The TTE using a transseptal needle-sheath system demonstrated to be feasible and effective to treat a persistent type II endoleak after failure of 2 attempts of transarterial embolization of the feeding vessels.

Magnetic resonance imaging (MRI) of knee has become the integral part of knee evaluation, hence any MRI based study adds more value if it helps in the decision-making process, especially for surgery in treating patellofemoral pain. We tried to determine normal patellar indices using knee MR images and the correlation between them and also compared the results with different ethnic population. We analyzed the prospectively collected MR images of 117 knees/patients, and Insall–Salvati (IS) index, modified IS index, patellotrochlear (PT) index, and patellophyseal (PP) index were calculated. Two standard deviations from the mean were used to define the normal and abnormal patellar position. Cohen's kappa values were used to assess the agreement between the indices and the correlation between them was analyzed using Pearson's correlation. The mean values for IS index, modified IS index, PT index, and PP index were 1.00, 1.53, 0.40, and 0.58, respectively. There was very good agreement between PT index and PP index. There was weak correlation between all the indices except the one between PT and PP indices which had a strong negative correlation. Based on commonly used methodology, there were 4% of asymptomatic patients who were outside the standardized cut-off values and different indices classified different knees as abnormal. This indicates patellar position should be one among the many other factors, not as a sole factor when making a surgical decision in patellofemoral pain. We also noted that the indices compared fairly with other populations. Further research is needed to determine the clinical applicability of these indices.

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Background: Pancreaticoduodenectomy is increasingly being offered as treatment for periampullary tumours in patients 80 years and older. Our aim was to evaluate clinical outcomes of pancreaticoduodenectomy in octogenarians from two high-volume tertiary HPB centres. Materials and Methods: A retrospective case-control analysis of a prospectively-maintained database, between January 2008 and December 2017, was performed. Octogenarians who underwent pancreaticoduodenectomy were matched with consecutively-operated younger patients with 1:1 ratio, based on extent of surgery (venous, arterial or additional resection). Pre-operative comorbidities, intraoperative variables, post-operative complications and mortality were compared, with statistical significance at p<0.05. Results: 88 octogenarians (median age 81 years,range:80-90) who underwent pancreaticoduodenectomy (either classical or pylorus-preserving) were compared to similar number of controls (median age 66 years,range:16-79). Gender, ASA (octogenarians median grade 2 [range:1-4] versus median grade 2 [range:1-3] for controls) and performance status (median score 0 [range:0-2] for both groups) were comparable (p=1.00,p=0.18 and p=0.11 respectively). Charlson Comorbidity Index scores were higher overall for octogenarians (median 7 [range:6-10] versus 5 [range2-9],p=0.001). Median LOS was comparable, 15 days (range:5-69) for octogenarians and 12 days (range:5-78) for controls (p=0.12), as was median ICU stay, 2 days (range:0-58) for octogenarians versus 2 days (range:0-25) (p=0.40). Negative resection margin (R0) rates were 64% for octogenarians and 59% for controls (p=0.53), with no significant difference in lymph node status (p=0.53). Overall post-operative complication rate was higher in octogenarians (60% versus 49%); however this was not statistically significant (p=0.17). Similarly, complication rates across the Clavien-Dindo classification categories were not statistically significant. 30-day and 90-day mortality were 2.3% and 8% for octogenarians versus 1.1% and 3.4% for controls (p=1.0 and p=0.33 respectively). Conclusion: Despite higher 90-day mortality, pancreaticoduodenectomy outcomes in octogenarians are comparable to their younger counterparts. Pancreaticoduodenectomy should therefore be offered as a curative surgical option in this cohort, in specialised centres after meticulous pre-operative assessment.