Good morning, everyone. My name is Marcin Von Sovic. I'm anesthesiologist and critical care physician practicing at Toronto General Hospital. I'm also a member of perioperative echocardiography group in our site. It's my pleasure to lead this session. I was curator by Andrew Deno. I don't think Andrew needs any presentation or introduction. He is truly the friend of our meeting for the last 21 years. He presented on most of our meetings. He rescued us in emergency situation when some lectures were cancelled in the very last moment for personal reasons. The title of the session is Extracaldiac ultrasound and definitely Andrew and his group are pioneers. He assembled three lecturers. I'm looking forward. I listened to all lectures yesterday because of my role. It's fascinating. What else I can add? Andres, professor of anesthesia and critical care in Montreal Heart Institute and University of Montreal. He published over 300 papers, wrote multiple chapters. He's editor of three books and I believe many of us are using them as a daily reference. And among your multiple research interests is Extracaldiac ultrasound. Andres, we are looking forward for your presentation. I know that you are also closing with some cases. Just as a housekeeping reminder, please post your questions or Q&A part and we will moderate discussion at the end of this session. Andres, floor is yours. Thank you so much. Thanks again for the invitation. I think we're ready to start so we could start the presentation now. They were pre-recorded by our team. So enjoy. My name is Andres De Noux. I'm professor of anesthesia at the University of Montreal. I'd like to thank the organizer for inviting me to discuss with you about trans-gastric abdominal ultrasound. I work at the Montreal Heart Institute as a cardiac anesthesiologist and these are my disclosures. I'm also supported by the Montreal Heart Institute Foundation and the Richard Kaufman Diamond Fund in anesthesia and critical care. My objectives are to present an overview of extracaldic organs in the vasculature that T can interrogate, to describe normal intrabdominal organs using T imaging, and also to identify common pathologies beyond the kidney and the liver. This presentation will be done in collaboration with Dr. Jean-Simon La Dancette, who is a cardiologist and also a critical care fellow at the University of Montreal, and also Dr. William Boubien-Soudigny, who is a nephrologist and the researcher at the University of Montreal. The classical application of extracardiac T are lung and upper GI cancer differential diagnosis and staging, and also ciliate blockade for pancreatic cancer related pain. However, the perioperative applications of these modalities include determining the cause of hypoxemia, which is done through transophageal lung ultrasound or TILUS, to identify any extracardiac cause of hemodynamic instability, and to monitor splenchnic and renal perfusion, which can be done using transgastric abdominal ultrasound or TGOs. In this article on the practice guideline for perioperative TEE, it is mentioned that TEE should be used in unexplained persistent hypotension or hypoxemia. Importantly, those conditions can be extracardiac. Similar to those James Bond glasses, extracardiac TEE will allow you to identify with ultrasound unsuspected dangers for your patients. In 2016, Alex Kaveyes reported the use of TILUS, and in 2021, we published this article on transgastric abdominal ultrasound that we will discuss. The following examples will be part also of our upcoming TEE multimedia manual third edition, which is scheduled for 2024 with all those editors. This is how we're using extracardiac TEE. So if you have hemodynamic instability but hypoxemia, then you would consider looking at the heart, but mostly looking at the long and performing transophageal long ultrasound. However, if there's no hypoxemia, then you would consider that you may have a cardiogenic or non-cardiogenic hemodynamic instability, and for the non-cardiogenic, those are the conditions that can be diagnosed with transgastric abdominal ultrasound. With transgastric abdominal ultrasound, most upper abdominal structures can be identified. The position of the TEE probe can easily be described. Solid organs can be interrogated, but also the Arta, its branches, and also you can assess perfusions and also signs of venous congestion. So in our article on TEE GUS, we identified 10 specific views and described their usefulness in perioperative medicine. Some of those views are interior, some views are on the right side, posterior, and on the left side. So the stomach is interior, to some extent. The splinic vein and the superior mesenteric vein are posterior to the stomach. They join together to form the portal vein. The kidneys are posterior. The spleen is between the stomach and the left kidney. The pancreas is posterior to the stomach, but anterior to the splinic vein. This is the large transverse colon, which is just below the stomach. And finally, on the right side there is the liver, with an interior extension with the left liver lobe. In order to scan vessels such as the aorta or the IVC, the ultrasound beam is electronically positioned at zero degree, and we will slowly advance the probe back and forth to identify the structures. In order to allow scanning of solid organs like the liver, the ultrasound beam will be electronically rotated to 90 degree. We will then perform axial rotation on the ultrasound beam from the left to the right. Using a TE probe outside the heart can change the orientation of the 2D image from the ultrasound beam. Normally from a transgastric view at zero degree, the TE ultrasound beam is relatively interior to the TE probe. The position of the dual knob on the TE probe will follow the position of the beam. In a normal neutral position it will describe as a clock, 12 o'clock. In this example, when we obtain a transgastric view, what you see on the right side of the screen is the left structure of the patient, and what you see on the left side of the screen is the right-sided structure. At zero degree, the dual rotating knob undergo an axial rotation. For instance, at 6 o'clock, right portion of the screen will correspond to the right posterior structures, and the left posterior position of the screen corresponds to the left-sided structure. When the probe is rotated at 90 degree, the right side of the screen will always display cephalate structure. The left of the screen will always display codal structure, and they will be interior-right, posterior, and left with axial rotation from 12, 3, 6, and 9 o'clock. Precise position of the terasic and abdominal structure can be done using the depth marker on the TE probe and the 2D orientation of the dual rotating knob at 3, 6, 9, or 12 o'clock for both transophageal lung and transomintegos. In order to use venous Doppler, there are some specific rules. First, very important to reduce the velocity scale from 5 to 20 a centimeter per second. Second, a normal Positile venous Doppler velocity, such as the epithetic vein, is always abnormal if not Positile, and a normal non- Positile venous Doppler, as the portal or the splenic vein, is always abnormal if Positile. Finally, if there's an abnormal venous Doppler, confirm it in another site, and this is the concept of the vexus core. In this view of the kidney, the color scale was reduced to 3 centimeter per second. Higher velocity scale could mask preserved renal perfusion. You will be able to notice that some vendors do not offer the ability to go below 15 centimeter per second. This is an example of a splenic vein. What you can do in those cases is to use tissue Doppler, and then you'll be able to identify very low velocity scale on your venous Doppler signals. Those are the rules for arterial Doppler interrogation. It's important to analyze your waveform. First, there should be a rapid systolic portion in a normal arterial Doppler signal. If you have pulse of stardust, it can be cardiac, but it can be extra cardiac such as vascular stenosis. There are quantitative values. The peak velocities, we will typically use pulse width Dopplers on the S-seria velocities are more than 200 centimeter per second, which would indicate a stenosis. The systolic velocities are definitively related to your stroke volume and your cardiac output, and the dastolic velocities are mostly related to resistance. And from those values, you can calculate the resistance index or the possibility index. And very important, if you have an abnormal arterial signal, never analyze it in isolation. This is an abnormal arterial Doppler signal from the splenic artery. Note the dastolic reversal and the very high resistance. However, you have a similar signal on the transcranial Doppler with low dastolic velocities. And this was secondary to severe aortic regurgitation signal obtained just before aortic valve replacement. Those are the normal arterial velocities of the abdominal vessels. Stomach is the first portion of the Tegos exam. We can examine the stomach structure, the content, the wall, but also the elements which are external to the stomach. All the transgastric abdominal ultrasound views originate from the stomach. The Tee probe is in the stomach, which surrounds it. The ultrasound beam can be at zero degree, or as shown here, adjusted to obtain the largest portion of the stomach, which can vary among patient. This is an oblique view that allow visualization of the largest portion of the stomach. This is the corresponding ultrasound image. This is a 2D view of an empty stomach and a 3D view of a stomach with clear fluid, where you can see the normal cirrus wall of the stomach. The role of the stomach view is to identify for stomach, upper GI bleed, bowel wall edema, gastric varices, and peritoneal fluid. This is a stomach filled with fluid, and this is a full stomach with food particles. 61 year old woman, cardiogenic shock with ECMO install. In this patient, gastric distention and full stomach was present. This can be the result of gut hyperperfusion and lead to abdominal compartment syndrome, which can be fatal if unrecognized. These are unstable patient, one with upper GI bleed, and this one has blood clots in the stomach. This is an example of the use of color Doppler around the stomach wall. Those are gastric varices in a patient with liver cirrhosis. 72 year old woman, undergoing both mitral and tracheal spit valve replacement. This patient has gastric edema, more than four millimeter wall thickness, which is often observed in patients with splenchnic penis congestion as a result of right heart failure and pulmonary hypertension. 50 year old hemodynamic unstable patient after a cardiac arrest. This patient had a significant hyperdynamic heart with almost leventcular alfotrack obstruction. He had free peritoneal fluid present anterior to the stomach and around the tip of the left lobe of the liver as shown here. So again, in patients who are unstable with a normal heart, it is relevant to look outside the heart as in this case. When the T probe is turned to the right, you can examine the inferior vena cava for its tracheal consent, respiratory variation, the external content. You can also interrogate the hepatic vein using Doppler. And you can also look at the liver again for the intrinsic content and the external structures. This is an interoperative view of the inferior vena cava as it enters into the right atrium to the tox just above the diaphragm. So this is the inferior vena cava. From the stomach, a transverse view of the IVC and the hepatic vein can be obtained. The ultrasound being can be initially at zero degree. And this would correspond to the ultrasound image that you would see in this position. From the stomach, a longitudinal view of the inferior vena cava and the right hepatic vein can be obtained. The ultrasound beam is aligned on the inferior vena cava at 90 plus or minus 10 degree. And this is the corresponding ultrasound image that you would see in this patient. The transverse orientation of the hepatic vein is not necessarily at zero degree, but by minus 30 plus or minus 10 degree. In order to visualize the three hepatic veins, it's often preferable to move from zero to 140 degree as in this example. You will then be able to see the middle hepatic vein, the right hepatic vein and the left hepatic vein. This is a patient in which the three hepatic veins are clearly seen at 157 degree. So these are the hepatic vein. However, rotating the image on the ultrasound system will allow easier analysis of the structures. Dr. Lalancet will discuss in more detail the Doppler analysis of the hepatic and the portal vein also. So another relevant diagnosis that can be made with liver ultrasound is acides, but also liver cirrhosis as shown here by the abnormal contour of the liver or the round liver edge. This is an example of a carcinoid tumor that was present in a patient with severe tracheuspid regurgitation. Note the irregular texture of the liver. The portal triad view can be useful for several reasons. The portal vein looking at intrinsic content, Doppler velocities, the hepatic artery and also the bile duct. The portal vein is anterior to the inferior vena cava, but not parallel and it is slightly oblique. From the stomach, a longitudinal view of the origin of the main portal vein can be obtained at about 70 degrees. The portal vein is formed by the junction of the splenic vein and the mesenteric vein. This is the corresponding ultrasound image where you can also see a portion of the inferior vena cava. In patients who have undergone a colisistectomy, you will often see two parallel portal veins. The real one is this one, but the following corresponds to a dilated bile duct. The term double barrel gun is used to describe this condition. 85 year old man, hypotensive with lactic acidosis after corneatory revascularization and intratheic balloon pump removal. This patient had a normal nurse which to some extent exclude the cardiogenic condition. Indeed, the transophageal echocardiographic exam was unchanged. However, when we examined the abdomen and we look at the portal vein, there was a significant amount of air into the portal vessel. A CT scan was ordered and you can see air which was present in the left lobe of the liver as a result of mesenteric ischemia. Again, a normal cerebral and somatic saturation indicated a non-cardiogenic type of shock. In this patient, you can appreciate again the tick and stomach, but also asides as a result of venous congestion and not surprisingly a normal portal vein possibility. This is a normal pericardium and this one is from a 63 year old man undergoing mitral valve replacement. Note the significant pericardial venous congestion which was associated with elevated central venous pressure, large V-wave and also portal possibility. Dr. Lalancette will discuss this in more detail. The aorta and its branches can be examined with transgastric abdominal ultrasound. In addition, all those vessels can also be analyzed. From the stomach, posterior rotation of the T probe will allow visualization of the celiac trunk at zero degree. This is the corresponding ultrasound image that you will see, but remember in this position the right is on the right and the left is on the left side of the screen. This is the aorta, this is the celiac trunk, this is the hepatic artery, the splinic artery and the pancreas. This image is typically called the whale tail sign. From the same previous position, T probe advance will allow visualization of the superior mesenteric artery and the surrounding vessel. This is the corresponding ultrasound image. In this position, remember again that the right side structure will be on the right, left side structure on the left. This is an example where you can see the aorta, the superior mesenteric artery, the right renal artery with the corresponding arterial Doppler signal, the left renal vein with the corresponding versatile venous signal and the superior mesenteric vein, which normally is a continuous non-positile signal. The role of those views are the following. They can be used to monitor your patient during arctic dissection or vascular stenting to evaluate also the adequate position of the enterotic balloon pump to detect compromise the splinic flow with celiac trunk and mesenteric artery monitoring. And finally, to diagnose splinic vascular stenosis and the nutcracker syndrome. We often verify the cephalate position of the enterotic balloon pump in the aorta, but less frequently the codial position. In this study published in circulation in 2010, Rastan et al. look at the visceral arterial compromise during enterotic balloon pump therapy. They look at 63 patients with an enterotic balloon pump requiring a CT scan. And based on the radiography, the proximal balloon position was correct in 96.8%, but appropriate only on 30% based on CT scan. In 97% of those patients, there was at least one visceral artery which was compromised, the celiac trunk in 97% of the time and the superior mesenteric artery 87% and the renal artery about two turns of the time. The paratomy for mesenteric ischemia was required in 23.8% of those patients and the hospital mortality was 60%. This is a 69-year-old woman redo aortic valve replacement and during the operation, the late lactate went up to 5.1%. When you look at the superior mesenteric artery, you can see an increase in the adiasing which suggests that this patient has a stenosis. Indeed, her peak velocity was 3 m per second. Fortunately, this patient died postoperatively from mesenteric ischemia and lactate increased up to 20 mm per liter. Left side structure will include the spleen in which the splenic vein and the splenic artery can be interrogated, but also the dimension, the content, the dimension, the content and the external structure around the spleen. From the stomach, left-sided rotation of the T-probe can result in a transverse view of the spleen. The ultrasound beam can be initially at zero degree and this would correspond to the ultrasound image that you would see on your TEE system. This is an example of a view of the spleen and the hyalum, the systolic artery velocities and the normal continuous splenic vein dopper signal can be analyzed. The splenic view can be used to monitor RV dysfunction which is associated with venous congestion and also evaluation of response to medical treatment. We can also diagnose splenic rupture, cyst and also abscess in the spleen. Presence of free abdominal fluid can also be detected in this view. This is a 57-year-old patient after cardiac arrest. He's a very unstable necmo. He had his cardiac arrest after hockey game. This is the splenic view. You can see the stomach and this is the spleen with free blood to your right portion of the screen and blood clot to the spleen. This is the lever and his hemoperitoneum was secondary to an hepatic laceration from the cardiac massage. The renal exam will be discussed in more detail by Dr. William Beaubien-Souligny. This is a transverse and a longitudinal pancreatic view which are mostly useful to interrogate also the splenic vein and the splenic artery. This view is similar to the supérieure mesenteric artery view but we will focus on the splenic vein which is just under the pancreas. The ultrasound beam will be typically at zero degree and this is the corresponding ultrasound image. So this is an example of a normal splenic vein with color Doppler. The pancreatic view can be used to interrogate the splenic vein and detect the severity of RV systolic and dastoid dysfunction. In addition we can use it to evaluate response to medical treatment. That is the return report or experience using this view before the procedure where you can see some degree of velocity immediately after bypass where you can see a normal but reduced velocity and then after return of cell saver fluid where you can appreciate the increase in velocity. She mentioned that the portal vein is easily made with surface ultrasound but the alignment is more problematic with TE. Doppler interrogation of the splenic vein with TE is much more easy to obtain. 77 year old man during off-punk bypass you have the hemodynamic value. There's a normal right ventricular pressure waveform. The brain saturation is normal and there's a normal continuous splenic venous Doppler. 56 year old woman to post bypass after aortic valve replacement. There is a normal right ventricular waveform with the dastolic slope. There is significant splenic venous Doppler possibility with also brain desaturation. So in conclusion TE is more than transsophageal echocardiography. TE is transsophageal echography. TELUS is indicated if you have a patient who is hypoxemic or abnormal blood gas you need to examine the lung. If you have an innermodernally unstable patient with a normal looking heart or hyperdynamic or left ventricular outflow tract obstruction and TELUS is normal it's important to examine the abdomen. TGAS in fact represent a new area of research in perioperative anesthesia. Thank you for your attention. Thank you. Thank you Andrea for fantastic lecture. I'm sure there will be plenty of questions at the end of the session.


Like most police officers, the reason is simple, to help people and be a part of a community. Those were the core reasons that I had within me when I started this career 10 years ago.


Suspense, and the producer of radio's outstanding theatre of thrills, the master of mystery and adventure, William M. Robeson. Radio drama is an art form which developed slowly during the quarter century between the perfecting of the audio tube of Dr. Lee de Forest and the video tube of Dr. Vladimir's Roy Orkin. We feel that great radio plays, just as great stage plays, should be revived from time to time. So, we are presenting a revival of one of the most famous radio plays of all time, Lucille Fletcher's Unforgettable Sorry Wrong Number. And of course, there is only one actress in the world entitled to play the leading role of the harassed Mrs. Stevenson, she who created the role 14 years ago, Miss Agnes Moorhead. Listen, listen then to Sorry Wrong Number, which begins in exactly one minute. We have together ample capacity in freedom to defend freedom. This is NATO, the North Atlantic Treaty Organization. Day after day, month after month, since April 4th, 1949, the activities of the North Atlantic Treaty Organization have moved steadily forward on many fronts. This complete cooperation must and will continue because the concept of national self-sufficiency is out of date. Countries of the free world are interdependent and only in genuine partnership and by combining their resources, sharing tasks in many fields can progress and safety be found. The United States of America is a part of NATO. You should be aware of and alert to the objectives and programs of the North Atlantic Treaty Organization. And now, Sorry Wrong Number, starring Miss Agnes Moorhead, a tale well calculated to keep you in suspense. Operator, I've been dialing Murray Hill 40599. Now for the last week quarters of an hour and the line is always busy. I don't see how it could be busy that long. Will you try it for me, please? I will be glad to try that number for you one moment, please. You see, it's my husband's office. He's working late tonight and I'm all alone here in the house. My health is very poor and I've been feeling so nervous all day. I am ringing Murray Hill 40599. Hello? Hello, is Mr. Stevenson there? Hello? Hello? Hello? Hello? Who's this? What number is this, please? I'm here. Yes, George. He says everything is set up. Good. What number is this, please? Where are you now? I'm on the phone. Oh, unspeakably. Operator, I've just been cut off. I'm sorry, what number were you calling? Well, it was supposed to be Murray Hill 40599, but it wasn't some wires must have got crossed and I was cut into a wrong number and I've just heard the most dreadful things, something about a murder. And operator, you'll simply have to trace that call at once. What was the number? Well, I don't know. It was a wrong number and these two men, they were cold-blooded fiends and they were going to murder somebody, some poor innocent woman who was all alone in a house near a bridge. We've got to stop them. We've just got to... What number were you calling? Well, that doesn't matter. It was a wrong number. Now, look, it was obviously a case of some little sip of the finger. I asked you to get me Murray Hill 40599, who dialed it, but your finger must have slipped and I was connected to some of the number. I could hear them, but they couldn't hear me. Now, I simply fail to see why you couldn't make that same mistake again on purpose, why you couldn't try to dial Murray Hill 40599 in the same sort of careless way. Murray Hill 40599, I will try to get it for you. Well, thank you. Murray Hill 40599 is busy... But operator... Yes, ma'am? You didn't try to get that wrong number at all. I asked you explicitly and all you did was dialed correctly. I'm sorry, I will connect you with the supervisor. Well, please. The supervisor, may I help you? Yes, I want you to trace a call, a telephone call immediately. I don't know where it came from or who was making it, but it's absolutely necessary that it be traced because it was about a murder that someone's planning. A terrible cold-blooded murder of a poor innocent woman tonight at 1115. I see. Well, can you trace it for me? Can you track down those men? I'm not certain. I can try. May I have your name, please? Mrs. Stevenson, Mrs. Albert Stevenson. But listen... And your telephone number, please? Plaza 37599. But if you go on wasting all this time... Why do you want this call, please, please? Why? Well, I told you why. These men sounded like killers. They're dangerous. They're going to murder this woman at 1115 tonight, and I thought the police ought to know. Have you reported this to the police? Well, no, not yet. You want this call checked purely as a private individual? Well, yes, but meanwhile... I'm sorry, Mrs. Stevenson, but I'm afraid we couldn't trace the call just on your say so as a private individual. We'd have to have something more official. Oh, for heaven's sake. Well, all right, I'll call the police. Thank you. I'm sure that would be the best way to get... The second act of suspense continues in one minute. Another visit with Joe and Daphne Forsythe. Hey, honey, I'm home. Daphne. Drop dead. Uh-oh. What's the matter, honey? Don't you speak to me. You don one. Don one? Daphne, I'm no don one. No habalespa no. Very funny.  Well, it was no prize winner, but... Neither are you. You lethario? I've often wondered, what's a lethario? I don't know, but that's what the wives on TV always call their husbands. I guess it applies. Do you want me to go out and come in again? As far as I'm concerned, you can go for a long walk, preferably on a short pier. Well, oh, come on, Daphne. What's wrong? You're good friend Harry called, and he spilled the beans. Which beans? He said, quote, tell Joe he was right about those blondes. They're great, unquote. Blondes? That's what he said. Oh, well... He didn't say blondes. He said bonds. Savings bonds. What? Sure. I buy them on the payroll savings plan, and I told Harry he ought to do it too. Savings bonds have a guaranteed interest that pays back four dollars for every three, which is a pretty good investment. That's a pretty good story, too. It's true, so help me. That's why Harry's so happy. Savings bonds are great. Well, maybe you're right. You wouldn't really fool around with blondes, would you? You're too faithful and sweet, kind, and... Fast talking. And now, we continue with act two of sorry wrong number, starring Miss Agnes Moorhead, a tale well calculated to keep you in suspense. The police department, get me the police department, please. Thank you. I will connect you with the police department. Oh, dear. Do you have to dial? Can't you ring them directly? Police station, precinct 43, Sergeant Martin speaking. Police department? Oh, this is Mrs. Stevenson. Mrs. Albert Smythe Stevenson, a 53 North Sutton place. I'm calling up to report a murder. I mean, the murder hasn't been committed yet, but I just... I overheard plans for it over the telephone, over a wrong number that the operator gave me. Yes, ma'am. It was a perfectly definite murder. I heard their plans distinctly. Two men were talking, and they were going to murder some woman at 11.15 tonight. She lived in a house near a bridge. Are you listening to me? Yes, ma'am. And there was a private patrolman on the street. He was going to go around for a beer on Second Avenue, and there was some third man, a client, who was paying to have this poor woman murdered. They were going to take her rings and bracelets and use a knife. Well, it's just unnerved me dreadfully, and I'm not well. I see, and when was all this, ma'am? About eight minutes ago. And what was that number you were calling? Murray Hill 40599. But that wasn't the number I overheard. I mean, Murray Hill 40599 is my husband's office. He's working late tonight, and I was trying to reach him to ask him to come home.  Well, we'll look and check it with the telephone coming. Check it? I've already taken care of that. Oh, you have? Yes. And personally, I feel you want to do something far more immediate and drastic than just check the call. I'd say the whole thing calls for a search. A complete and thorough search of the whole city. I'm very near the bridge, and I'm not far from Second Avenue, and I know I'd feel a whole lot better if you sent around a radio car to this neighborhood at once. And what makes you am? Well, I... Well, I don't know. Only the coincidence is so horrible. Second Avenue, the patrolman, the bridge? Look, lady, why don't you look at it this way? Suppose you hadn't broken in on that telephone call. Suppose you'd got your husband the way you always do. You wouldn't be so upset, would you? I suppose not, only it sounded so inhuman, so cold-blooded. Unless, of course, you have some reason for thinking that someone may be planning to murder you. Me? Oh, no. No, I hardly think so.  I'm alone all day and night. I see nobody except my maid, Eloise. She's a big girl. She weighs 200 pounds.  And the only other person is my husband, Albert. He says, crazy about me. Just adores me. Waits on me hand and foot. It's scarcely left my side since I took sick 12 years ago.  Now, if you'll just leave the rest of this to us, we'll take care of it. But what will you do? It's so late. It's nearly 11 now. We'll take care of it, lady.  Look, lady, I said we'd take care of it. Just now, I've got a couple of drunks here that require my immediate attention. Good night, ma'am, and thank you.  Now, why did I end up on the phone like that?  Oh, why doesn't Albert come home? Why doesn't he get the operator? Operator for Heaven's sake. Will you ring that Murray Hill 40599 number again? I can't think what's keeping him so long. I will try it for you. I'm sorry, Murray Hill 40599 is busy. I can hear it. You don't have to tell me. I know it's busy. I can only get out of this bed for a little while. If I could just get a breath of fresh air or just lean out of the window and see the street. Hello? Al? What's the matter with this phone? Hello? Hello? Hello, for Heaven's sake, who is this? Hello? Hello, operator? I don't know what's the matter with this telephone tonight, but it's positively driving me crazy. I've never seen such inefficient miserable service. Now, look, I'm an invalid and I'm very nervous and I'm not supposed to be annoyed. But if this keeps on much longer... What seems to be the trouble, please? Well, everything's wrong. I haven't had one bit of satisfaction out of one call I've made this evening. The whole world could be murdered for all you people care and now my phone keeps ringing and ringing and ringing and ringing and ringing every five seconds of money picking up this over there. I'm sorry. If you will hang up, I will test it for you. I don't want you to test it for me. I want you to put that call through whoever it is at once. I'm afraid I can't do that. You can't? Oh, you can't? And why? Why may I ask? The dial system is automatic. Automatic? And meanwhile, I've got to sit here in my bed suffering every time that phone rings, imagining everything. I will try to check the trouble for you. Oh, my heavens. Thank you.  Hello? Hello? Stop ringing me. Do you hear the answer? Are you with this? Do you realize you're driving me crazy? Who's calling me? What are you doing here for? Now, stop it! Stop it! Stop it! I say, hello? If you don't stop ringing me, I'm going to call the police. Do you hear the police? I say, hello? If Albert would only come on. Oh, let it be.   I'm going to answer that one. Go on, ring! Ring! Ring! The of follows in one minute. Can an active heroism be symbolized? It can and is in one of its most distinguished forms by a medallion of gold bronze bearing the great seal of the United States surrounded by a blue enamel band inscribed for distinguished service. On the reverse side is a group of flags representing the Allied nations. The medallion is suspended from a plain bar attached to a ribbon with vertical stripes of red, white, and blue. This is the Army's Distinguished Service Medal awarded to military personnel for exceptionally meritorious service to the government in a duty of great responsibility. This medal also has been awarded to military personnel of other countries, notably the leaders of the Allied troops in World War I, General Patan of France, Field Marshal Hague of Great Britain, and Lieutenant General Diaz of Italy. In nature and background, the Distinguished Service Medal is somewhat similar to the Legion of Honor bestowed by France. Only a few are worthy. Only a few can measure up to this symbol of selfless dedication, a vital and living form of freedom. And now, we continue with Act 3 of Sorry Wrong Number starring Miss Agnes Moorhead, a tale well calculated to keep you in suspense. I can't stand anymore! Stop it! Hello! What do you want? Stop ringing! Will you stop it? Just stop it! Hello, is this Plaza 37599? Oh, yes. Yes, I'm sorry. This is Plaza 37599. This is Western Union. I have a telegram here from Mrs. Albert Stevenson. Oh, well, I'm Mrs. Stevenson. The telegram is as follows. Darling, terribly sorry. Tried to get you for last hour, but line busy. Oh. Leaving for Boston, 11 p.m. tonight on urgent business. Oh, no. Back tomorrow afternoon. Oh, oh, no. Do you wish us to deliver a copy of the message? No, no, thank you. Thank you, madam. Good night. Good night. He couldn't do it. Not when he knows I'll be all alone. It's some freak, some fiendish trick. Operator, try that Murray Hill 40599 number before he does once more, please. You may dial that number direct. Oh, I'm kidding. For me. Albert, how could you? How could you? Can't be alone tonight. I just, I just can't. If I'm alone one more second, I'll go mad. Know what he says or what the expense is.  I'm entitled to a little consideration. Information. I want the telephone number of Hensley Hospital. Hensley Hospital? Do you have a street address? No, no, but it's somewhere in the 70s. It's a very small, private and exclusive hospital where I had my appendix out two years ago. Hensley, H-E-N-C. One moment, please. Well, please hurry and please. What is the time? You may find out the time by dialing Meridian 71212. Oh, for heaven's sake. I've no time to be dialing. The Hensley Hospital is Butterfield 82598. Oh, Butterfield. A nurse's registry, please. Who was it you wished to speak to, please? I want the nurse's registry at once. I want a trained nurse. I want to hire her immediately for the night. I see. I'm nervous. I need soothing and companionship. You see, my husband is away. Have you been represented to us by any doctor in particular, madam? No. And our superintendent has asked us to chin in charge. It is absolutely necessary.  I'm very upset. I'm alone in this house and I'm an invalid. And tonight I overheard a telephone conversation that upset me dreadfully. In fact, if someone doesn't come at once, I'm afraid I'll go out of my mind. Miss Phillips? And what is your name, madam? When do you expect her in? I really couldn't say. She went out to supper at 11 o'clock. But it's not 11 o'clock. What time is it? In my own telephone. As though someone has lifted this receiver off the hook of the extension foam downstairs. I didn't hear it, madam. Now about... The kitchen of the... They're listening to me now. They'll be quiet no more, Melty. But if I don't call someone now, while they're still down there, there'll be no time. Sir? Operator, I'm in desperate trouble. I'm sorry. I cannot hear you. Please speak louder. I don't... I don't dare. There's someone listening. Can you hear me now? I'm sorry. But you've got to hear me. Oh, please, you've got to help me. There's... there's someone in this house. Someone who's going to murder me and you've got to get in touch with him. There it is. Did you hear it? He's put it down. He's put down my extension foam. He's coming up. He's coming up the stairs. Give me the police department. Give me the police department. One moment, please. I will connect you. Please. Police department? Sorry, wrong number. Don't worry. Everything is okay here. Suspense. In which Ms. Agnes Moorhead starred in William and Robeson's production of Sorry, Wrong Number. Written by Lucille Fletcher. Supporting Ms. Moorhead in Sorry, Wrong Number were Jeanette Nolan, Virginia Gregg, Ellen Morgan, Joda Santis, Byron Kane, and Norm Alden. Listen. Listen again next week. When we return with The Country of the Blind by H.G. Wells, another tale well calculated to keep you in suspense. Suspense has been brought to you through the worldwide facilities of the United States Armed Forces radio and television service.


Recent research highlights the importance of lipid synthesis and metabolism in tumoregesis, specifically in cancer cell migration and invasion and in the induction of tumor angiogenesis, which are crucial processes for the dissemination of tumor cells and formation of metastases.


Can we get a little piece of paper, please? Can we get that one, please? I'm ready whenever you guys are. Can we get a scabble blade, please? Because we're going to be the first to move. Giggling, like a little girl. Enjoying this conversation. You got good sess, good HR, good BP. That's all for this early level share. We wish you the nine lines for completion.


We will start off a stardust overdrive. It is Kwaki Mirror's Seapanther. Slip Summon. Ritual Buster. Herculean Power. Solitaire Magician. Regulus. Fortune Lady one. Wait, this is First Dead! Somehow I didn't see these. They're like mixed in. First Dead Packs. Oh my gosh, now I'm freaking out. This could be big. I think this actually might be money. This is a ghost right here. It's huge. Or any of the secretaries. Let's see. This shit!