We report a series of four acute external iliac artery dissections occurring in three patients within days of completion of ultraendurance athletic events. Acute dissection of the external iliac artery in highly trained athletes after competition has not been previously documented. A retrospective review of three cases was performed with subsequent follow-up, including imaging and hemodynamic measurements. Dissection was suspected on the basis of duplex imaging results in one case, and arteriography confirmed dissection in all cases. All patients were endurance athletes over the age of 40 years. One patient was found to have bilateral lesions. Treatment in two cases was initiated with percutaneous transluminal angioplasty, one with a successful result and subsequent Plamaz stent placement. In the other case percutaneous transluminal angioplasty was unsuccessful, and operative repair was required with the placement of a graft. The final patient who had bilateral involvement was treated conservatively. At a mean follow-up of 32 months, there have been no complications, and all patients have normal resting hemodynamics. Follow-up duplex imaging shows healing of the dissections in the untreated patient. Histopathologic study in the patient treated with operation disclosed dissection in an otherwise normal arterial wall. Highly trained athletes over the age of 40 are susceptible to external iliac artery dissection, and successful treatment has been achieved by surgical, endovascular, and conservative therapies.

This study demonstrated a significant reduction in common femoral venous flow during laparoscopic cholecystectomy coincident with pneumoperitoneum and reverse Trendelenburg's position. Intermittent sequential pneumatic compression reversed that effect, returning peak systolic velocity to normal.

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We develop and defend a distinction between two types of self-censorship: public and private. First, we suggest that public self-censorship refers to a range of individual reactions to a public censorship regime. Second, private self-censorship is the suppression by an agent of his or her own attitudes where a public censor is either absent or irrelevant. The distinction is derived from a descriptive approach to self-censorship that asks: who is the censor, who is the censee, and how do they interact? We label situations in which censor and censee are different agents as public self-censorship, and situations in which they are the same agents as private self-censorship.We demonstrate the salience of this distinction by analysing the case of publication of Mohammed cartoons by the Danish newspaper Jyllands-Posten. Our analysis reveals the presence and interaction of a number of different instances of private and public self-censorship. While our article is primarily concerned with establishing this novel descriptive distinction between public and private self-censorship, our analysis has important evaluative implications. We explain for instance how Jyllands-Posten was laudable as a public self-censor but not so as a private self-censor. In general, our analysis reveals that the agents and processes involved in public and private self-censorship are substantively different, as are the agents to whom normative principles regarding censorship should be applied. In particular, principles of free speech do not apply to the case of private self-censorship, because while an instance of censorship, the absence of an external censor makes the censorship non-coercive.

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