREThe authors report no disclosures relevant to the manuscript. Go to Neurology.org for full disclosures.

Cardiac dysfunction is common in patients with severe sepsis and septic shock. We present a 71-year-old woman with Escherichia coli urosepsis and sepsis-induced myocardial injury masquerading as non-ST elevated myocardial ischemia. Spontaneous psoas hematoma requiring blood transfusion and intracranial hemorrhage developed after antiplatelet and anticoagulant therapies, even in therapeutic doses. The patient was managed conservatively and recovered well with minor residual hemiparesis. Bleeding complications are a common risk of antithrombotic therapy. It is therefore crucial to weigh the impact of efficacy against safety. Old age, female gender, renal insufficiency and sepsis character increased the risk of bleeding in this patient. A misinterpretation of elevated cardiac troponin I may give rise to a diagnostic dilemma and cause unnecessary morbidity.