UNASSIGNED: Portal vein thrombosis is a common problem of end-stage liver disease in patients with portal hypertension and Yerdel grade IV thrombosis may be a contraindication for liver transplantation. Advances in surgical technique have indicated the feasibility of liver transplantation with PVT such as Reno-portal anastomosis, cavo-portal hemitransposition, but low graft portal blood perfusion and regional portal hypertension were the limitations.
UNASSIGNED: We introduce a new approach for portal system reconstruction in a patient underwent liver transplantation: A 28-year-old male was diagnosed with Budd-Chari syndrome and portal hypertension with grade IV portal vein thrombosis.
UNASSIGNED: The \"Pull-out\" technique was applicated for thrombectomy, which can aid in exposing the superior mesenteric vein and portal vein branches and reducing technical difficulties associated with the identification and dissociation of surrounding anatomical structures. To collect sufficient portal vein blood perfusion and avoid regional portal hypertension, the portal vein system was reconstructed through double-approach procedure: reno-portal anastomosis combined with portal-portal anastomosis.
UNASSIGNED: Based on a precision preoperative evaluation, application of the Pull-out technique and double-approach procedure may be an effective method of thrombectomy especially in cases of grade IV portal vein thrombosis.

BACKGROUND: The reconstruction of the continuity of flexor tendons disruptions in zone II still remains one of the most challenging problems in hand surgery. The ideal repair has to provide sufficient strength and the possibility of early mobilization in the attempt to obtain a functional range of motion. One of the methods which appears to respond to these requests is the pull-out technique described by Brunelli, which moves the tension from the level of the tendon disruption to the finger pulp over the tendon insertion.
METHODS: After using this method, but by doing some modifications of the original technique, our aim was to conduct a retrospective study looking at gap formation, suture strength, rupture rate, efficiency of the two-strand suture repair and of the early active mobilization against resistance in obtaining a good range of flexion rate. We reviewed a series of 71 flexor digitorum profundus disruptions in zone II, in 58 patients admitted in our service between 2000 and 2008, and treated with this method.
RESULTS: We achieved a complete range of flexion in 41 fingers (57.7%) and a flexion deficit of 5-10° in eight fingers (11.3%) and of 10-20° in 22 fingers (31%). We had no ruptures, major strength deficit, or bowstringing.
CONCLUSIONS: Our study demonstrates that, by moving the tension from the level of disruption to the finger pulp, the rehabilitation program can begin very early post surgery. We had 0% ruptures.