5/3/2023 0 Comments Definition ofsplenic flextureNote the omental cake in the omentum toward the left side in front of the encased colon. Note how the malignant process surrounds the splenic flexure. The process surrounding the beginning of the descending colon is caused by extension of a malignant pancreatic carcinoma into the phrenicocolic ligament along the lateral aspect of the transverse mesocolon. This is a beautiful example of the colon cutoff sign demonstrated by a single contrast barium enema in a patient with acute pancreatitis. The cutoff in this instance is quite straight, but in most patients there is usually a sharp transition from dilated transverse to decompressed descending colon. The colon cutoff sign in the splenic flexure is obvious in this patient with acute pancreatitis. As the inflammatory process spreads along this ligament it comes into contact and spreads the inflammatory process to the splenic flexure and proximal descending colon resulting in a reversible stricture caused by a combination of swelling and spasm. This ligament is called the phrenicocolic ligament because it is connected to the diaphragm (phrenic) on the one end and the colon on the other. The colon cutoff sign ( Pickhardt) is a characteristic finding in patients with pancreatitis where the inflammatory process extends along the tail of the pancreas to the left side where it comes into contact with a triangular ligament that connects the left colon to the diaphragm- just to the left of the lateral aspect of the transverse mesocolon. In this normal double contrast study, the splenic flexure has a steep climb to its mountain top position and then an almost 180 degree turn as it begins its steep descent. Note its cranial position – it is the highest point of the colon in the abdominal cavity. The splenic flexure in this single contrast barium enema is relatively short and almost a 90 degree turn. Like the hepatic flexure it can also vary in length and at its longest can be quite redundant with similar radiological difficulties to uncoil it during a barium enema. It is attached to the diaphragm by the phrenicocolic ligament. Its drainage is via the corresponding mesenteric veins into the SMV and then portal circulation. The splenic flexure is a watershed region as it receives dual blood supply from the terminal branches of the superior mesenteric artery and the inferior mesenteric artery, thus making it prone to ischemic damage in cases of low blood pressure because it does not have its own primary source of blood. It is the embryological junction point between the midgut and hindgut, and is the watershed of two circulations so that it is the border where the circulations of the SMA and IMA meet. The splenic flexure is the junction between the transverse colon and the descending colon and is usually the most cranial portion of the colon. The surgical treatment of splenic flexure carcinoma (SFC) has been traditionally neglected in the literature, mainly because of its relatively low incidence, as it represents only 3 to 5 of all colonic cancers 1, 2, 3, 4.
0 Comments
Yes, this can be annoying if you want to use Lucy’s fire magic against a particular boss, but Dead Mage rewards character switching. Given how valuable runes and other item drops are, exploring every inch of a dungeon is a good idea, even if you know you may get in over your head at times.ĭeveloper Dead Mage wants the player to bounce between the playable characters as much as possible and ensures this through a fatigue meter that can greatly deplete a family member’s health for a set amount of time if they are used too frequently. A few steps further, the ground may bubble to life with magic portals, and you quickly find yourself overrun and unleashing everything you have, praying that the cool-down meters on your specials replenish faster.Įvasive maneuvers are also excellently implemented into combat, allowing each character to dive out of the way of a charging enemy or under a sword's cut if the timing is right. A few enemies may advance on you, and can easily be swatted away with basic attacks. As you uncover more of a dungeon's map, you don't know what lurks in the shadows. The special attacks they unleash are finely balanced and each character more than stands a chance in the dungeons, even when the odds are against them. All six characters are unique – both in performance and their deep skill paths. Both of these family members are a blast to control, as are the other four Bergson family members that unlock as the story progresses. Linda is a talented archer brought to life with twin-stick shooter controls. John functions like a typical warrior with rapid sword techniques, a shield for defense, and area-of-effect magic attacks to damage approaching hordes. When this force begins spreading across the land, the family is forced into action, beginning with John, the father, and Linda, one of his daughters. We learn that this home sits at the epicenter of an ancient evil known as the Corruption. It’s a cool touch that again hammers home the family dynamic. Whether you succeed or fail in that run, you are often treated to new snapshots of the Bergson's lives and can hear what they are thinking. The family home is the hub players visit after each dungeon run. Even small moments, like the adoption of a new pet, are brought to life in playful and gorgeous ways. The unique animations used to frame the story moments are impressive and great in number, often including all of the family members in a scene. The visuals follow suit with beautifully animated pixel-art characters atop colorful backdrops. The writing is top notch from start to finish and unfolds through the soothing voice of a narrator who speaks of the Bergson’s lives as though they are unfolding through a children’s picture book. This action/RPG strikes an odd balance between showing the purity of family life and the need to sacrifice all to save the world, but it ends up being compelling and thoughtful, giving you plenty of reason to cheer the Bergson's on. As you skillfully hack your way through skeleton hordes and fire arrows at demonic ghouls, the lives of the ten people in the Bergson family are explored fully you watch them bond, struggle, and ultimately grow – from children and parents to magic-wielding gods. Children of Morta is a nicely designed dungeon crawler with a huge heart. |