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1

Iatrogenic perforations during colonoscopy.  

PubMed

The incidence of iatrogenic colonic perforations in the medical literature ranges between 0.005% and 0.63% with the majority of patients requiring laparotomy for repair. Colonoscopic perforation may occur due to several mechanisms: blunt trauma to the colonic wall, barotrauma from air insufflation, unintentional endoscopic resection or excessive thermal injury. Our clinical experience includes 1,953 colonoscopies, performed by three surgeons over the course of five years, between 2008 and 2012. During this period of time, four colonic perforations occurred, which corresponds to an incidence of 0.2%. None of these four colonoscopies included therapeutic procedures. Two of the four lesions were diagnosed during the procedure, while the other two were diagnosed after 24 hours. All patients needed a laparotomy for repair. Segmental colonic resections were performed in three cases, followed by a primary anastomosis (one case) or by a terminal colostomy (two cases). In the fourth patient, in whom a generalized peritonitis had developed, the suture of the perforation protected by a lateral colostomy was thought to be a safer solution. Colostomies were removed six months after the first operation. No major post-operative morbidity or mortality were recorded. Age over 75 years, female gender, lower BMI, associated comorbidities and diverticulitis were identified as possible risk factors associated with these injuries. PMID:25149617

Doran, H; Marin, I T; Iaciu, M; P?tra?cu, T

2014-01-01

2

Endoscopic Treatments of Endoscopic Retrograde Cholangiopancreatography-Related Duodenal Perforations  

PubMed Central

Iatrogenic duodenal perforation associated with endoscopic retrograde cholangiopancreatography (ERCP) is a very uncommon complication that is often lethal. Perforations during ERCP are caused by endoscopic sphincterotomy, placement of biliary or duodenal stents, guidewire-related causes, and endoscopy itself. In particular, perforation of the medial or lateral duodenal wall usually requires prompt diagnosis and surgical management. Perforation can follow various clinical courses, and management depends on the cause of the perforation. Cases resulting from sphincterotomy or guidewire-induced perforation can be managed by conservative treatment and biliary diversion. The current standard treatment for perforation of the duodenal free wall is early surgical repair. However, several reports of primary endoscopic closure techniques using endoclip, endoloop, or newly developed endoscopic devices have recently been described, even for use in direct perforation of the duodenal wall. PMID:24143315

Han, Joung-Ho; Park, Sang-Heum

2013-01-01

3

[Spontaneous perforation of a retroperitoneal duodenal diverticulum].  

PubMed

Spontaneous perforation is a rare complication of a retroperitoneal duodenal diverticulum; diagnosis and treatment are both difficult. We report a case of perforated duodenal diverticulitis diagnosed by CT, which required surgical intervention after failure of medical treatment. PMID:18772741

Guinier, D; Kovacs, R

2008-01-01

4

Endoscopic duodenal perforation: surgical strategies in a regional centre  

PubMed Central

Background Duodenal perforation is an uncommon complication of endoscopic retrograde cholangio-pancreatography (ERCP) and a rare complication of upper gastrointestinal endoscopy. Most are minor perforations that settle with conservative management. A few perforations however result in life-threatening retroperitoneal necrosis and require surgical intervention. There is a relative paucity of references specifically describing the surgical interventions required for this eventuality. Methods Five cases of iatrogenic duodenal perforation were ascertained between 2002 and 2007 at Cairns Base Hospital. Clinical features were analyzed and compared, with reference to a review of ERCP at that institution for the years 2005/2006. Results One patient recovered with conservative management. Of the other four, one died after initial laparotomy. The other three survived, undergoing multiple procedures and long inpatient stays. Conclusions Iatrogenic duodenal perforation with retroperitoneal necrosis is an uncommon complication of endoscopy, but when it does occur it is potentially life-threatening. Early recognition may lead to a better outcome through earlier intervention, although a protracted course with multiple procedures should be anticipated. A number of surgical techniques may need to be employed according to the individual circumstances of the case. PMID:24461069

2014-01-01

5

Iatrogenic corneal perforation in Terrien Marginal Degeneration.  

PubMed

This case report is about a rare disease with unusual presentation. Failure to recognise atypical presentation may lead to error in managing the patient and cause disastrous complications. Here we highlight a case of Terrien Marginal Degeneration in both eyes with atypical presentation; namely pseudopterygium. A 22 year old man was referred to our centre for iatrogenic right eye corneal perforation after having an atypical pterygium removed at another hospital. On arrival, his vision was 1/60 in both eyes with bilateral cornea Terrien Marginal Degeneration. His right eye anterior chamber was deep with a conjunctival flap covering the perforation site which was located from the 2.30 - 3.30 clock position nasally with no aqueous leak. However after a day his right eye anterior chamber became flat and there was fast aqueous leak from the perforation site. An emergency C shaped peripheral corneal lamellar keratoplasty was performed to seal the perforation. Post operatively his right eye improved to 6/24. PMID:23629570

M R, Kursiah

2013-04-01

6

Biliary Stent Migration with Duodenal Perforation  

PubMed Central

Intestinal perforation from a migrated biliary stent is a known complication of endoscopic biliary stent placement. We present a case of stent migration and resultant duodenal perforation after stent placement for a malignant biliary stricture in a 52-year-old woman. We review the current literature on the diagnosis and management of stent migration and intestinal perforation after endoscopic stent placement for biliary strictures. A plain abdominal radiograph is necessary for early diagnosis of biliary stent migration. If a stent becomes lodged in the gastrointestinal tract, endoscopic or operative extraction of the stent is necessary to prevent subsequent intestinal perforation and peritonitis. Intestinal perforation secondary to biliary stent dislocation should be considered in all patients presenting with fever and abdominal pain after biliary stent insertion. Any abnormality that prevents stent migration through the intestinal tract such as gastroenterostomy, abdominal wall hernia, extensive adhesions or colonic divertucula may be a contraindication for insertion of a plastic biliary stent because of increased perforation risk.

Yaprak, Muhittin; Mesci, Ayhan; Colak, Taner; Yildirim, Bulent

2008-01-01

7

Endoluminal vacuum therapy for iatrogenic perforation of the proximal oesophagus.  

PubMed

Iatrogenic perforation of the upper gastrointestinal tract is one of the most serious complications of upper gastrointestinal endoscopy, with high rates of morbidity and mortality. Treatment is challenging because stent placement or surgical repair of the perforation in this area is often impossible. We report on two cases of iatrogenic perforations of the very proximal oesophagus and distal hypopharynx which could be successfully closed by using an endoluminal vacuum sponge treatment for 5 days. Thus, the endoluminal vacuum therapy may be a useful alternative to surgery in such cases of difficultly managable perforations of the upper oesophagus. PMID:24622870

Möschler, O; Müller, M K

2014-03-01

8

Duodenal perforation caused by a bird feather  

PubMed Central

Ingestion of gastrointestinal (GI) foreign bodies represents a challenging clinical scenario. The greater risk is at extremes of age, in those wearing dentures, alcoholics and mentally handicapped. We present a case of duodenal perforation caused by a bird feather. A 64-year-old man was presented with abdominal pain for 4?days. Abdominal examination showed signs of peritonitis. The erect abdominal x-ray showed free gas under diaphragm. Exploratory laparotomy showed purulent fluid, but no definite site of perforation could be found. So the abdomen was closed with a drain in Morison's pouch. The postoperative recovery was uneventful. He came for a repeat check-up at 4?weeks with dull aching pain in the upper abdomen and was advised for a routine upper GI endoscopy which revealed a feather penetrating the first part of the duodenum, which was removed with a foreign body removing forceps. GI foreign bodies represent a significant problem and an increased level of suspicion is important for timely diagnosis and treatment. PMID:23417953

Sahoo, Manash Ranjan; Kumar, Anil

2013-01-01

9

Isolated perforation of a duodenal diverticulum following blunt abdominal trauma  

PubMed Central

Only 10% of duodenal diverticula are symptomatic. We present the case of a man who fell from a height of 6 ft, landing on his abdomen and presenting 4 h later with severe back pain and a rigid abdomen. At laparotomy, a perforated retroperitoneal duodenal diverticulum was found and repaired with an omental patch. No other injury was noted. Not only is this perforation unusual, but the absence of other injuries sustained during this minor blunt trauma makes this case unique. This case highlights the need for a high index of suspicion when managing patients with back or abdominal pain following minor trauma. PMID:20165728

Metcalfe, Matthew J; Rashid, Tanwir G; Bird, Richard le R

2010-01-01

10

Perforated duodenal ulcer: A rare complication of deferasirox in children  

PubMed Central

Duodenal ulcer perforation in pediatric age group is an uncommon entity; hence, it is not usually considered in the differential diagnosis of acute abdomen in these patients. It is important for the emergency physician to consider perforated peptic ulcer in the differential diagnosis of children presenting with acute abdominal pain, gastrointestinal bleeding, or shock. We report a 6½-year-old male child with thalassemia major who presented to emergency room with an acute abdomen and shock, who was subsequently found to have a perforated duodenal ulcer, probably related to use of oral chelating agent, deferasirox. Although, gastrointestinal symptoms like nausea, vomiting, and abdominal pain has been mentioned as infrequent adverse event in the scientific product information of deferasirox, in our current knowledge this is the first case report of perforated duodenal ulcer after oral deferasirox. The severity of this event justifies the reporting of this case. This patient had an atypical presentation in that there were no signs or symptoms of peptic ulcer disease before perforation and shock he was successfully managed with open surgery after initial resuscitation and stabilization of his general condition. PMID:23833377

Yadav, Sunil Kumar; Gupta, Vipul; El Kohly, Ashraf; Al Fadhli, Wasmi

2013-01-01

11

Perforated duodenal ulcer: a rare complication of deferasirox in children.  

PubMed

Duodenal ulcer perforation in pediatric age group is an uncommon entity; hence, it is not usually considered in the differential diagnosis of acute abdomen in these patients. It is important for the emergency physician to consider perforated peptic ulcer in the differential diagnosis of children presenting with acute abdominal pain, gastrointestinal bleeding, or shock. We report a 6½-year-old male child with thalassemia major who presented to emergency room with an acute abdomen and shock, who was subsequently found to have a perforated duodenal ulcer, probably related to use of oral chelating agent, deferasirox. Although, gastrointestinal symptoms like nausea, vomiting, and abdominal pain has been mentioned as infrequent adverse event in the scientific product information of deferasirox, in our current knowledge this is the first case report of perforated duodenal ulcer after oral deferasirox. The severity of this event justifies the reporting of this case. This patient had an atypical presentation in that there were no signs or symptoms of peptic ulcer disease before perforation and shock he was successfully managed with open surgery after initial resuscitation and stabilization of his general condition. PMID:23833377

Yadav, Sunil Kumar; Gupta, Vipul; El Kohly, Ashraf; Al Fadhli, Wasmi

2013-01-01

12

Duodenal Perforation: Unusual Complication of Gastrostomy Tube Replacement  

PubMed Central

Feeding gastrostomy is widely used for children with feeding impairment. The replacement of gastrostomy tube is known as an easy and safe procedure. However, various complications associated with replacement of gastrostomy tube were reported, including fistula disruption and colo-cutaneous fistula. For replacement of gastrostomy tube in small children with small stomach, special cautions are needed. Here, we report a rare case of duodenal perforation as an acute complication after the replacement of gastrostomy tube for a 33-month-old girl. PMID:25061587

Kim, Soo-Hong; Min, Sa-Hong; Jung, Sung-Eun

2014-01-01

13

Rescue endoscopic band ligation of iatrogenic gastric perforations following failed endoclip closure  

PubMed Central

Iatrogenic gastric perforation is one of the most serious complications during therapeutic endoscopy, despite significant advances in endoscopic techniques and devices. This case study evaluated the clinical efficacy and safety of the rescue endoscopic band ligation (EBL) technique in iatrogenic gastric wall perforation following the failure of primary endoclip closure. Five patients were enrolled in this study. These patients underwent emergency endoscopy following the onset of acute gastric wall perforation during endoscopic procedures. The outcome measurements were primary technical success and immediate or delayed procedure-related complications. Successful endoscopic closure using band ligation was reported in all patients, with no complication occurring. We conclude that EBL may be a feasible and safe alternate technique for the management of acute gastric perforation, especially in cases where closure is difficult with endoclips. PMID:23429885

Han, Joung-Ho; Lee, Tae Hoon; Jung, Yunho; Lee, Suck-Ho; Kim, Hyun; Han, Hye-Suk; Chae, Heebok; Park, Seon Mee; Youn, Seijin

2013-01-01

14

Iatrogenic perforation of the lamina cribrosa by nasogastric tube in an infant  

Microsoft Academic Search

A case of iatrogenic perforation of the lamina cribrosa, followed by intracranial placement of a nasogastric tube in a preterm neonate is described. By routine ultrasound examination of the brain an echogenic structure was seen, which was radiographically diagnosed as a nasogastric tube. The tube was manually removed under antibiotic prophylaxis. No complications were observed. The false route disappeared and

J. N. van den Anker; W. Baerts; J. M. E. Quak; S. G. F. Robben; M. Meradji

1992-01-01

15

Perforated Duodenal Ulcer –A Rare Cause of Acute Abdomen in Pregnancy  

PubMed Central

Acute abdomen during pregnancy is a medico-surgical emergency demanding concerted, synchronized specialties approach of obstetrician, surgeon and gastroenterologist. Duodenal perforation is one of the rarer causes of acute abdomen in pregnancy. Here, we report a case of duodenal perforation with peritonitis in third trimester of pregnancy requiring surgical management. Our aim of reporting this case is to stress the physicians to keep the differential of duodenal perforation also in mind while dealing with cases of acute abdomen in pregnancy and to proceed with multidisciplinary approach for better feto-maternal outcome. PMID:25386494

Rani, Jyotsna; Huria, Anju; Gupta, Pratiksha; Dalal, Usha

2014-01-01

16

Role of over the scope clips in the management of iatrogenic gastrointestinal perforations.  

PubMed

Advances in endoscopic and surgical techniques have increased the frequency and complexity of these procedures and associated complications such as gastrointestinal perforation. With the advancements in the field of gastroenterology, the promising use of an over the scope clips (OTSC) has fulfilled the unmet need for a reliable endoscopic devise in approximation of gastrointestinal perforation. This novel approach has raised the level of confidence in endoscopist in dealing with this serious complication during endoscopy. Here we have shared our experience with OTSC to evaluate its efficacy and safety in managing iatrogenic gastrointestinal perforations during endoscopy. PMID:25170237

Changela, Kinesh; Virk, Muhhamad A; Patel, Niravkumar; Duddempudi, Sushil; Krishnaiah, Mahesh; Anand, Sury

2014-08-28

17

Role of over the scope clips in the management of iatrogenic gastrointestinal perforations  

PubMed Central

Advances in endoscopic and surgical techniques have increased the frequency and complexity of these procedures and associated complications such as gastrointestinal perforation. With the advancements in the field of gastroenterology, the promising use of an over the scope clips (OTSC) has fulfilled the unmet need for a reliable endoscopic devise in approximation of gastrointestinal perforation. This novel approach has raised the level of confidence in endoscopist in dealing with this serious complication during endoscopy. Here we have shared our experience with OTSC to evaluate its efficacy and safety in managing iatrogenic gastrointestinal perforations during endoscopy. PMID:25170237

Changela, Kinesh; Virk, Muhhamad A; Patel, Niravkumar; Duddempudi, Sushil; Krishnaiah, Mahesh; Anand, Sury

2014-01-01

18

Small bowel perforation after duodenal stent migration: An interesting case of a rare complication  

PubMed Central

Duodenal stents are frequently used for palliating malignant gastric outlet obstruction. Successful stent placement relieves obstructive symptoms, is cost effective, and has a relatively low complication rate. However, enteral stents have the potential of migrating distally and rarely, even lead to bowel perforation. We present a rare case of a duodenal stent placed as a palliative measure for gastric outlet obstruction due to unresectable pancreatic cancer that migrated distally after a gastrojejunostomy resulting in small bowel perforation. PMID:21860709

Lee, Peter HU; Moore, Robert; Raizada, Akshay; Grotz, Richard

2011-01-01

19

Endoscopic diagnosis and management of iatrogenic cervical esophageal perforation in extremely premature infants.  

PubMed

Blind oro-(naso)-pharyngeal suction and feeding catheter intubation are very common practices in pediatric critical care. However, these simple procedures may produce unexpected complications in friable tiny patients. We encountered 3 extremely premature infants in whom cervical esophageal perforation and further submucosal excavation were caused by traumatic catheter injury and subsequently led to catastrophes. These episodes of iatrogenic trauma were all successfully diagnosed early, documented and managed with the aid of ultrathin flexible endoscopy. PMID:17475599

Soong, Wen-Jue

2007-04-01

20

A novel system for endoscopic closure of iatrogenic colon perforations using the Ovesco® clip and omental patch.  

PubMed

The growing endoscopic activity, both diagnostic and therapeutic, are also globally makes frequent endoscopic complications, perforation being one of the most serious. However, we also have more possibilities for endoscopic resolution of iatrogenic caused. We report the case of a sigmoid perforation during a colonoscopy that was resolved satisfactorily, avoiding surgery, by endoscopic closure with a nitinol clip Ovesco®. PMID:23268636

Díez-Redondo, P; Blanco, J I; Lorenzo-Pelayo, S; De-la-Serna-Higuera, C; Gil-Simón, P; Alcaide-Suárez, N; Pérez-Miranda, M

2012-01-01

21

Iatrogenic left common iliac artery and vein perforation during lumbar discectomy: A fatal case.  

PubMed

Iatrogenic vascular injury during lumbar disk surgery, although rare, is a serious complication, and when it does occur, can be sudden and life-threatening. The risk of injury to the pelvic vessels intra-operatively can be explained by the close proximity of the retroperitoneal vessels to the vertebral column therefore causing injury to the anterior longitudinal ligament, which can give access to the retroperitoneal space. If signs of circulatory instability are noted during lumbar disk surgery, early diagnosis of vascular injury and urgent transperitoneal surgery or emergency stenting can save the patient's life. Here, is presented the case of a 52-year-old man who underwent an elective lumbar discectomy for a rightward disk herniation in the L4-L5 intervertebral space and died 12h after the operation for a hemorrhagic shock due to a severe intra-abdominal hemorrhage following iatrogenic left common iliac artery and vein perforation during lumbar discectomy. PMID:25467198

Busardò, Francesco Paolo; Frati, Paola; Carbone, Iacopo; Pugnetti, Paola; Fineschi, Vittorio

2015-01-01

22

[Laparoscopic surgery of perforated duodenal and gastric ulcers].  

PubMed

During the period of 13 months, the authors have operated on seven patients with perforated gastroduodenal ulcers. All surgeries were completely performed by the laparoscopic method. The laparoscopic suture of perforated ulcers was performed with lavage and only in one case it involved omentoplasty. The healing process was free of any complications in all patients. The advantage of laparoscopic operations of perforated ulcers resides in fast convalescence and in the fast restoration of working abilities. This method is appropriate in cases when the surgeon performing laparoscopic surgeries has sufficient experience in coincidence with the treatment of perforated ulcers. PMID:9721467

Ferencík, O; Tutka, S; Sabol, V; Lycius, M; Jalcovík, M; Cierny, A; Stepienová, A

1998-06-01

23

Duodenal perforation by an inferior vena cava filter in a polyarteritis nodosa sufferer  

PubMed Central

INTRODUCTION Inferior vena cava (IVC) filters are currently used in the management of pulmonary embolism (PE) and lower limb venous thromboembolism (VTE). Despite their widespread use, associated complications including duodenal perforation have been reported. PRESENTATION OF CASE We describe a unique case of duodenal perforation 2 years post IVC filter insertion in a patient with polyarteritis nodosa (steroid dependent) and thrombocytopenia secondary to chronic cyclophosphamide use. DISCUSSION IVC filters are commonly employed in the management of VTE. Associated complications have been reported including filter migration, fracture and adjacent organ perforation. There is growing consensus that temporary IVC filters should be retrieved as soon as possible with dedicated IVC filter registries to ensure patients are not lost to follow-up post insertion. CONCLUSION Duodenal perforation is a rare complication of IVC filter insertion. This case however illustrates the potentially catastrophic consequences of a relatively common endovascular procedure. Caution should be taken when considering the insertion of IVC filters in patients with longstanding vasculopathies who are on immunosuppressants. PMID:25437665

Dat, Anthony; McCann, Andrew; Quinn, John; Yeung, Shinn

2014-01-01

24

Perforated duodenal ulcer associated with an incarcerated hiatal hernia: report of a case.  

PubMed

We report the case of a perforated duodenal ulcer and diffuse peritonitis associated with an incarcerated hiatal hernia. A 77-year-old woman with a 17-year history of rheumatoid arthritis treated with nonsteroidal anti-inflammatory drugs, who had also been receiving treatment for non-Hodgkin's lymphoma over 4 years, was referred to us for investigation of nausea and vomiting. An abdominal compute tomography (CT) scan showed an incarcerated hiatal hernia and free air in the hernia sac. Emergency laparotomy revealed an incarcerated hiatal hernia involving the stomach, transverse colon, and omentum. A perforated ulcer was also found in the posterior wall of the first portion of the duodenum. The combination of these disorders is thought to be rare in patients with a hiatal hernia and free air in its sac. As the reported mortality of perforated gastric ulcer associated with a hiatal hernia is high, early elective surgery should be performed in patients with a duodenal ulcer associated with a hiatal hernia. PMID:12541028

Otsuka, Yuichi; Nara, Satoshi; Ito, Kei; Nakajima, Kentaro; Mieno, Hiroaki; Konishi, Toshiro

2002-01-01

25

Perforated duodenal ulcer presenting with massive hematochezia in a 30-month-old child  

PubMed Central

Peptic ulcer disease is uncommon in children and rarely suspected as a cause of abdominal complaints in this age group; the diagnosis is therefore made almost exclusively when complications develop. Peptic ulcer disease is usually not considered in the differential diagnosis of pediatric patients. We present the case of a 30-month-old boy with duodenal perforation due to a peptic ulcer without a known etiology. The patient was admitted through the emergency department due to severe hematochezia and ongoing anemia; he presented with neither abdominal pain nor abdominal distension. There were no medical problems, and no drugs, such as corticosteroids or nonsteroidal anti-inflammatory drugs, had been prescribed or administered recently. We tried to control the active bleeding by medical treatment including arterial embolization, but the active bleeding was not controlled. Finally, an exploratory laparotomy was performed. A discrete anterior perforation with active bleeding of the duodenal wall was found. After the operation, there were no complications and the patient recovered fully. PMID:19824124

Lee, Na Mi; Yun, Sin Weon; Chae, Soo Ahn; Yoo, Byoung Hoon; Cha, Seong Jae; Kwak, Byung Kook

2009-01-01

26

Risk stratification in perforated duodenal ulcers. A prospective validation of predictive factors.  

PubMed Central

In order to validate a previously derived set of risk factors, 259 consecutive patients who had simple closure or definitive operation for perforated duodenal ulcers were studied prospectively. Major medical illness, preoperative shock, and longstanding perforation (more than 24 hours) correctly predicted the outcome in 93.8% of patients. Most importantly, 16 patients (6.2%) who died after operation could be identified (no false-negative error). The mortality rate increased progressively with increasing numbers of risk factors: 0%, 10%, 45.5%, and 100% in patients with none, one, two, and all three risk factors, respectively. These findings underscore the importance of patient selection and the feasibility of a risk grading system in guiding surgical management. Definitive surgery can be done safely in good-risk patients. Simple closure is preferable in those patients with uncomplicated perforations if any risk factor is present. Truncal vagotomy and drainage may be required if there is coexisting bleeding or stenosis. Nonoperative treatment deserves re-evaluation in patients with all three risk factors because of their uniformly dismal outcome after operation. PMID:3800459

Boey, J; Choi, S K; Poon, A; Alagaratnam, T T

1987-01-01

27

Coincidental Occurrence of Acute In-stent Thrombosis and Iatrogenic Vessel Perforation During a Wingspan Stent Placement: Management with a Stent In-stent Technique.  

PubMed

We presented a case that an acute in-stent thrombosis after the deployment of a Wingspan stent was successfully managed with a stent in-stent technique. Because vessel perforation and subarachnoid hemorrhage were iatrogenically developed during the procedure, we were unable to use the thrombolytic agents to correct the in-stent thrombosis. When a thrombotic complication following an intracranial stent placement occurs with a coincidentally hemorrhagic complication, the stent in-stent technique should be considered as a treatment option. PMID:22454784

Lee, Sun Joo; Shin, Hee Sup; Lee, Seung Hwan; Koh, Jun Seok

2012-02-01

28

Unusual Development of Iatrogenic Complex, Mixed Biliary and Duodenal Fistulas Complicating Roux-en-Y Antrectomy for Stenotic Peptic Disease of the Supraampullary Duodenum Requiring Whipple Procedure: An Uncommon Clinical Dilemma  

PubMed Central

Complex fistulas of the duodenum and biliary tree are severe complications of gastric surgery. The association of duodenal and major biliary fistulas occurs rarely and is a major challenge for treatment. They may occur during virtually any kind of operation, but they are more frequent in cases complicated by the presence of difficult duodenal ulcers or cancer, with a mortality rate of up to 35%. Options for treatment are many and range from simple drainage to extended resections and difficult reconstructions. Conservative treatment is the choice for well-drained fistulas, but some cases require reoperation. Very little is known about reoperation techniques and technical selection of the right patients. We present the case of a complex iatrogenic duodenal and biliary fistula. A 42-year-old Caucasian man with a diagnosis of postoperative peritonitis had been operated on 3 days earlier; an antrectomy with a Roux-en-Y reconstruction for stenotic peptic disease was performed. Conservative treatment was attempted with mixed results. Two more operations were required to achieve a definitive resolution of the fistula and related local complications. The decision was made to perform a pancreatoduodenectomy with subsequent reconstruction on a double jejunal loop. The patient did well and was discharged on postoperative day 17. In our experience pancreaticoduodenectomy may be an effective treatment of refractory and complex iatrogenic fistulas involving both the duodenum and the biliary tree. PMID:21103208

Polistina, Francesco A.; Costantin, Giorgio; Settin, Alessandro; Lumachi, Franco; Ambrosino, Giovanni

2010-01-01

29

Closing perforations and postperforation management in endoscopy: duodenal, biliary, and colorectal.  

PubMed

Early recognition of adverse events arising from endoscopy is essential. In some cases the injury can be viewed clearly during the procedure, and immediate action should be taken to repair the defect endoscopically if feasible. If perforation is unclear, imaging can be used to confirm the diagnosis. Surgical intervention is not always necessary; however, a surgical consultation for backup is essential. Selective cases can be managed conservatively or endoscopically with successful outcomes. Early recognition and intervention, input from specialist colleagues, and communication with the patient and family are keys to successfully managing the event. PMID:25442957

Boumitri, Christine; Kumta, Nikhil A; Patel, Milan; Kahaleh, Michel

2015-01-01

30

[Traumatic duodenal rupture].  

PubMed

Traumatic duodenal perforation has an incidence of 1%-17% (blunt injury) or 1.7%-5% (penetrating injury). Its prognosis correlates to the kind of injury, associated injuries, size of perforation and delayed diagnosis. Mortality in cases of delayed repair is 65% compared with 5% mortality in early repaired perforation. In cases of delayed diagnosis, we recommend drainage of the perforation, naso-duodenal suction tube, parenteral alimentation. 5 patients where diagnosis was delayed for 8 days or longer were treated in this way and the duodenal wound healed completely without any complications within 22-44 days. PMID:4072459

Kupczyk-Joeris, D; Raguse, T

1985-01-01

31

Laparoscopic closure of perforated gastro-duodenal ulcer: 15 years’ experience in our centre  

PubMed Central

Introduction The objective of the study is to share the results and development findings on the laparoscopic closure technique applied in our centre during a 15-year period (1998–2012). Aim To compare statistically the standard parameters (hospitalization, duration of operation) versus conventional surgery, and at the same time we compared mainly morbidity and mortality. Material and methods During the period under review we operated on a total of 259 patients, 115 (44.4%) of them laparoscopically, and 144 (55.6%) of them conventionally. The sample was divided into two groups: patients with ASA physical status classification system 1–3, and patients with ASA 4–5. Results The results favour laparoscopy within the group with ASA 1–3 in terms of several parameters, namely: duration of hospitalization – 7.7 days in the case of laparoscopic intervention, vs. 10.6 days for conventional surgery (p < 0.05); and duration of operation – 61 min vs. 85.1 min respectively (p < 0.05). Total morbidity was 27.5% in the case of patients with conventional surgery, vs. 10.9% with laparoscopic intervention (p < 0.05). The sample of patients with ASA 4–5 suffered a high mortality of 82.7%. Conclusions Laparoscopic closure of perforated ulcer is a safe therapeutic method, as confirmed by the results of many other studies around the world, which in many aspects favour the laparoscopic technique.

Vá?a, Juraj; Babiš, Boris

2014-01-01

32

Iatrogenic meningitis.  

PubMed

Iatrogenic meningitis can be caused by a number of mechanisms. The recent case reports of fungal meningitis after application of epidural methylprednisolone caused warning in the medical community. Cases were caused by contaminated lots of methylprednisolone from a single compounding pharmacy. Several medications can cause meningitis by probable hypersensitivity mechanism. Neurologists should be alert to the recent description of the use of lamotrigine and development of aseptic meningitis. PMID:24141499

Mutarelli, Eduardo Genaro; Adoni, Tarso

2013-09-01

33

Duodenal atresia  

MedlinePLUS

... 20-30% of infants with duodenal atresia have Down syndrome. Duodenal atresia is often associated with other birth ... abnormality. Associated problems (such as those related to Down syndrome) must be treated as appropriate.

34

Complete duodenogastric reflux: A scintigraphic sign of significant duodenal pathology  

SciTech Connect

Complete reflux of duodenal contents into the stomach with persistent retention on hepatobiliary scintigraphy or radionuclide gastrointestinal bleeding studies is a relatively rare occurrence. Two cases of complete duodenogastric reflux are reported: one case in a patient with a perforated duodenal diverticulum and the other in a patient with an inflamed, bleeding duodenal ulcer. The finding of complete duodenogastric reflux and persistent retention in the stomach should instigate a thorough evaluation for significant duodenal pathology.

Drane, W.E.; Hanner, J.S. (Shands Hospital, Gainesville, FL (USA))

1989-09-01

35

[Duodenal decompression in the surgical management of complicated ulcers].  

PubMed

Operative duodenal decompression for correction of and prophylaxis against duodenostasis is discussed. The methods used for treating complicated pyloric or duodenal ulcers include: perforation suture according to Opel-Polykarpov, resection of the stomach after Billroth-Haberer-Finney, resection of the stomach after Billroth-Vitebsky. All procedures listed above are performed in conjunction with operative interventions aimed at duodenostasis decompression. PMID:11194652

Yaramov, N; Yankov, V

1999-01-01

36

Gastrointestinal perforation  

MedlinePLUS

Intestinal perforation; Perforation of the intestines ... Perforation of the intestine causes the contents of the intestines to leak into the abdominal cavity. This causes a serious infection called peritonitis . ...

37

Spectrum of perforation peritonitis in delhi: 77 cases experience.  

PubMed

Perforation peritonitis is the most common surgical emergency encountered by surgeons all over the world as well in India. The spectrum of etiology of perforation peritonitis in tropical countries continues to differ from its western counterpart. This study was conducted at Hindu Rao Hospital, Municipal Corporation of Delhi, New Delhi, India, designed to highlight the spectrum of perforation peritonitis in the eastern countries and to improve its outcome. This prospective study included 77 consecutive patients of perforation peritonitis studied in terms of clinical presentations, causes, site of perforation, surgical treatment, postoperative complications, and mortality at Hindu Rao Hospital, Delhi, from March 1, 2011 to December 1, 2011, over a period of 8 months. All patients were resuscitated and underwent emergency exploratory laparotomy. On laparotomy cause of perforation peritonitis was found and controlled. The most common cause of perforation peritonitis noticed in our series was perforated duodenal ulcer (26.4 %) and ileal typhoid perforation (26.4 %), each followed by small bowel tuberculosis (10.3 %) and stomach perforation (9.2 %), perforation due to acute appendicitis (5 %). The highest number of perforations was seen in ileum (39.1 %), duodenum (26.4 %), stomach (11.5 %), appendix (3.5 %), jejunum (4.6 %), and colon (3.5 %). Overall mortality was 13 %. The spectrum of perforation peritonitis in India continuously differs from western countries. The highest number of perforations was noticed in the upper part of the gastrointestinal tract as compared to the western countries where the perforations seen mostly in the distal part. The most common cause of perforation peritonitis was perforated duodenal ulcer and small bowel typhoid perforation followed by typhoid perforation. Large bowel perforations and malignant perforations were least common in our setup. PMID:24426408

Yadav, Dinesh; Garg, Puneet K

2013-04-01

38

Genetic markers and duodenal ulcer.  

PubMed

Serum pepsinogen, alpha 1-antitrypsin (alpha 1-AT) and blood groups were studied as genetic markers in 32 patients with endoscopically proven duodenal ulcer and 44 control subjects with no family history of ulcer disease. Serum pepsinogen was determined by the modified method of Edward et al, alpha 1-AT by single radial immunodiffusion (RID) and phenotyping was carried out by isoelectric focusing (IEF). Duodenal ulcer patients with hyper- pepsinogenemia (28%) and low serum alpha 1-AT (35%) had a dominant blood group O, lower mean age, an early onset of disease, a higher frequency of gastrointestinal (GI) bleeding and ulcer perforation. These parameters were found considerably different in patients with normal serum pepsinogen and alpha 1-AT. Phenotype analysis of alpha 1-AT revealed that four duodenal ulcer patients had partial deficiency of the protease inhibitor and none of the normal exhibited the deficiency pattern. The etiology of the disease appears to be genetic anomaly in 28% of patients while the rest (72%) had ulcers as a result of neuroendocrinological or environmental factors. PMID:9230579

Shahid, A; Zuberi, S J; Siddiqui, A A; Waqar, M A

1997-05-01

39

Effects of Antiulcer Agents on Healing of Mepirizole-induced Duodenal Ulcers in Rats  

Microsoft Academic Search

Healing processes of duodenal ulcers induced by mepirizole and effects of several drugs on the ulcer healing were studied in rats. Mepirizole-induced duodenal ulcers, except for the perforated ones within 3 days after ulceration, gradually diminished in size and depth by the 15th day. Several ulcers persisted for up to 40 days, but complete healing in all rats occurred by

Y. Ishihara; S. Okabe

1983-01-01

40

An Overview of History, Pathogenesis and Treatment of Perforated Peptic Ulcer Disease with Evaluation of Prognostic Scoring in Adults  

PubMed Central

Peptic ulcer disease including both gastric and duodenal ulcer form a substantial part of patients seeking surgical opinion world-wide. The concept of acid in peptic ulcer disease, which was the basis of treatment of peptic ulcer was revolutionized by the discovery of H2-receptor antagonists, that led to the principle of acid suppression therapy for duodenal ulcer which followed decades of preference for surgical interventions in the form of gastric resections, vagotomy etc., After the discovery of Helicobacter pylori organism as the causative factor a triple drug regime was identified to treat peptic disease which was further modified to sequential therapy to avoid antibiotic resistance. This recognition has not concluded the chapter on peptic ulcers. The management of ulcer disease and its complications remain a surgical challenge. All the materials for this review have been accessed from various internet search engines. The references have been narrowed down to 34 by excluding cross references, duplicated citations, pediatric studies, case reports, iatrogenic and malignant perforations and including microbiological, immunohistochemistry references and studies with more than a sample size of ten. Case control, cohort studies, prospective/retrospective, metaanalytical studies were preferred in that order. This article attempts to take an overview of all aspects of the management of peptic ulcer. PMID:24669326

Prabhu, V; Shivani, A

2014-01-01

41

Iatrogenic intraspinal epidermoid cyst.  

PubMed

Epidermoid cyst is generally regarded as congenital disease, and commonly related to other congenital spinal anomalies. However, it also develops iatrogenically. We report one rare case of epidermoid cyst that we experineced among intradural extramedullary tumors. A 21-year-old female patient was admitted to the hospital due to low back pain with radiating pain into a right lower extremity that initiated about a month ago. She complained sensory lose and motor weakness (grade 4+) on her right extremity as well as urinary dysfunction and sphincter dysfunction. She had a lumbar puncture three times due to Pneumococcal meningitis when she was 13 years old. The well-circumscribed intradural extramedullary mass of 1.8×1.6×4 cm size was found on the L4-5 in a magnetic resonance image. Gross total tumor removal was garried out after the total laminectomy L5 and partial laminectomy L4. The tumor mass was gray-colored and so fragile that it was easy to be removed. The histological diagnosis confirmed epidermoid cyst without malignancy. After the operation, the patient progressively showed remarkable neurological recovery. In this case, the cause of epidermoid cyst is considered iatrogenic concerning history of several times of lumbar puncture as meningitis. PMID:25346768

Park, Min Ho; Cho, Tach Geun; Moon, Jae Gon; Kim, Chang Hyun; Lee, Ho Kook

2014-09-01

42

Oesophageal perforation following perioperative transoesophageal echocardiography.  

PubMed

Transoesophageal echocardiography (TOE) is being used more often by cardiothoracic anaesthetists for the perioperative management of cardiac problems. Reports of iatrogenic oesophageal perforation by instrumentation of the oesophagus are increasing. Although TOE is considered safe, it may be more risky during surgery, because the probe is passed and manipulated in an anaesthetized patient. It may be in place for several hours so the risk of mucosal pressure and thermal damage is increased. Patients on cardiopulmonary bypass are also fully anticoagulated. We describe a case of oesophageal perforation following insertion of the TOE probe in a patient with gross cardiomegaly. Oesophageal distortion by cardiac enlargement may increase the risk of oesophageal perforation. Difficulty in passage of the TOE probe should be regarded with suspicion and withdrawal should be contemplated because the symptoms of oesophageal perforation are often delayed and non-specific. Delay in investigation, diagnosis and treatment will increase morbidity and mortality. PMID:10844846

Massey, S R; Pitsis, A; Mehta, D; Callaway, M

2000-05-01

43

Bleeding from duodenal lymphangiectasia.  

PubMed

An 8 year old girl with recurrent upper gastrointestinal bleeding was found to have localised duodenal lymphangiectasia by fibreoptic endoscopy. She did not show physical signs or laboratory evidence of significant enteric protein loss. A low fat diet seemed to prevent further bleeding. Duodenal lymphangiectasia may be associated with gastrointestinal bleeding in children. PMID:1994845

Perisic, V N; Kokai, G

1991-01-01

44

Radiological assessment of duodenal calibre in congenital duodenal obstruction  

Microsoft Academic Search

A review of barium meal studies in 32 cases of congenital intrinsic duodenal obstruction (CDO) from the Adelaide Childrens Hospital was performed to assess and measure pre and post operative duodenal dilatation. Comparisons were made with a group of 153 normal barium studies from the same Hospital with a view to quantifying normal and abnormal proximal duodenal calibre. Duodenal size

R. J. Linke; L. L. Morris; R. P. Davies; T. M. Cain; R. B. Davey

1992-01-01

45

Perforated Eardrum  

MedlinePLUS

... sound, out of place, or injuries the inner ear, hearing loss may be serious. If the perforated eardrum ... on the eardrum. Usually with closure of the ear drum, hearing is improved. Several patches may be required before ...

46

Perforated monolayers  

SciTech Connect

Our research over this past grant period has focused on (1) developing methods for making in situ permeation measurements at the air-water interface, (2) defining the structural and conformational behavior of selected calix(4)arenes, (3) defining the metal complexation properties of certain upper-rim functionalized calix(4)arenes, and (4) synthesizing a broad series of polymerizable calixarenes, to be used for constructing perforated monolayers and multilayers.

Regen, S.L.

1992-01-01

47

Successful embolization of iatrogenic ruptured coronary artery using Onyx: a new technique.  

PubMed

Iatrogenic perforation of coronary artery is rare during percutaneous coronary intervention (PCI); however the complications are life-threatening. Patients in this clinical setting may be treated either by stent placement, closure of the perforation with fibrin glue or coils, or with emergency bypass surgery. Onyx, a new material that has been used successfully in cerebral arteries, represents a new and safe alternative. The advantage of Onyx is that it is easily injected through a microcatheter and it allows for a longer injection time having also the ability to reach difficult anatomical locations. We present the first case of successful embolization of a right coronary artery perforation during coronary angiography using Onyx. PMID:25110834

Asouhidou, I; Katsaridis, V

2014-12-01

48

Iatrogenic hallux varus treatment algorithm.  

PubMed

Iatrogenic hallux varus is a relatively rare complication of corrective hallux valgus surgery that has multiple pathologic facets. It requires a comprehensive assessment that focuses on joint flexibility, joint integrity, soft tissue balance, and bony deformity. A step-wise treatment approach is used to address all elements of the deformity. The literature on hallux varus treatments consists mainly of retrospective case series, with several proposed procedures addressing various degrees of deformity. Comparison of these procedures is a challenging endeavor and each case should be considered on an individual basis. PMID:25129350

Crawford, Matthew D; Patel, Jaymin; Giza, Eric

2014-09-01

49

Perforated monolayers  

SciTech Connect

Goal of this research program is to create ultrathin organic membranes that possess uniform and adjustable pores ( < 7[angstrom] diameter). Such membranes are expected to possess high permeation selectivity (permselectivity) and high permeability, and to provide the basis for energy-efficient methods of molecular separation. Work carried out has demonstrated feasibility of using perforated monolayer''-based composites as molecular sieve membranes. Specifically, composite membranes derived from Langmuir-Blodgett multilayers of the calix[6]arene-based surfactant shown below plus poly[l-(trimethylsilyl)-l-propyne] (PTMSP) were found to exhibit sieving behavior towards He, N[sub 2] and SF[sub 6]. Results of derivative studies that have also been completed are also described in this report.

Regen, S.L.

1992-12-01

50

Management of iatrogenic ureteral injury  

PubMed Central

Iatrogenic injury to the ureter is a potentially devastating complication of modern surgery. The ureters are most often injured in gynecologic, colorectal, and vascular pelvic surgery. There is also potential for considerable ureteral injury during endoscopic procedures for ureteric pathology such as tumor or lithiasis. While maneuvers such as perioperative stenting have been touted as a means to avoid ureteral injury, these techniques have not been adopted universally, and the available literature does not make a case for their routine use. Distal ureteral injuries are best managed with ureteroneocystostomy with or without a vesico-psoas hitch. Mid-ureteral and proximal ureteral injuries can potentially be managed with ureteroureterostomy. If the distal segment is unsuitable for anastomosis then a number of techniques are available for repair including a Boari tubularized bladder flap, transureteroureterostomy, or renal autotransplantation. In rare cases renal autotransplantation or ureteral substitution with gastrointestinal segments may be warranted to re-establish urinary tract continuity. Laparoscopic and minimally invasive techniques have been employed to remedy iatrogenic ureteral injuries. PMID:24883109

Burks, Frank N.

2014-01-01

51

Acute duodenal ulcer.  

PubMed Central

A series of 31 infants and children with acute duodenal ulcer verified by endoscopy was studied over an eight year period. Eighteen (58%) of them were under 2 years of age. The most common symptom was upper gastrointestinal bleeding (n = 27, 87%). Twenty nine patients (94%) had a preceding illness characterised by diarrhoea, upper respiratory tract infection, or fever, which was not necessarily treated with antipyretic drugs. Initial endoscopy showed that ulcer lesions were solitary in 14 patients and present on the anterior wall (n = 11), posterior wall (n = 2), or both (n = 1). Multiple ulcers were found in 17 patients, and present in the bulb with (n = 6) or without (n = 11) extension into the second part of duodenum. The most conspicuous finding was the irregularly shaped ulcers seen in eight young children with similar clinical and endoscopic features. Sixteen patients were re-endoscoped one to two weeks after the initial examination; the ulcers had entirely disappeared in 13, and there were only small residual ulcers in three. Thirty patients were treated medically and only one (with uncontrollable haemorrhage) required operation. Most patients were symptom free two to six years after the initial diagnosis. Our results suggest that young children may develop acute duodenal ulcers after viral illnesses whether or not they are treated with drugs, mainly antipyretics. This kind of acute duodenal ulcer usually heals quickly irrespective of the morphology, site, and number of ulcers. Images Figure PMID:2774612

Hsu, H Y; Chang, M H; Wang, T H; Hsu, J Y; Wang, C Y; Lin, M I; Wu, M H

1989-01-01

52

Band ligation of the perforated gall bladder during laparoscopic cholecystectomy.  

PubMed

Perforation of the gall bladder is a frequent complication during laparoscopic cholecystectomy. Grasping the perforated part of the gall bladder, clip application, or endoscopic loop application are possible solutions to prevent spillage. We propose laparoscopic rubber band application to close the perforated part of the gall bladder as an easy and safe method. We performed rubber band application after iatrogenic perforation of the gall bladder during laparoscopic cholecystectomy in 5 patients. Two-millimeter-wide multiple rubber rings, cut from a 14-Fr Foley catheter, are loaded on a grasper. When a perforation occurred during the dissection of the gall bladder, the hole is grasped with this instrument and 1 of the rings is placed on the gall bladder by the aid of a dissector. Thus, the grasper remained available for traction of the Hartmann's pouch during further dissection of the gall bladder. The rubber bands were placed successfully in all cases. Two perforations occurred in 1 case, and 2 bands were placed with ease. Bile leakage or gall stone spillage did not occur. Operation time was not prolonged. Rubber band ligation of perforation of the gall bladder is a simple, safe, inexpensive, and effective method to prevent spillage of the bile or gallstones in laparoscopic surgery. PMID:18097314

Derici, Hayrullah; Bozda?, Ali Do?an; Tansug, Tugrul; Nazli, Okay; Reyhan, Enver

2007-12-01

53

Duodenal carcinoid with carcinoid syndrome.  

PubMed

Carcinoid tumours are uncommon well-differentiated neuroendocrine tumours. Primary duodenal carcinoids account for less than 2% of all gastrointestinal carcinoids. Duodenal carcinoids are seldom associated with carcinoid syndrome. We report a rare case of duodenal carcinoid presenting as a carcinoid syndrome in a middle-aged man with upper abdominal pain, hot flushes, diarrhoea and dry cough. Endoscopy-guided biopsy and 24 h urine 5-hydroxyindoleacetic acid (5-HIAA) proved the diagnosis. He was further evaluated and managed with definitive surgical treatment. PMID:24414187

Naalla, Ravikiran; Konchada, Kamesh; Kannappan, Odaiyappan; Lingadakai, Ramachandra

2014-01-01

54

[Iatrogenic injury of peripheral nerves].  

PubMed

Abstract There are many risks of iatrogenic peripheral-nerve injuries during routine medical procedures. These injuries may occur during venipuncture for drawing blood, endoscopic treatments, punctures of joints or ganglions, various kinds of surgical procedures, and in numerous other situations. It is important to create a "Manual" of such accidents or incidents. In case an accident occurs, both the medical staff and the injured patient should receive adequate support to avoid any anxiety. The doctor must examine the person's injury carefully, and must judge its severity as soon as possible. The doctor must also offer the patient a prompt explanation about their injury and its proper care or treatment. This explanation must be easy to understand. This step can reduce patient anxiety and even prevent the early stages of complex regional pain syndrome (CRPS). One of my therapeutic strategies for treating early-stage CRPS is to use prednisolone for a short period for the treatment of strong pain and serious edema; the other approach is to do administer a warm-cold alternating bath with range-of-motion (ROM) exercise. Creation of manuals and education of staff to quickly respond to such situations is extremely essential. PMID:25475033

Horiuchi, Yukio

2014-12-01

55

[Duodenal atresia in the newborn].  

PubMed

The specific features of intrauterine development and pheno- and genotypic characteristics were studied in newborn infants with duodenal atresia. Main anthropometric parameters at birth (weight, height, and head and chest circumferences), concomitant developmental malformations, gene frequencies and phenotypic combinations of ABO and Rhesus factor blood groups were analyzed. The babies with duodenal atresia were found to have considerably impaired intrauterine development, multiple concomitant hypoplastic developmental abnormalities, significantly higher frequencies of the ORh+ phenotype, and lower frequencies of the ARh+ phenotype. PMID:23342657

Botvin'ev, O K; Eremeeva, A V; Kondrikova, E V

2012-01-01

56

Conjugal perforated duodenal ulcers — Simultaneous fatal perforation in an elderly couple  

Microsoft Academic Search

When a husband and wife both suffer from the same disease the association is usually attributed to chance but with rare diseases such a co-occurrence may raise the possibility of environmental exposure to an aetiological or precipitating agent. There have been recent reports of conjugal multiple sclerosis, Graves' disease, giant cell arteritis and Alzheimer's disease. We now report the death

N. Leonard; D. S. O’Briain

1995-01-01

57

Clinicopathological evaluation of duodenal well-differentiated endocrine tumors  

PubMed Central

AIM: To assess the clinicopathological characteristics of duodenal well-differentiated endocrine tumors. METHODS: We examined clinicopathological characteristics in 11 consecutive patients with duodenal well-differentiated endocrine tumors treated by endoscopic therapy or surgery in our hospital from 1992 through 2007. Patients with well-differentiated endocrine tumors of the papilla of Vater or with gastrinoma were excluded. RESULTS: Three patients received endoscopic treatment, and 8 underwent surgery. In patients who received endoscopic treatment, the tumor diameter was less than 1.0 cm, with no histopathological evidence of lymphovascular invasion or invasion of the muscularis. There were no complications such as late bleeding or perforation after treatment. Among 8 patients with tumors less than 1.0 cm in diameter, 3 underwent partial resection, and 2 underwent radical surgery. Three patients had lymphovascular invasion, 1 had invasion of the muscularis, and 1 had proximal lymph node metastasis. Among 3 patients with tumors 1.0 cm or more in diameter, 1 underwent partial resection, and 2 underwent radical surgery. One patient had lymphovascular invasion, with no lymph node metastasis. After treatment, all patients are alive and have remained free of metastasis and recurrence. CONCLUSION: Duodenal well-differentiated endocrine tumors less than 1.0 cm in diameter have a risk of lymphovascular invasion, invasion of the muscularis, and lymph node metastasis, irrespective of procedural problems. PMID:20857530

Ishido, Kenji; Tanabe, Satoshi; Higuchi, Katsuhiko; Sasaki, Tohru; Katada, Chikatoshi; Azuma, Mizutomo; Naruke, Akira; Koizumi, Wasaburo; Mikami, Tetsuo

2010-01-01

58

Treatment for superficial non-ampullary duodenal epithelial tumors  

PubMed Central

Because of the low prevalence of non-ampullary duodenal epithelial tumors (NADETs), standardized clinical management of sporadic superficial NADETs, including diagnosis, treatment, and follow-up, has not yet been established. Retrospective studies have revealed certain endoscopic findings suggestive of malignancy. Duodenal adenoma with high-grade dysplasia and mucosal cancer are candidates for local resection by endoscopic or minimally invasive surgery. The use of endoscopic treatment including endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD), for the treatment for superficial NADETs is increasing. EMR requires multiple sessions to achieve complete remission and repetitive endoscopy is needed after resection. ESD provides an excellent complete resection rate, however it remains a challenging method, considering the high risk of intraoperative or delayed perforation. Minimally invasive surgery such as wedge resection and pancreas-sparing duodenectomy are beneficial for superficial NADETs that are technically difficult to remove by endoscopic treatment. Pancreaticoduodenectomy remains a standard surgical procedure for treatment of duodenal cancer with submucosal invasion, which presents a risk of lymph node metastasis. Endoscopic or surgical treatment outcomes of superficial NADETs without submucosal invasion are satisfactory. Establishing an endoscopic diagnostic tool to differentiate superficial NADETs between adenoma and cancer as well as between mucosal and submucosal cancer is required to select the most appropriate treatment. PMID:25253950

Kakushima, Naomi; Kanemoto, Hideyuki; Tanaka, Masaki; Takizawa, Kohei; Ono, Hiroyuki

2014-01-01

59

Endoscopic drainage for duodenal hematoma following endoscopic retrograde cholangiopancreatography: A case report  

PubMed Central

Intramural duodenal hematoma (IDH) is a rare complication following endoscopic retrograde cholangiopancreatography (ERCP). Blunt damage caused by the endoscope or an accessory has been suggested as the main reason for IDH. Surgical treatment of isolated duodenal hematoma after blunt trauma is traditionally reserved for rare cases of perforation or persistent symptoms despite conservative management. Typical clinical symptoms of IDH include abdominal pain and vomiting. Diagnosis of IDH can be confirmed by imaging techniques, such as magnetic resonance imaging or computed tomography and upper gastrointestinal endoscopy. Duodenal hematoma is mainly treated by drainage, which includes open surgery drainage and percutaneous transhepatic cholangial drainage, both causing great trauma. Here we present a case of massive IDH following ERCP, which was successfully managed by minimally invasive management: intranasal hematoma aspiration combined with needle knife opening under a duodenoscope. PMID:23599635

Pan, Ya-Min; Wang, Tian-Tian; Wu, Jun; Hu, Bing

2013-01-01

60

Videothoracoscopic management of a perforated central vein and pleura after ultrasound-guided internal jugular vein cannulation: a case report  

PubMed Central

A 23-year-old male underwent a left internal jugular vein catheterization during extended surgery for treatment of multiple fractures due to a traffic accident. Although the catheterization was performed under ultrasound (US) guidance, iatrogenic perforation of the central vein and pleura occurred. The catheter was removed, and the perforated site was addressed under thoracoscopy rather than an open thoracotomy. This case suggests that using US does not completely guarantee a complication-free outcome, and that catheter placement should be carefully confirmed. In addition, this case suggests that thoracoscopy may be an ideal method of resolving a perforation of the central vein and pleura. PMID:24851167

Kim, Jeong-Eun; Jeon, Joon-Pyo; Kim, Yongsuk; Jeong, Su Ah

2014-01-01

61

Nontraumatic terminal ileal perforation  

PubMed Central

Background There is still confusion and controversy over the diagnosis and optimal surgical treatment of non traumatic terminal ileal perforation-a cause of obscure peritonitis. Methods This study was a prospective study aimed at evaluating the clinical profile, etiology and optimal surgical management of patients with nontraumatic terminal ileal perforation. Results There were 79 cases of nontraumatic terminal ileal perforation; the causes for perforation were enteric fever(62%), nonspecific inflammation(26%), obstruction(6%), tuberculosis(4%) and radiation enteritis (1%). Simple closure of the perforation (49%) and end to side ileotransverse anastomosis(42%) were the mainstay of the surgical management. Conclusion Terminal ileal perforation should be suspected in all cases of peritonitis especially in developing countries and surgical treatment should be optimized taking various accounts like etiology, delay in surgery and operative findings into consideration to reduce the incidence of deadly complications like fecal fistula. PMID:16759405

Wani, Rauf A; Parray, Fazl Q; Bhat, Nadeem A; Wani, Mehmood A; Bhat, Tasaduq H; Farzana, Fowzia

2006-01-01

62

Iatrogenic’ Wernicke’s Encephalopathy in Japan  

Microsoft Academic Search

Iatrogenic’ Wernicke’s encephalopathy has appeared to occur more frequently in Japan, probably induced by the change of our Japanese national health insurance policy in 1992. We report 4 nonalcoholic patients with such Wernicke’s encephalopathy, which occurred during the early postoperative oral food intake period following intravenous nutrition without vitamin supplements. We analyzed the medical records of 4 patients, 3 men

Elisa Shikata; Tomohiko Mizutani; Yuji Kokubun; Toshiaki Takasu

2000-01-01

63

A Novel Iatrogenic Dermopigmentation: Liposculpting-Tattoo  

Microsoft Academic Search

.   Recently, two patients with iatrogenic tattoos resulting from ink-marking at insertion-sites of liposuction cannulas were\\u000a observed. It is advisable to insert cannulas between and not through ink markings and thus prevent this complication in an\\u000a aesthetic procedure.

Rene Ruedlinger

2001-01-01

64

Tuberculous duodenal stenosis: report of two cases.  

PubMed

Duodenal tuberculosis is a rare clinical entity. The authors report and emphasize the lack of special clinical, radiological and endoscopic signs of duodenal tuberculosis. The diagnosis is affirmed, at laparotomy, out of the findings of peritoneal granulations or histology of lymphatic nodes. We report our experience of two cases of duodenal tuberculosis presenting with proximal intestinal obstruction and review the available literature. PMID:21897797

Benzekri, O; Mouhadi, S El; Chourak, M; Boussetta, S; Absi, M El; Echarab, M; Elouanani, M; Amraoui, M; Errougani, A; El Alami, F H; Chkoff, R

2008-09-01

65

Intramural Duodenal Haematoma after Endoscopic Biopsy: Case Report and Review of the Literature  

PubMed Central

The development of intramural duodenal haematoma (IDH) after small bowel biopsy is an unusual lesion and has only been reported in 18 children. Coagulopathy, thrombocytopenia and some special features of duodenal anatomy, e.g. relatively fixed position in the retroperitoneum and numerous submucosal blood vessels, have been suggested as a cause for IDH. The typical clinical presentation of IDH is severe abdominal pain and vomiting due to duodenal obstruction. In addition, it is often associated with pancreatitis and cholestasis. Diagnosis is confirmed using imaging techniques such as ultrasound, magnetic resonance imaging or computed tomography and upper intestinal series. Once diagnosis is confirmed and intestinal perforation excluded, conservative treatment with nasogastric tube and parenteral nutrition is sufficient. We present a case of massive IDH following endoscopic grasp forceps biopsy in a 5-year-old girl without bleeding disorder or other risk for IDH, which caused duodenal obstruction and mild pancreatitis and resolved within 2 weeks of conservative management. Since duodenal biopsies have become the common way to evaluate children or adults for suspected enteropathy, the occurrence of this complication is likely to increase. In conclusion, the review of the literature points out the risk for IDH especially in children with a history of bone marrow transplantation or leukaemia. PMID:22379465

Grasshof, Claudia; Wolf, Anna; Neuwirth, Frank; Posovszky, Carsten

2012-01-01

66

Acupuncture treatment for duodenal ulcer.  

PubMed

The effect of acupuncture therapy for duodenal ulcer was investigated in 21 male and female patients. The diagnosis and healing were verified by gastroscopy. It was found that the needle therapy for 3 weeks led to complete recovery in 76 percent of the patients. Diet, alcohol and cigarette abstinency were necessary for healing. Cuti-visceral reflex activation eliciting the improvement of the secretory and motor function of the gastrointestinal tract and effects in the CNS leading to analgesia and tranquilization may play a role in the mechanism of action. Our conclusion is that acupuncture can be satisfactory method to cure duodenal ulcer. PMID:2904207

Debreceni, L; Denes, L

1988-01-01

67

Integrating geology and perforating  

SciTech Connect

Perforating is a very common well completion operation. Usually, it is considered to be as simple as making holes in casing. Actually, perforating is one of the most critical tasks for establishing a path from reservoir rock to borehole form which hydrocarbons can flow to surface. The objective of this article is to relate perforating technology with geological aspects and completion type to determine the best shooting equipment (gun type, charge and differential pressure) to perform the most efficient perforating job. Several subjects related to formation geology are taken into account for a shooting job, such as: compressive strength, reservoir pressure and thickness, lithology type, porosity and permeability, ratio between horizontal and vertical permeabilities, and fluid type. Gun geometry used in the oil industry incorporates several parameters, including shot density, hole entrance diameter, gun phase and jet penetration. API tests are done on perforating guns to define applicability and performance. A new geometrical parameter is defined as the relative angle of the jet, which is the angle between the jet tunnel and formation dip. GEOCAN is a methodology which relates geology to gun geometry and type to define the most efficient gun system for perforated completions. It uses the intelligent perforating technique with the SPAN (Schlumberger Perforating Analysis) program to confirm optimum gun choice.

Araujo, P.F. de [Petrobras, Rio de Janeiro (Brazil); Souza Padilha, S.T.C. de [Schlumberger Wireline and Testing, Rio de Janeiro (Brazil)

1997-02-01

68

Cryoballoon ablation for iatrogenic left atrial tachycardia  

PubMed Central

Percutaneous and surgical left atrial ablation has been widely used to treat paroxysmal and persistent atrial fibrillation. However, left atrial ablation may result in left atrial tachycardia due to an iatrogenic substrate created by the ablation lesion sets. Ablation of these iatrogenic arrhythmias can be technically challenging, requiring prolonged procedures and the use of three-dimensional electroanatomical mapping systems. In some cases, the atrial tachycardia may terminate during mapping, or may degenerate into atrial fibrillation during the procedure before adequate mapping. Some patients also have several arrhythmia circuits, each requiring separate mapping, which may be time consuming. The present article reports the cases of three patients in whom a large cryoballoon was used to empirically ablate the pulmonary vein antral region, which is important for the initiation and maintenance of these arrhythmias. PMID:23620703

Dhillon, Paramdeep S; Chen, Zhong; Sunni, Nadia; Norman, Mark; Ward, David E

2012-01-01

69

Iatrogenic post biopsy hemobilia with pseudoaneurysm.  

PubMed

Hemobilia is defined as bleeding into the biliary tree from an abnormal communication between a blood vessel and bile duct. It is an uncommon cause of upper gastrointestinal hemorrhage and iatrogenic most of the times. We report a case of hemobilia secondary to percutaneous liver biopsy presenting with classical Quincke's triad in a young lady which was treated with combined biliary balloon sweep thrombectomy and transarterial embolization for complete resolution of symptoms. PMID:25404450

Qureshi, Muhammad Saleem; Iqbal, Musarrat; Butt, Muhammad Qaisar; Nomani, Ali Zohair

2014-11-01

70

Novel transcatheter closure of an iatrogenic perimembranous ventricular septal defect.  

PubMed

Iatrogenic membranous ventricular septal defects (VSD) are rare complications of cardiothoracic surgery, most commonly seen as a complication of aortic valve replacements. An iatrogenic VSD can lead to right sided heart failure, systemic hypoxia, and arrhythmias, and closure is often necessary. Given the increased mortality associated with repeat surgical procedures, percutaneous transcatheter closure of these iatrogenic VSDs has increasingly become the preferred choice of therapy. We describe the first case of iatrogenic membranous VSD in the setting of mitral valve replacement and tricuspid valve repair, using the newly approved Amplatzer Duct Occluder II Device from an entirely retrograde approach. © 2014 Wiley Periodicals, Inc. PMID:25176592

Retzer, Elizabeth M; Dill, Karin E; Shah, Atman P

2015-01-01

71

Cervical esophageal perforation: a 10-year clinical experience in north of iran.  

PubMed

Perforations of the cervical esophagus are infrequent severe conditions associated with a high rate of morbidity and mortality if misdiagnosed. The diagnosis and management of cervical esophageal perforation remains a challenging clinical problem. We aimed to present our experience of the etiology, presentation, management and outcome of cervical esophageal perforation in a 10 years period. In this cross-sectional study, we reviewed the records of all patients with a diagnosis of cervical esophageal perforation admitted at the teaching Razi Hospital of Rasht, north of Iran, between 2001 and 2011. 26 patients (15 male) were studied with mean age of 47.6 ± 13.78 years, a range from 10 to 68 years. Only 16 (61.5 %) of patients were referred within 24 h of injury. The etiology was iatrogenic in 15 cases (57.69 %), foreign body ingestion in 7 cases (26.9 %), and penetrating traumatic injury in 4 cases (15.4 %). The common clinical manifestations of perforation were neck pain in 22 cases (84.6 %), fever in 19 cases (73.1 %), and subcutaneous emphysema in 12 cases (46.2 %). Barium and gastrografin swallow were performed in 57.7 and 23.1 % of patients, respectively and flexible esophagoscopy was used in 23.06 %. Most of patients (65.4 %) were managed by primary repair. Overall, mortality rate was 7.7 %. Our study demonstrates that the most common cause of cervical esophageal perforation is iatrogenic injury. Clinical suspicion is most important problem. Furthermore, Diagnosis is mainly made by Barium and gastrografin swallow. For a successful outcome, primary repair is a preferred treatment for most perforation patients. PMID:25621251

Aghajanzadeh, Manouchehr; Porkar, Nastaran Farahmand; Ebrahimi, Hannan

2015-03-01

72

Portland Cement Use in Dental Root Perforations: A Long Term Followup  

PubMed Central

Root canal and furcal perforations are causes of endodontic therapy failure and different materials that stimulate tissue mineralization have been proposed for perforation treatment. In the first case, a patient presented tooth 46 with unsatisfactory endodontic treatment and a periapical radiographic lesion. A radiolucent area compatible with a perforating internal resorption cavity was found in the mesial root. The granulation tissue was removed, and root canals were prepared. The intracanal medication was composed of calcium hydroxide and the perforation cavity was filled with Portland cement. The 11-year followup showed radiographic repair of the tissue adjacent to the perforation and absence of clinical signs and symptoms or periapical lesion. In the second case, a patient presented with edema on the buccal surface of tooth 46. The examination showed a radiolucent area in the furcation region compatible with an iatrogenic perforation cavity. The mesial root canals were calcified, and only the distal root canal was prepared. The cavity was filled with a calcium hydroxide-based paste and the distal root canal was obturated. In sequence, the perforation cavity was filled with Portland cement. The 9-year followup showed the tooth in masticatory function with radiographic and clinical aspects compatible with normality. PMID:24715998

Borges, Álvaro Henrique; Bandeca, Matheus Coelho; Tonetto, Mateus Rodrigues; Faitaroni, Luis Augusto; Carvalho, Elibel Reginna de Siqueira; Guerreiro-Tanomaru, Juliane Maria; Tanomaru Filho, Mário

2014-01-01

73

Laparoscopic-endoscopic cooperative surgery for duodenal tumors: a unique procedure that helps ensure the safety of endoscopic submucosal dissection.  

PubMed

A new rendezvous-style surgical technique has been developed to ensure the safety of endoscopic submucosal dissection (ESD) for duodenal tumors. The new technique, called "laparoscopic-endoscopic cooperative surgery (LECS)," combines ESD with laparoscopic, reinforcing, seromuscular suturing. This case series report describes how three patients with a duodenal tumor were safely treated by LECS. ESD was performed by endoscopy, followed by closure of the mucosal defect using seromuscular suturing by laparoscopy. ESD was successfully completed in all patients. Endoscopic findings after suturing revealed that the mucosal defect was closed appropriately and tightly. None of the three patients experienced delayed perforation or stricture after LECS. LECS for extraction of duodenal tumors seems to be feasible and helps to ensure the safety of ESD in the duodenum. PMID:25479560

Irino, Tomoyuki; Nunobe, Souya; Hiki, Naoki; Yamamoto, Yorimasa; Hirasawa, Toshiaki; Ohashi, Manabu; Fujisaki, Junko; Sano, Takeshi; Yamaguchi, Toshiharu

2014-12-01

74

Iatrogenic lumbar meningocoele: report of three cases  

PubMed Central

We have reported three cases of iatrogenic lumbar meningocoeles after surgery for herniated lumbar intervertebral discs. We reject the term spurious, pseudo, or false as given by earlier writers. We feel that, in reality, these sacs are true meningocoeles, with complete arachnoidal lining and freely communicating with the intraspinal subarachnoid space. We have also given a brief outline of the clinical features, elucidated the mechanisms operative in the production of symptoms, and suggested the cardinal features of radiographic diagnosis. Prevention is, of course, the best way to avoid this complication. If a dural tear does occur, every effort should be made to suture it in a watertight manner. Images PMID:4918460

Rinaldi, Italo; Hodges, Thomas O.

1970-01-01

75

Iatrogenic bacterial meningitis: an unmasked threat.  

PubMed

Iatrogenic bacterial meningitis (IBM) is a rare but serious complication of neuraxial procedures, such as spinal and epidural anesthesia or lumbar puncture. We report a case of a 46-year-old female who presented to the emergency department with bacterial meningitis after spinal anesthesia. We review the existing literature outlining the pathogenesis, vector hypothesis, diagnosis, treatment, and prevention as they relate to IBM. We highlight the role of the emergency physician in the rapid diagnosis of this disease, and underscore the need for sterile technique when performing lumbar punctures. PMID:22813400

Barnwell, Robert; Ball, Vincent

2012-07-01

76

Octreotide therapy: a new horizon in treatment of iatrogenic chyloperitoneum  

Microsoft Academic Search

Chyloperitoneum is a rare and challenging complication of abdominal surgery. We report a case of iatrogenic chyloperitoneum. Infusion of octreotide, a somatostatin analogue, together with total parenteral nutrition followed by medium chain triglyceride diet resulted in rapid resolution of chyloperitoneum. We believe this to be the first report of successful use of octreotide in iatrogenic chyloperitoneum in a child.

C Bhatia; U Pratap; Z Slavik

2001-01-01

77

Iatrogenic fungal infections of central nervous system.  

PubMed

Iatrogenic fungal infections of the central nervous system had been considered a medical curiosity. Generally, they are a rare isolated complication of neurosurgical procedures, but periodically these infections are observed in larger populations as a result of exposure to contaminated materials during diagnostic or therapeutic procedures. In the last year, an epidemic of iatrogenic fungal central nervous system disease accompanied the use of fungal-contaminated compounded methylprednisolone distributed by one facility, heightening the attention given to this infectious disorder. As of May 6, 2013, 758 individuals from 20 US states have developed meningitis and/or spinal or paraspinal infection because of contaminated methylprednisolone from the New England Compounding Center in Framingham, Massachusetts, and 58 deaths have been reported. A total of 12 different fungi have been identified; Exserohilum rostratum, a filamentous environmental fungus rarely associated with human disease previously, has been the most commonly isolated pathogen. Meningitis has dominated the clinical presentation, accounting for more than half of the cases, but spinal and paraspinal infections, arachnoiditis, and stroke have also been observed. The diagnosis can be challenging as the organisms may be fastidious. An assay for ?-D-glycan has been proposed as an effective adjunctive test for E. rostratum infection. The current therapeutic recommendation is a 6 mg/kg dose of voriconazole every 12 h followed by liposomal amphotericin B. In some instances, surgical debridement and drainage may be necessary. PMID:24078440

Lahoti, Sourabh; Berger, Joseph R

2013-11-01

78

Gut perforation after orthotopic liver transplantation in adults  

PubMed Central

AIM: To describe cases of gut perforation after orthotopic liver transplantation. METHODS: Data were colleted from our center database and medical records. Six of 187 patients (3.2%) who underwent orthotopic liver transplantation from January to December 2005 developed gut perforation. All patients were male with an average age of 46 years. Modified piggyback liver transplantation was performed at the Organ Transplantation Center, First Affiliated Hospital, Sun Yat-Sen University. RESULTS: Previous operation, steroid therapy, and prolonged portal venous cross clamp time, poor nutritional status and iatrogenic injury were found to be its ecological factors. The patients with gut perforation were found to have fever, increased leukocytes, mild abdominal pain and tenderness. The median portal venous clamp time was 63 min (range 45-72 min), median cold ischaemia time was 11.3 h (range 7-15 h). Median intraoperative blood loss was 500 mL (range 100-1200 mL) and median operation time was 8.8 h (range 6-12 h). None of the six patients developed acute cellular rejection. White cell count was above 18 × 109/L in five patients (neutrophilic leukocytes were above 90%) and 1.5 × 109/L in one patient. Bacterial culture in drainage liquid revealed enterococci in five patients. Of the 6 patients undergoing orthotopic liver transplantation, 3 survived and 3 died after modified piggyback liver transplantation. CONCLUSION: Gut perforation occurs after orthotopic liver transplantation in adults. A careful and minimal dissection during OLT, longer retention of the stomach tube, and reducing the portal clamp time and steroid dose should be taken into consideration. If gut perforation is not prevented, then early diagnosis, preferably through detection of enterococci may ensure better survival. PMID:17465460

Xiong, Jun; You, Shen; He, Xiao-Shun

2007-01-01

79

Dragstedt, gastric acid and duodenal ulcer.  

PubMed Central

Dragstedt believed that basal hypersecretion of gastric acid was the root cause of duodenal ulcer, that the hypersecretion was due to an increased vagal stimulation, and that vagotomy would therefore cure duodenal ulcer. He introduced vagotomy and demonstrated that the operation was successful in curing most patients of their duodenal ulcers. This article reviews how further research in the succeeding half century has demonstrated that it is the effect of vagotomy on stimulated, rather than upon basal secretion that cures duodenal ulcer and that the apparent basal hypersecretion of patients with duodenal ulcer is due to an increased parietal cell mass. The article points out that there is no convincing explanation as yet of the mechanism whereby vagotomy reduces histamine-stimulated gastric secretion. PMID:7502527

Hobsley, M.

1994-01-01

80

Duodenal Chemosensing and Mucosal Defenses  

PubMed Central

The duodenal mucosa is exposed to endogenous and exogenous chemicals, including acid, CO2, bile acids and nutrients. Mucosal chemical sensors are necessary to exert physiological responses such as secretion, digestion, absorption, and motility. We propose a mucosal chemosensing system by which luminal chemicals are sensed via mucosal acid sensors and G-protein-coupled receptors. Luminal acid/CO2 sensing consists of ecto- and cytosolic carbonic anhydrases, epithelial ion transporters, and acid sensors expressed on the afferent nerves in the duodenum. Furthermore, a luminal L-glutamate signal is mediated via mucosal L-glutamate receptors, including metabotropic glutamate receptors and taste receptor 1 family heterodimers, with activation of afferent nerves and cyclooxygenase, whereas luminal Ca2+ is differently sensed via the calcium-sensing receptor in the duodenum. Recent studies also show the involvement of enteroendocrine G-protein-coupled receptors in bile acid and fatty acid sensing in the duodenum. These luminal chemosensors help activate mucosal defense mechanisms in or- der to maintain the mucosal integrity and physiological responses. Stimulation of luminal chemosensing in the duodenal mucosa may prevent mucosal injury, affect nutrient metabolism, and modulate sensory nerve activity. PMID:21389725

Akiba, Yasutada; Kaunitz, Jonathan D.

2011-01-01

81

Selective Embolization of Large Symptomatic Iatrogenic Renal Transplant Arteriovenous Fistula  

SciTech Connect

We report on the successful treatment of hypertension by occlusion of a large iatrogenic renal transplant arteriovenous fistula using detachable embolization coils with concomitant flow reduction by occlusion balloon in two patients.

Barley, Fay L.; Kessel, David, E-mail: david.kessel@leedsth.nhs.uk; Nicholson, Tony [St. James University Hospital, Department of Radiology (United Kingdom); Robertson, Iain [Gartnaval Hospital, Department of Radiology (United Kingdom)

2006-12-15

82

Acquired Reactive Perforating Collagenosis  

PubMed Central

Acquired reactive perforating collagenosis (ARPC) is commonly recognized as an unusual skin reaction to superficial trauma that is observed in patients with a certain genetic predisposition or underlying diseases, such as diabetes mellitus or renal diseases. We present the unusual case of a 55-year-old female diabetic patient with numerous characteristic dome-shaped nodules, which consisted of central umbilication containing firm keratotic plugs.

Ataseven, Arzu; Kayacetin, Serra

2012-01-01

83

Gastric conduit perforation.  

PubMed

As patients with carcinoma of the esophagus live longer, complications associated with the use of a gastric conduit are increasing. Ulcers form in the gastric conduit in 6.6% to 19.4% of patients. There are a few reports of perforation of a gastric conduit in the English literature. Almost all of these were associated with serious complications. We report a patient who developed a tension pneumothorax consequent to spontaneous perforation of an ulcer in the gastric conduit 7 years after the index surgery in a patient with carcinoma of the gastroesophageal junction. He responded well to conservative management. Complications related to a gastric conduit can be because of multiple factors. Periodic endoscopic surveillance of gastric conduits should be considered as these are at a higher risk of ulcer formation than a normal stomach. Long term treatment with proton pump inhibitors may decrease complications. There are no guidelines for the treatment of a perforated gastric conduit ulcer and the management should be individualized. PMID:25133156

Patil, Nilesh; Kaushal, Arvind; Jain, Amit; Saluja, Sundeep Singh; Mishra, Pramod Kumar

2014-08-16

84

Perforated gastrointestinal ulcers presenting as acute respiratory distress  

PubMed Central

BACKGROUND: Dyspnea is one of the most common complaints facing the emergency medicine physician. Some of the gastrointestinal causes of dyspnea are self-limited and not life-threatening, yet others are, and early diagnosis and treatment are crucial. METHODS: In this article we presented one of these life-threatening conditions through a clinical description of a patient presenting with acute respiratory distress that was finally diagnosed to be the result of a perforated gastric ulcer. RESULTS: An emergent thoracotomy revealed a small ulcer with perforation in the fundus of the stomach. The patient was transferred after the operation to the intensive care unit and after a prolonged hospitalization discharged home. Biopsies taken from the ulcer showed diffuse inflammation, with no evidence of microorganisms or malignancy. CONCLUSION: Perforation of gastric and duodenal ulcers is a rare yet existing cause of dyspnea and respiratory failure and should be kept in mind by the emergency physician, especially when other more common causes are ruled out. PMID:25215055

Raviv, Bennidor; Israelit, Shlomo H.

2012-01-01

85

Inhalational Steroids and Iatrogenic Cushing’s Syndrome  

PubMed Central

Bronchial asthma (BA) and Allergic rhinitis (AR) are common clinical problems encountered in day to day practice, where inhalational corticosteroids (ICS) or intranasal steroids (INS) are the mainstay of treatment. Iatrogenic Cushing syndrome (CS) is a well known complication of systemic steroid administration. ICS /INS were earlier thought to be safe, but now more and more number of case reports of Iatrogenic Cushing syndrome have been reported, especially in those who are taking cytochrome P450 (CYP 450) inhibitors. Comparing to the classical clinical features of spontaneous Cushing syndrome, iatrogenic Cushing syndrome is more commonly associated with osteoporosis, increase in intra-ocular pressure, benign intracranial hypertension, aseptic necrosis of femoral head and pancreatitis, where as hypertension, hirsuitisum and menstrual irregularities are less common. Endocrine work up shows low serum cortisol level with evidence of HPA (hypothalamo-pituitary-adrenal) axis suppression. In all patients with features of Cushing syndrome with evidence of adrenal suppression always suspect iatrogenic CS. Since concomitant administration of cytochrome P450 inhibitors in patients on ICS/INS can precipitate iatrogenic CS, avoidance of CYP450 inhibitors, its dose reduction or substitution of ICS are the available options. Along with those, measures to prevent the precipitation of adrenal crisis has to be taken. An update on ICS-/INS- associated iatrogenic CS and its management is presented here.

A.V, Raveendran

2014-01-01

86

Occupational mortality from gastric and duodenal ulcer.  

PubMed Central

The pronounced geographical and temporal variations in gastric and duodenal ulcer suggest that important environmental factors must play a part in their aetiology. To determine the nature of possible factors, the Registrar General's decennial supplement and the vital statistics special reports of the United States Department of Health, Education, and Welfare on occupational mortality were analysed for occupation-specific mortality from peptic ulcer. The data disclose a high mortality from both types of ulcer among manual workers and a low mortality among sedentary occupations. This general pattern runs parallel to a low mortality from gastric and duodenal ulcer among the high social classes and a high mortality in the low social classes. Married women displayed a gradient of gastric ulcer mortality increasing from social class 1 to social class 5 but gave no evidence of social class correlation with respect to duodenal ulcer. The significant correlation between mortality from gastric and duodenal ulcer among different occupations could suggest that both types of ulcer hold some of the precipitating environmental risks in common. In duodenal ulcer the varying extent of energy expenditure among different occupations may be responsible for the different risk of contracting duodenal ulcer and dying from it. The association between energy expenditure and peptic ulcer mortality seems to be less important for gastric ulcer where additional factors associated with social class may also be operating. PMID:3947561

Sonnenberg, A; Sonnenberg, G S

1986-01-01

87

Gastric emptying abnormal in duodenal ulcer  

SciTech Connect

To investigate the possibility that an abnormality of gastric emptying exists in duodenal ulcer and to determine if such an abnormality persists after ulcer healing, scintigraphic gastric emptying measurements were undertaken in 16 duodenal ulcer patients before, during, and after therapy with cimetidine; in 12 patients with pernicious anemia, and in 12 control subjects. No difference was detected in the rate or pattern of gastric emptying in duodenal ulcer patients before and after ulcer healing with cimetidine compared with controls, but emptying of the solid component of the test meal was more rapid during treatment with the drug. Comparison of emptying patterns obtained in duodenal ulcer subjects during and after cimetidine treatment with those obtained in pernicious anemia patients and controls revealed a similar relationship that was characterized by a tendency for reduction in the normal differentiation between the emptying of solid and liquid from the stomach. The similarity in emptying patterns in these groups of subjects suggests that gastric emptying of solids may be influenced by changes in the volume of gastric secretion. The failure to detect an abnormality of gastric emptying in duodenal ulcer subjects before and after ulcer healing calls into question the widespread belief that abnormally rapid gastric emptying is a feature with pathogenetic significance in duodenal ulcer disease.

Holt, S.; Heading, R.C.; Taylor, T.V.; Forrest, J.A.; Tothill, P.

1986-07-01

88

Ultrastructural changes in non-specific duodenitis  

PubMed Central

AIM: To investigate the ultrastructural and morphological changes of non-specific duodenitis (NSD) in an attempt to grade them according to the extent of the lesions. METHODS: Biopsies were taken from the mucosa of duodenal bulb of 44 patients selected from the patients undergoing upper gastrointestinal endoscopy for epigastric discomforts. From each patient, two pinch biopsies on the same area were obtained from duodenal bulb. One was for scanning electron microscopy and the other was stained with hematoxylin-eosin, Warthin-Starry silver and both were then examined under light microscope. A total of 12 specimens (three from each degree of the normal and I-III of NSD diagnosed and graded by histology) selected from the 44 patients were dehydrated, critical point dried, coated with gold palladium and examined under a JEOL JSM-30 scanning electron microscope (SEM) at 20 kV. RESULTS: According to the ultrastructural morphologic changes, non-specific duodenitis was divided into normal (as control group), mild, moderate and severe degrees according to results of SEM. The normal villi of duodenal bulb were less than 0.2 mm. There were inflammation cells, occasionally red blood cells and macrophages on the mucosal epithelial surface. Erosion and desquamation of epithelium could be seen. Three cases (25%, 3/12) had gastric metaplasia and Helicobacter pylori (H pylori) infection could be found in 5 cases (41.67%, 5/12) in duodenal bulb mucosa. The most distinctive feature was the ulcer-like defect on the surface of epithelial cells. CONCLUSION: Non-specific duodenitis is a separate entity disease caused by different factors. SEM is of value as an aid in the diagnosis of mucosal diseases of duodenum. PMID:15655822

Wang, Cheng-Xin; Liu, Li-Jiang; Guan, Jing; Zhao, Xiao-Ling

2005-01-01

89

Duodenal adenomatosis in familial adenomatous polyposis  

PubMed Central

Background: The prevalence of duodenal carcinoma is much higher in familial adenomatous polyposis (FAP) than in the background population, and duodenal adenomatosis is found in most polyposis patients. Aims: To describe the long term natural history of duodenal adenomatosis in FAP and evaluate if cancer prophylactic surveillance of the duodenum is indicated. Methods: A prospective five nation study was carried out in the Nordic countries and the Netherlands. Patients: A total of 368 patients were examined by gastroduodenoscopy at two year intervals during the period 1990–2001. Results: At the first endoscopy, 238 (65%) patients had duodenal adenomas at a median age of 38 years. Median follow up was 7.6 years. The cumulative incidence of adenomatosis at age 70 years was 90% (95% confidence interval (CI) 79–100%), and of Spigelman stage IV 52% (95% CI 28–76%). The probability of an advanced Spigelman score increased during the study period (p<0.0001) due to an increasing number and size of adenomas. Two patients had asymptomatic duodenal carcinoma at their first endoscopy while four developed carcinoma during the study at a median age of 52 years (range 26–58). The cumulative incidence rate of cancer was 4.5% at age 57 years (95% CI 0.1–8.9%) and the risk was higher in patients with Spigelman stage IV at their first endoscopy than in those with stages 0–III (p<0.01). Conclusions: The natural course of duodenal adenomatosis has now been described in detail. The high incidence and increasing severity of duodenal adenomatosis with age justifies prophylactic examination, and a programme is presented for upper gastrointestinal endoscopic surveillance. PMID:14960520

Bülow, S; Björk, J; Christensen, I J; Fausa, O; Järvinen, H; Moesgaard, F; Vasen, H F A

2004-01-01

90

Comparison between uncovered and covered self-expandable metal stent placement in malignant duodenal obstruction  

PubMed Central

AIM: To compare the clinical outcomes of uncovered and covered self-expandable metal stent placements in patients with malignant duodenal obstruction. METHODS: A total of 67 patients were retrospectively enrolled from January 2003 to June 2013. All patients had symptomatic obstruction characterized by nausea, vomiting, reduced oral intake, and weight loss. The exclusion criteria included asymptomatic duodenal obstruction, perforation or peritonitis, concomitant small bowel obstruction, or duodenal obstruction caused by benign strictures. The technical and clinical success rate, complication rate, and stent patency were compared according to the placement of uncovered (n = 38) or covered (n = 29) stents. RESULTS: The technical and clinical success rates did not differ between the uncovered and covered stent groups (100% vs 96.6% and 89.5% vs 82.8%). There were no differences in the overall complication rates between the uncovered and covered stent groups (31.6% vs 41.4%). However, stent migration occurred more frequently with covered than uncovered stents [20.7% (6/29) vs 0% (0/38), P < 0.05]. Moreover, the overall cumulative median duration of stent patency was longer in uncovered than in covered stents [251 d (95%CI: 149.8 d-352.2 d) vs 139 d (95%CI: 45.5 d-232.5 d), P < 0.05 by log-rank test] The overall cumulative median survival period was not different between the uncovered stent (70 d) and covered stent groups (60 d). CONCLUSION: Uncovered stents may be preferable in malignant duodenal obstruction because of their greater resistance to stent migration and longer stent patency than covered stents.

Kim, Ji Won; Jeong, Ji Bong; Lee, Kook Lae; Kim, Byeong Gwan; Ahn, Dong Won; Lee, Jae Kyung; Kim, Su Hwan

2015-01-01

91

Use of temporary oesophageal stent in the management of oesophageal perforation after laparoscopic redo-Nissen Fundoplication in a paediatric case  

PubMed Central

Iatrogenic perforation of the oesophagus is life threatening, usually managed surgically. A 4 year-old boy sustained an intra-operative oesophageal perforation while undergoing laparoscopic redo-Nissen Fundoplication for gastrooesophgeal reflux symptoms. After several failed attempts to manage the patients surgically and conservatively, he was successfully treated by deployment of a temporary covered stent. Although commonly employed as an alternative management option in adults, the use of temporary covered stents in the paediatric population is rare especially for nonmalignant disease. This technique can potentially reduce morbidity and surgical intervention. PMID:24147234

Radford, Anna; Horton, David; Besarovic, Sanja; Razack, Abdul

2013-01-01

92

Perforated midgut diverticulitis: Revisited  

PubMed Central

AIM: To study and provide data on the evolution of medical procedures and outcomes of patients suffering from perforated midgut diverticulitis. METHODS: Three data sources were used: the Medline and Google search engines were searched for case reports on one or more patients treated for perforated midgut diverticulitis (Meckel’s diverticulitis excluded) that were published after 1995. The inclusion criterion was sufficient individual patient data in the article. Both indexed and non-indexed journals were used. Patients treated for perforated midgut diverticulitis at Vestfold Hospital were included in this group. Data on symptoms, laboratory and radiology results, treatment modalities, surgical access, procedures, complications and outcomes were collected. The Norwegian patient registry was searched to find patients operated upon for midgut diverticulitis from 1999 to 2007. The data collected were age, sex, mode of access, surgical procedure performed and number of patients per year. Historical controls were retrieved from an article published in 1995 containing pertinent individual patient data. Statistical analysis was done with SPSS software. RESULTS: Group?I: 106 patients (48 men) were found. Mean age was 72.2 ± 13.1 years (mean ± SD). Age or sex had no impact on outcomes (P = 0.057 and P = 0.771, respectively). Preoperative assessment was plain radiography in 53.3% or computed tomography (CT) in 76.1%. Correct diagnosis was made in 77.1% with CT, 5.6% without (P = 0.001). Duration of symptoms before hospitalization was 3.6 d (range: 1-35 d), but longer duration was not associated with poor outcome (P = 0.748). Eighty-six point eight percent of patients underwent surgery, 92.4% of these through open access where 90.1% had bowel resection. Complications occurred in 19.2% of patients and 16.3% underwent reoperation. Distance from perforation to Treitz ligament was 41.7 ± 28.1 cm. At surgery, no peritonitis was found in 29.7% of patients, local peritonitis in 47.5%, and diffuse peritonitis in 22.8%. Peritonitis grade correlated with the reoperation rate (r = 0.43). Conservatively treated patients had similar hospital length of stay as operated patients (10.6 ± 8.3 d vs 10.7 ± 7.9 d, respectively). Age correlated with hospital stay (r = 0.46). No difference in outcomes for operated or nonoperated patients was found (P = 0.814). Group II: 113 patients (57 men). Mean age 67.6 ± 16.4 years (range: 21-96 years). Mean age for men was 61.3 ± 16.2 years, and 74.7 ± 12.5 years for women (P = 0.001). Number of procedures per year was 11.2 ± 0.9, and bowel resection was performed in 82.3% of patients. Group III: 47 patients (21 men). Patient age was 65.4 ± 14.4 years. Mean age for men was 61.5 ± 17.3 years and 65.3 ± 14.4 years for women. Duration of symptoms before hospitalization was 6.9 d (range: 1-180 d). No patients had a preoperative diagnosis, 97.9% of patients underwent surgery, and 78.3% had multiple diverticula. Bowel resection was performed in 67.4% of patients, and suture closure in 32.6%. Mortality was 23.4%. There was no difference in length of history or its impact on survival between Groups?I?and III (P = 0.241 and P = 0.198, respectively). Resection was more often performed in Group?I?(P = 0.01). Mortality was higher in Group III (P = 0.002). CONCLUSION: In cases with contained perforation, conservative treatment gives satisfactory results, laparoscopy with lavage and drainage can be attempted and continued with a conservative course. PMID:23002340

Spasojevic, Milan; Naesgaard, Jens Marius; Ignjatovic, Dejan

2012-01-01

93

Duodenal adenomatosis in Japanese patients with familial adenomatous polyposis.  

PubMed

Duodenal adenomatosis is the most frequent extracolonic manifestation of familial adenomatous polyposis (FAP), and duodenal cancer has been assumed to be the second most significant cause of death in patients with the disease. To stratify the risk of duodenal cancer, Spigelman's classification was proposed for the staging of duodenal adenomatosis. According to Western guidelines, patients with stage IV of the classification are candidates for prophylactic duodenectomy. Since our institutional experience disclosed only 2% of duodenal or ampullary cancers among 130 patients with FAP, and because most duodenal adenomatosis remains unchanged under endoscopic surveillance, it seems likely that aggressive endoscopic or surgical removal is unnecessary for most FAP patients with duodenal adenomatosis. In the present article, we demonstrate our data and present our strategy for duodenal adenomatosis of FAP. PMID:24750145

Maehata, Yuji; Esaki, Motohiro; Hirahashi, Minako; Kitazono, Takanari; Matsumoto, Takayuki

2014-04-01

94

Prostaglandin pathways in duodenal chemosensing.  

PubMed

Acid-sensing pathways, which trigger mucosal defense mechanisms in response to luminal acid, involve the rapid afferent-mediated "capsaicin pathway" and the sustained "prostaglandin (PG) pathway." Luminal acid quickly increases protective PG synthesis and release from epithelia, although the mechanism by which luminal acid induces PG synthesis is still mostly unknown. Acid exposure augments purinergic ATP-P2Y signaling by inhibition of intestinal alkaline phosphatase activity. Since P2Y activation increases intracellular Ca2+, we further hypothesized that ATP-P2Y signals increase the generation of H2O2 derived from dual oxidase, a member of the nicotinamide adenine dinucleotide phosphate (NADPH) oxidase family activated by Ca2+. Our recent studies suggest that acid exposure increases H2O2 output, followed by phospholipase A2 and cyclooxygenase activation, increasing PG synthesis. Released prostaglandin E2 augments protective HCO3- and mucus secretion via EP4 receptor activation. Thus, the PG pathway as a component of duodenal acid sensing consists of acid-related intestinal alkaline phosphatase inhibition, ATP-P2Y signals, dual oxidase 2-derived H2O2 production, phospholipase A2 activation, prostaglandin E2 synthesis, and EP4 receptor activation. The PG pathway is also involved in luminal bacterial sensing in the duodenum via activation of pattern recognition receptors, including Toll-like receptors and nucleotide-binding oligomerization domain 2. The presence of acute mucosal responses to luminal bacteria suggests that the duodenum is important for host defenses and may reduce bacterial loading to the hindgut using H2O2, complementing gastric acidity and anti-bacterial bile acids. PMID:25521740

Akiba, Yasutada; Kaunitz, Jonathan D

2014-12-01

95

[Mucinous gastric adenocarcinoma and duodenal somato-statinoma. Case report].  

PubMed

The Authors present a rare association of gastric adenocarcinoma and somatostatin-producing duodenal carcinoid. The pre-operative abdominal CT scan revealed the gastric lesions and a duodenal polypoid lesion, giving an important indication to perform a subtotal gastrectomy and a duodenal resection. The definitive diagnosis was possible with histological examination. PMID:18834564

Biffoni, M; Macrina, N; Napoli, A; Amabile, M I; Cavallo Marincola, B; Anzidei, M; Catalano, C; Maturo, A; Pasta, V

2008-01-01

96

Shaped charge perforating device  

SciTech Connect

A shaped charge perforating apparatus is described which consists of: an elongated tubular housing member having recesses spirally spaced therealong; an elongated tubular carrier member having shaped charge mounting locations spirally spaced therealong; a plurality of shaped charge units positioned in the mounting locations of the carrier member; a length of detonator cord helically wound about the tubular carrier member for transferring detonation waves to the shaped charge units and for retaining the shaped charge units within the mounting locations; and means for aligning the tubular carrier within the tubular housing member so as to align the shaped charge units with the spaced recesses along the housing member, the alignment means further comprising an elongated slot in the housing member; and biasing means affixed to the carrier member for engagement within the slot.

Ayers, D.B.

1986-04-22

97

Perforated Muffler Manifold Catalyst  

NASA Astrophysics Data System (ADS)

An alternative exhaust manifold system, the Perforated Manifold, Muffler, and Catalyst (PMMC), is proposed to improve sound suppression while reducing engine pumping losses and exhaust emissions. One-dimensional predictions from acoustic theory are used to configure the initial design. Preliminary evaluation of the concept is based on bench tests, including an extended impedance tube set-up for acoustic attenuation and a flow bench for flow loss characteristics. Experiments with the fabricated hardware are then conducted in an engine dynamometer facility, and the results were compared to the existing production system as a benchmark. Engine experiments show that the PMMC concept provides enhanced upstream sound suppression, reducing the need for restrictive downstream silencers. This results in reduced engine pumping work and thus improved engine break horsepower. Additionally, conservation of exhaust gas thermal energy and the reduced thermal inertia of the exhaust system provides earlier catalyst light-off, and therefore reduced pollutant emissions.

Norman, K. R.; Selamet, A.; Novak, J. M.

1998-12-01

98

Iatrogenic Displacement of a Foreign Body into the Periapical Tissues  

PubMed Central

The presence of a foreign body in the periapical tissues can cause endodontic failure by triggering an inflammatory response and a subsequent foreign body reaction. This inflammatory response, which can occur to varying degrees, appears radiographically as a radiolucency that can remain asymptomatic for many years. A foreign object can reach the apical region by accident or iatrogenic procedures during dental procedures. The aim of the present case report is to describe the endodontic surgical treatment of an iatrogenic displacement of a foreign body (a metal fragment) into the periapical tissues and to describe its clinical and radiographic follow-up over a period of 52 months. PMID:25478244

Cruz, Alvaro; Solís, Rodrigo; Díaz, Mariana; Vázquez, Josué

2014-01-01

99

[Iatrogenic pathology of the optic nerve].  

PubMed

Iatrogenic pathology of the optic nerve is examined according to a framework which distinguishes direct and indirect effects on the optic nerve. Direct effects due to toxic drugs should be suspected when unexplained, usually bilateral loss of visual acuity occurs. The 3 clinical stages of classical optic toxic neuropathy are 1) anomalies of color vision, 2) loss of visual acuity and narrowing field of vision, and 3) papillary palor corresponding to irreversible optic atrophy. Usually only the 1st stages are reversible, but the reversibility may be incomplete. The list of drugs which can cause such effects is lengthy and includes antiinfectious drugs such as sulfamides and derivatives of hydroxyquinoleins, chloramphenicol especially when used to treat cystic fibrosis of the pancreas in children, the antituberculins ethambutol in high doses and isoniazide, which occasion particular risks when combined; antiparasitics such as quinine and its derivatives chloroquine and hydroxychloroquine, which cause optic neuropathy through their effect on the retina; arsenic pentavalents such as tryparsamide, quinacrine, trecator and mystatin; drugs affecting the central nervous system such as monoamineoxydase inhibitors, laroxyl, phenothiazine and the barbituates; anticonvulsants such as phenytoin; antimitotics such as vincristine; digitalics, disulfiram; penicillamines, and pexid. The action of lasers on the optic nerve can have a similar effect. The optic nerve may be indirectly damaged during surgical procedures leading to hypotonia, acute ischemia of the head of the optic nerve or embolic accident after a local or regional injection. Damage may also be caused by radiotherapy of intracranial tumors and certain drugs which cause isolated papillary edema or edema associated with headaches, such as Tetracycline, large doses of vitamin A or D, corticoids, and oral contraceptive (OC) pills, which may cause papillary edema through cerebral pseudo-tumors that regress with discontinuation of treatment. This condition has been observed in women with uncontrolled hyperlipidemia. It is probable that an alteration ofaxonal transport is at the basis of the neuropathic mechanisms. The 1st step in therapy is the suppression of the toxin, or at least its discontinuation. Some success has been obtained with vitamin B therapy, corticotherapy, zinc, or isaxonine, depending on the specific condition. PMID:6764592

Hamard, H; Desbordes, J M

1982-01-01

100

Iatrogenic injury of the intrathoracic esophagus sustained during a gastric banding procedure.  

PubMed

The wide diffusion of laparoscopic adjustable gastric banding as a common surgical procedure for the treatment of morbidly obese patients can be attributed not only to the easy surgical technique, the ability to caliber the stoma, and the potential for reversibility, but also to the fact that this procedure is associated with a low rate of immediate postoperative complications compared to other more complex bariatric procedures. Herein reported is the case of a 63-year-old morbidly obese woman who sustained an iatrogenic injury of the intrathoracic esophagus during a laparoscopic adjustable gastric banding procedure. The putative mechanism of this previously unreported complication of laparoscopic adjustable gastric banding and the therapeutic options are discussed. The patient was initially treated with left pleural cavity drainage, antibiotics and the placement of an endoscopic silicone covered stent to cover the esophageal tear. Nine days later she underwent surgery through left thoracotomy due to the persistence of the esophageal leak. Esophageal perforation is a potentially life- threatening complication that may occur during a laparoscopic gastric banding procedure. The conservative treatment with an endoscopic stent should be reserved to patients with no signs of progressive systemic inflammation and include the drainage of the pleural cavity and the mediastinum, the endoscopic lavage and debridement. Standard surgical treatment with direct repair should not be retarded in case of persistence of the leak. PMID:18317858

Iannelli, Antonio; Negri, Chiara; Piche, Thierry; Becaud, André; Gugenheim, Jean

2008-06-01

101

Duodenal adenocarcinoma: why the extreme rarity of duodenal bulb primary tumors?  

PubMed

Adenocarcinoma of the small bowel accounts for only one per cent of all gastrointestinal malignancies. Duodenal adenocarcinoma accounts for half of all small bowel adenocarcinomas. The duodenum is divided into four segments: D1 (proximal horizontal 5 cm beginning with the 3-cm duodenal bulb), D2 (descending), D3 (distal horizontal), and D4 (ascending). The most common location of duodenal adenocarcinomas is the ampullary region of D2. Based on observational experience, our hypothesis was that primary adenocarcinomas arising from the mucosa of the duodenal bulb are extremely rare or possibly nonexistent. Our institutional cancer registry provided a list of patients for the years 1990 through 2012 who had small bowel cancers. Only those patients with primary adenocarcinomas of the duodenal mucosa were reviewed. Ampullary cancers arising from bile duct mucosa were specifically excluded. Medical records were abstracted to obtain patient age, sex, race, anatomic location of the tumor, disease stage (as per American Joint Committee on Cancer 7th edition staging guidelines), operation performed, and current vital status. A total of 30 patients with primary duodenal adenocarcinomas were identified. The mean age was 58 years and 17 (57%) patients were male. The tumor locations were: D2 in 26 (87%), D3 in two (7%), and D4 in two (7%). No tumors arose from D1. The patients presented with the following stages of disease: Stage 0is in three (10%), Stage I in three (10%), Stage II in five (17%), Stage III in 15 (50%), and Stage IV in four (13%). These findings combined with a diligent review of 724 reported cases in the English language literature yielded only five clearly defined cases of adenocarcinoma arising from the mucosa of the duodenal bulb. Although a 1991 published multicenter tumor registry series of 128 localized duodenal adenocarcinomas reported 29 D1 tumors, no anatomic distinction was made between duodenal bulb and more distal D1 tumors. Earlier reports used nonanatomic divisions of the duodenum or a simple breakdown into supra-ampullary, periampullary, and infra-ampullary portions. These data beg the question as to why primary duodenal bulb adenocarcinomas are so exceedingly rare. The obvious implication is that the duodenal bulb mucosa may be physiologically, immunologically, or otherwise uniquely privileged to virtually escape oncogenic transformation. The scientific challenge and opportunity is to explore and understand the important phenomena responsible for this finding. PMID:25264638

Goldner, Bryan; Stabile, Bruce E

2014-10-01

102

AUTOMATIVE QUANTIFICATION OF RAT DUODENAL RHYTHMIC CONTRACTION  

EPA Science Inventory

The pacemaker activity of longitudinal muscle, as reflected by in vitro rhythmic contractions of the adult male rat's duodenum, has been examined in terms of intercontraction intervals that were collected using a microprocessor-based system. For each duodenal segment studied, 512...

103

A novel phosphorus repletion strategy in a patient with duodenal perforation.  

PubMed

We describe a case in which a patient receiving parenteral nutrition (PN) developed hypophosphatemia. Due to lack of availability of parenteral phosphate supplements, we chose to restore phosphate using diluted hypertonic sodium phosphate enemas. Due to the recent shortages of parenteral minerals and vitamins, such an alternate means of repletion is of increasing importance. Diluted hypertonic sodium phosphate enemas are inexpensive, easy to administer, and effective since phosphate is readily absorbed across the rectal mucosa. We hope that through this type of repletion, life-threatening hypophosphatemia among patients receiving PN can be avoided. PMID:24743045

Kemmerly, Thomas; Vuong, Carolyn; Kaunitz, Jonathan D

2014-06-01

104

Laparoscopic repair of a post-myomectomy spontaneous uterine perforation accompanied by a bizarre tumor resembling polypoid endometriosis.  

PubMed

Among various long-term complications after previous myomectomy, increasing risk of uterine rupture or dehiscence during pregnancy, and in particular during labor, has been widely recognized. In contrast, the world literature includes no case report of spontaneous uterine perforation or rupture after myomectomy in a nonpregnant woman, and only 1 case of iatrogenic uterine perforation after uterine artery embolization has been reported. Recently, we encountered an extremely rare case of spontaneous uterine perforation after previous myomectomy accompanied by a bizarre tumor resembling polypoid endometriosis, which was successfully treated via laparoscopic surgery. The patient reported genital bleeding and lower abdominal pain. Preoperative magnetic resonance imaging and intraoperative findings clearly demonstrated the presence of a uterine wall defect and a multicystic tumor that had developed from the perforated portion of the uterus. The patient underwent successful laparoscopic surgery for repair of the perforated uterus and resection of the tumor. The clinicopathologic diagnosis of the tumor was tentatively confirmed as an endometriosis-like lesion resembling polypoid endometriosis. We speculate that the cause of the tumor was retrograde menstruation, as in the pathogenesis of endometriosis. PMID:24183281

Koyama, Shinsuke; Kobayashi, Masaki; Tanaka, Yusuke; Isobe, Masanori; Miwa, Hideaki; Shiki, Yasuhiko

2013-01-01

105

Microleakage of CEM Cement and ProRoot MTA as Furcal Perforation Repair Materials in Primary Teeth  

PubMed Central

Introduction: Iatrogenic furcal perforation is a procedural accident in endodontic treatments of primary/permanent teeth; prognosis may be favorable if a complete seal with biomaterial is immediately established. The purpose of this in vitro study was to evaluate microleakage of calcium enriched mixture (CEM) cement and ProRoot mineral trioxide aggregate (MTA) for sealing primary molar furcal perforations. Materials and Methods This study was conducted on 38 extracted human primary molars. Furcation perforations were created in the pulp chamber floor. The teeth were divided randomly in two experimental groups (n=17) and two positive and negative controls (n=2). Perforations were then repaired with biomaterials. After 72 h, the teeth were submerged in 2% fuchsin dye solution for 24h. The samples were sectioned longitudinally and evaluated for dye leakage. Data analyzed statistically using ANOVA test. Results: The negative and positive controls behaved as expected. Dye microleakage was observed in all experimental samples; however, there was no statistically significant difference between the microleakage of MTA (4.411±2.042 mm) and CEM (3.647±1.040 mm) groups (P>0.05). Conclusion: Based on the findings of this in vitro study, CEM and tooth-colored ProRoot MTA have similar sealing ability for furcal perforation repair of primary molar teeth. PMID:24171027

Haghgoo, Roza; Arfa, Sara; Asgary, Saeed

2013-01-01

106

Semianalytical productivity models for perforated completions  

SciTech Connect

This paper discusses the effects of various perforation and reservoir parameters on the productivity (or injectivity) of perforated completions. Because of the complex, 3D flow into a spiral system of perforations, productivity analysis of perforated completion is not easily amenable to analytical treatment. This paper presents a semianalytical solution for the estimation of skin in perforated completions. Results are presented for two separate cases: the 2D-plane-flow problem, which is essentially valid at small dimensionless perforation spacings (large perforation penetrations or high perforation shot densities) and the general 3D problem, where the vertical convergent flow into perforations is significant. In these analyses, the wellbore and vertical-flow effects are quantified in terms of pseudoskins obtained by accurate finite-element simulations. The effects of perforation damage and formation anisotropy are also included. The results provide a better understanding of the relative role of various perforation parameters in affecting well productivity. Because they are based on theoretical considerations, the correlations allow reliable estimates of the skin in perforated completions. New relations are provided for estimating productivity of perforated completions with formation permeability damage. Results indicate the importance of angular phasing, in addition to perforation penetration, in overcoming the effects of formation damage on well productivity.

Karakas, M.; Tariq, S.M. (Schlumberger Well Services (US))

1991-02-01

107

Management of pulpal floor perforation and grade II Furcation involvement using mineral trioxide aggregate and platelet rich fibrin: A clinical report  

PubMed Central

To report the management of an iatrogenic perforation of pulpal floor in the furcation of mandibular first molar, using Mineral Trioxide Aggregate (MTA) and platelet rich fibrin (PRF). Unpredictable endodontic root/pulp chamber floor perforations resulting in unacceptable high rate of clinical failure has now been a lesser threat with the advent of new technologies and biocompatible materials that utilize the applications of basic research along with tissue engineering concept in clinical practice. Present case report illustrates the use of MTA and platelet rich fibrin (PRF) for the repair of the perforation defect and regeneration of the lost periodontium in furcation area. Although, histologic events and reaction of MTA with PRF is not studied so far, however, the autologous and biocompatible nature of the components used for present treatment modalities seems to be beneficial for the long term clinical results obtained in our case. PMID:23230369

Bains, Rhythm; Bains, Vivek K.; Loomba, Kapil; Verma, Kavita; Nasir, Afreena

2012-01-01

108

Duodenal string test in typhoid fever.  

PubMed

Twenty five children between 4-12 years of age hospitalized with a clinical diagnosis of enteric fever were studied for evaluating the practicality and sensitivity of duodenal string-capsule culture (DSCC) and compared with conventional cultures from blood (BC), urine (UC) and stool (SC). Duodenal string capsule (DSCC) was successfully inserted in 18 patients (72%). Insertion of DSCC failed in 7 patients (28%) and all of them were below 6 years of age. Salmonella typhi was isolated from DSCC and/or BC in 13 cases (72.2%). DSCC was positive in 11 out of 13 confirmed cases of typhoid fever (84.6%). BC was positive in 8 cases (61.5%). DSCC was successful in isolating the organism in about 30% more cases than BC. Duodenal string test was a simple, non-invasive and a reliable test which when used in combination with BC could identify almost all cases of enteric fever irrespective of duration of fever and prior use of antibiotics. PMID:8282391

Antony, T J; Patwari, A K; Anand, V K; Pillai, P K; Aneja, S; Sharma, D

1993-05-01

109

Successful Treatment of Iatrogenic Vertebral Pseudoaneurysm Using Pipeline Embolization Device  

PubMed Central

Traumatic pseudoaneurysms are uncommon and one of the most difficult lesions to treat. Traditional treatment methods have focused on parent vessel sacrifice with or without revascularization. We report the case of a patient who underwent successful treatment of an iatrogenic extracranial vertebral artery pseudoaneurysm using the Pipeline Embolization Device. A 47-year-old man sustained an inadvertent injury to the left vertebral artery during C1-C2 fixation. Subsequent imaging revealed an iatrogenic vertebral artery pseudoaneurysm. Immediate angiogram was normal. A repeat angiogram done after 3 days of the surgery revealed a vertebral artery pseudoaneurysm. He underwent aneurysm exclusion and vascular reconstruction using the Pipeline Embolization Device. Although flow-diverting stents are currently not being used for treating traumatic pseudoaneurysms, their use may be considered in such cases if active bleeding has ceased. In our case, the patient did well and the aneurysm was excluded from circulation while reconstructing the vessel wall. PMID:25276469

Sharma, Mayur; Smith, Donald

2014-01-01

110

Iatrogenic injury and unexpected hospital death in the newborn.  

PubMed

Neonates are unusually vulnerable to iatrogenic injury due to small body size, delicate tissues, and immature immune systems. Investigation of an unexpected neonatal death in the hospital should begin with a review of the medical record and discussion with medical staff involved in the patient?s care. Postmortem investigation should include a complete and well-documented autopsy. Additional investigations, such as microbiological studies and chemical and toxicological studies of postmortem and antemortem fluid samples, may be crucial in arriving at a diagnosis. Causes of iatrogenic injury include birth trauma, medication errors and adverse drug effects, hospital-acquired infection, and medical device malfunction, incorrect placement, and misuse. Autopsy is an important tool for understanding the cause of an unexpected death, improving the quality of care, and providing closure to parents and family. PMID:25444418

Reed, Robyn C

2015-02-01

111

Iatrogenic Stenosis of Anterior Nares: A Case Report  

PubMed Central

Stenosis of anterior nares may be congenital or acquired. Acquired stenosis may be caused by the diseases which cause destruction of skin or normal cartilage. The various causes of acquired stenosis of anterior nares are burns, trauma, infections, etc. Iatrogenic stenosis of anterior nares is a rare condition. Doing simple excision of fibrosed tissue, with septoplasty and endoscopic adenoidectomy in a 5-year child, improved nasal breathing. Use of Mitomycin-C topical solution prevents recurrence of fibrosis, with good outcome. PMID:24959466

Garag, Santosh S.; Anchan, Shibani

2014-01-01

112

Extensive bilateral intracranial calcifications: a case of iatrogenic hypoparathyroidism.  

PubMed

This is a case of a 69-year-old male patient with long-standing iatrogenic hypoparathyroidism after total thyroidectomy. The clinical evaluation revealed mild neurological symptoms and excessive brain calcinosis. Intracranial calcification that affects structures other than the basal ganglia and the cerebellum is a rare manifestation of postoperative hypoparathyroidism. Detection of brain calcinosis in patients who had total thyroidectomy can motivate clinicians in further investigation of possible hypoparathyroidism with measurement of calcium and phosphorus serum levels. PMID:23509468

Zisimopoulou, Vaso; Siatouni, Anna; Tsoukalos, Grigorios; Tavernarakis, Antonios; Gatzonis, Stylianos

2013-01-01

113

Extensive Bilateral Intracranial Calcifications: A Case of Iatrogenic Hypoparathyroidism  

PubMed Central

This is a case of a 69-year-old male patient with long-standing iatrogenic hypoparathyroidism after total thyroidectomy. The clinical evaluation revealed mild neurological symptoms and excessive brain calcinosis. Intracranial calcification that affects structures other than the basal ganglia and the cerebellum is a rare manifestation of postoperative hypoparathyroidism. Detection of brain calcinosis in patients who had total thyroidectomy can motivate clinicians in further investigation of possible hypoparathyroidism with measurement of calcium and phosphorus serum levels. PMID:23509468

Siatouni, Anna; Tsoukalos, Grigorios; Tavernarakis, Antonios; Gatzonis, Stylianos

2013-01-01

114

Iatrogenic risks and maternal health: Issues and outcomes  

PubMed Central

Objective: To observe acute maternal morbidity and mortality due to iatrogenic factors and outcomes. Methods: This observational cross sectional study was conducted at intensive care unit of Liaquat University of Medical and Health sciences Jamshoro from 1-January-2011 to 31-December-2012. In this study all the delivered or undelivered women who needed intensive care unit (ICU) admission due to management related life threatening complication referred from periphery or within this hospital were included, while those women who had pregnancy complicated by medical conditions were excluded. These women were registered on the predesigned proforma containing variables like Demographic characteristics, various iatrogenic risk factors, complications and management out comes. The data was collected and analyzed on SPSS version 20. Results: During these study period 51 women needed ICU care for different complications due to adverse effects of medical treatments. Majority of these women were between 20-40 years of age 41(80.39%), multiparous 29(56.86%), unbooked 38(74.50%), referred from periphery 39(76.47%), common iatrogenic factors were misuse of oxytocin 16(31.37%), fluid overload/cardiac failure 8(15.68%), blood reaction 7(13.72%), anesthesia related problems were delayed recovery 3(5.88%), cardiac arrest 2(3.92%), spinal shock 2(3.92%), surgical problems were bladder injury 5(9.8%), post operative internal haemorrhage 3(5.88%), 37(72.54%) women recovered and 14(27.45%) expired. Conclusion: The maternal morbidity and mortality rate with iatrogenic factors was high and majority of these factors were avoidable. PMID:24639842

Khaskheli, Meharun-nissa; Baloch, Shahla; Sheeba, Aneela

2014-01-01

115

The anatomic basis of perforator flaps.  

PubMed

The recent enthusiasm for perforator flaps underlines the need for a detailed understanding of the cutaneous vasculature. The principle determinant of success in perforator flap surgery is the inclusion of an adequately sized cutaneous perforator in the flap. Therefore, the size, distribution, and variability of cutaneous perforators of the human body are crucial to the design and execution of successful perforator flap surgery. Based on numerous anatomic studies, the authors have found that the main source arteries supplying the skin are fairly constant but the individual cutaneous perforators are quite variable. Knowledge of the overall architecture of the vasculature and an awareness of the variability, combined with a flexible operative plan, will enable the perforator flap surgeon to take advantage of the most appropriate perforators to execute a successful operative plan. PMID:20816512

Morris, Steven F; Tang, Maolin; Almutari, Khalid; Geddes, Christopher; Yang, Daping

2010-10-01

116

Russell body duodenitis with immunoglobulin kappa light chain restriction.  

PubMed

Russell bodies are eosinophilic intracytoplasmic globules which are likely the result of disturbed secretion of immunoglobulins that accumulate within the plasma cell. Russell body collections have been identified within the stomach, known as Russell body gastritis. Similar lesions within the duodenum are referred to as Russell body duodenitis, which is rare. Several Russell body gastritis case reports are associated with Helicobacter pylori. However, the etiology of Russell body duodenitis remains unclear. Here we report the first case of Russell body duodenitis with immunoglobulin light chain restriction in a background of peptic duodenitis. PMID:25610537

Munday, William R; Kapur, Lucy Harn; Xu, Mina; Zhang, Xuchen

2015-01-16

117

Russell body duodenitis with immunoglobulin kappa light chain restriction  

PubMed Central

Russell bodies are eosinophilic intracytoplasmic globules which are likely the result of disturbed secretion of immunoglobulins that accumulate within the plasma cell. Russell body collections have been identified within the stomach, known as Russell body gastritis. Similar lesions within the duodenum are referred to as Russell body duodenitis, which is rare. Several Russell body gastritis case reports are associated with Helicobacter pylori. However, the etiology of Russell body duodenitis remains unclear. Here we report the first case of Russell body duodenitis with immunoglobulin light chain restriction in a background of peptic duodenitis. PMID:25610537

Munday, William R; Kapur, Lucy Harn; Xu, Mina; Zhang, Xuchen

2015-01-01

118

Duodenal pH in health and duodenal ulcer disease: effect of a meal, Coca-Cola, smoking, and cimetidine  

Microsoft Academic Search

Intraluminal duodenal pH was recorded using a combined miniature electrode and logged digitally every 10 or 20 seconds for five hours (basal\\/meal\\/drink) in eight control subjects and 11 patients with duodenal ulcer (five on and off treatment with cimetidine). Over the whole test there were no significant differences in duodenal mean pH or log mean hydrogen ion activity (LMHa) between

R F McCloy; G R Greenberg; J H Baron

1984-01-01

119

Electromagnetic measurements of duodenal digesta flow in cannulated sheep  

E-print Network

Electromagnetic measurements of duodenal digesta flow in cannulated sheep C. PONCET, M. IVAN M of duodenal digesta flow were made in sheep implanted with an electromagnetic flowmeter probe on the ascending and transverse duodenum and in sheep equipped in the ascending duodenum with a 'Y'-type or 'Ash'-type reentrant

Paris-Sud XI, Université de

120

Metastasis of breast cancer to major duodenal papilla.  

PubMed

Metastasis is an infrequent cause of tumor involvement of the major duodenal papilla and of cholestasis. We report a case of obstructive jaundice due to a metastatic breast carcinoma to the major duodenal papilla, and assess curative and palliative treatment that interventional endoscopy can offer. PMID:25028907

Bastos, Tiago; Souza, Thiago F; Otoch, Jose P; Grecco, Eduardo; Àvila, Fabio; Artifon, Everson L A

2014-04-01

121

Does duodenal atresia and stenosis prevent midgut volvulus in malrotation?  

PubMed

Thirty-six of the 64 (56%) neonates with duodenal atresia and stenosis who were retrospectively reviewed had associated malrotation. A volvulus neonatorum (age: <28 days) was not encountered among these patients. Can the duodenal atresia and stenosis act as a flood gate mechanism, in the prevention of volvulus in these children? PMID:9085801

Samuel, M; Wheeler, R A; Mami, A G

1997-02-01

122

Duodenal bulb tumour of unknown origin  

PubMed Central

Gastrointestinal stromal tumours (GIST) are rare mesenchymal neoplasms of the gastrointestinal tract. Their development typically depends on mutations in the Kit or PDGFRA gene. We have diagnosed and treated a duodenal bulb GIST in a 63-year-old woman. The confirmation of the diagnosis was made on the basis of a histological test after radical resection of the tumour. Making the right diagnosis is crucial for patients, since complex surgical and pharmacological approaches are effective even in the advanced stages of the disease. Nevertheless, radical surgical treatment is still the primary choice for patients with GIST.

Sobo?, Marcin; Szylberg, Tadeusz; Rudzi?ski, Janusz

2014-01-01

123

[Sonography in extensive juxtapapillary duodenal diverticulum].  

PubMed

The ultrasonic appearance of a juxtapapillary duodenal diverticulum as a pancreatic pseudo-mass is the subject of the discussion. An attempt is made to explain the homogeneous, echo-poor and solid aspect--even after rescanning through the fluid-filled stomach and duodenum and to correlate it with the diverticula's histological layers. The ERCP is the method of choice to examine the diverticula's inner wall and to investigate at the same time the frequently involved biliary tract and pancreatic diseases. PMID:6441251

Müller, G E; Brandstätter, G; Kratochvil, P; Harnoncourt, K

1984-12-01

124

Iatrogenic Circumflex Coronary Lesion in Mitral Valve Surgery  

PubMed Central

Ischemic iatrogenic lesions can complicate surgical procedures on the mitral valve. One of the causative mechanisms is direct injury to or distortion of the circumflex coronary artery. The risk of damaging the circumflex coronary artery depends mainly upon the proximity of that vessel to the posterior segment of the mitral annulus, and this varies from patient to patient. Herein, we report a case of iatrogenic circumflex coronary artery lesion after mitral annuloplasty, and we review the literature on the subject, in order to highlight a possible relationship between iatrogenic circumflex lesions and coronary dominance. In a 60-year-old man who had severe mitral regurgitation due to prolapse of both leaflets, preoperative coronary angiography showed irregularities only along the left anterior descending coronary artery and a coronary network of right dominance. The patient underwent mitral annuloplasty (32-mm Carpentier-Edwards ring) by means of minimally invasive right thoracotomy through the right 4th intercostal space (HeartPort®). When the procedure was over, and before the patient was taken to intensive care, ventricular fibrillation developed; the administration of direct-current shock (200 joules) resulted in a resumption of sinus rhythm. Repeat transesophageal echocardiography showed posterolateral dyskinesis of the left ventricle and ST-segment elevation suggestive of acute lateral myocardial infarction. Emergency cardiac catheterization revealed a subocclusion of the distal circumflex coronary artery. Dual percutaneous angioplasty and stenting (Taxus, 2.5 × 24 mm) was performed with optimal result. At the 1-year follow-up, the patient showed good results of the mitral annuloplasty. PMID:18612492

Grande, Antonino M.; Fiore, Antonio; Massetti, Massimo; Viganò, Mario

2008-01-01

125

Hypercalcemia in a dog with resolution of iatrogenic Cushing's syndrome.  

PubMed

A six-year-old spayed Pug was presented with crust formation and ulcer on the skin. The patient had received long-term glucocorticoid therapy for treatment of tentatively diagnosed panniculitis. Severe calcification and pyoderma was observed and the patient was diagnosed with iatrogenic Cushing's syndrome and predonisolone was gradually withdrawn. After the withdrawal, the patient developed marked hypercalcemia (15.3 mg/dl) and finally died from renal failure. It is postulated that the eluted calcium from the calcified lesions may have contributed to the high serum calcium level as the underlying disease was not identified on necropsy. PMID:15107569

Nakamura, Momoko; Kawamura, Yuko; Minegishi, Michiyo; Momoi, Yasuyuki; Iwasaki, Toshiroh

2004-03-01

126

Chorioretinectomy for perforating eye injuries  

PubMed Central

Purpose To report the outcomes of chorioretinectomy in severe ocular injuries where a foreign body penetrated the choroid or perforated the globe. Methods The study sample consisted of a retrospective, non-comparative, consecutive interventional case series of 13 perforating or severe intraocular foreign body ocular injuries that were treated at a single institution from March 2008 to March 2010. All the patients were operated with 20-gauge three-port pars plana vitrectomy (PPV) by removing the choroid and/or retina with scar tissue at the perforation site of the foreign body. The reports of patients were examined for best-corrected visual acuity, globe survival, retinal detachment status, and proliferative vitreoretinopathy. Results A total of 13 eyes of 13 patients with a mean age of 25.8±9.0 years (range, 11–38 years) were followed for a median of 13.8±5.4 months (range, 8–29 months). The mean time period between injury and the vitreoretinal surgery was 13.6±9.3 days. All had an exit/impact site wound, eight of which were located in the posterior pole, which caused choroidal and retinal incarceration in the macular area. PPV together with chorioretinectomy, endolaser applications, silicone oil tamponade, with/without encircling band, and lensectomy surgery was applied to all of them. Final best-corrected visual acuity (BCVA) ?20/200 occurred in 4 of 13 (30.76%) patients. Globe survival rates were 100% (13 of 13), and final retinal attachment rate was 84.6% (11 of 13). The proliferative vitreoretinopathy rate was 2 of 13 (15.3%). Conclusion Chorioretinectomy is a surgical option that may decrease post-traumatic proliferative vitreoretinopathy and tractional retinal detachment rates, thus improving final BCVA and increasing globe survival rates when a foreign body penetrates the choroid and perforates the globe. PMID:23519273

Ozdek, S; Hasanreisoglu, M; Yuksel, E

2013-01-01

127

Conservative treatment of iatrogenic left main coronary artery dissection: report of two cases  

PubMed Central

Revascularization treatment is mostly recommended for iatrogenic left main coronary artery dissection because of potential for catastrophic sequel, even in case of initial TIMI 3 flow and hemodynamic stability. However, conservative treatment seems to be feasible in asymptomatic and hemodinamically stable patient with low-grade dissection. We report two cases of iatrogenic left main coronary dissection managed conservatively. PMID:24400208

Yuksel, Uygar Cagdas; Yalcinkaya, Emre; Gokoglan, Yalcin; Iyisoy, Atila

2013-01-01

128

Endovascular Management of Iatrogenic Native Renal Arterial Pseudoaneurysms  

SciTech Connect

Purpose: Our purpose was to evaluate iatrogenic renal pseudoaneurysms, endovascular treatment, and outcomes. Methods: This retrospective study (2003-2011) reported the technical and clinical outcomes of endovascular therapy for renal pseudoaneurysms in eight patients (mean age, 46 (range 24-68) years). Renal parenchymal loss evaluation was based on digital subtraction angiography and computed tomography. Results: We identified eight iatrogenic renal pseudoaneurysm patients with symptoms of hematuria, pain, and hematoma after renal biopsy (n = 3), surgery (n = 3), percutaneous nephrolithotomy (n = 1), and endoscopic shock-wave lithotripsy (n = 1). In six patients, the pseudoaneurysms were small-sized (<20 mm) and peripherally located and were treated solely with coil embolization (n = 5). In one patient, coil embolization was preceded by embolization with 500-700 micron embospheres to control active bleeding. The remaining two patients had large-sized ({>=}50 mm), centrally located renal pseudoaneurysms treated with thrombin {+-} coils. Technical success with immediate bleeding cessation was achieved in all patients. There were no procedure-related deaths or complications (mean follow-up, 23.5 (range, 1-67) months). Conclusions: Treatment of renal pseudoaneurysms using endovascular approach is a relatively safe and viable option regardless of location (central or peripheral) and size of the lesions with minimal renal parenchymal sacrifice.

Sildiroglu, Onur; Saad, Wael E.; Hagspiel, Klaus D.; Matsumoto, Alan H.; Turba, Ulku Cenk, E-mail: Turba@me.com [University of Virginia Health System, Department of Radiology (United States)

2012-12-15

129

Iatrogenic Cushing syndrome caused by ocular glucocorticoids in a child  

PubMed Central

A boy aged 7.6 years presented to our Unit of Paediatric Endocrinology for evaluation of obesity. Progressive weight gain (10 kg) started 6 months earlier after an accidental penetrating orbital injury on the right eye. During this period the child has been treated with oral betamethasone (0.5 mg/day) for 1 month and dexamethasone 2% ocular drops (2 hourly by day) for 6 months. Physical examination showed he was 113.5 cm in height (?1.5 SD), weight 36.0 kg, blood pressure 110/90 mmHg (90th centile), body mass index 28 (+5 SD), truncal obesity, buffalo hump, “moon-face”, increased lanugo hair and supraclavicular fullness. Endocrinological work-up revealed undetectable levels of basal adrenocorticotropic hormone (ACTH), basal and ACTH-stimulated cortisol and 24 h urine excretion cortisol, confirming the diagnosis of iatrogenic Cushing syndrome. The abrupt withdrawal of ocular glucocorticoids by the parents evoked two adrenal crises; 4 months later the patient recovered. In conclusion, we would alert doctors that every formulation of glucocorticoids, no ocular drops excluded, can determine severe systemic side effects and iatrogenic Cushing syndrome. PMID:21686405

Messina, Maria Francesca; Valenzise, Mariella; Aversa, Salvatore; Arrigo, Teresa; De Luca, Filippo

2009-01-01

130

Malignant gastric lymphoma with spontaneous perforation.  

PubMed

Malignant gastric lymphoma, accounting only for 1% of primary gastric carcinoma, is usually a diffuse large B-cell lymphoma. Toyota et al reported that 37% of gastric perforations involved malignancy, generally gastric carcinoma. Fukuda et al found that less than 5% of malignant gastric lymphomas perforate. While it is relatively well known that perforations often take place during chemotherapy, they are rare in patients not receiving chemotherapy. To our knowledge, spontaneous perforation is rare in gastric malignant lymphoma, having been reported in the Japanese literature only 26 times, including this case, in the last 25 years. PMID:23329705

Shimada, Satoko; Gen, Tokichi; Okamoto, Hiroyuki

2013-01-01

131

Malignant gastric lymphoma with spontaneous perforation  

PubMed Central

Malignant gastric lymphoma, accounting only for 1% of primary gastric carcinoma, is usually a diffuse large B-cell lymphoma. Toyota et al reported that 37% of gastric perforations involved malignancy, generally gastric carcinoma. Fukuda et al found that less than 5% of malignant gastric lymphomas perforate. While it is relatively well known that perforations often take place during chemotherapy, they are rare in patients not receiving chemotherapy. To our knowledge, spontaneous perforation is rare in gastric malignant lymphoma, having been reported in the Japanese literature only 26 times, including this case, in the last 25?years. PMID:23329705

Shimada, Satoko; Gen, Tokichi; Okamoto, Hiroyuki

2013-01-01

132

Surgical clipping of a basilar perforator artery aneurysm: a case of avoiding perforator sacrifice.  

PubMed

Background?Aneurysms arising from basilar perforator arteries are very rare. A primary goal of surgery is always preservation of perforator flow. However, in most surgically managed cases in the literature, sacrifice of the perforator was reported. It is important for the literature to demonstrate that patency of the perforator is an achievable goal. Objective?To present the second reported case of perforator flow preservation in the surgical management of basilar perforator artery aneurysms. Clinical Presentation?A 45-year-old woman presented with World Federation of Neurologic Surgeons grade 1 subarachnoid hemorrhage. Digital subtraction angiography ultimately revealed a 2-mm aneurysm of the basilar artery arising from a perforator after an initially negative angiogram. Clipping was performed with perforator patency confirmed on direct inspection and intraoperative angiography. The patient's postoperative course was uneventful, and postoperative magnetic resonance imaging (MRI) showed no evidence of brainstem stroke. Conclusion?Although patency of the perforator is a rather obvious goal of cerebrovascular surgery, the current literature does not reflect an ability to do so in the case of basilar perforator aneurysms. We present only the second reported case of maintenance of perforator flow after clipping of a basilar perforator artery aneurysm. PMID:25111793

Sivakanthan, Sananthan; Carlson, Andrew P; van Loveren, Harry; Agazzi, Siviero

2015-01-01

133

Improving management of duodenal ulcer disease.  

PubMed Central

Audit of treatment of duodenal ulcer disease has allowed management to improve and keep abreast of rapid advances in care. Eradication of Helicobacter pylori was assessed by 14C urea breath test one to two months after anti-Helicobacter therapy. The old triple therapy regime of bismuth, tetracycline and metronidazole for two weeks was found to be toxic and of low effectiveness (82%). Regimes with lansoprazole for one month and antibiotics for one week gave 90-98% success rates. The best success has been with regimes containing both clarithromycin and a nitro-imidazole. There was complete success in 98% of 109 patients given quadruple therapy with lansoprazole 30 mg daily for one month plus tetracycline 500 mg twice daily, clarithromycin 250 mg twice daily and metronidazole 400 mg twice daily for one week. PMID:9519185

Bateson, M. C.; Diffey, B. L.

1997-01-01

134

Surface morphology of the gastroduodenal mucosa in duodenal ulceration.  

PubMed Central

Endoscopic biopsies from the duodenal cap and prepyloric areas of 25 patients have been examined with the scanning electron microscope. Eleven patients had duodenal ulceration. Bacteria are related only to the surface of gastric type epithelial cells whether these cells are located at areas of gastric metaplasia in the duodenal bulb or in the pre-pyloric region of the stomach. The bacteria are not associated with the surface of intestinal type epithelial cells. The bacteria are absent from the biopsies of those patients with a normal stomach and duodenum. Of those patients with duodenal ulceration, 73% have bacteria related to the epithelial surface. The bacteria are of two morphological types - a kidney shaped bacillus and an S-shaped bacillus. Images Fig. 1 Fig. 2 Fig. 3 Fig. 4 Fig. 5 PMID:6500361

Steer, H W

1984-01-01

135

Duodenal switch for intractable reflux gastroesophagitis after proximal gastrectomy.  

PubMed

Reflux gastroesophagitis is a common postgastrectomy complication after proximal gastrectomy, and conservative treatments including protease inhibitors and proton pump inhibitors are effective in most patients. Here we report a patient with severe reflux gastroesophagitis after proximal gastrectomy, in whom surgical treatment of duodenal switch was effective. An 80-year-old man complained of intractable heartburn, anorexia, and body weight loss after having undergone proximal gastrectomy, with reconstruction by esophagogastrostomy with valvuloplasty and pyloroplasty, for early gastric cancer 14 months before referral to our department. Oral administration of protease inhibitors and proton pump inhibitors was ineffective. Laboratory evaluation showed poor nutritional status. On endoscopic examination, we noted the redness, bleeding, and multiple erosions in the esophagus and the gastric remnant. He was diagnosed to have severe gastroesophagitis due to reflux of duodenal juice into the gastric remnant and esophagus. We performed duodenal switch to divert duodenal juice from the gastric remnant and esophagus; the duodenum was transected 2 cm distal to the pylorus, the duodenal distal end was closed, and a 50-cm Roux limb from the proximal jejunum was anastomosed to the proximal end of the duodenum. The heartburn disappeared postoperatively, and endoscopic examination revealed marked improvement of the reflux gastroesophagitis. One year postoperatively, the patient is free from symptoms including heartburn. His body weight increased, and laboratory data showed improvement in nutritional status. In conclusion, the duodenal switch may be surgical treatment of choice for intractable reflux gastroesophagitis after proximal gastrectomy. PMID:23803250

Someya, Soutoku; Shibata, Chikashi; Tanaka, Naoki; Kudoh, Katsuyoshi; Naitoh, Takeshi; Miura, Koh; Unno, Michiaki

2013-01-01

136

Shaped charge perforating apparatus and method  

Microsoft Academic Search

An apparatus for perforating oil and gas wells and the like and methods for completing such wells in an unconsolidted formation are described. The apparatus includes one or more shaped charges having inert particles in them arranged to be carried, upon detonation of the charge, into the perforation formed by the charge and also includes a carrier for positioning the

Venghiattis

1968-01-01

137

A hypervelocity projectile launcher for well perforation  

Microsoft Academic Search

Current oil well perforation techniques use low- to medium-velocity gun launchers for completing wells in soft rock. Shaped-charge jets are normally used in harder, more competent rock. A launcher for a hypervelocity projectile to be used in well perforation applications has been designed. This launcher will provide an alternative technique to be used when the conventional devices do not yield

L. E. Fugelso; J. N. Albright; G. C. Langner; K. L. Burns

1989-01-01

138

Bioplast ® fibrin implants in nasoseptal perforation  

Microsoft Academic Search

This study includes 9 cases of nasoseptal perforation following submucous septectomy. Sheets from Bioplast fibrin, an absorbable biomaterial, were implanted to prevent the persistence of perforations. Postoperative mucosal growth on both implant surfaces ensured closure in 6 of the 9 cases. The method has the advantage of simplicity and it is commendable in the case of smaller defects when the

László Gyeney; Géza Kerényi

1977-01-01

139

High power laser perforating tools and systems  

DOEpatents

ystems devices and methods for the transmission of 1 kW or more of laser energy deep into the earth and for the suppression of associated nonlinear phenomena. Systems, devices and methods for the laser perforation of a borehole in the earth. These systems can deliver high power laser energy down a deep borehole, while maintaining the high power to perforate such boreholes.

Zediker, Mark S; Rinzler, Charles C; Faircloth, Brian O; Koblick, Yeshaya; Moxley, Joel F

2014-04-22

140

Dimensional scaling for impact cratering and perforation  

NASA Technical Reports Server (NTRS)

This report summarizes the development of two physics-based scaling laws for describing crater depths and diameters caused by normal incidence impacts into aluminum and TFE Teflon. The report then describes equations for perforations in aluminum and TFE Teflon for normal impacts. Lastly, this report also studies the effects of non-normal incidence on cratering and perforation.

Watts, Alan; Atkinson, Dale; Rieco, Steve

1993-01-01

141

Perforator flaps--how many perforators are necessary to keep a flap alive?  

PubMed

Perforator flaps are becoming increasingly important in reconstructive microsurgery because of their reduced donor-site morbidity. However, one drawback is partial necrosis caused by vasospasm or inconsistency of delicate perforator vessels. In this study we have evaluated the number and capacity of perforator vessels with respect to the size of a flap, and the influence of vascular endothelial growth factor (VEGF) on the capacity of perforators in a standard animal model. We realised an epigastric perforator flap 4cm×7cm in 36 rats. In 3 control groups (n=6 in each), flaps were raised based on 4, 2, or 1 perforator vessel(s), while all other perforators as well as the epigastric vessels were ligated. In three study groups (n=6 in each), set up in the same way as the control groups, we also injected a single dose of VEGF into the wound area. After one week, all areas of necrosis were assessed planimetrically. We also evaluated the wounds by laser Doppler flowmetry preoperatively and after one week, and by histological and immunohistochemical examination. An increased number of perforators, together with VEGF, was associated with a significant reduction in the areas of necrosis. This observation was particularly true in flaps based on only one perforator. The inclusion of additional perforators has a more important role in the success of a flap than theoretical models suggest. Proangiogenetic factors may improve the viability of perforator flaps. PMID:24629454

Fichter, Andreas M; Borgmann, Anna; Ritschl, Lucas M; Mitchell, David A; Wagenpfeil, Stefan; Dornseifer, Ulf; Wolff, Klaus-Dietrich; Mücke, Thomas

2014-05-01

142

Gastric Leiomyosarcoma as a rare cause of gastric outlet obstruction and perforation: a case report  

PubMed Central

Background Gastrointestinal stromal tumours are the most common mesenchymal malignancies of the gastrointestinal (GI) tract and gastric leiomyosarcoma represent 1-3% of gastric malignancies. Case presentation We report a case of a 69-year- old black African man who presented with a rare cause of gastric outlet obstruction and duodenal perforation. A Billroth- II gastrectomy was performed and histology confirmed a gastric leiomyosarcoma. Conclusions It is important to identify the gastric leiomyosarcoma which is a variant of the more common malignant gastrointestinal stromal tumours as the pathogenesis and management are currently well established. As the facilities for differentiating these are not easily available in resource-limited areas gastrointestinal stromal tumours may remain underdiagnosed and undertreated. PMID:25069607

2014-01-01

143

Debate: whether venous perforator surgery reduces recurrences.  

PubMed

Superficial venous surgery and perforator vein surgery, specifically, have a long and varied history in the evolution of vascular surgery, especially because venous disease continues to be extremely common. As with other areas of our specialty, perforator vein procedures have progressed from being purely open operations to becoming less invasive procedures. Despite this, there remains much discussion (as well as overt disagreement) about whether perforator vein surgery is actually appropriate and beneficial in the first place. Surgeons have no level I evidence from randomized controlled studies to determine whether perforator vein surgery does or does not reduce the chances of recurrence of superficial venous varicosities, so we must rely on the evidence as it currently is. Perhaps not surprisingly, our two experts have assembled divergent opinions on the role of perforator venous surgery in contemporary practice. PMID:25154966

Whiteley, Mark S; O'Donnell, Thomas F

2014-09-01

144

Correlation of Tissue Transglutaminase Antibody with Duodenal Histologic Marsh Grading  

PubMed Central

BACKGROUND Recent guidelines have proposed that there is a correlation between tissue transglutaminase (tTG) antibody titers and degrees of duodenal biopsy, and that duodenal biopsy can be omitted in some patients with high levels of tTG antibody. Using data of registered patients in a gastrointestinal clinic we aimed to assess the correlation between tissue transglutaminase antibody with duodenal histologic Marsh grading in Iranian patients with celiac disease. METHODS We retrospectively reviewed hospital files of registered patients in the gastrointestinal clinic of Firoozgar Hospital, Tehran, Iran. Demographic, laboratory, and histology data of those who had tTG titer and pathology reports of duodenal biopsy based on the modified Marsh classification were extracted and used for the study. RESULTS 159 patients with available tTG titer and pathology reports were enrolled in our study. Mean ±SD of the patients was 35.6±15.2 and 100 (62.9%) of them were women. 133 out of 153 patients had villous atrophy (Marsh IIIa-IIIc). Anemia was the most common sign and bloating, abdominal pain, and diarrhea were the first three common symptoms in these patients. Mean tTG titers was significantly higher in patients graded as Marsh III (p for trend=0.003). Our results showed that tTG titer more than 9 folds higher than the kit’s cut-off value was about 97.2% sensitive for Marsh II and more duodenal damage. CONCLUSION There was a correlation between tTG titers and degrees of duodenal damage in patients with celiac disease. Duodenal biopsy is not always necessary for diagnosing celiac disease and when tTG level is more than 9 folds higher than the manufacture’s recommended cut-off value it can be avoided. Meanwhile small intestinal biopsy should always be considered in case of high clinical suspicion, regardless of the results of serologic testing. PMID:25093060

Rahmati, Atieh; Shakeri, Ramin; Sohrabi, Masoudreza; Alipour, Abbass; Boghratian, Amirhossein; Setareh, Massomeh; Zamani, Farhad

2014-01-01

145

Correlation of tissue transglutaminase antibody with duodenal histologic marsh grading.  

PubMed

BACKGROUND Recent guidelines have proposed that there is a correlation between tissue transglutaminase (tTG) antibody titers and degrees of duodenal biopsy, and that duodenal biopsy can be omitted in some patients with high levels of tTG antibody. Using data of registered patients in a gastrointestinal clinic we aimed to assess the correlation between tissue transglutaminase antibody with duodenal histologic Marsh grading in Iranian patients with celiac disease. METHODS We retrospectively reviewed hospital files of registered patients in the gastrointestinal clinic of Firoozgar Hospital, Tehran, Iran. Demographic, laboratory, and histology data of those who had tTG titer and pathology reports of duodenal biopsy based on the modified Marsh classification were extracted and used for the study. RESULTS 159 patients with available tTG titer and pathology reports were enrolled in our study. Mean ±SD of the patients was 35.6±15.2 and 100 (62.9%) of them were women. 133 out of 153 patients had villous atrophy (Marsh IIIa-IIIc). Anemia was the most common sign and bloating, abdominal pain, and diarrhea were the first three common symptoms in these patients. Mean tTG titers was significantly higher in patients graded as Marsh III (p for trend=0.003). Our results showed that tTG titer more than 9 folds higher than the kit's cut-off value was about 97.2% sensitive for Marsh II and more duodenal damage. CONCLUSION There was a correlation between tTG titers and degrees of duodenal damage in patients with celiac disease. Duodenal biopsy is not always necessary for diagnosing celiac disease and when tTG level is more than 9 folds higher than the manufacture's recommended cut-off value it can be avoided. Meanwhile small intestinal biopsy should always be considered in case of high clinical suspicion, regardless of the results of serologic testing. PMID:25093060

Rahmati, Atieh; Shakeri, Ramin; Sohrabi, Masoudreza; Alipour, Abbass; Boghratian, Amirhossein; Setareh, Massomeh; Zamani, Farhad

2014-07-01

146

Massive Thoracoabdominal Aortic Thrombosis in a Patient with Iatrogenic Cushing Syndrome  

PubMed Central

Massive thoracoabdominal aortic thrombosis is a rare finding in patients with iatrogenic Cushing syndrome in the absence of any coagulation abnormality. It frequently represents an urgent surgical situation. We report the case of an 82-year-old woman with massive aortic thrombosis secondary to iatrogenic Cushing syndrome. A follow-up computed tomography scan showed a decreased amount of thrombus in the aorta after anticoagulation therapy alone. PMID:25246825

Kim, Dong Hun; Lee, Young-Min; Kang, Joon Tae; Chae, Seung Seok; Kim, Bo-Bae; Ki, Young-Jae; Kim, Jin Hwa; Chung, Joong-Wha; Koh, Young-Youp

2014-01-01

147

Perforating gun charge carrier improvements  

SciTech Connect

This patent describes a perforating gun for perforating a casing located downhole in a cased borehole, the gun having a housing, shaped charges in the housing spaced from one another and connected to a detonation means, each shaped charge having a flange means on one end of a body portion, the other end of the body portion being the detonator end, the combination with the housing, charges, and detonation means of a charge carrier assembly. The charge carrier assembly comprises charge holders connected together along the longitudinal axis of the gun; each charge holder describes a polyhedron, each polyhedron being described by relatively thin wall surfaces joined together by lateral edges which extend parallel to the axial centerline of the gun and provide opposed fasteners for the shaped charge. Each charge holder has lateral faces, one of the faces is apertured to telescopingly receive a shaped charge therewithin, adjacent charge holders have means for orienting the shaped charges of alternate charge holders in different radial directions; and means for capturing a shaped charge within an aperture of a charge holder. The body portion of the shaped charge is received within the aperture of the charge holder with the flange means of the shaped charge abutting a lateral of the charge holder, and having the opposed fasteners extending towards an opposed fastener located on an alternate charge holder to capture the flange between two opposed fasteners and the lateral face of the charge holder so that the inner detonator end of the charge is positioned near the geometrical center of the charge holder.

Vann, R.R.; Colle, E.A. Jr.

1986-07-08

148

Predictors for failure of stent treatment for benign esophageal perforations - a single center 10-year experience  

PubMed Central

AIM: To investigate possible predictors for failed self-expandable metallic stent (SEMS) therapy in consecutive patients with benign esophageal perforation-rupture (EPR). METHODS: All patients between 2003-2013 treated for EPR at the Karolinska University Hospital, a tertiary referral center, were studied with regard to initial management with SEMS. Patients with malignancy as an underlying cause and those with anastomotic leakages were excluded. Sealing of the perforation with a covered SEMS was the primary strategy whenever feasible. Stent therapy failure was defined as a radical change of treatment strategy due to uncontrolled mediastinitis, which in this setting consisted of emergency esophagectomy with end-esophagostomy or death as a consequence of the perforation and subsequent uncontrolled sepsis. Patient and lesion characteristics were analyzed and are presented as median and interquartile range. Possible predictors for failed stent therapy were analyzed with uni-variate logistic regression, while variables with P < 0.2 were further analyzed with multi-variate logistic regression. RESULTS: Of the total number of 48 patients presenting with EPR, 40 patients (83.3%) were treated with SEMS at the time of admission, with an intention to heal the perforation. Twenty-three patients had Boerhaave’s syndrome (58%), 16 had an iatrogenic perforation (40%) and 1 had external trauma to the esophagus (3%). The total in-hospital mortality, including the cases that had other initial treatments (n = 8), was 10.4% and 7.5% among those who were subjected to the SEMS-based strategy. In 33 of the 40 patients (82.5%) who were treated with stent, the EPR healed without further change in treatment strategy. Patients classified as treatment success received a SEMS at a median time of 1 (1-1) d after the actual EPR, compared to 3 (1-10) d among those where the initial treatment failed, P = 0.039 in uni-variate analysis and P = 0.052 in multi-variate analysis. No other significant factors emerged, indicating an increased risk for failure. Six of 7 patients, where stent treatment of the defect failed, underwent an emergency esophagectomy with end esophagostomy and one patient died. CONCLUSION: SEMS as an upfront therapeutic strategy seems to be a successful concept, when applied to an unselected group of patients with EPR. PMID:25132783

Persson, Saga; Elbe, Peter; Rouvelas, Ioannis; Lindblad, Mats; Kumagai, Koshi; Lundell, Lars; Nilsson, Magnus; Tsai, Jon A

2014-01-01

149

Perforator Flaps in Head and Neck Reconstruction  

PubMed Central

Free tissue transfer has revolutionized the management of complex head and neck defects. Perforator flaps represent the most recent advance in the development of free flap surgery. These flaps are based on perforating vessels and can be harvested without significant damage to associated muscles, thereby reducing the postoperative morbidity associated with muscle-based flaps. Elevation of perforator flaps requires meticulous technique and can be more challenging than raising muscle-based flaps. Use of a Doppler device enables reliable identification of the perforating vessels and aids in the design of free-style free flaps, where the flaps are designed purely according to the perforator located. The major advantage of free-style free flaps is that an unlimited number of flaps can potentially be designed on much shorter pedicles. The anterolateral thigh flap is the most commonly used perforator flap in head and neck reconstruction. Its use is described in detail, as is use of other less common perforator flaps. This article also describes head and neck reconstruction in a region-specific manner and gives a short-list of suitable flaps based on the location of the defect. PMID:22550446

Chana, Jagdeep S.; Odili, Joy

2010-01-01

150

Percutaneous Management of Postoperative Duodenal Stump Leakage with Foley Catheter  

SciTech Connect

Purpose: This study was designed to evaluate retrospectively the safety and efficacy of the percutaneous management of duodenal stump leakage with a Foley catheter after subtotal gastrectomy. Methods: Ten consecutive patients (M:F = 9:1, median age: 64 years) were included in this retrospective study. The duodenal stump leakages were diagnosed in all the patients within a median of 10 days (range, 6-20). At first, the patients underwent percutaneous drainage on the day of or the day after confirmation of the presence of duodenal stump leakage, and then the Foley catheters were replaced at a median of 9 days (range, 6-38) after the percutaneous drainage. Results: Foley catheters were placed successfully in the duodenal lumen of all the patients under a fluoroscopic guide. No complication was observed during and after the procedures in all the patients. All of the patients started a regular diet 1 day after the Foley catheter placement. The patients were discharged at a median of 7 days (range, 5-14) after the Foley catheter placement. The catheters were removed in an outpatient clinic 10-58 days (median, 28) after the Foley catheter placement. Conclusions: Fluoroscopy-guided percutaneous Foley catheter placement may be a safe and effective treatment option for postoperative duodenal stump leakage and may allow for shorter hospital stays, earlier oral intake, and more effective control of leakage sites.

Oh, Jung Suk, E-mail: oj-cumc@daum.net; Lee, Hae Giu, E-mail: hgleehfh@catholic.ac.kr; Chun, Ho Jong; Choi, Byung Gil [Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Department of Radiology (Korea, Republic of)] [Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Department of Radiology (Korea, Republic of); Lee, Sang Hoon; Hahn, Seong Tai [Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Department of Radiology (Korea, Republic of)] [Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Department of Radiology (Korea, Republic of); Ohm, Joon Young [Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Department of Radiology (Korea, Republic of)] [Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Department of Radiology (Korea, Republic of)

2013-10-15

151

The Impact of Perforator Number on Deep Inferior Epigastric Perforator Flap Breast Reconstruction  

PubMed Central

Background Perforator flaps minimize abdominal site morbidity during autologous breast reconstruction. The purpose of this study was to assess whether the number of perforators harvested influences the overall deep inferior epigastric perforator (DIEP) flap survival and flap-related complications. Methods A retrospective review was performed of all DIEP flaps performed at the Hospital of the University of Pennsylvania from 2006 to 2011. The outcomes assessed included flap loss and major complications. We compared flaps by the number of total perforators (1-4) and then carried out a subgroup analysis comparing flaps with one perforator to flaps with multiple perforators. Lastly, we conducted a post-hoc analysis based on body mass index (BMI) categorization. Results Three hundred thirty-three patients underwent 395 DIEP flaps. No significant differences were noted in the flap loss rate or the overall complications across perforator groups. However, the subgroup analysis revealed significantly higher rates of fat necrosis in the case of one-perforator flaps than in the case of multiple-perforator flaps (10.2% vs. 3.1%, P=0.009). The post-hoc analysis revealed a significant increase in the flap loss rate with increasing BMI (<30=2.0%, 30-34.9=3.1%, 35-39.9=3.1%, >40=42.9%, P<0.001) in the DIEP flaps, but no increase in fat necrosis. Conclusions This study demonstrates that the number of perforators does not impact the rate of flap survival. However, the rate of fat necrosis may be significantly higher in DIEP flaps based on a single perforator. Multiple perforators should be utilized if possible to decrease the risk of fat necrosis. PMID:24511497

Grover, Ritwik; Nelson, Jonas A; Fischer, John P; Kovach, Stephen J; Serletti, Joseph M

2014-01-01

152

Ultrastructural analysis of interneuronal syncytial perforations.  

PubMed

The structural regularities of the organization of interneuronal syncytial cytoplasmic connections between neuronal bodies in gyrus dentatus and CA1 and CA2 (CA is cornu ammonis) of hippocampus, as well as between cell neurites of the caudal mesenteric ganglion were studied by transmission electron microscopy. The syncytial perforations are located only on the base of tight junctions. The perforations have rounded edges corresponding to the fusion edges of perforated membranes of adjacent neurons - or where their edges have a form of thinned plate - a remnant of the tight junction. In the lumen of the perforations, remnants of contact membranes - residual bodies - are revealed. On living neurons in tissue culture, the syncytial connection of two contacting processes of different neurons is found during the death of the body of one of them, but with preservation of viability of its processes that contact with other neurons. PMID:19947925

Sotnikov, Oleg S; Paramonova, Nataly M; Archakova, Ludmila I

2010-04-01

153

Aflibercept-related nasal septum perforation.  

PubMed

Hypertension, cytopenia and diarrhea are the most common side effects of aflibercept. Rarely thromboembolism, hemorrhage, fistulization and reversible posterior leukoencephalopathy have been reported. Here we report a patient experiencing nasal septum perforation during aflibercept therapy. PMID:25487369

Alkan, Ali; Yücel, Levent; M?zrak, D?l?a; Akbulut, Hakan

2014-12-01

154

Iatrogenic Pulmonary Nodule in a Heart Transplant Recipient  

PubMed Central

A 58-year-old female with a history of non-Hodgkin lymphoma and end-stage nonischemic cardiomyopathy from Adriamycin toxicity underwent orthotic heart transplantation during June 2013. She developed shortness of breath in September 2013 and was suspected to have invasive pulmonary aspergillosis. A flexible bronchoscopy (FB) with a transbronchial biopsy (TBBx) was performed. She was found to have a focal lung nodule in the same location at the site of the TBBx on day 13 after the FB. Spontaneous resolution of the nodule was confirmed on the computed tomography (CT) scan of chest performed at 3 months. We believe that this nodule was as a consequence of the TBBx. Formation of a peripheral pulmonary nodule (PPN) following a TBBx is occasionally encountered among the recipients of the lung transplantation. To our knowledge, this is the first case of TBBx producing a pulmonary nodule in a heart transplant recipient. Physicians caring for the patients with heart transplantation should be cognizant of the iatrogenic nature of such nodule to avoid unnecessary diagnostic work-up. PMID:25405052

Mehta, Atul C.; Wang, Juan; Cicenia, Joseph

2014-01-01

155

Iatrogenic bile duct injuries: Etiology, diagnosis and management  

PubMed Central

Iatrogenic bile duct injuries (IBDI) remain an important problem in gastrointestinal surgery. They are most frequently caused by laparoscopic cholecystectomy which is one of the commonest surgical procedures in the world. The early and proper diagnosis of IBDI is very important for surgeons and gastroenterologists, because unrecognized IBDI lead to serious complications such as biliary cirrhosis, hepatic failure and death. Laboratory and radiological investigations play an important role in the diagnosis of biliary injuries. There are many classifications of IBDI. The most popular and simple classification of IBDI is the Bismuth scale. Endoscopic techniques are recommended for initial treatment of IBDI. When endoscopic treatment is not effective, surgical management is considered. Different surgical reconstructions are performed in patients with IBDI. According to the literature, Roux-en-Y hepaticojejunostomy is the most frequent surgical reconstruction and recommended by most authors. In the opinion of some authors, a more physiological and equally effective type of reconstruction is end-to-end ductal anastomosis. Long term results are the most important in the assessment of the effectiveness of IBDI treatment. There are a few classifications for the long term results in patients treated for IBDI; the Terblanche scale, based on clinical biliary symptoms, is regarded as the most useful classification. Proper diagnosis and treatment of IBDI may avoid many serious complications and improve quality of life. PMID:19725140

Jab?o?ska, Beata; Lampe, Pawe?

2009-01-01

156

Iatrogenic possibilities of orthodontic treatment and modalities of prevention  

PubMed Central

The benefits of orthodontic treatment are numerous and in most cases, the benefits outweigh the possible disadvantages. Orthodontic treatment can play an important role in enhancing esthetics, function, and self-esteem in patients. However, it carries with it the risks of enamel demineralization, tissue damage, root resorption, open gingival embrasures in the form of triangular spaces, allergic reactions to nickel, and treatment failure in the form of relapse. These potential complications are easily avoidable by undertaking certain precautions and timely interventions by both the orthodontist and the patient. The orthodontist must ensure that the patient is aware of the associated risks and stress the importance of the patient's role in preventing these untoward outcomes. The decision whether to proceed with the orthodontic treatment is essentially a risk-benefit analysis, where the perceived benefits of commencing treatment outweigh the potential risks. This article provides an overview of the iatrogenic possibilities of orthodontic treatment and the role of the patient as well as the orthodontist in preventing the associated risks. PMID:24987646

Meeran, Nazeer Ahmed

2013-01-01

157

New insight into non-healing corneal ulcers: iatrogenic crystals  

PubMed Central

Aims To characterise and correlate crystalline precipitations implicated in non-healing corneal ulceration in two patients with a previous history of acanthamoeba keratitis. Materials and methods Persistence of acanthamoeba and secondary bacterial infection was excluded with negative corneal scrapes. Confocal microscopy identified crystal-like deposits within the corneal stroma. To investigate possible precipitating combinations, all concurrent treatments at the time of presentation were mixed in wells, with observation of precipitate formation. Precipitates were observed with phase-contrast microscopy, and subsequently characterised via crystallography techniques and electrospray ionisation mass spectrometry. Results Combinations of dexamethasone 0.1% minims and chlorhexidine gluconate 0.2% formed an amorphous material characterised by electrospray ionisation mass spectrometry as an insoluble chlorhexidine salt. Combinations of chloramphenicol drops and timolol 0.5% formed a crystal identified via X-ray crystallography as santite (K(B5O6(OH)4).(H2O)2). This is a borate mineral identified in nature, arising from thermal springs, but never reported in biological tissues. Clinical improvement was observed following the cessation of the implicated precipitating combinations. Conclusion Our observations suggest iatrogenic precipitate formation, with a potential deleterious effect upon healing. The substrates for these precipitates include several frequently prescribed topical ophthalmic treatments. These findings shed new light on the aetiopathogenesis of non-healing corneal ulceration, and have broad implications on topical prescribing for this challenging condition. PMID:23558213

Livingstone, I; Stefanowicz, F; Moggach, S; Connolly, J; Ramamurthi, S; Mantry, S; Ramaesh, K

2013-01-01

158

A parametric study of perforated muzzle brakes  

NASA Astrophysics Data System (ADS)

A firing test was conducted to study the parameters influencing the recoil efficiency and the blast characteristics of perforated muzzle brakes. Several scaled (20 mm) devices were tested as candidates for the 105 mm Armored Gun System (AGS). Recoil impulse, blast overpressures, muzzle velocity, sequential spark shadowgraphs, and photographs of the muzzle flash were obtained. A total of nine different perforated brakes were tested as well as a scaled M 198 double muzzle brake.

Dillon, Robert E., Jr.; Nagamatsu, H. T.

1993-07-01

159

Surface Experiment of Abrasive Water Jet Perforation  

Microsoft Academic Search

This article presents the experiment process and results of abrasive water jet perforation. This experiment was conducted in Kalamayi, China, Xinjiang Oilfield in October 2004. Referring to explosive perforation experiment, we made two cement cylinder samples with a diameter of 2.4 m, 1.2 m high, putting a 139.7 mm (5-1\\/2?) and a 177.8 mm (7?) casing sub in them, respectively.

Z. Huang; J. Niu; G. Li; X. Yuan; Y. Liu

2008-01-01

160

Surgical resection of duodenal lymphangiectasia: a case report.  

PubMed

Intestinal lymphangiectasia, characterized by dilatation of intestinal lacteals, is rare. The major treatment for primary intestinal lymphangiectasia is dietary modification. Surgery to relieve symptoms and to clarify the etiology should be considered when medical treatment failed. This article reports a 49-year-old woman of solitary duodenal lymphangiectasia, who presented with epigastralgia and anemia. Her symptoms persisted with medical treatment. Surgery was finally performed to relieve the symptoms and to exclude the existence of underlying etiologies, with satisfactory effect. In conclusion, duodenal lymphangiectasia can present clinically as epigastralgia and chronic blood loss. Surgical resection may be resorted to relieve pain, control bleeding, and exclude underlying diseases in some patients. PMID:14669360

Chen, Chih-Ping; Chao, Yee; Li, Chung-Pin; Lo, Wen-Ching; Wu, Chew-Wun; Tsay, Shyh-Haw; Lee, Rheun-Chuan; Chang, Full-Young

2003-12-01

161

Campylobacter pylori, duodenal ulcer, and gastric metaplasia: possible role of functional heterotopic tissue in ulcerogenesis.  

PubMed Central

Multiple pinch biopsies were taken from the duodenum and antrum of 137 subjects (46 active duodenal ulceration; 44 healed ulcers; 47 'normal'), and examined for the presence and grade of gastritis, gastric metaplasia, and Campylobacter pylori. These factors, as well as age, sex, cigarette, and anti-inflammatory agent intake were evaluated as possible risk factors for duodenal ulceration. Pentagastrin induced Congo Red staining of the duodenal bulb was performed in an additional 43 cases, to determine the presence of functioning parietal cells in the duodenum. Ninety eight per cent of patients with duodenal infection with C pylori had active or healed duodenal ulcers. Bacteria were confined to areas of gastric metaplasia which was always infiltrated with inflammatory cells. The metaplastic tissue was usually superficial in type, although patients had C pylori associated with heterotopic tissue: this has not been previously described. Congo Red staining of the duodenal bulb showed that functioning endogenous acid producing tissue could be found most often at the edges of duodenal ulcers, but also in non-ulcer subjects. Cigarette smoking, age, sex, and ingestion of non-steroidal anti-inflammatory agents were not to be found to be significant risk factors for duodenal ulceration. In contrast, the presence of duodenal infection with C pylori proved to be a strong risk factor for duodenal ulceration (RR = 51), together with gastric metaplasia (RR = 6.2), and antral C pylori infection (RR = 7.6). These data identify duodenal infection with C pylori as the strongest risk factor for development of duodenal ulceration. Our finding of endogenous acid production around the edges of duodenal ulcers suggests an active role for parietal cells in the duodenum. We postulate a synergistic role for duodenal C pylori and endogenous acid production in the development of duodenal ulceration. Images Fig. 1 Fig. 3 PMID:2753403

Carrick, J; Lee, A; Hazell, S; Ralston, M; Daskalopoulos, G

1989-01-01

162

Proper management for morbid iatrogenic retroperitoneal barium insufflation.  

PubMed

A barium enema is a diagnostic and therapeutic procedure commonly used for colon and rectum problems. Rectal perforation with extensive intra- and/or extraperitoneal spillage of barium is a devastating complication of a barium enema that leads to a significant increase in patient mortality. Due to the low number of reported cases in recent scientific literature and the lack of experience with the management of these cases, we would like to present our treatment approach to a rare case of retroperitoneal contamination with barium, followed by its intraperitoneal involvement during a diagnostic barium enema. Our experience with long-term management of the patient and the good outcome will be depicted in this paper. PMID:25580416

Vahedian-Ardakani, Jalal; Nazerani, Shahram; Saraee, Amir; Sarmast, Ali; Saraee, Ehsan; Keramati, Mohammad Reza

2014-12-01

163

Proper Management for Morbid Iatrogenic Retroperitoneal Barium Insufflation  

PubMed Central

A barium enema is a diagnostic and therapeutic procedure commonly used for colon and rectum problems. Rectal perforation with extensive intra- and/or extraperitoneal spillage of barium is a devastating complication of a barium enema that leads to a significant increase in patient mortality. Due to the low number of reported cases in recent scientific literature and the lack of experience with the management of these cases, we would like to present our treatment approach to a rare case of retroperitoneal contamination with barium, followed by its intraperitoneal involvement during a diagnostic barium enema. Our experience with long-term management of the patient and the good outcome will be depicted in this paper. PMID:25580416

Vahedian-Ardakani, Jalal; Nazerani, Shahram; Saraee, Amir; Sarmast, Ali; Saraee, Ehsan

2014-01-01

164

Through-tubing perforating apparatus  

SciTech Connect

This patent describes an apparatus for perforating a wall of a cylindrical wellbore of a given diameter after having passed through a tubing of a smaller diameter. The apparatus comprising: a plurality of shaped charges including an uppermost shaped charge and a lowermost shaped charge, the shaped charge having a pair of diametrically opposed connecting means extending laterally therefrom, a line interconnecting the diametrically opposed connecting means defining a first length of the shaped charge which comprises the shortest distance between the line and a first outermost longitudinal point on the shaped charge and a second length of the shaped charge which is defined as the shortest distance from the line to a second innermost longitudinal point on the shaped charge; suspension wire means extending from a point above the uppermost shaped charge to a point beneath the lowermost shaped charge; separate individual linkage means extending between and pivotally attached to one of the connecting means of each of a pair of adjacent shaped charges. Termination connector means connecting the uppermost and the lowermost shaped charges to the suspension wire means at first and second termination connection points; whereby, when the apparatus has passed through the smaller diametered tubing, the uppermost termination connector means can be allowed to slip down the suspension wire means to define a second lesser vertically extending length of the shaped charges and allowing the shaped charges to slump outwardly into contact with the wall of the wellbore by virtue of their own weight. The individual linkage means holding the shaped charges in direct contact with the wall of the wellbore.

Clark, D.A.

1989-07-04

165

Morphometrical study of the arterial perforators of the deep inferior epigastric perforator flap.  

PubMed

Although abdominal perforator flaps based on a cutaneous branch of the deep inferior epigastric artery (DIEP flaps) have many advantages, preparing these flaps is technically difficult and requires great skill, especially as the portion of the artery running under the anterior rectus abdominis sheath must be operated upon "blind". To allow easier preparation and elevation of a DIEP flap pedicle, we propose that the arterial perforator should: 1) be more than 1.0 mm large; 2) run a straight intramuscular course, parallel to the rectus abdominis m. fibers, with no large muscular branches; and 3) have only a short portion running immediately under the anterior rectus abdominis sheath. We examined 329 perforators (more than 0.5 mm in diameter at the anterior sheath) in 66 rectus abdominis mm. from 33 cadavers among them: 1) 52 "large" perforators were over 1.0 mm in diameter; 2) 107 "suitable" perforators ran parallel to the muscle fibers without giving off large muscular branches; and 3) 35 "ideal" perforators combined these characteristics. The ideal perforators were usually located in the mid-abdominal region, 10-30 mm lateral to the umbilicus. The suitable perforators were usually present, often in combination with the ideal perforator(s), in a restricted area 20 mm cranial and 40-50 mm lateral to the umbilicus. We classified the course and ramification pattern of the deep inferior epigastric a. into six patterns, depending on whether the anastomosis was sited in the medial or lateral branch and the level at which the branches originated. PMID:11963619

Kikuchi, N; Murakami, G; Kashiwa, H; Homma, K; Sato, T J; Ogino, T

2001-01-01

166

Autonomic control of heart period in duodenal ulcer patients  

Microsoft Academic Search

Beyond the fundamental pathogenetic importance of Helicobacter Pylori a possible additional role of vagal innervation in favouring or modulating the clinical history of duodenal ulcer (DU) has been suggested by old studies employing invasive methodologies. Aim of this study was to assess whether vagal prevalence in autonomic modulation was present in healed DU patients (n=20) as compared to controls,(n=50), using

Daniela Lucini; Manfredo Cerchiello; Guido Basilisco; Manuela Cainelli; Paolo A Bianchi; Gemino Fiorelli; Alberto Malliani; Massimo Pagani

2000-01-01

167

What is the Best Elective Operation for Duodenal Ulcer?  

PubMed Central

During the past 40 years, after gastroenterostomy and pyloroplasty for duodenal ulcer had been replaced by partial gastrectomy in many centres, partial gastrectomy itself gave way to combinations of vagotomy with gastroenterostomy, pyloroplasty or antrectomy. Opinions differ concerning the procedure of choice and in this paper the author examines the causes of this diversity of opinion and assesses the reliability of conclusions that can be drawn about the elective treatment of duodenal ulcer today. Most reports of results from various operations have come from retrospective studies, and the causes of variability among such reports are analyzed to point out the great difficulty in making a valid judgment about the relative worth of the various operations used to treat duodenal ulcer. Results of some of the few prospective studies with randomized operations assessed blindly are then presented and note is taken of the surprising observation that greatly different operations appear to give remarkably similar results. From the data available the author develops a logical way of approaching the choice of operation for the various problems related to duodenal ulcer that require elective surgical treatment. PMID:4922168

Hallenbeck, G. A.

1970-01-01

168

Congenital duodenal obstruction with Down's syndrome and Hirschsprung's disease  

Microsoft Academic Search

Two rare cases of congenital duodenal obstruction (CDO) with Down's syndrome and Hirschsprung's disease (HD) are reported. The incidence of associated anomalies in CDO, with reference to the literature, and the diagnosis of HD with CDO are discussed. If intestinal dilation or difficulty in defecation persist after CDO has been diagnosed and relieved, then a barium enema should be repeated

Hiroyuki Tsuchiya; Kinzi Nagashima; Sumio Kohno

1995-01-01

169

Tubercular duodenal, jejunal and ileocecal stricture in a patient.  

PubMed

Gastrointestinal tuberculosis is a major health problem in the developing countries. Duodenal involvement is uncommon and can mimic superior mesenteric artery syndrome. Our case presented as proximal intestinal obstruction had tubercular stricture in the third part of the duodenum, proximal jejunum and ileocecal region, an uncommon and difficult intraoperative situation. PMID:24334467

Sisodiya, Rajesh; Ramachandra, Lingadakai

2013-01-01

170

DUODENAL CYTOCHROME B: A NOVEL FERRIREDUCTASE IN AIRWAY EPITHELIAL CELLS  

EPA Science Inventory

Catalytically active iron in the lung causes oxidative stress and promotes microbial growth that can be limited by intracellular sequestration of iron within ferritin. Because cellular iron uptake requires membrane ferrireductase activity that in the gut can be provided by duoden...

171

Duodenal Toxicity After Fractionated Chemoradiation for Unresectable Pancreatic Cancer  

SciTech Connect

Purpose: Improving local control is critical to improving survival and quality of life for patients with locally advanced unresectable pancreatic cancer (LAPC). However, previous attempts at radiation dose escalation have been limited by duodenal toxicity. In order to guide future studies, we analyzed the clinical and dosimetric factors associated with duodenal toxicity in patients undergoing fractionated chemoradiation for LAPC. Methods and Materials: Medical records and treatment plans of 106 patients with LAPC who were treated with chemoradiation between July 2005 and June 2010 at our institution were reviewed. All patients received neoadjuvant and concurrent chemotherapy. Seventy-eight patients were treated with conventional radiation to 50.4 Gy in 28 fractions; 28 patients received dose-escalated radiation therapy (range, 57.5-75.4 Gy in 28-39 fractions). Treatment-related toxicity was graded according to Common Terminology Criteria for Adverse Events, version 4.0. Univariate and multivariate analyses were performed to assess prognostic influence of clinical, pathologic, and treatment-related factors by using Kaplan-Meier and Cox regression methods. Results: Twenty patients had treatment-related duodenal toxicity events, such as duodenal inflammation, ulceration, and bleeding. Four patients had grade 1 events, 8 had grade 2, 6 had grade 3, 1 had grade 4, and 1 had grade 5. On univariate analysis, a toxicity grade ?2 was associated with tumor location, low platelet count, an absolute volume (cm{sup 3}) receiving a dose of at least 55 Gy (V{sub 55} {sub Gy} > 1 cm{sup 3}), and a maximum point dose >60 Gy. Of these factors, only V{sub 55} {sub Gy} ?1 cm{sup 3} was associated with duodenal toxicity on multivariate analysis (hazard ratio, 6.7; range, 2.0-18.8; P=.002). Conclusions: This study demonstrates that a duodenal V{sub 55} {sub Gy} >1 cm{sup 3} is an important dosimetric predictor of grade 2 or greater duodenal toxicity and establishes it as a dosimetric constraint when treating patients with unresectable pancreatic cancer with concurrent chemoradiation.

Kelly, Patrick; Das, Prajnan; Pinnix, Chelsea C.; Beddar, Sam; Briere, Tina; Pham, Mary; Krishnan, Sunil; Delclos, Marc E. [Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States)] [Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Crane, Christopher H., E-mail: ccrane@mdanderson.org [Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States)

2013-03-01

172

Mechanisms for acute corneal hydrops and perforation.  

PubMed

Acute corneal hydrops (ACH) and perforation in corneal thinning diseases are the consequences of exposure to distending intraocular pressure (IOP) forces that are in excess of corneal resistance to them. Apart from thinning, resistance to these forces may be reduced by disease-related tissue changes, such as corneal scarring, which could lower resistance to IOP. Eye rubbing trauma has sometimes been found to be associated with ACH and perforation. This association is not surprising given that the combination of rubbing-related mechanical tissue trauma and the associated increased distending stress of higher IOP seem likely to increase the risk of complications. Many cases of ACH and perforation are described as spontaneous, but this classification may be the consequence of not considering the multiple potential mechanisms for IOP elevation such as coughing, sneezing, nose blowing, and sneeze suppression in addition to those related to eye rubbing/wiping/massaging/touching as well as changes in body orientation, strenuous exercise, and wearing swimming goggles for example. Classification of ACH or perforation as spontaneous may lead patients to assume that nothing can be done to avoid these complications. Patients with corneal thinning diseases who are counseled regarding the potential precipitating mechanisms for IOP elevation will have the opportunity of reducing exposure to them and the risk of the associated complications. In addition, when ACH or perforation occur, faster resolution of edema and wound healing may depend on reducing potentially exacerbating exposures to mechanisms for IOP elevation. PMID:25390550

McMonnies, Charles W

2014-07-01

173

Colonoscopic Perforation in Inflammatory Bowel Disease  

PubMed Central

Colonoscopy has become the diagnostic and therapeutic modality of choice in patients with inflammatory bowel disease (IBD) by allowing for the assessment of disease extent and activity; the distinction between ulcerative colitis, Crohn’s disease, and other differential diagnoses; the surveillance of dysplasia; and the delivery of treatment (eg, stricture dilation). Colonoscopy-associated perforation is a dreaded complication associated with significant mortality and morbidity. Understanding and mitigating the risks of perforation in patients with IBD has become an important issue with the increasing use of immunomodulators and biologic agents. Studies have shown that patients with IBD are at a higher risk for perforation from diagnostic or therapeutic endos-copy than individuals in the general population. Reported risk factors associated with colonoscopic perforation include female sex, advanced age, severe colitis, use of corticosteroids, presence of multiple comorbidities, and stricture dilation. Disease-, tech-nique-, and endoscopist-associated risk factors for perforation can be stratified and modified. This review, based on current available literature and the authors’ expertise, should shed some light on the proper management of this challenging disease phenotype. PMID:24729766

Makkar, Rohit

2013-01-01

174

Progress in management of typhoid perforation.  

PubMed

Case fatality rate (CFR) for typhoid perforation (TP) has been on gradual but variable decline world wide. This review highlights the progress in management of TP from 1960 including the controversies, current principles of management and the advances associated with the best results of treatment. This is a review of publications on TP from 1960 to 2010 principally from Medline and Ovid databases. Main search terms used are typhoid and perforation. The median CFR by decade was estimated from studies that reported CFR. With advances in surgery and supportive care, median CFR for TP declined from over 50% in 1960 to single digits in the last decade in some countries but with West Africa lagging behind at 16%. Variations in CFR are attributed to differences in perforation-operation interval and quality of care. Opportunities now exist for patients with TP to recover from the disease but priority remains with prevention of enteric fever in endemic areas. PMID:22064250

Ukwenya, A Y; Ahmed, A; Garba, E S

2011-01-01

175

Iatrogenic blood-borne viral infections in refugee children from war and transition zones.  

PubMed

Pediatric infectious disease clinicians in industrialized countries may encounter iatrogenically transmitted HIV, hepatitis B virus, and hepatitis C virus infections in refugee children from Central Asia, Southeast Asia, and sub-Saharan Africa. The consequences of political collapse and/or civil war-work migration, prostitution, intravenous drug use, defective public health resources, and poor access to good medical care-all contribute to the spread of blood-borne viruses. Inadequate infection control practices by medical establishments can lead to iatrogenic infection of children. Summaries of 4 cases in refugee children in Australia are a salient reminder of this problem. PMID:23739597

Goldwater, Paul N

2013-06-01

176

Iatrogenic Blood-borne Viral Infections in Refugee Children from War and Transition Zones  

PubMed Central

Pediatric infectious disease clinicians in industrialized countries may encounter iatrogenically transmitted HIV, hepatitis B virus, and hepatitis C virus infections in refugee children from Central Asia, Southeast Asia, and sub-Saharan Africa. The consequences of political collapse and/or civil war—work migration, prostitution, intravenous drug use, defective public health resources, and poor access to good medical care—all contribute to the spread of blood-borne viruses. Inadequate infection control practices by medical establishments can lead to iatrogenic infection of children. Summaries of 4 cases in refugee children in Australia are a salient reminder of this problem. PMID:23739597

2013-01-01

177

Transmission or recurrence? A historical dilemma of iatrogenic infections due to cytomegalovirus.  

PubMed

This article traces the changes in thought regarding the etiology of iatrogenic infections due to cytomegalovirus from the 1960s to the 1990s. Initial investigations using serologic and culture methods focused on how the virus was acquired. Following the application of molecular tools, theories on disease causality expanded beyond concerns of the microorganism itself to include aspects of the virus-host interaction and the host response. Eventually, the insights gained from the investigations into the etiology of iatrogenic cytomegalovirus disease were applied to other intracellular viruses. In addition, recognition of the factors responsible for reactivation of latent viruses had not only theoretical value, but also practical consequences. PMID:12680010

Diosi, Peter; Kazanjian, Powel

2003-01-01

178

Iatrogenic Cushing Syndrome to Facial Nerve Palsy: Via Intracranial Tuberculoma-An Interesting Journey  

PubMed Central

Isolated Facial nerve palsy is a less common neurological manifestation of intracranial tuberculoma. Again, tuberculoma can arise following development of Cushing syndrome after prolonged intake of steroids due to origin of immunosuppressed state. Thus exogenous steroid administration leading to iatrogenic Cushing Syndrome which again causing tuberculoma, with facial nerve palsy developing as a manifestation of tuberculoma is not unnatural but definitely a unique scenario. The author reports an interesting case where a patient developed left sided facial palsy following development of intracranial tuberculoma from iatrogenic Cushing syndrome after longterm intake of Dexamethasone as a treatment for low back pain. This situation is rarely reported before.

2014-01-01

179

Surgical Treatment of Pulmonary Hydatid Cysts, Which Perforated to the Pleura  

PubMed Central

Objective: Hydatid cyst disease, endemic in Eastern region of Turkey, is a significant parasitic public health problem. In this study, pleural complications of hydatid cysts were presented in 76 cases. Materials and Methods: In our study, of the 412 pulmonary hydatid cyst cases operated on between 2003 and 2011, 76 cases had ruptured into the pleura for various reasons, and the different clinicoradiological presentations were evaluated retrospectively. The age distribution of the cases was between 7 and 56 years, and the mean age was 26.20±13.04. Results: The most frequent symptom due to pleural rupture in patients was dyspnea (44 cases, 57.8%). Etiologically, iatrogenic perforation was detected in four cases and thoracic trauma in nine cases (six car accidents and three falls from a height). An anthelmintic drug use history was found in three cases of ruptured pleura. Spontaneous perforation was detected in the other 60 (78.9%) cases. Two cases that were admitted to the emergency unit and were immediately administered a tube thoracostomy developed tension pneumothorax. In addition, 21 cases had hydropneumothorax, 17 had pneumothorax, and 36 had pleurisy. Morbidity was observed in 30 cases (39.4%). Atelectasis was the most frequent cause of morbidity in these patients (10 cases). The mean duration of hospitalization was determined to be 12.26±2.90 days. Conclusion: This disease can progress asymptomatically for a long time and can sometimes lead to life-threatening emergency situations, such as tension pneumothorax. The delayed admission of a patient to a physician causes the disease to become more complicated and to increase the morbidity and mortality rates. Treatment of the disease is in the form of surgery. Possible parenchymal protection should be applied in surgical treatment, and anatomic resection should not be performed unless necessary.

Sayir, Fuat; Cobanoglu, Ufuk; Sehitogullari, Abidin

2012-01-01

180

Laser skin perforator with focal point detection  

NASA Astrophysics Data System (ADS)

The development of laser skin perforator device for obtaining blood samples is presented. The use of photoelectric proximity photoelectric sensor permits to determine the focal point eliminating any contact and them avoiding the risk of contamination. Perforation of about 0.2 mm - 0.5 mm in diameter can be obtained in order to take the sample of blood. The method permits to make the blood analysis not only avoiding the contamination risk but also diminishing the pain sensation in comparison with metal lancet.

Ponce, L.; Arronte, M.; Cabrera, J. L.; Flores, T.

2006-02-01

181

Quasistatic Droplets in Randomly Perforated Domains  

NASA Astrophysics Data System (ADS)

We consider the Hele-Shaw problem in a randomly perforated domain with zero Neumann boundary conditions. A homogenization limit is obtained as the characteristic scale of the domain goes to zero. Specifically, we prove that the solutions as well as their free boundaries converge uniformly to those corresponding to a homogeneous and anisotropic Hele-Shaw problem set in . The main challenge when deriving the limit lies in controlling the oscillations of the free boundary. This is overcome first by extending De Giorgi-Nash-Moser type estimates to perforated domains and second by proving the almost sure non-degenerate growth of the solution near its free boundary.

Guillen, Nestor; Kim, Inwon

2015-01-01

182

Duodenal follicular lymphoma lacks AID but expresses BACH2 and has memory B-cell characteristics.  

PubMed

We have reported previously that duodenal follicular lymphoma (FL) is distinct from nodal FL and showed more resemblance to mucosa-associated lymphoid tissue lymphoma, and that FL frequently involved the duodenal second portion. In the present study, we examined duodenal FLs and gastric/colonic FLs to clarify the clinicopathological and immunological differences between the tumor types. We analyzed 8 samples of gastric FL, 17 of duodenal ones, and 5 of colonic/rectal ones, and characterized them by immunohistochemistry, immunogenotyping, and histology. Gastric and colonic FLs presented in submucosal to subserosal areas, whereas duodenal ones presented in the mucosal to submucosal layers. Immunohistochemical analysis revealed that duodenal FLs exhibited the following phenotypes: CD10 (+), B-cell lymphoma 2 (BCL-2) (+), BCL-6 (+), activation-induced cytidine deaminase (AID) (-), BACH2 (+), CD27 (+), MUM-1 (-), Blimp-1 (-), and loose CD21 network (duodenal pattern). Gastric/colonic FLs exhibited the following phenotypes: CD10 (+), BCL-2 (+), BCL-6 (+), AID (+), BACH2 (+), CD27 (-), MUM-1 (-), Blimp-1 (-), and a dense CD21 network (nodal pattern). Expression of AID and CD27 in lymphoma cells and the CD21 network pattern were considerably different between duodenal FLs and gastric/colonic ones. Moreover, in situ hybridization revealed that, in the duodenal FLs, BACH2 was expressed at the periphery of the tumor follicle and tumor villi. The number of immunoglobulin heavy-chain variable domains VH4 and VH5 were higher in duodenal follicular lymphomoas than in gastric FLs. The lymphoma cells of duodenal FLs are different from those of gastric/colonic FLs, and duodenal FL is distinct even within the gastrointestinal tract. Somatic hypermutation in immunoglobulin genes and CD27 expression are hallmarks of memory B cells. We suggest that duodenal FL cells are in the memory B-cell stage, and require BACH2 instead of AID for ongoing mutation. PMID:22899287

Takata, Katsuyoshi; Sato, Yasuharu; Nakamura, Naoya; Tokunaka, Mami; Miki, Yukari; Yukie Kikuti, Yara; Igarashi, Kazuhiko; Ito, Etsuro; Harigae, Hideo; Kato, Seiichi; Hayashi, Eiko; Oka, Takashi; Hoshii, Yoshinobu; Tari, Akira; Okada, Hiroyuki; Al-Kader, Lamia Abd; Mohamad, Abd Alkader Lamia; Maeda, Yoshinobu; Tanimoto, Mitsune; Kinoshita, Tomohiro; Yoshino, Tadashi

2013-01-01

183

Perforated diverticulitis presenting as necrotising fasciitis of the leg.  

PubMed

Diverticulosis of the colon is a common condition of increasing age. Complications of diverticulitis including stricture, perforation and fistula formation often require surgery. Perforated diverticulitis may rarely present with spreading superficial sepsis. We describe for the first time, to our knowledge, a case of retroperitoneal diverticula perforation presenting as necrotising fasciitis of the leg necessitating hind-quarter amputation. PMID:18304351

Underwood, Timothy J; Southgate, Jeremy; Talbot, Robert; Nash, Guy F

2008-01-01

184

Correlating the site of tympanic membrane perforation with Hearing loss  

Microsoft Academic Search

BACKGROUND: It is recognized that the size of tympanic membrane(TM) perforation is proportional to the magnitude of hearing loss, however, there is no clear consensus on the effect of the location (site) of the perforation on the hearing loss. Hence the study is set to investigate the relationship between the location of perforation on TM and hearing loss. METHODS: A

Titus S Ibekwe; Onyekwere G Nwaorgu; Taiwo G Ijaduola

2009-01-01

185

A hypervelocity projectile launcher for well perforation  

Microsoft Academic Search

Current oil well perforation techniques use low- to medium-velocity gun launchers for completing wells in soft rock. Shaped-charge jets are normally used in harder, more competent rock. A device to create a much higher velocity projectile was designed. This launcher will provide an alternative technique to be used when the conventional devices do not yield the maximum well performance. It

J. N. Albright; L. E. Fugelso; G. C. Lagner; K. L. Burns

1989-01-01

186

Asymptomatic Gastric Perforation by a Toothpick  

Microsoft Academic Search

Background: Many cases of gastric perforation with peritonitis, pylephlebitis, hepatic abscesses, or lethal bleeding, caused by ingested long and sharp objects, are reported in the literature. Methods: During a right hepatectomy for a giant hemangioma, a wooden toothpick was found between the two layers of the hepatogastric ligament. It was not possible to find the passage of the foreign body

Alberto Porcu; Antonio Dessanti; Claudio F. Feo; Giuseppe Dettori

1999-01-01

187

Vaginal perforation due to jet ski accident.  

PubMed

A case of full thickness vaginal perforation into the peritoneal cavity resulting from a jet-skiing accident is presented. Attention is drawn to the previously reported cases of similar injuries due to high speed water sports, and the need for adequate protective clothing in all people undertaking such sports. PMID:2082899

Wein, P; Thompson, D J

1990-11-01

188

Landing gear noise control using perforated fairings  

NASA Astrophysics Data System (ADS)

Landing gears of commercial aircraft make an important contribution to total aircraft noise in the approach configuration. Using fairings to shield components from high speed impingement reduces noise. Furthermore, perforating these fairings has been confirmed by flight tests to further enable noise reduction. Following an earlier fundamental study of the application of perforated fairings, a study has been performed to investigate and optimize the benefits of bleeding air through landing gear fairings. By means of wind tunnel tests, an aerodynamic and acoustic survey has been performed on a simplified generic main landing gear to explore the influence of (perforated) fairings on the lower part of the gear. The results show that for this specific case, the application of impermeable fairings reduces noise in the mid- and high frequency range by shielding sharp edged components from high velocity impingement. However, below 1 kHz the noise is shown to increase significantly. Application of the perforations is shown to diminish this low frequency increase whilst maintaining the reduction in the mid- and high frequency range. The aerodynamic and acoustic measurements point in the direction of the separated flow of the fairings interacting with the downstream gear components responsible for the low frequency noise increase. Bleeding of the air through the fairings reduces the large scale turbulence in the proximity of these components and hence diminishes the low frequency noise increase.

Boorsma, K.; Zhang, X.; Molin, N.

2010-05-01

189

Jejunal Diverticular Perforation due to Enterolith  

PubMed Central

Jejunal diverticulosis is a rare entity with variable clinical and anatomical presentations. Although there is no consensus on the management of asymptomatic jejunal diverticular disease, some complications are potentially life-threatening and require early surgical treatment. Small bowel perforation secondary to jejunal diverticulitis by enteroliths is rare. The aim of this study was to report a case of small intestinal perforation caused by a large jejunal enterolith. An 86-year-old woman was admitted with signs of diffuse peritonitis. After initial fluid recovery the patient underwent emergency laparotomy. The surgery showed that she had small bowel diverticular disease, mainly localized in the proximal jejunum. The peritonitis was due to intestinal perforation caused by an enterolith 12 cm in length, localized inside one of these diverticula. The intestinal segment containing the perforated diverticulum with the enterolith was removed and an end-to-end anastomosis was done to reconstruct the intestinal transit. The patient recovered well and was discharged from hospital on the 5th postoperative day. There were no signs of abdominal pain 1 year after the surgical procedure. Although jejunal diverticular disease with its complications, such as formation of enteroliths, is difficult to suspect in patients with peritonitis, it should be considered as a possible source of abdominal infection in the elderly patient when more common diagnoses have been excluded. PMID:21960947

Nonose, Ronaldo; Valenciano, Juliana Santos; de Souza Lima, Jacintho Soares; Nascimento, Enzo Fabrício; Silva, Camila Morais Gonçalves; Martinez, Carlos Augusto Real

2011-01-01

190

Analysis of perforated-pipe watercollector systems  

Microsoft Academic Search

When there is the need for domestic or industrial use of water from a natural stream or lake, a filtering process through layers of soil and a perforated collector-pipe system is customarily used. The water enters the pipe through a series of small opening cut in the pipe wall. Discharge through the pipe increasing as flow proceeds along its length.

Rouhollah Fatahi; Otto Haszpra

2004-01-01

191

Dimensional scaling for impact cratering and perforation  

Microsoft Academic Search

The issue of generic scaling laws able to adequately predict (within better than 20%) cratering in semi-infinite targets and perforations through finite thickness targets was revisited. The approach used was to apply physical logic for hydrodynamics in a consistent manner able to account for chunky-body impacts such that the only variables needed are those directly related to known material properties

Alan J. Watts; Dale Atkinson

1995-01-01

192

Axial perforation of aluminum honeycombs by projectiles  

Microsoft Academic Search

Deformation and energy absorption characteristics of aluminum honeycomb when penetrated or perforated in the axial direction by spheres and cylinders with diameters of the order of and twice the cell size have been observed experimentally. The work of static penetration using a standard test machine was obtained from measured force histories when hard-steel spheres with three different diameters were pushed

Werner Goldsmith; Dell L. Louie

1995-01-01

193

Dacryocystitis secondary to an iatrogenic foreign body in the lacrimal apparatus.  

PubMed

Dacryocystitis is an infection of the lacrimal sac that is usually caused by obstruction of the nasolacrimal duct. We describe a case of iatrogenic dacryocystitis that occurred secondary to the presence of an impacted piece of a metallic dilator in the lacrimal apparatus. The foreign body was detected on dacryocystography and removed during dacryocystorhinostomy. The patient recovered uneventfully. PMID:19623527

Gupta, Deepak; Whittet, Heikki B; Sood, Salil; Maitra, Suchir

2009-07-01

194

Optimal design of perforating completion for gas well  

SciTech Connect

The productivity characteristics of perforated gas well are investigated for the first time under real conditions considering drilling damage, perforation compacted zone and anisotropy in this paper. A non-linear finite element model for non-Darcy flow in perforated gas reservoir is built to consider the effects of twelve factors on productivity ratio (PR) of perforated gas well. The nomographs for two cases are presented in this paper. Compared with previous works, the following results are found: (1) the effects of drilling damage and perforation diameter on PR of gas well are more remarkable than that in oil well; (2) any perforation phase may be the best or the worst as to perforating gas well, which depends on anisotropy, drawdown and that whether or not perforations are beyond drilling damage zone; (3) the increase in perforation length hardly improve PR of gas well when perforations have been beyond drilling damage zone. The new method is suggested to predict or determine the turbulent flow co-efficient D{prime}, total skin S, pseudo skin St{prime}, and individual skin factors (Sp, Sd, Sdp) in perforated gas well. The minimum underbalance required to obtain a zero perforating skin is discussed as well. Some drawbacks of the equation proposed by Tariq (SPE 20636) are analyzed and a new Reynold`s number criterion is established. The critical Reynold`s number for clean perforation is dependent on formation permeability. Based on this research, the principle and the program for optional design of perforating completion in gas well are highlighted. These new concepts, results and conclusions would be of importance to both gas well perforating and gas reservoir engineering.

Tang, Y.; Pan, Y.; Wang, Y.

1995-10-01

195

Histologic and ultrastructural features of experimental duodenal ulcers in Sprague-Dawley rats.  

PubMed

The histologic and ultrastructural features of a time sequence study of the development, evolution, and healing of acetic acid-induced experimental duodenal ulcer are presented. Duodenal ulcers produced by serosal application of acetic acid featured microvascular injury with progressive disintegration of the tips of the mucosal villi and subtotal necrosis of the duodenal wall. At 3 days ulcers transformed into a chronic state with regenerating epithelium originating from the crypts of the intact bordering mucosa extending toward the center of the ulcers. By 21 days healed ulcers were covered by distorted duodenal surface mucosa. We conclude that this reproducible and standardized model of duodenal ulcer features vascular injury as the earliest microscopic event, that ischemic necrosis leads to ulceration, and that the chronic phase bears morphologic resemblance to human duodenal ulcer. PMID:8224114

Bui, H X; Lee, C Y; del Rosario, A; Abdulla, M; Ballouk, F; Khan, M; Sheehan, C; Ross, J S

1993-10-01

196

Long-term results of subtotal gastrectomy for duodenal ulcer  

Microsoft Academic Search

Long-term clinical and metabolic results of subtotal gastrectomy for duodenal ulcer in 133 patients are reported. The operative\\u000a procedure consisted of a 4\\/5 gastric resection with a retrocolic no-loop Hoffmeister anastomosis. After detailed clinical\\u000a and metabolic assessment, 84% of the patients were graded Visick grades I and II. Postgastrectomy symptoms were few, only\\u000a mild or moderate in intensity, and were

A. Dinbar; I. Avigad; R. Shafir; D. B. Tulcinsky

1980-01-01

197

Structural analysis for Wingspan stent in a perforator model.  

PubMed

Perforator infarction represents a critical problem after intracranial Wingspan stent. To explore the mechanism of perforator infarction, we simulated the stent-artery interaction at an atheromatous plaque with perforator. Structural deformation and biomechanical stress distribution after stenting were analyzed. High radial stress values were located along the stent struts, which surrounded the area with high circumferential stress. Stretched perforator orifice in a circumferential direction after stenting was simulated. These results show that structural deformation could play a role in the mechanism of perforator occlusion after Wingspan stenting. PMID:24070074

Fujimoto, Motoaki; Shobayashi, Yasuhiro; Takemoto, Koichiro; Tateshima, Satoshi; Viñuela, Fernando

2013-09-01

198

Structural Analysis for Wingspan Stent in a Perforator Model  

PubMed Central

Summary Perforator infarction represents a critical problem after intracranial Wingspan stent. To explore the mechanism of perforator infarction, we simulated the stent-artery interaction at an atheromatous plaque with perforator. Structural deformation and biomechanical stress distribution after stenting were analyzed. High radial stress values were located along the stent struts, which surrounded the area with high circumferential stress. Stretched perforator orifice in a circumferential direction after stenting was simulated. These results show that structural deformation could play a role in the mechanism of perforator occlusion after Wingspan stenting. PMID:24070074

Fujimoto, Motoaki; Shobayashi, Yasuhiro; Takemoto, Koichiro; Tateshima, Satoshi; Viñuela, Fernando

2013-01-01

199

The Modified Kimura's Technique for the Treatment of Duodenal Atresia  

PubMed Central

Background/Purpose. Kimura's diamond-shaped-duodenoduodenostomy (DSD) is a known technique for the correction of congenital intrinsic duodenal obstruction. We present a modification of the technique and review the advantages of this new technique. Methods. From 1992 to 2006, 14 newborns were treated for duodenal atresia. We inverted the direction of the duodenal incisions: a longitudinal incision was made in the proximal duodenum while the distal was opened by transverse incision. Results. Our “inverted-diamond-shaped-duodenoduodenostomy” (i-DSD) allowed postoperative oral feeding to start on days 2 to 3, peripheral intravenous fluids discontinuity on days 3 to 8 (median values 3.6); time to achieve full oral feeds on days 8 to 12 (median values 9.4); the length of hospitalisation ranged from 10 and 14 days (median value 11.2). No complications related to the anastomosis, by Viz leakage, dehiscence, biliary stasis, or stenosis were observed. Conclusions. The i-DSD provides a safe procedure to protect the ampulla of Vater from injury and avoids any formation of a blind loop. The results show that patients who have i-DSD achieve full oral feeds in a very short time period and, consequently, the length of hospitalisation is also significantly reduced. PMID:19946416

Zuccarello, Biagio; Spada, Antonella; Centorrino, Antonio; Turiaco, Nunzio; Chirico, Maria Rosaria; Parisi, Saveria

2009-01-01

200

Splenosis mimicking an extramural duodenal mass: A case report.  

PubMed

Splenosis is a common disease, patients with splenosis are generally asymptomatic and therapy is not indicated. Splenosis is frequently observed in the abdomen and pelvic cavity and may mimic malignancy on imaging, often leading to unnecessary surgical intervention. The current study presents the case of a 55-year-old female patient, with a rare case of duodenal splenosis, who underwent unnecessary laparotomy due to a misdiagnosis of a malignant duodenal stromal tumor. Although splenosis was confirmed by intraoperative tissue biopsy, this mass was resected due to the lack of information with regard to this condition, an increased suspicion of progressive growth of the mass and chronic duodenal compression. The aim of this report is to raise the awareness of this entity in patients post-splenectomy, to avoid unnecessary surgery, particularly with an increased prevalence of patients with previous splenic trauma due to road traffic accidents. Therefore, the possibility of abdominal splenosis must be included in the differential diagnosis of patients with abdominal mass as the main clinical manifestation, where there is a history of splenic trauma or splenectomy and no other systemic symptoms. In the future noninvasive nuclear scintigraphy may serve as a suitable diagnostic approach for splenosis, thereby avoiding unnecessary laparotomies. PMID:25364471

Deng, Yilei; Jin, Yanwen; Li, Fuyu; Zhou, Yong

2014-12-01

201

Bovine Milk Inhibits Proteolytic Degradation of Epidermal Growth Factor in Human Gastric and Duodenal Lumen  

Microsoft Academic Search

R. K. Rao, R. D. Baker and S. S. Baker. Bovine milk inhibits proteolytic degradation of epidermal growth factor in human gastric and duodenal lumen. Peptides 19(3) 495–504, 1998.—Degradation of epidermal growth factor (EGF) in human gastric and duodenal lumen was analyzed by incubating 125I-labeled or unlabeled human recombinant EGF with human gastric or duodenal luminal fluids in vitro. Degradation

R. K Rao; R. D Baker; S. S Baker

1998-01-01

202

Pancreatic Arteriovenous Malformation Associated with Duodenal Ulcer and H.Pylori Infection.  

PubMed

Pancreatic arteriovenous malformation (PAVM) is a rare condition that may cause duodenal ulcer. A36-yr-old man with PAVM associated with duodenal ulcer and H.Pylori infection is described. The patienthad recurrent episode of upper abdominal pain despite healed ulcer and H.Pylori eradication.The preoperative diagnosis was confirmed by computed tomography and the patient was treated with apancreatoduodenectomy. Histological examination of the resected pancreas revealed a pancreatic arteriovenousmalformation involving the adjacent duodenal wall. PMID:12754395

Regenet, Nicolas; Tuech, Jean-Jacques; Pessaux, Patrick; Aube, Christophe; Rousselet, Marie-Christine; Arnaud, Jean-Pierre

2001-01-01

203

The Duodenal Switch Operation for the Treatment of Morbid Obesity  

PubMed Central

Objective: To determine the safety and efficacy of the duodenal switch procedure as surgical treatment of morbid obesity. Summary Background Data: The longitudinal gastrectomy and duodenal switch procedure as performed for morbid obesity involves a 75% subtotal greater curvature gastrectomy and long limb suprapapillary Roux-en-Y duodenoenterostomy. This results in a restricted caloric intake and diversion of bile and pancreatic secretions to induce fat malabsorption. Broad acceptance of this procedure has been impeded because of concerns that the malabsorptive component may produce serious nutritional complications. Methods: Review of data collected prospectively from all patients who underwent duodenal switch as the primary surgical treatment of morbid obesity at a single institution during the 10-year period beginning September 1992. Operative morbidity and mortality, weight loss, volume of food intake, and bowel function were recorded. Sequential measurements of serum albumin, hemoglobin, and calcium levels were obtained to assess metabolic function and nutrient absorption. Results: Duodenal switch was performed as the primary operation in 701 (81%) of a total 863 patients undergoing bariatric surgery during the period of study. The average body mass index (BMI) was 52.8 (range, 34–95). Perioperative mortality was 1.4%, and morbidity (including leaks, wound dehiscence, splenectomy, and postoperative hemorrhage) occurred in 21 patients (2.9%). Weight loss averaged 127 pounds at 1 year, 131 at 3 years, and 118 at 5 or more years (% EBWL of 69%, 73%, and 66%, respectively). The mean number of bowel movements was fewer than 3 per day. Patients reported and maintained a mean restriction of 63% of their preoperative intake (approximately 1600 calories), with no specific food intolerance, at 3 or more years follow-up. At 3 years, serum albumin remained at normal levels in 98% of patients, hemoglobin in 52%, and calcium in 71%. No patients reported dumping, and marginal ulcers were not seen. Conclusions: The longitudinal gastrectomy with duodenal switch is a safe and effective primary procedure for the treatment of morbid obesity. It has the advantage of allowing acceptable alimentation with a minimum of side effects while producing and maintaining significant weight loss. These results are achieved without developing significant dietary restrictions or clinical metabolic or nutritional complications. PMID:14530733

Anthone, Gary J.; Lord, Reginald V. N.; DeMeester, Tom R.; Crookes, Peter F.

2003-01-01

204

Analyses and applications of pressure, flow rate, and temperature measurements during a perforating run. [Measurement while perforating  

SciTech Connect

Perforating technology has undergone significant advances during the last decade. Tubing-conveyed perforating, underbalanced perforating, high-shot-density guns, better shaped charges, and improved gun systems have contributed to safer operations and improved productivity of the perforated completions. A recent development described in this paper is a perforating tool that makes real-time downhole measurements (including pressure, flow rate, temperature, gamma ray, casing-collar locator (CCL), and cable tension) during a perforating run and can selectively fire a number of guns at different depths or times. In addition to providing better control of the perforating process, the simultaneous downhole measurements can provide in a single trip a production log, conventional well tests before and after perforating, and a fill-up or slug test soon after perforating for underbalanced conditions. Thus, the completion can be evaluated in real time and any needed remedial reperforating can be performed while the gun is still in the hole. Other applications include limited-entry perforating, monitoring of bottomhole pressure (BHP) during minifracture jobs, better depth control with a gamma ray detector, fluid-level monitoring, and underbalance control. The applications of these measurements, with field data obtained with the Measurement While Perforating (MWP{sup SM}) tool, are the subject of this paper. Examples show the capabilities and the versatility of the MWP tool.

Tariq, S.M. (Schlumberger Perforating and Testing Center (US)); Ayestaran, L.C. (Schlumberger Well Services (US))

1991-02-01

205

Gallbaldder perforation causing a subcutaneous abscess  

PubMed Central

INTRODUCTION This is a report of a rare case of an old woman with a large round mass in the right hypochondrium that was proven to be an abscess. PRESENTATION OF CASE A 82-year old woman with a firm round mass in the right hypochondrium was admitted for evaluation. The abdominal CT showed an abscess produced by a gallbladder perforation, and a gallstone impacted at the Hartmann's pouch. DISCUSSION The abscess was treated with a transcutaneous paracentesis, while the stone passed to the gastrointestinal tract through a cholecystoenteric fistula, without causing any further problems. CONCLUSION Gallbaldder perforation can rarely create a subcutaneous abscess especially in thin, elder subjects. Abscess drainage is the first line of treatment. PMID:25460482

Misiakos, Evangelos; Tzepi, Ira; Brountzos, Ilias; Zavras, Nick; Charalampopoulos, Anestis; Macheras, Anastasios

2014-01-01

206

Pneumomediastinum caused by colonic diverticulitis perforation  

PubMed Central

A 59-year-old man presented with abdominal and left flank pain. The symptom had started 30 days before as an acute nephrolithiasis, which had worsened despite conservative management. The abdomen was slightly distended and tender over the lower abdomen, without signs of generalized peritoneal irritation. A computed tomography (CT) scan showed an abscess in left para-renal space up to the subphrenic space and an unexpected pneumomediastinum. An emergency operation was performed, which showed retroperitoneal diverticulitis perforation of the sigmoid descending junction with abscess formation. A segmental resection of the diseased colon and end-colostomy was performed (Hartmann's procedure). However, the patient's condition progressively deteriorated, and he died of sepsis and multi-organ failure on the 5th postoperative day. Although pneumomediastinum caused by colonic diverticulitis perforation is extremely rare, it could be a life-threatening condition in patients without signs of peritonitis because of delayed diagnosis. PMID:22066076

2011-01-01

207

[Spontaneous cecum perforation following cesarean section].  

PubMed

There is a certain risk of paralytic distension of the bowel, especially of the coecum, during the initial post-operative days following caesarean section. As can be seen from the overview presented, the possible result is spontaneous perforation of the coecum, which frequently has lethal consequences. Early differential diagnostic consideration for a mother exhibiting early warning post-caesarean symptoms can be life saving. We would recommend as prophylaxis early bowel stimulation with a laxative already on the second day following surgery. By distension of the coecum over 9 cm, as measured by sonography, decompression using either coloscopy or even coecostomy is recommended. Ischemic damage of the intestinal wall, as a result of excessive distension, is the main etiological factor for spontaneous perforation. The declining post partum oestrogen levels and resulting decreased parasympathetic tone, as well as the preceding anaesthesia account for the paralytic bowel symptoms. PMID:3215444

Strecker, J R; Jaluvka, V

1988-07-01

208

Perforation of thin unreinforced concrete slabs  

Microsoft Academic Search

This report discusses fourteen tests which were conducted to investigate the perforation of thin unreinforced concrete slabs. The 4340-steel projectile used in the test series is 50.8 mm in diameter, 355.6 mm in length, has a mass of 2.34 kg. and an ogive nose with caliber radius head of 3. The slabs, contained within steel culverts, are 1.52 m in

J. D. Cargile; M. E. Giltrud; V. K. Luk

1993-01-01

209

Perforating devices for use in wells  

DOEpatents

The perforating device for use in completing a well includes a case, an explosive charge contained in the case, and a generally bowl-shaped liner. The liner is positioned adjacent the explosive charge and has non-uniforrn thickness along its length. The liner further includes a protruding portion near its tip. In another configuration, the liner includes a hole near its tip to expose a portion of the explosive charge.

Jacoby, Jerome J. (Grass Valley, CA); Brooks, James E. (Manvel, TX); Aseltine, Clifford L. (late of Houston, TX)

2002-01-01

210

Acute gastric dilatation with infarction and perforation  

PubMed Central

This is a report of a 22-year-old woman with treated anorexia nervosa who died of complications of acute gastric dilatation—that is, infarction and perforation with severe and irreversible shock. Binge eating and drinking, precipitated by emotional crises, contributed to her acute gastric dilatation. This complication of anorexia nervosa has been previously reported, but, unlike the others, this case ended fatally. The literature is reviewed. ImagesFigure PMID:7308853

Saul, S H; Dekker, A; Watson, C G

1981-01-01

211

Chondrodermatitis nodularis helicis: a transepidermal perforating disorder.  

PubMed

Chondrodermatitis nodularis helicis is a chronic disorder occurring exclusively on the ear. It is most common in the sixth decade, and two thirds of the patients are men. Although it has no single characteristic histologic feature, a diagnosis can be made with certainty with a clinical history and a combination of morphologic changes seen in the cartilage and overlying skin. The natural history and histology are similar to a group of disorders characterized by transepithelial elimination known as the perforating dermatoses. PMID:7372881

Santa Cruz, D J

1980-04-01

212

Perforation of thin unreinforced concrete slabs  

SciTech Connect

This report discusses fourteen tests which were conducted to investigate the perforation of thin unreinforced concrete slabs. The 4340-steel projectile used in the test series is 50.8 mm in diameter, 355.6 mm in length, has a mass of 2.34 kg. and an ogive nose with caliber radius head of 3. The slabs, contained within steel culverts, are 1.52 m in diameter and consist of concrete with a nominal unconfined compressive strength of 38.2 MPa and maxima aggregate size of 9.5 mm. Slab thicknesses are 284.4, 254.0, 215.9 and 127.0 mm. Tests were conducted at impact velocities of about 313 m/s on all slab thicknesses and about 379 and 471 m/s on the 254.0-mm-thick slab. All tests were conducted at normal incidence to the slab. All tests were conducted at normal incidence to the slab. Information obtained from the tests used to determine the loading (deceleration) on the projectile during the perforation process, the velocity-displacement of the projectile as it perforated the slab, and the projectile position as damage occurred on the backface of the slab. The test projectile behaved essentially as a rigid body for all of the tests.

Cargile, J.D. [Army Engineer Waterways Experiment Station, Vicksburg, MS (United States); Giltrud, M.E. [Defense Nuclear Agency, Washington, DC (United States); Luk, V.K. [Sandia National Labs., Albuquerque, NM (United States)

1993-10-01

213

Treatment of iatrogenic previable premature rupture of membranes with intra-amniotic injection of platelets and cryoprecipitate (amniopatch): Preliminary experience  

Microsoft Academic Search

Objective: Our aim was to describe the treatment of iatrogenic previable premature rupture of membranes with the intra-amniotic injection of platelets and cryoprecipitate (amniopatch). Study Design: Patients with iatrogenic previable premature rupture of membranes and without evidence of intra-amniotic infection underwent transabdominal intra-amniotic injection of platelets and cryoprecipitate through a 22-gauge needle. The study was approved by the Institutional Review

Rubén A. Quintero; Walter J. Morales; Mary Allen; Patricia W. Bornick; Jorge Arroyo; German LeParc

1999-01-01

214

Malignant colo-duodenal fistula; case report and review of the literature  

Microsoft Academic Search

BACKGROUND: Colo-duodenal fistula is a rare complication of malignant and inflammatory bowel disease. Cases with malignant colo-duodenal fistulae can present with symptoms from the primary, from the fistula or from metastatic disease. The fistula often results in diarrhoea and vomiting with dramatic weight loss. Upper abdominal pain is usually present as is general malaise both from the presence of the

Ruth Soulsby; Edmund Leung; Nigel Williams

2006-01-01

215

Limited utilization of serologic testing in patients undergoing duodenal biopsy for celiac disease  

PubMed Central

Background Clinical algorithms for the workup of celiac disease often recommend the use of serologic assays for initial screening, followed by duodenal biopsy for histologic confirmation. However, the majority of duodenal biopsies submitted to pathology for “rule out celiac” are negative. The objective of this study was to determine the underlying causes for this low diagnostic yield. Methods We performed a retrospective review of pathology reports from 1432 consecutive duodenal biopsies submitted for pathologic assessment to “rule out celiac” and correlated biopsy results with results for concurrent serologic testing for celiac autoantibodies. Results The majority of patients had no record of serologic testing prior to biopsy, and evidence of positive serology results was found in only 5% of patients. Most duodenal biopsies were submitted as part of a multi-site GI sampling strategy that included biopsies from other locations. In this context, serologic results correlated with the likelihood of significant duodenal and non-duodenal findings, and were also helpful in evaluating patients with indeterminate duodenal histology. Conclusions The presence of a positive screening test for celiac autoantibodies does not appear to be a major driver in the decision to submit duodenal biopsies for evaluation of celiac disease, which accounts for the low incidence of findings in these samples. In patients where celiac serology testing was performed, the results were a good predictor of the likelihood of findings on biopsy. PMID:24209459

2013-01-01

216

Controlled therapeutic trial to determine the optimum dose of antacids in duodenal ulcer  

Microsoft Academic Search

Antacids are widely used in the management of duodenal ulcer but the optimum dose of antacid required for ulcer healing has not been determined. We therefore studied 107 patients with endoscopically diagnosed duodenal ulcer who were allotted at random to one of the following treatment groups; placebo (group P) and antacid (groups A, B and C). A liquid antacid (Aludrox

N Kumar; J C Vij; A Karol; B S Anand

1984-01-01

217

Adjuvant antibiotic therapy in duodenal ulcers treated with colloidal bismuth subcitrate  

Microsoft Academic Search

Persistence of Helicobacter pylori after duodenal ulcer healing is associated with high rates of ulcer relapse. We compared colloidal bismuth subcitrate alone with CBS combined with one of four antibiotic regimens in the treatment of duodenal ulcers. Endoscopy and antral biopsies were performed before treatment and four weeks afterwards. Biopsy specimens were examined for histological evidence of gastritis and by

T ORiordan; E Mathai; E Tobin; D McKenna; C Keane; E Sweeney; C OMorain

1990-01-01

218

Supraduodenal Branch of the Left Hepatic Artery: A Rare Cause of Bleeding Duodenal Ulcer  

SciTech Connect

This is a case report describing a rare cause of massive duodenal ulcer hemorrhage resulting from the erosion of the supraduodenal branch of the left hepatic artery. This arterial branch is not a well known variation and is rarely recognized as a source of duodenal bleeding.

Kapoor, Baljendra S., E-mail: bkapoor@uabmc.ed [University of Alabama at Birmingham NHB H623, Vascular and Interventional Radiology (United States); Berscheid, Bruce [St. Paul's Hospital, Interventional Radiology (Canada); Saddekni, Souheil [University of Alabama at Birmingham NHB H623, Vascular and Interventional Radiology (United States)

2009-07-15

219

Continuous passive motion as an alternative treatment for iatrogenic hallux limitus.  

PubMed

The use and effect of continuous passive motion (CPM) was evaluated for 10 patients suffering from iatrogenic hallux limitus. All patients had previous hallux valgus corrective surgery. After their initial evaluation, patients were instructed to begin CPM therapy at home for a minimum of 4 hr. a day and were instructed to increase range of motion (ROM) as tolerated. CPM was used for 4 weeks. ROM was measured on day 0, 28, 48, 90. There were significant increases in mean extension (p < 0.025) and mean flexion (p < 0.05). All patients reported a decrease in pain and stiffness of the first metatarsophalangeal joint. Seven of the 10 patients treated with CPM had increases in ROM. Three patients, all of whom had first metatarsal elevatus, required an additional surgical procedure. Patients suffering from iatrogenic hallux limitus with no associated first metatarsal elevatus can utilize CPM as a viable alternative to return to functional ROM. PMID:8019541

Connor, J C; Berk, D M

1994-01-01

220

Iatrogenic injury to the pulp in dental procedures: aspects of pathogenesis, management and preventive measures.  

PubMed

This review calls attention to the fact that iatrogenic ('dentistogenic') injury to the dental pulp is not an insignificant problem in clinical dentistry. On a short-term basis pulpal inflammatory lesions and hypersensitive teeth are frequently associated with procedures that involve removal of the dental hard tissue structures. Although the pulp is likely to recover, reparative processes induced by the insult may impair pulpal function on a long-term basis. In this paper current concepts regarding pathogenic mechanisms associated with injuries induced in the pulp by restorative and periodontal treatment procedures are reviewed. Aspects of the management of accidental pulp exposures are also described as well as measures to prevent or reduce iatrogenic injuries to the pulp. PMID:2032743

Bergenholtz, G

1991-04-01

221

Iatrogenic nostril stenosis: aesthetic correction using a vestibular labial mucosa flap.  

PubMed

Nostril stenosis is an infrequent finding that often has an iatrogenic cause. It is a very difficult problem to resolve and usually requires several months of prosthetic support in order to counteract the recurrence of internal scarring and shrinking. We present a 4-year-old child with a monolateral iatrogenic nostril stenosis. A satisfactory and stable correction was obtained using a "piercing" flap taken from the labial vestibule. The use of a nasal stent (not placed immediately and worn only at night) was necessary for only 2 months. This technique has a number of advantages: the absence of external scars, little or no tendency to recurrence due to the absence of contraction provided by the well-vascularized flap tissue, and the ease and rapidity of the surgical procedure. PMID:7870785

Blandini, D; Tremolada, C; Beretta, M; Mascetti, M

1995-03-01

222

Conventional mesh repair of a giant iatrogenic bilateral diaphragmatic hernia with an enterothorax  

PubMed Central

Purpose Diaphragmatic hernias (DHs) are divided into congenital and acquired hernias, most of which are congenital. Among acquired DHs, up to 80% are left-sided, only a few iatrogenic DHs have been reported, and bilateral hernias are extremely rare. For diagnostic reasons, many DHs are overlooked by ultrasonography or X-ray and are only recognized at a later stage when complications occur. Methods In 2009, we performed three partial diaphragm replacements in our clinic for repairing DHs using a PERMACOL™ implant. Results As all patients had uneventful postoperative courses and the clinical outcomes were very good, we present one special case of a 65-year-old male with a giant iatrogenic bilateral DH with an enterothorax. Conclusion We see a good indication for diaphragm replacements by using a PERMACOL™ implant for fixing especially DHs with huge hernial gaps and in cases with fragile tissue. PMID:24600251

Lingohr, Philipp; Galetin, Thomas; Vestweber, Boris; Matthaei, Hanno; Kalff, Jörg C; Vestweber, Karl-Heinz

2014-01-01

223

Autosomal Dominant Type I Osteopetrosis Is Related with Iatrogenic Fractures in Arthroplasty  

PubMed Central

Autosomal dominant osteopetrosis (ADO) is a sclerotic bone disorder due to failure of osteoclasts. ADO poses difficulties during arthroplasty because of the increased chance for iatrogenic fractures due to sclerotic bone. ADO is divided into two types based on radiological findings, fracture risk, and osteoclast activity. These differences suggest less brittle bone in patients with ADO I compared to that of patients with ADO II, which suggests a smaller chance of preoperative fractures during cementless arthroplasty in ADO I compared with that in ADO II. A case of cementless total knee arthroplasty in a patient with ADO I is presented. Total hip arthroplasty was performed during follow-up, and known major problems related to ADO II were experienced. Therefore, the differences between ADO I and ADO II may not be clinically relevant for an iatrogenic fracture during arthroplasty in patients with ADO. PMID:25436076

van Hove, Ruud P.; de Jong, Tjitte

2014-01-01

224

Autosomal dominant type I osteopetrosis is related with iatrogenic fractures in arthroplasty.  

PubMed

Autosomal dominant osteopetrosis (ADO) is a sclerotic bone disorder due to failure of osteoclasts. ADO poses difficulties during arthroplasty because of the increased chance for iatrogenic fractures due to sclerotic bone. ADO is divided into two types based on radiological findings, fracture risk, and osteoclast activity. These differences suggest less brittle bone in patients with ADO I compared to that of patients with ADO II, which suggests a smaller chance of preoperative fractures during cementless arthroplasty in ADO I compared with that in ADO II. A case of cementless total knee arthroplasty in a patient with ADO I is presented. Total hip arthroplasty was performed during follow-up, and known major problems related to ADO II were experienced. Therefore, the differences between ADO I and ADO II may not be clinically relevant for an iatrogenic fracture during arthroplasty in patients with ADO. PMID:25436076

van Hove, Ruud P; de Jong, Tjitte; Nolte, Peter A

2014-12-01

225

Placebo effect in the treatment of duodenal ulcer  

PubMed Central

Aims To assess whether frequency of placebo administration is associated with duodenal ulcer healing. Methods A systematic literature review of randomized clinical trials was undertaken. 79 of 80 trials that met the inclusion criteria. The pooled 4 week placebo healing rate of all duodenal ulcer trials that employed a four times a day regimen was compared with the rate obtained from trials with a twice a day regimen. Results The pooled 4 week healing rate of the 51 trials with a four times a day regimen was 44.2% (805 of 1821 patients) compared with 36.2% (545 of 1504 patients) in the 28 trials with a twice a day regimen (difference, 8.0% [equal effects model]; 95% confidence interval, 4.6% to 11.3%). Depending on the statistical analysis, the rate difference ranged from 6.0% (multivariable random effects model) to 8.0% (equal effects model). A number of sensitivity analyses showed comparable differences between the two regimens. Most of these sensitivity analyses were not significant, probably because a number of trials were excluded resulting in a loss of power. Conclusions We found a relation between frequency of placebo administration and healing of duodenal ulcer. We realize that the comparison was based on nonrandomized data. However, we speculate that the difference between regimens was induced by the difference in frequency of placebo administration. A better knowledge of various placebo effects is required in order to make clinically relevant assessments of treatment effects derived from placebo-controlled trials. PMID:10594490

de Craen, Anton J M; Moerman, Daniel E; Heisterkamp, Simon H; Tytgat, Guido N J; Tijssen, Jan G P; Kleijnen, Jos

1999-01-01

226

Synchronous perforation of sigmoid diverticula: a rare presentation.  

PubMed

Diverticular disease affects more than 50% of the population over the age of 60 years in the west and becomes even more common as the population ages. Diverticulitis is one of the complications of diverticular disease and can culminate into colonic perforation. Though perforated diverticular disease is not uncommon, synchronous colonic perforations in diverticulitis is rare. Our patient was admitted with acute abdomen and exploratory laparotomy revealed two side-by-side perforations of the sigmoid colon. A Hartmann's procedure was performed. Macro- and microscopic evaluation confirmed the presence of two perforated sigmoid diverticula due to diverticulitis. Simultaneous perforation of two abreast sigmoid diverticula is uncommon; thus, a cautious surgeon should always take into account such a probable diagnosis. PMID:19562554

Andrabi, Syed Imran Hussain; Latif, Muhammad Usman; Ahmad, Jawad; Malik, Arshad Hussain; El-Hakeem, Ahmed A S

2009-05-01

227

Colonic carcinoma with multiple small bowel perforations mimicking intestinal obstruction  

PubMed Central

Background Carcinoma of the colon may present with perforation proximal to the site of malignancy. Caecum is the commonest site of perforation if the ileocecal valve is patent and the jejunal and ileal perforations are very rare. Case presentation A 35 year male presented with intestinal obstruction. Emergency laparotomy revealed carcinoma of the transverse colon with multiple pinpoint perforations along antimesenteric border of ileum, which were wrapped with omentum, and no peritoneal contamination was present. Extended right hemicolectomy with jejunocolic anastomosis was done. Patient made uneventful recovery in postoperative period and was treated with adjuvant chemotherapy. Conclusion Patients with colonic carcinoma and incompetent ileocecal valve may present with intestinal perforation. Increased intraluminal pressure and closed loop obstruction may lead to ischemia and perforation of the small bowel. PMID:16978402

Tiwary, Satyendra K; Singh, Manish K; Khanna, Rahul; Khanna, Ajay K

2006-01-01

228

Pouching a draining duodenal cutaneous fistula: a case study.  

PubMed

Blockage of the mesenteric artery typically causes necrosis to the colon, requiring extensive surgical resection. In severe cases, the necrosis requires removal of the entire colon, creating numerous problems for the WOC nurse when pouching the opening created for effluent. This article describes the management of a draining duodenal fistula in a middle-aged woman, who survived surgery for a blocked mesenteric artery that necessitated the removal of the majority of the small and large intestine. Nutrition, skin management, and pouch options are described over a number of months as the fistula evolved and a stoma was created. PMID:10036421

Zwanziger, P J

1999-01-01

229

The possibility of dietary protective factors in duodenal ulcer  

PubMed Central

Rats fed on a supplement of raw cabbage, brinjal, dhal or powdered milk given in addition to a staple rice or laboratory stock diet show a high degree of protection against experimental ulceration following pyloric ligation. Wheat bran and ragi (a millet) conferred some protection, whereas rice bran and maize conferred no protection. The protection conferred by raw cabbage was destroyed by cooking. The lettuce used conferred no protection. The significance of such findings with regard to the geographical distribution of duodenal ulcer in India and Africa is discussed. PMID:1240629

Tovey, F. I.; Jayaraj, A. Paul; Clark, C. G.

1975-01-01

230

Surgical Excision of Duodenal/Pancreatic Metastatic Renal Cell Carcinoma  

PubMed Central

Renal cell carcinoma (RCC) has a potential to metastasize to almost any site and this may occur many years following nephrectomy. We present six cases with uncommon sites of metastasis: four patients presented with distal pancreatic metastasis and two with duodenal/head of the pancreas metastasis. Time to metastatic disease varied from 1 to 19?years following renal surgery. For patients are alive and two succumbed to their disease. Long-term survival can be achieved with aggressive surgical excision of disease. PMID:25177547

Espinoza, Eduardo; Hassani, Ali; Vaishampayan, Ulka; Shi, Dongping; Pontes, J. Edson; Weaver, Donald W.

2014-01-01

231

Iatrogenic Arteriovenous Fistula in a Renal Allograft: The Result of a TAD Guidewire Injury  

SciTech Connect

A case is presented of an iatrogenic arteriovenous fistula developing in a renal allograft following guidewire manipulation during transplant renal artery angioplasty. Hyperdynamic flow through the fistula was causing a shunt of blood away from the renal cortex as demonstrated on sonography and scintigraphy. Selective embolization was performed, correcting the maldistribution of flow to the peripheral renal cortex. The diagnosis and difficulty in management of asymptomatic renal arteriovenous fistulae is also discussed.

Lee-Elliott, Catherine; Khaw, Kok-Tee; Belli, Anna-Maria; Patel, Uday [Department of Radiology, St. George's Hospital NHS Trust, London SW17 0QT (United Kingdom)

2000-07-15

232

Iatrogenic Left Main Bronchus Injury following Atraumatic Double Lumen Endotracheal Tube Placement  

PubMed Central

Tracheobronchial disruption is an uncommon but severe complication of double lumen endotracheal tube placement. The physical properties of a double lumen tube (large external diameter and length) make tracheobronchial injury more common than that associated with smaller single lumen endotracheal tubes. Here we present the case of an iatrogenic left main bronchus injury caused by placement of a double lumen tube in an otherwise unremarkable airway. PMID:24288629

Hartman, William R.; Brown, Michael; Hannon, James

2013-01-01

233

Closing Perforations and Postperforation Management in Endoscopy: Esophagus and Stomach.  

PubMed

Luminal perforation after endoscopy is a dreaded complication that is associated with significant morbidity and mortality, longer and more costly hospitalization, and the specter of potential future litigation. The management of such perforations requires a multidisciplinary approach. Until recently, surgery was required. However, nowadays the endoscopist has a burgeoning armamentarium of devices and techniques that may obviate surgery. This article discusses the approach to endoscopic perforations in the esophagus and stomach. PMID:25442956

Stavropoulos, Stavros N; Modayil, Rani; Friedel, David

2015-01-01

234

Palliation of Malignant Biliary and Duodenal Obstruction with Combined Metallic Stenting  

SciTech Connect

Purpose. The purpose of this study is to evaluate the efficacy of palliation of malignant biliary and duodenal obstruction with combined metallic stenting under fluoroscopy guidance. Materials and Methods. A retrospective analysis of 9 patients (6 men and 3 women) who underwent biliary and duodenal stenting was performed. The mean age of patients was 61 years (range: 42-80 years). The causes of obstruction were pancreatic carcinoma in 7 patients, cholangiocellular carcinoma in one, and duodenal carcinoma in the other. Biliary and duodenal stents were placed simultaneously in 4 patients. In other 5 patients dudodenal stents were placed after biliary stenting when the duodenal obstruction symptoms have developed. In two patients duodenal stents were advanced via transgastric approach. Results. Technical success rate was 100 %. After percutaneous biliary drainage and stenting bilirubin levels decreased to normal levels in 6 patients and in remaining 3 patients mean reduction of 71% in bilirubin levels was achieved. Tumoral ingrowth occurred in one patient and percutaneous biliary restenting was performed 90 days after the initial procedure. Of the 9 patients, 6 patients were able to tolerate solid diet, whereas 2 patients could tolerate liquid diet and one patient did not show any improvement. Mean survival periods were 111 and 73 days after biliary and duodenal stenting, respectively. Conclusion. Combined biliary and duodenal stent placement which can be performed under fluoroscopic guidance without assistance of endoscopy is feasible and an effective method of palliation of malignant biliary and duodenal obstructions. If transoral and endoscopic approaches fail, percutaneous gastrostomy route allows duodenal stenting.

Akinci, Devrim, E-mail: akincid@hotmail.com; Akhan, Okan; Ozkan, Fuat; Ciftci, Turkmen; Ozkan, Orhan S.; Karcaaltincaba, Musturay; Ozmen, Mustafa N. [Hacettepe University School of Medicine, Department of Radiology (Turkey)

2007-11-15

235

Endoscopic retrograde cholangiopancreatography-related perforation: Management and prevention  

PubMed Central

Endoscopic retrograde cholangiopancreatography (ERCP) is a procedure that can result in serious complications, and thus should be handled by a skilled endoscopist to minimize the risk of complications and to enhance the success rate. The incidence of ERCP-related complications is 5%-10%, most commonly involving post-ERCP pancreatitis and clinically significant post-endoscopic sphincterotomy bleeding. Although ERCP-related perforation has a relatively lower incidence of 0.14%-1.6%, this complication is associated with a high mortality rate of 4.2%-29.6%. A classification of perforation type based on the instrument that caused the perforation was recently described that we postulated could affect the implementation of perforation management. In the present article, an algorithm for management and prevention of ERCP-related perforations is proposed that is based on the perforation type and delay of diagnosis. Available evidence demonstrates that a delayed diagnosis and/or treatment of perforation results in a poorer prognosis, and thus should be at the forefront of procedural consideration. Furthermore, this review provides steps and recommendations from the pre-procedural stage through the post-procedural evaluation with consideration of contributing factors in order to minimize ERCP-related complication risk and improve patient outcome. To avoid perforation, endoscopists must evaluate the risks related to the individual patient and the procedure and perform the procedure gently. Once a perforation occurs, immediate diagnosis and early management are key factors to minimize mortality. PMID:25325062

Prachayakul, Varayu; Aswakul, Pitulak

2014-01-01

236

Spontaneous free perforation of the small intestine in adults  

PubMed Central

Spontaneous free perforation of the small intestine is uncommon, especially if there is no prior history of visceral trauma. However, free, even recurrent, perforation may complicate a defined and established clinical disorder, such as Crohn’s disease. In addition, free perforation may be the initial clinical presentation of an occult intestinal disorder, such as a lymphoma complicating celiac disease, causing diffuse peritonitis and an acute abdomen. Initial diagnosis of the precise cause may be difficult, but now has been aided by computerized tomographic imaging. The site of perforation may be helpful in defining a cause (e.g., ileal perforation in Crohn’s disease, jejunal perforation in celiac disease, complicated by lymphoma or collagenous sprue). Urgent surgical intervention, however, is usually required for precise diagnosis and treatment. During evaluation, an expanding list of other possible causes should be considered, even after surgery, as subsequent management may be affected. Free perforation may not only complicate an established intestinal disorder, but also a new acute process (e.g., caused by different infectious agents) or a longstanding and unrecognized disorder (e.g., congenital, metabolic and vascular causes). Moreover, new endoscopic therapeutic and medical therapies, including use of emerging novel biological agents, have been complicated by intestinal perforation. Recent studies also support the hypothesis that perforation of the small intestine may be genetically-based with different mutations causing altered connective tissue structure, synthesis and repair. PMID:25110427

Freeman, Hugh James

2014-01-01

237

Jejunal perforation: a rare presentation of B-cell lymphoma.  

PubMed

A 42-year-old man who was being treated for pneumonia developed severe, sudden-onset abdominal pain with features of shock and peritonism. The clinical picture combined with radiological investigations raised suspicion of a bowel perforation necessitating urgent surgical review and emergency laparotomy. This diagnosed a jejunal perforation with abnormal lymph nodes. Histological examination confirmed diffuse large B-cell lymphoma. The patient was subsequently started on a course of chemotherapy. While gastrointestinal perforation secondary to antilymphoma treatment is a well-recognised complication, primary perforation caused by the lymphoma itself must always be considered. PMID:24557479

Santharam, V; Kumar, P; Lee, L Y W

2014-01-01

238

Preoperative Identification of a Perforator Using Computed Tomography Angiography and Metal Clip Marking in Perforator Flap Reconstruction  

PubMed Central

In perforator flap reconstruction, vascular mapping using preoperative computed tomography (CT) angiography is widely used to confirm the existence and location of an appropriate perforator. This study proposes a rapid, accurate, and convenient method for marking the perforator location on the skin surface. For 12 patients who underwent perforator flap reconstruction between November 2011 and November 2013, metal clips were fixed on the skin surface at the anticipated perforator locations, which were decided using a handheld Doppler. CT angiography was used to compare the location between the metal clip and the actual perforator. The metal clip was moved and repositioned, if needed, on the basis of the CT images. The locations of the appropriate perforator and the metal clip, which were observed during the surgery, were then compared. In CT angiography, the mean distance between the metal clip and the perforator was 3±3.9 mm, and the mean distance that was measured during surgery was 0.8±0.8 mm. In conclusion, we report a simple, rapid, and precise technique to indicate the accurate location of the appropriate perforator on the skin surface. PMID:25606494

Lee, Jung Woo; Kim, Han Kyeol; Kim, Sin Rak; Han, Yea Sik

2015-01-01

239

Sigmoid perforation by compressed carbon dioxide.  

PubMed

Self-induced injuries of the bowel have various accidental mechanisms. This is a report of a 35-year-old patient with disruption of the recto-sigmoid junction caused by carbon dioxide (CO2) originating from a bottle of sparkling wine, which was introduced transanally for sexual stimulation. The patient underwent resection of the recto-sigmoid junction and primary anastomosis. The postoperative course was uneventful except for wound infection. The patient was discharged 12 days later. The physical backgrounds, the pathological pathways for perforation and diagnostic modalities including diagnostic pitfalls are critically discussed. PMID:15932178

Ikapischke, Matthias; Tepel, Juergen; Pai, Muhdra; Schulz, Tim

2005-03-01

240

Pressure enhanced penetration with shaped charge perforators  

DOEpatents

A downhole tool, adapted to retain a shaped charge surrounded by a superatmospherically pressurized light gas, is employed in a method for perforating a casing and penetrating reservoir rock around a wellbore. Penetration of a shaped charge jet can be enhanced by at least 40% by imploding a liner in the high pressure, light gas atmosphere. The gas pressure helps confine the jet on the axis of penetration in the latter stages of formation. The light gas, such as helium or hydrogen, is employed to keep the gas density low enough so as not to inhibit liner collapse.

Glenn, Lewis A. (Danville, CA)

2001-01-01

241

Bladder Perforation Secondary to Primary Systemic Amyloidosis  

PubMed Central

Amyloidosis is a disorder of protein folding characterized by extracellular aggregation and deposition of amyloid protein fibrils. Light-chain amyloidosis, also known as primary systemic amyloidosis, is the most common form of the disease. We present a case of an 84-year-old male with a history of systemic primary amyloidosis causing genitourinary, cardiac, and autonomic dysfunction who presented with hematuria and hypotension secondary to bladder perforation. He underwent open repair of a large extraperitoneal bladder defect. He ultimately died as a result of medical complications from his disease. PMID:25587481

Dru, Christopher J.; Feng, Tom S.; Kim, Howard H.

2014-01-01

242

Conservative treatment of an intraperitoneal bladder perforation  

PubMed Central

Introduction The management of bladder rupture depends on its anatomical location. Material and methods Case report and review of the pertinent English language literature. Results A 56-year-old man with history of an anterior rectum resection with partial cystectomy presented with signs of acute renal failure, and later with a tender, distended abdomen. Work-up including serum and ascites biochemistry, cystoscopy, and CT cystography diagnosed urinary ascites. The small intraperitoneal bladder rupture was treated conservatively via continued urinary drainage under urinary antibiotic prophylaxis until closure. Conclusion A conservative treatment of a small intraperitoneal bladder perforation is possible under certain conditions. PMID:24578862

Michielsen, Dirk

2011-01-01

243

Cushing's disease presenting with gastrointestinal perforation: a case report  

PubMed Central

Gastrointestinal perforation is a complication associated with steroid therapy or hypercortisolism, but it is rarely observed in patients with Cushing's disease in clinical practice, and only one case has been reported as a presenting symptom. Herein, we report a rare case of Cushing's disease in which a patient presented with gastrointestinal perforation as a symptom. A 79-year-old man complained of discomfort in the lower abdomen for 6 months. Based on the endocrinological and gastroenterological examinations, he was diagnosed with Cushing's disease with a perforation of the descending colon. After consultation with a gastroenterological surgeon, it was decided that colonic perforation could be conservatively observed without any oral intake and treated with parenteral administration of antibiotics because of the mild systemic inflammation and lack of abdominal guarding. Despite the marked elevated levels of serum cortisol, oral medication was not an option because of colonic perforation. Therefore, the patient was submitted to endonasal adenomectomy to normalize the levels of serum cortisol. Subsequently, a colostomy was successfully performed. Despite its rarity, physicians should be aware that gastrointestinal perforation may be associated with hypercortisolism, especially in elderly patients, and immediate diagnosis and treatment of this life-threatening condition are essential. If a perforation can be conservatively observed, endonasal adenomectomy prior to laparotomy is an alternative treatment option for hypercortisolism. Learning points Thus far, only one case of gastrointestinal perforation as a presenting clinical symptom of Cushing's disease has been reported.Physicians should be aware that gastrointestinal perforation might be associated with hypercortisolism in elderly patients because elevated levels of serum cortisol may mask the clinical signs of perforation. Because of this masking effect, the diagnosis of the perforation also tends to be delayed.Although parenteral administration of etomidate is a standard treatment option for decreasing the elevated levels of serum cortisol, endonasal adenomectomy prior to laparotomy is an alternative treatment option if etomidate therapy is unavailable. PMID:24616779

Hara, Takuma; Akutsu, Hiroyoshi; Yamamoto, Tetsuya; Ishikawa, Eiichi; Matsuda, Masahide; Matsumura, Akira

2013-01-01

244

Colonic perforation due to necrotizing amoebic colitis.  

PubMed

A seriously ill woman with the history of fever for 14 days and severe pain in abdomen with frequent passage of blood and mucous mixed loose stool for 11 days was admitted in the Surgery Unit-3 of Mymensingh Medical Collage Hospital. On examination the patient was toxic, moderately anaemic and dehydrated and there was diffuse abdominal tenderness with a palpable tender cystic intra abdominal lump in right lower abdomen. Fluidthril was present with absent bowel sound. Digital rectal examination revealed bulged anterior rectal wall. X-ray abdomen revealed multiple gas and fluid leveled loops of intestine with increased haziness of the film. On emergency laparotomy it revealed huge amount of faecal matter with fluid in peritoneal cavity. The greater omentum was adherent to caecum with multiple friable necrotic areas in the caecum, transverse and splenic flexure of the colon with multiple small perforations, Subtotal colectomy and end to end anastomosis was done. Histopathological examination of the resected gut revealed features compatible with amoebic ulcer perforations. On 13th post operative day the patient was discharged without any post operative complication and in the 1st follow up after one month the patient was found without any complication. PMID:12715648

Hasan, M; Islam, M A; Siddiqua, S S; Shuvra, M R

2003-01-01

245

Prevalence of non-Helicobacter pylori duodenal ulcer in Karachi, Pakistan  

PubMed Central

AIM: To determine the prevalence of non-Helicobacter pylori (H pylori)-related duodenal ulcer in patients with acid-peptic diseases. METHODS: Medical records of patients who attended the Gastroenterology Department at Aga Khan University Hospital from 1999 to 2001 and had endoscopic diagnosis of duodenal ulcers were reviewed. Duodenal ulcer associated with H pylori was diagnosed on the basis of endoscopy, rapid urease test and histopathology whereas histories of aspirin or other non-steroidal anti-inflammatory drugs (NSAIDs) related duodenal ulcers. Non-H pylori, non-NSAID duodenal ulcers were those without H pylori infection and history of NSAID intake. Co-morbid conditions associated were noted. RESULTS: Of 2260 patients, 10% (217/2 260) had duodenal ulcer. Duodenal ulcer related to H pylori infection accounted for 53% (116/217), NSAID-related 10% (22/217), non-H pylori non-NSAID 29% (62/217), and 8% (17/217) had both H pylori infection and histories of NSAID intake. Fifteen percent (18/116) patients had past histories of peptic ulcer disease in H pylori infection, while 8% (5/62) in non-H pylori non-NSAID ulcer. Co-morbid conditions in H pylori infection were seen in 23% (27/116) and 34% (21/62) in non-H pylori non-NSAID ulcer. CONCLUSION: Incidence of H pylori infection related with duodenal ulcer is common. In the presence of co-morbids, non-H pylori and non-NSAID duodenal ulcer is likely to be present. PMID:15962375

Yakoob, Javed; Jafri, Wasim; Jafri, Nadim; Islam, Muhammad; Abid, Shahab; Hamid, Saeed; AliShah, Hasnain; Shaikh, Hizbullah

2005-01-01

246

Powder composite materials for plugless facing of perforator shaped charges  

Microsoft Academic Search

Shaped changes are used for driving perforation channels in casing and rock though which oil enters a well. Important characteristics governing the quality of exposing an oil stratum are the depth of the perforation channel and its free volume. Currently shaped charges are mainly supplied with formed copper facings. Use of these facings, depending on charge construction, is accompanied in

Yu. A. Bykov; T. E. Vorkina

1994-01-01

247

On the thermal performance of perforated heat exchanger plates  

SciTech Connect

This paper presents heat transfer characteristics of perforated copper plates for use in regenerators at low Reynolds number flow. A simple experimental system is described for quick evaluation of heat transfer performance. A simple theoretical model is used for evaluation of heat transfer coefficient from transient single blow experiments of low Biot number perforated single plate systems.

Ravikumar, K.V.; Frederking, T.H.K. [Univ. of California, Los Angeles, CA (United States)

1994-12-31

248

Cheek mucosa territories perfused by perforators from the facial artery.  

PubMed

The cutaneous areas perfused by the cutaneous perforators of the facial artery have been well defined. However, the oral mucosal areas perfused by perforators of the facial artery have not been described. We studied 20 hemifaces from 10 cadavers. Perforators between the branching off sites of the labial arteries larger than 0.5mm were selected and their diameters were measured; the distance between their exit point over the facial artery and the branching-off point from the superior labial artery was also measured. The selected perforators were injected with 1ml of diluted ink. Both labial arteries were ligated to limit the study to the mucosal perforators from the facial artery. Seventy-four perforators from 20 hemifaces were studied; the mean diameter was 0.58mm and the mean number per artery was 3.7. The total stained area, a triangle-shaped zone on the cheek, was determined. The more constant perforators larger than 0.5mm were localized next to the branching-off site of the superior labial artery. With this information, flaps based on the mucosal perforators from the facial artery could be designed. PMID:25218801

Coronel-Banda, M E; Serra-Renom, J M; Lorente, M; Larrea-Terán, W P

2015-01-01

249

Body Force Model for the Aerodynamics of Inclined Perforated Surfaces  

E-print Network

Body Force Model for the Aerodynamics of Inclined Perforated Surfaces Juntao Xiong, Andrew Johnson of perforated surfaces inclined to a freestream. The goal is to characterize the key parameters affecting coefficient Cp = pressure coefficient D = hole size on plane of freestream FB = body force H = nozzle height h

Papamoschou, Dimitri

250

Acoustic Transmission Loss of Perforated Plates Vincent Phong1  

E-print Network

Acoustic Transmission Loss of Perforated Plates Vincent Phong1 and Dimitri Papamoschou2 University of California, Irvine, CA 92697, USA A study has been conducted on the acoustic response of perforated plates through experimentation. The acoustic response was quantified through the transmission loss and absorption

Papamoschou, Dimitri

251

Pneumoscrotum: A rare manifestation of perforation associated with therapeutic colonoscopy  

PubMed Central

Pneumoscrotum is uncommon and also rarely reported as a complication associated with colonic perforation. A case of colonic perforation in delayed fashion associated with EMR, revealed by pneumoscrotum, is reported and the associated literatures are reviewed. A 52-year-old male received piecemeal EMR for a laterally spreading tumor 35 mm in size in our hospital. He complained of enlargement of the scrotum and revisited our hospital the day after the procedure. A diagnosis of pneumoscrotum was made, and as most such cases have been reported to be associated with pneumoperitoneum, colonic perforation was suspected. Free air but no fluid collection was found by abdominal computed tomography, and delayed colonic perforation was diagnosed. However, as there were no clinical signs of peritoneal irritation, conservative treatment was administered and the patient recovered uneventfully. Pneumoscrotum could be a sign of colonic perforation after EMR, and treatment should be carefully chosen. PMID:16124067

Fu, Kuang-I; Sano, Yasushi; Kato, Shigeharu; Fujii, Takahiro; Sugito, Masanori; Ono, Masato; Saito, Norio; Kawashima, Kiyotaka; Yoshida, Shigeaki; Fujimori, Takahiro

2005-01-01

252

Esophageal Perforation due to Transesophageal Echocardiogram: New Endoscopic Clip Treatment.  

PubMed

Esophageal perforation due to transesophageal echocardiogram (TEE) during cardiac surgery is rare. A 72-year-old female underwent TEE during an operation for aortic valve replacement. Further, the patient presented hematemesis. Gastroscopy revealed an esophageal bleeding ulcer. Endoscopic therapy was successful. Although a CT scan excluded perforation, the patient became febrile, and a second gastroscopy revealed a big perforation at the site of ulcer. The patient's clinical condition required endoscopic intervention with a new OTSC(®) clip (Ovesco Endoscopy, Tübingen, Germany). The perforation was successfully sealed. The patient remained on intravenous antibiotics, proton pump inhibitors and parenteral nutrition for few days, followed by enteral feeding. She was discharged fully recovered 3 months later. We clearly demonstrate an effective, less invasive treatment of an esophageal perforation with a new endoscopic clip. PMID:25120414

Robotis, John; Karabinis, Andreas

2014-05-01

253

Perforated Jejunal Diverticulum in the Use of Mycophenolate Mofetil  

PubMed Central

Context: Jejunal diverticulosis is a rare disease. Common acute complications include diverticulitis, intestinal obstruction, bleeding and perforation. Gastrointestinal tract perorations have also been rarely observed in the use of mycophenolate mofetil. Case Report: We report a 44-year-old man with end-stage renal disease post failed kidney transplant on low-dose mycophenolate mofetil who presented with acute onset of abdominal pain. He was successfully given the diagnosis of perforated jejunal diverticulum. The patient successfully underwent a segmental jejunal resection and anastomosis. He unfortunately developed a recurrent jejunal perforation a month later and again had the second segmental jejunal resection operation. Mycophenolate mofetil then was discontinued. Conclusion: The present case illustrates jejunal diverticulum perforation in the use of mycophenolate mofetil. Physicians should increase the awareness of this association of perforated jejunal diverticulum in patients using mycophenolate mofetil.

Thongprayoon, Charat; Cheungpasitporn, Wisit; Edmonds, Peter J.; Thamcharoen, Natanong

2014-01-01

254

Esophageal Perforation due to Transesophageal Echocardiogram: New Endoscopic Clip Treatment  

PubMed Central

Esophageal perforation due to transesophageal echocardiogram (TEE) during cardiac surgery is rare. A 72-year-old female underwent TEE during an operation for aortic valve replacement. Further, the patient presented hematemesis. Gastroscopy revealed an esophageal bleeding ulcer. Endoscopic therapy was successful. Although a CT scan excluded perforation, the patient became febrile, and a second gastroscopy revealed a big perforation at the site of ulcer. The patient's clinical condition required endoscopic intervention with a new OTSC® clip (Ovesco Endoscopy, Tübingen, Germany). The perforation was successfully sealed. The patient remained on intravenous antibiotics, proton pump inhibitors and parenteral nutrition for few days, followed by enteral feeding. She was discharged fully recovered 3 months later. We clearly demonstrate an effective, less invasive treatment of an esophageal perforation with a new endoscopic clip. PMID:25120414

Robotis, John; Karabinis, Andreas

2014-01-01

255

[Clinico-radiographic evaluation of the state of the spine in stomach and duodenal diseases].  

PubMed

Data are given on the condition of the thoracic spine of 465 patients with certain gastric and duodenal diseases. Degenerative-dystrophic lesions (spondylosis deformans and intervertebral osteochondrosis) of the thoracic spine together with osteoarthritis deformans of the costovertebral and costotransverse articulations lead to neurodystrophy of the gastric and duodenal mucosa through chronic stimulation by osteophytes of the thoracic sympathetic ganglia. Disorders of gastric and duodenal motor activity are also important. The attendant reflux gastritis is stipulated by reflux of the intestinal contents into the gastric lumen. Condition of the stomach and duodenum can be improved by relieving changes in the spine. PMID:2716242

Dmitriev, A E; Arapov, N A

1989-01-01

256

Effects of glucagon-like peptide-1(7-36)amide on antro-pyloro-duodenal motility in the interdigestive state and with duodenal lipid perfusion in humans  

PubMed Central

BACKGROUND—Glucagon-like peptide-1(7-36)amide (GLP-1) is a gut hormone released postprandially. Synthetic GLP-1 strongly inhibits gastric emptying in healthy subjects and in patients with diabetes mellitus.?AIMS—To investigate the effects of GLP-1 on antro-pyloro-duodenal motility in humans.?METHODS—Eleven healthy male volunteers were studied on two separate days. On the interdigestive study day, a basal period was followed by a 60 minute period of saline infusion and two further 60 minute periods of intravenous infusion of GLP-1 0.4 and 1.2 pmol/kg/min to achieve postprandial and supraphysiological plasma levels, respectively. On the postprandial study day, the same infusions were coadministered with intraduodenal lipid perfusion at 2.5 ml/min (2.5 kcal/min) followed by another 60 minutes of recording after cessation of GLP-1. Antro-pyloro-duodenal motility was measured by perfusion manometry.?RESULTS—GLP-1 significantly inhibited the number and amplitudes of antral and duodenal contractions in the interdigestive state and after administration of duodenal lipid. It abolished interdigestive antral wave propagation. In the interdigestive state, GLP-1 dose dependently increased pyloric tone and significantly stimulated isolated pyloric pressure waves (IPPW). Pyloric tone increased with duodenal lipid, and this was further enhanced by GLP-1. GLP-1 transiently restored the initial IPPW response to duodenal lipid which had declined with lipid perfusion. Plasma levels of pancreatic polypeptide were dose dependently diminished by GLP-1 with and without duodenal lipid.?CONCLUSIONS—GLP-1 inhibited antro-duodenal contractility and stimulated the tonic and phasic motility of the pylorus. These effects probably mediate delayed gastric emptying. Inhibition of efferent vagal activity may be an important mechanism. As postprandial plasma levels of GLP-1 are sufficient to appreciably affect motility, we believe that endogenous GLP-1 is a physiological regulator of motor activity in the antro-pyloro-duodenal region.???Keywords: GLP-1; gastrointestinal motility; pylorus; pancreatic polypeptide PMID:10764704

Schirra, J; Houck, P; Wank, U; Arnold, R; Goke, B; Katschinski, M

2000-01-01

257

Role of Subfascial Endoscopic Perforator Surgery (SEPS) in Management of Perforator Incompetence in Varicose Veins : A Prospective Randomised Study.  

PubMed

The study was carried out to compare the efficacy of subfascial endoscopic perforator surgery (SEPS) and open subfascial ligation of perforators in varicose veins. This study was conducted on 100 patients of varicose veins from January 2006 to December 2010. Clinical scoring and color Doppler were performed in all the patients before surgery. Patients were divided into two groups: Group A and Group B alternately. Management of the perforators was done by subfascial endoscopic perforator surgery (SEPS) in Group A and by open subfascial ligation of perforators in Group B. Fifty patients were treated in each group. All the patients underwent ligation of incompetent saphenofemoral junction with stripping of long saphenous veins wherever the junction was incompetent with multiple ligation of superficial prominent veins. SEPS was done by two-port method without any tourniquet or balloon dissector. Total numbers of perforators ligated were 178 in Group A and 136 in Group B. Patients in both the groups got symptomatic relief of symptoms, but ulcer healing in 33 % patients in Group A was faster as compared to Group B. However, at 3 months of follow-up the ulcers healed in all the patients in both groups. Incidence of wound infection was higher in group B (16 %) as compared to group A (0 %). There were residual perforators in 8 % of patients on color Doppler at 3 months of follow-up in Group B while there was no residual incompetent perforator in Group A. Subfascial endoscopic perforator vein surgery is a safe and effective method for treating incompetent perforating veins. The number of perforators ligated in SEPS was more as compared to the open subfascial ligation group. Possibly some perforators may be missed on Doppler localization and missed ligation, which may be a cause of future recurrence in varicose veins. Early relief of symptoms in terms of ulcer healing was better in the SEPS group with less wound complication rate; however, all the ulcers healed in both the groups at 3 months of follow-up. Cosmetic results were equal in both the groups. Major advantage of SEPS was less incidence of wound complications and less incidence of residual incompetent perforators. Hence, SEPS should be added for the management of perforators along with conventional surgery in varicose veins. PMID:24891775

Vashist, M G; Malik, Vijay; Singhal, Nitin

2014-04-01

258

Duodenal-Mucosal Bacteria Associated with Celiac Disease in Children  

PubMed Central

Celiac disease (CD) is an immune-mediated enteropathy triggered by the ingestion of cereal gluten proteins. This disorder is associated with imbalances in the gut microbiota composition that could be involved in the pathogenesis of CD. The aim of this study was to characterize the composition and diversity of the cultivable duodenal mucosa-associated bacteria of CD patients and control children. Duodenal biopsy specimens from patients with active disease on a gluten-containing diet (n = 32), patients with nonactive disease after adherence to a gluten-free diet (n = 17), and controls (n = 8) were homogenized and plated on plate count agar, Wilkins-Chalgren agar, brain heart agar, or yeast, Casitone, and fatty acid agar. The isolates were identified by partial 16S rRNA gene sequencing. Renyi diversity profiles showed the highest diversity values for active CD patients, followed by nonactive CD patients and control individuals. Members of the phylum Proteobacteria were more abundant in patients with active CD than in the other child groups, while those of the phylum Firmicutes were less abundant. Members of the families Enterobacteriaceae and Staphylococcaceae, particularly the species Klebsiella oxytoca, Staphylococcus epidermidis, and Staphylococcus pasteuri, were more abundant in patients with active disease than in controls. In contrast, members of the family Streptococcaceae were less abundant in patients with active CD than in controls. Furthermore, isolates of the Streptococcus anginosus and Streptococcus mutans groups were more abundant in controls than in both CD patient groups, regardless of inflammatory status. The findings indicated that the disease is associated with the overgrowth of possible pathobionts that exclude symbionts or commensals that are characteristic of the healthy small intestinal microbiota. PMID:23835180

Sánchez, Ester; Donat, Ester; Ribes-Koninckx, Carmen; Fernández-Murga, Maria Leonor

2013-01-01

259

Percutaneous Treatment of Iatrogenic Pseudoaneurysms by Cyanoacrylate-Based Wall-Gluing  

SciTech Connect

Purpose. Although the majority of iatrogenic pseudoaneurysms (PSAs) are amenable to ultrasound (US)-guided thrombin injection, patients with those causing neuropathy, claudication, significant venous compression, or soft tissue necrosis are considered poor candidates for this option and referred to surgery. We aimed to test the effectiveness and feasibility of a novel percutaneous cyanoacrylate glue (NBCA-MS)-based technique for treatment of symptomatic and asymptomatic iatrogenic PSA. Material and Methods. During a 3-year period, we prospectively enrolled 91 patients with iatrogenic PSA [total n = 94 (femoral n = 76; brachial n = 11; radial n = 6; axillary n = 1)]. PSA were asymptomatic in 66 % of cases, and 34 % presented with symptoms due to neuropathy, venous compression, and/or soft tissue necrosis. All patients signed informed consent. All patients received NBCA-MS-based percutaneous treatment. PSA chamber emptying was first obtained by US-guided compression; superior and inferior walls of the PSA chamber were then stuck together using NBCA-MS microinjections. Successfulness of the procedure was assessed immediately and at 1-day and 1-, 3-, and 12-month US follow-up. Results. PSA occlusion rate was 99 % (93 of 94 cases). After treatment, mean PSA antero-posterior diameter decrease was 67 {+-} 22 %. Neuropathy and vein compression immediately disappeared in 91 % (29 of 32) of cases. Patients with tissue necrosis (n = 6) underwent subsequent outpatient necrosectomy. No distal embolization occurred, nor was conversion to surgery necessary. Conclusion. PSA treatment by way of NBCA-MS glue injection proved to be safe and effective in asymptomatic patients as well as those with neuropathy, venous compression, or soft-tissue necrosis (currently candidates for surgery). Larger series are needed to confirm these findings.

Del Corso, Andrea, E-mail: adelcorso2000@hotmail.com [Universita di Pisa, Division of General and Vascular Surgery, Ospedale Cisanello (Italy); Vergaro, Giuseppe [Fondazione G. Monasterio CNR-Regione Toscana, Division of Cardiovascular Medicine (Italy)

2013-06-15

260

Management of an iatrogenic injury in a crossed ectopic kidney without fusion.  

PubMed

Crossed renal ectopia is a condition in which a kidney is located on the side opposite of its ureteral insertion. Ninety percent of crossed ectopic kidneys are fused to their ipsilateral uncrossed renal unit. Crossed renal ectopia without fusion is rare, with only 62 patients reported in the literature to date. These kidneys may suffer iatrogenic injury during an unrelated surgical intervention. The injury, unless self-limiting, may necessitate the removal of the ectopic kidney. We present a unique case of a dual injury, renal as well as ureteric, in a crossed ectopic kidney without fusion that was successfully managed without surgical excision. PMID:25132952

Jindal, Tarun; Kamal, Mir Reza; Mukherjee, Satyadip; Mandal, Soumendra Nath; Karmakar, Dilip

2014-08-01

261

Iatrogenic absence of maxillary canines: Bolton discrepancy treated with mandibular incisor extraction.  

PubMed

This case report describes the orthodontic treatment of an adult patient with iatrogenic absence of the maxillary canines, moderate maxillary and severe mandibular dental crowding, a Bolton discrepancy with a large mandibular anterior excess, a maxillary right lateral incisor crossbite, and Angle Class II molar relationships. The treatment consisted of fixed appliance therapy, mandibular incisor extraction, tooth bleaching, and dental recontouring. This method of treatment maintained the patient's good facial appearance, improved the dental esthetics, and provided a good functional occlusion, eliminating the arch length and Bolton discrepancies and providing a good outcome with minimal undesirable effects. PMID:23631973

Simão, Tassiana Mesquita; Valladares-Neto, José; Rino-Neto, José; de Paiva, João Batista

2013-05-01

262

Successful Endovascular Treatment of Iatrogenic Thyrocervical Trunk Pseudoaneurysm with Concomitant Arteriovenous Fistula Using 0.010-Inch Detachable Microcoils  

PubMed Central

Pseudoaneurysms (PsA) and arteriovenous fistulae (AVF) of the thyrocervical trunk and its branches are rare complications of traumatic or iatrogenic arterial injuries. Most such injuries are iatrogenic and are associated with central venous catheterization. Historically, thyrocervical trunk PsA and AVF have been managed with open surgical repair; however, multiple treatment modalities are now available, including ultrasound-guided compression repair, ultrasound-guided thrombin injection, and endovascular repair with covered stent placement. We report a case of a 65-year-old woman with an iatrogenic thyrocervical trunk PsA with concomitant AVF that developed after attempted internal jugular vein cannulation for hemodialysis access. The PsA was successfully treated by transcatheter coil embolization using 0.010-inch detachable microcoils. Our case is the first published instance of a thyrocervical trunk PsA with concomitant AVF that was successfully treated by endovascular procedure. PMID:25610701

Hamamoto, Kohei; Nakano, Mitsunori; Omoto, Kiyoka; Tsubuku, Masahiko; Chiba, Emiko; Okochi, Tomohisa; Matsuura, Katsuhiko; Tanaka, Osamu

2014-01-01

263

Hydrodynamics characterization of perforated plate flow passages  

SciTech Connect

Plates and screens are components in regenerator stacks whose thermal performance depends on the hydrodynamics of the flow. The present studies supplement transient runs of preceding screen work. Perforated plates with hole diameters on the order of 300 micrometer have been characterized hydrodynamically using gas flow and liquid nitrogen near atmospheric pressure. The data obtained are compared to dimensionless equations based on the Reynolds number containing the {open_quotes}Darcy length{close_quotes} (square root of permeability). The Reynolds number range extends from intermediate to turbulent flow rates (order of magnitude 1 to 100). The flow behavior observed qualitatively is in first order agreement with linear superposition equations, e.g. Reynolds-Forchheimer-Ergun equation. Quantitatively the effective permeability ratio is used which requires a turbulent friction factor which departs from the value 1.75 of the Ergun equation.

Shull, C.; Ravikumar, K.V.; Frederking, T.H.K. [Univ. of California, Los Angeles, CA (United States)

1994-12-31

264

Intrathoracic Caecal Perforation Presenting as Dyspnea  

PubMed Central

Introduction. Bochdalek hernia is a congenital defect of the diaphragm that is usually diagnosed in the neonatal period and incidentally in asymptomatic adults. Small bowel incarceration in a right-sided Bochdalek hernia is exceptional for an adult. Case Presentation. A 54-year-old woman was admitted for acute dyspnea, tachycardia, hypotension, and fever. Five days before, she had been experiencing an episode of diffuse abdominal pain. The admission chest X-ray was interpreted as right pleural effusion and pneumothorax with left mediastinal shift. Chest tube drainage was purulent. The thoracoabdominal CT examination suspected an intestinal incarceration through a right diaphragmatic defect. At laparotomy, a right-sided Bochdalek hernia was confirmed with a complete necrosis of the incarcerated caecum. Ileocaecal resection was performed, but the patient died from delayed septic complications. Conclusion. Intrathoracic perforation of the caecum is a rare occurrence; delayed diagnosis due to misleading initial symptoms may lead to severe complications and poor prognosis. PMID:21331329

Granier, Vincent; Coche, Emmanuel; Hantson, Philippe; Thoma, Maximilien

2010-01-01

265

Viscous damping of perforated planar micromechanical structures  

PubMed Central

The paper gives an analytical approximation to the viscous damping coefficient due to the motion of a gas between a pair of closely spaced fluctuating plates in which one of the plates contains a regular system of circular holes. These types of structures are important parts of many microelectromechanical devices realized in MEMS technology as microphones, microaccelerometers, resonators, etc. The pressure satisfies a Reynolds’ type equation with coefficients accounting for all the important effects: compressibility of the gas, inertia and possibly slip of the gas on the plates. An analytical expression for the optimum number of circular holes which assure a minimum value of the total damping coefficient is given. This value realizes an equilibrium between the squeeze-film damping and the viscous resistance of the holes. The paper also provides analytical design formulas to be used in the case of regular circular perforated plates. PMID:19365579

Homentcovschi, D.; Miles, R.N.

2008-01-01

266

Chronic diarrhea due to duodenal candidiasis in a patient with a history of kidney transplantation.  

PubMed

Candida infection in the small intestine is uncommon. We report an unusual case of duodenal candidiasis that presented as chronic diarrhea in a patient who had previously undergone kidney transplantation. A 60-year-old man presented with profuse watery diarrhea that had lasted 6 months 13 years after kidney transplantation. Upper gastrointestinal endoscopy results indicated candidiasis within the esophagus and duodenum. Biopsy results revealed active duodenitis with hyphal and yeast forms of Candida overlying the duodenal epithelium in periodic acid Schiff staining. The patient was successfully treated with fluconazole. After 6 months of follow-up, the patient had no complaint of diarrhea. Duodenal candidiasis may be the result of chronic diarrhea in patients with a history of kidney transplantation. PMID:25362226

Nouri-Majalan, Nader; Moghaddasi, Sarasadat; Qane, Mohammad Davud; Shefaie, Farzane; Masoumi Dehshiri, Roghayyeh; Amirbaigy, Mohammad Kassem; Baghbanian, Mahmoud

2014-11-01

267

The papilla of Vater just below the pylorus presenting as recurrent duodenal ulcer bleeding.  

PubMed

The papilla of Vater emptying into the duodenal bulb site is extremely rare and considered an aberrant condition. We report here a case with recurrent duodenal ulcer bleeding associated with this anomaly. A 42-year-old man was admitted to St. Mary Hospital because of tarry stool for three days. Despite no documented etiology to explain recurrent ulceration, the patient had about ten episodes of ulcer bleeding since 1995. On duodenoscopy, 1.0 x 0.6 cm sized active stage duodenal ulcer with oozing was observed at the posterior wall side below the pylorus. The papilla of Vater was bulging just below the pylorus. Bile juice was excreted from its opening. Pancreatic duct and common bile duct, which drained into the bulb site, were observed on ERCP. In this report, we show that recurrent duodenal ulcer can be associated with the papilla of Vater just below the pylorus. PMID:18025767

Sung, Hye Young; Kim, Jin Il; Park, Yong Bum; Cheung, Dae Young; Cho, Se Hyun; Park, Soo-Heon; Han, Joon-Yeol; Kim, Jae Kwang

2007-01-01

268

Laser-mediated perforation of plant cells  

NASA Astrophysics Data System (ADS)

The functional analysis of plant cells at the cellular and subcellular levels requires novel technologies for the directed manipulation of individual cells. Lasers are increasingly exploited for the manipulation of plant cells, enabling the study of biological processes on a subcellular scale including transformation to generate genetically modified plants. In our setup either a picosecond laser operating at 1064 nm wavelength or a continuous wave laser diode emitting at 405 nm are coupled into an inverse microscope. The beams are focused to a spot size of about 1.5 ?m and the tobacco cell protoplasts are irradiated. Optoporation is achieved when targeting the laser focal spot at the outermost edge of the plasma membrane. In case of the picosecond laser a single pulse with energy of about 0.4 ?J was sufficient to perforate the plasma membrane enabling the uptake of dye or DNA from the surrounding medium into the cytosol. When the ultraviolet laser diode at a power level of 17 mW is employed an irradiation time of 200 - 500 milliseconds is necessary to enable the uptake of macromolecules. In the presence of an EYFP encoding plasmid with a C-terminal peroxisomal signal sequence in the surrounding medium transient transformation of tobacco protoplasts could be achieved in up to 2% of the optoporated cells. Single cell perforation using this novel optoporation method shows that isolated plant cells can be permeabilized without direct manipulation. This is a valuable procedure for cell-specific applications, particularly where the import of specific molecules into plant cells is required for functional analysis.

Wehner, Martin; Jacobs, Philipp; Esser, Dominik; Schinkel, Helga; Schillberg, Stefan

2007-07-01

269

Evaluation of perforated and nonperforated appendicitis with CT.  

PubMed

Fifty-three patients with 38 cases of perforated appendicitis and 15 cases of appendicitis without perforation were evaluated based on the computed tomography (CT) appearances of appendiceal diameter, phlegmon, abscess, extraluminal air, appendiceal wall enhancement, lateroconal fascial thickening, appendicolith, bowel wall thickening, ascites, ileal wall enhancement, peritoneal enhancement, periappendiceal fluid, omental haziness, retrocecal appendix, intraluminal air, and the combination of intraluminal air and appendicolith. The result of appendiceal diameter was compared using two-sample Student's t test, and the other CT findings were analyzed by Fisher's Exact Test. Our results showed that appendix was larger in caliber in perforated appendix (P< .05). Direct CT signs (i.e., phlegmon, abscess, and extraluminal air) were more specific for perforated appendicitis (P< .05). Indirect signs (bowel wall thickening, ascites, ileal wall enhancement, intraluminal air, and combined intraluminal air and appendicolith) were also found in higher incidence in appendiceal perforation (P< .05). Appendiceal enlargement and ileal wall enhancement were the two predominant findings in one case of perforation. We concluded that direct and indirect CT appearances can differentiate appendicitis with and without perforation. Indirect signs may be helpful in difficult case. PMID:15531143

Yeung, Kwok-Wan; Chang, Ming-Sung; Hsiao, Chao-Peng

2004-01-01

270

Gallbladder perforation: A rare complication of enteric fever?  

PubMed Central

INTRODUCTION Gallbladder perforation is a rare complication of acute calculous cholecystitis in adults. Perforation of gallbladder due to enteric fever is extremely rare condition. Pre-operative diagnosis is rarely made and mortality is high. PRESENTATION OF CASE We report a case of acalculous gallbladder perforation following enteric fever in a 14-year-old boy, who presented as acute abdomen and responded very well after emergency laparotomy and cholecystectomy. DISCUSSION Enteric fever is common in tropics and a common cause of bowel perforation. Acute cholecystitis is a rare complication of typhoid and gallbladder perforation is extremely rare complication. Ultrasound and CT lack specificity to detect gallbladder perforation. Diagnosis is usually made intra-operatively. Cholecystectomy is treatment of choice in such cases and provides good result. CONCLUSION Gallbladder perforation secondary to enteric fever requires a high degree of clinical suspicion. In typhoid endemic region, it should be considered as a differential diagnosis in patient presenting with a history of prolonged fever and signs of peritonitis. Early diagnosis and immediate surgical intervention are very important in reducing the morbidity and mortality. Cholecystectomy is the choice with a good outcome. PMID:24441441

Singh, Mahendra; Kumar, Lovekesh; Singh, Rashpal; Jain, Aaron K.; Karande, Snehal K.; Saradna, Arjun; Prashanth, U.

2013-01-01

271

Characterization of secretin release in secretin cell-enriched preparation isolated from canine duodenal mucosa  

Microsoft Academic Search

The release of secretin was studied in secretin cell-enriched preparations isolated from canine duodenal mucosa. The crude enterocytes were isolated by treating the duodenal mucosa sequentially with collagenase and ethylenediaminetetraacetic acid. Secretin cell-enriched fraction was prepared by centrifugation of the crude enterocytes in a counterflow elutriation rotor to obtain a final preparation containing 3.2±0.3 pmol\\/106 cell of immunoreactive secretin, which

Weijian Sue; William Y. Chey; Qi Sun; Ta-Min Chang

1993-01-01

272

Urinary excretion of duodenal purine derivatives in Kedah-Kelantan cattle  

Microsoft Academic Search

Three male Kedah-Kelantan (KK) cattle each fitted with a ruminal and a T-shaped duodenal cannulae, with an initial body weight of 178.3±5.78kg were used to study the recovery rate of urinary purine derivatives (PD) after duodenal infusion of incremental amounts of purine bases (PB). During the experiment, the cattle were fed at a maintenance energy level with a diet containing

O Pimpa; J. B Liang; Z. A Jelan; N Abdullah

2001-01-01

273

Septic Complication After Balloon-Occluded Retrograde Transvenous Obliteration of Duodenal Variceal Bleeding  

SciTech Connect

We report a 64-year-old woman with duodenal varices who underwent balloon-occluded retrograde transvenous obliteration (B-RTO) complicated by intraprocedural variceal rupture. The patient developed shivering and a fever higher than 40{sup o}C 3 days after the B-RTO procedure. A blood culture grew Entereobacter cloacoe. This case represents a rare septic complication of B-RTO for duodenal varices.

Akasaka, Thai; Shibata, Toshiya, E-mail: ksj@kuhp.kyoto-u.ac.jp; Isoda, Hiroyoshi [Kyoto University Graduate School of Medicine, Department of Radiology (Japan); Taura, Kojiro [Kyoto University Graduate School of Medicine, Department of Surgery (Japan); Arizono, Shigeki; Shimada, Kotaro; Togashi, Kaori [Kyoto University Graduate School of Medicine, Department of Radiology (Japan)

2010-12-15

274

Spontaneous Reversibility of an Iatrogenic Orthodontic Elastic Band-induced Localized Periodontitis Following Surgical Intervention - Case Report.  

PubMed

Orthodontic elastic bands are an important iatrogenic etiologic factor in the causation of periodontal attachment apparatus breakdown. Appropriate diagnosis and a well constructed treatment plan tailor-made to suit the requirements of the particular patient is imperative for management of periodontal lesions induced by subgingival retention of rubber band. There are conflicting reports regarding the reattachment and regeneration of lost periodontal supporting tissues in such cases. The present case report highlights the spontaneous reversal and correction of periodontal destruction due to iatrogenic orthodontic elastic band displacement deep into the subgingival tissues. PMID:23613652

Nettem, Sowmya; Kumar Nettemu, Sunil; Kumar, Kiran; Reddy, Venkat; Siva Kumar, Pendyala

2012-10-01

275

Neuroendocrinology of gastric H+ and duodenal HCO3- secretion: the role of brain-gut axis.  

PubMed

Gastric H+ and duodenal HCO3- secretions are precisely regulated by neuro-hormonal mechanisms at central and peripheral levels to match the rate of these secretions with the type of stimulation of sensory receptors in the head area (sight, smell, taste, etc.) and in the gastro-intestinal system. Two-way communication pathways operate between the brain and the gut, each comprising afferent fibers signaling sensory information from the gut to the brain and efferent fibers transmitting signals in opposite direction. Short intramural and long extramural reflexes are triggered as well as various gut hormones are released by feeding that "cooperate" with the "brain-gut axis" in the alteration of exocrine and endocrine gastro-duodenal secretion, motility and blood circulation. The malfunction of gastric or duodenal secretory mechanisms may lead to disturbances of gastric H+-pepsin or duodenal mucus-HCO3- secretion and to gastro-duodenal disorders and diseases. This review presents recent advances in pathophysiological mechanisms underlying gastro-duodenal secretory disorders. PMID:15363947

Konturek, Peter C; Konturek, Stanislaw J; Ochma?ski, Wladyslaw

2004-09-19

276

Laparoscopic and endoscopic cooperative surgery for duodenal neuroendocrine tumor (NET) G1: Report of a case  

PubMed Central

INTRODUCTION We report a case of duodenal neuroendocrine tumor (NET) G1 resected by laparoscopic and endoscopic cooperative surgery (LECS) technique. PRESENTATION OF CASE A 58-year-old woman underwent esophagastroduodenoscopy, revealing an 8-mm, gently rising tumor distal to the pylorus, on the anterior wall of the duodenal bulb. Endoscopic ultrasonography suggested the tumor might invade the submucosal layer. The tumor was pathologically diagnosed as a G1 duodenal NET, by biopsy. Endoscopic submucosal dissection was attempted, but was unsuccessful because of the difficulty of endoscopically performing an inversion operation in the narrow working space. The case was further complicated by the patient's duodenal ulcer scar. We performed a full-thickness local excision using laparoscopic and endoscopic cooperative surgery. The tumor was confirmed and endoscopically marked along the resection line. After full-thickness excision, using endoscopy and laparoscopy, interrupted full-thickness closure was performed laparoscopically. DISCUSSION Endoscopic treatment is generally recommended for G1 NETs <10 mm in diameter and extending only to the submucosal layer. However, some cases are difficult to resect endoscopically because the wall of duodenum is thinner than that of stomach, and endoscope maneuverability is limited within the narrow working space. LECS is appropriate for early duodenal G1 NETs because they are less invasive and resection of the lesion area is possible. CONCLUSION We demonstrated that LECS is a safe and feasible procedure for duodenal G1 NETs in the anterior wall of the first portion of the duodenum. PMID:25460463

Tsushimi, Takaaki; Mori, Hirohito; Harada, Takasuke; Nagase, Takashi; Iked, Yoshitaka; Ohnishi, Hiromo

2014-01-01

277

Time to Appendectomy and Risk of Perforation in Acute Appendicitis  

PubMed Central

IMPORTANCE In the traditional model of acute appendicitis, time is the major driver of disease progression; luminal obstruction leads inexorably to perforation without timely intervention. This perceived association has long guided clinical behavior related to the timing of appendectomy. OBJECTIVE To evaluate whether there is an association between time and perforation after patients present to the hospital. DESIGN, SETTING, AND PARTICIPANTS Using data from the Washington State Surgical Care and Outcomes Assessment Program (SCOAP), we evaluated patterns of perforation among patients (?18 years) who underwent appendectomy from January 1, 2010, to December 31, 2011. Patients were treated at 52 diverse hospitals including urban tertiary centers, a university hospital, small community and rural hospitals, and hospitals within multi-institutional organizations. MAIN OUTCOMES AND MEASURES The main outcome of interest was perforation as diagnosed on final pathology reports. The main predictor of interest was elapsed time as measured between presentation to the hospital and operating room (OR) start time. The relationship between in-hospital time and perforation was adjusted for potential confounding using multivariate logistic regression. Additional predictors of interest included sex, age, number of comorbid conditions, race and/or ethnicity, insurance status, and hospital characteristics such as community type and appendectomy volume. RESULTS A total of 9048 adults underwent appendectomy (15.8% perforated). Mean time from presentation to OR was the same (8.6 hours) for patients with perforated and nonperforated appendicitis. In multivariate analysis, increasing time to OR was not a predictor of perforation, either as a continuous variable (odds ratio = 1.0 [95% CI, 0.99-1.01]) or when considered as a categorical variable (patients ordered by elapsed time and divided into deciles). Factors associated with perforation were male sex, increasing age, 3 or more comorbid conditions, and lack of insurance. CONCLUSIONS AND RELEVANCE There was no association between perforation and in-hospital time prior to surgery among adults treated with appendectomy. These findings may reflect selection of those at higher risk of perforation for earlier intervention or the effect of antibiotics begun at diagnosis but they are also consistent with the hypothesis that perforation is most often a prehospital occurrence and/or not strictly a time-dependent phenomenon. These findings may also guide decisions regarding personnel and resource allocation when considering timing of nonelective appendectomy. PMID:24990687

Drake, Frederick Thurston; Mottey, Neli E.; Farrokhi, Ellen T.; Florence, Michael G.; Johnson, Morris G.; Mock, Charles; Steele, Scott R.; Thirlby, Richard C.; Flum, David R.

2014-01-01

278

Acute appendicitis in the elderly: risk factors for perforation  

PubMed Central

Background Acute appendicitis is the most common surgical emergency and becomes serious when it perforates. Perforation is more frequent in the elderly patients. The aim of this study was to identify the risk factors of perforation in elderly patients who presented with acute appendicitis. Methodology The medical records of 214 patients over the age of 60 years who had a pathologically confirmed diagnosis of acute appendicitis over a period of 10 years (2003-2013) were retrospectively reviewed. Patients were grouped into those with perforated and those with nonperforated appendicitis. Comparison was made between both groups in regard to demography, clinical presentation, and time delay to surgery, diagnosis, hospital stay and postoperative complications. Clinical assessment, Ultrasonography and Computerized tomography, in that order, were used for diagnosis. The incidence of perforation was also compared with a previous report from the same region 10 years earlier. Results During the study period, a total of 214 patients over the age of 60 years had acute appendicitis, 103 males and 111 females. Appendix was found perforated in 87 (41%) patients, 46 (53%) males and 41 (47%) females. Of all patients, 31% were diagnosed by clinical assessment alone, 40% needed US and 29% CT scan. Of all the risk factors studied, the patient’s pre-hospital time delay was the most important risk factor for perforation. Perforation rate was not dependent on the presence of comorbid diseases or in-hospital time delay. Post operative complications occurred in 44 (21%) patients and they were three times more common in the perforated group, 33 (75%) patients in the perforated and 11 (25%) in the nonperforated group. There were 6 deaths (3%), 4 in the perforated and 2 in the nonperforated group. Conclusion Acute appendicitis in elderly patients is a serious disease that requires early diagnosis and treatment. Appendiceal Perforation increases both mortality and morbidity. All elderly patients presented to the hospital with abdominal pain should be admitted and investigated. The early use of CT scan can cut short the way to the appropriate treatment. PMID:24428909

2014-01-01

279

Laparoscopic appendectomy for perforated appendicitis: a comparison with open appendectomy  

Microsoft Academic Search

Background  The role of laparoscopic appendectomy for perforated appendicitis remains controversial. This study aimed to compare laparoscopic\\u000a and open appendectomy outcomes for children with perforated appendicitis.\\u000a \\u000a \\u000a \\u000a Methods  Over a 36-month period, 111 children with perforated appendicitis were analyzed in a retrospective review. These children\\u000a were treated with either laparoscopic (n = 59) or open appendectomy. The primary outcome measures were operative time,

A. Yagmurlu; A. Vernon; D. C. Barnhart; K. E. Georgeson; C. M. Harmon

2006-01-01

280

Prophylactic Phenylephrine for Iatrogenic Priapism: A Pilot Study With Peyronie's Patients  

PubMed Central

Purpose Although penile duplex Doppler ultrasonography (PDDU) is a common and integral procedure in a Peyronie's disease workup, the intracavernosal injection of vasoactive agents can carry a serious risk of priapism. Risk factors include young age, good baseline erectile function, and no coronary artery disease. In addition, patients with Peyronie's disease undergoing PDDU in an outpatient setting are at increased risk given the inability to predict optimal dosing. The present study was conducted to provide support for a standard protocol of early administration of phenylephrine in patients with a sustained erection after diagnostic intracavernosal injection of vasoactive agents to prevent the deleterious effects of iatrogenic priapism. Materials and Methods This was a retrospective review of Peyronie's disease patients who received phenylephrine reversal after intracavernosal alprostadil (prostaglandin E1) administration to look at the priapism rate. Safety was determined on the basis of adverse events reported by subjects and efficacy was determined on the basis of the rate of priapism following intervention. Results Patients with Peyronie's disease only had better hemodynamic values on PDDU than did patients with Peyronie's disease and erectile dysfunction. All of the patients receiving prophylactic phenylephrine had complete detumescence of erections without adverse events, including no priapism cases. Conclusions The reversal of erections with phenylephrine after intracavernosal injections of alprostadil to prevent iatrogenic priapism can be effective without increased adverse effects. PMID:25324950

Jiang, Pengbo; Christakos, Athena; Fam, Mina

2014-01-01

281

[Endonasal treatment of iatrogenic or spontaneous cerebrospinal rhinorrhea of the anterior cranial fossa].  

PubMed

There is a 25% risk of meningitis in case of cerebrospinal fluid rhinorrhea from the anterior cranial fossa. Treatment usually is based on neurosurgery when medical management is unsuccessful. The risk of morbidity and mortality in such operations is important and recurrence is observed in 25% of the cases. The development of endonasal surgery has increased the incidence of iatrogenic breaches but has also allowed the development of new techniques for closing breaches. Certain authors recently published a recent series of patients treated via the endonasal route. We present here six cases of cerebrospinal fluid rhinorrhoea from the anterior cranial fossa treated at the Foch Hospital. Etiology was iatrogenic in 4 cases, trauma in 1 and spontaneous in 1. The operative technique and mid-term results are presented. Cure was achieved in all cases after a mean follow-up of 2 years. One patient with osteopetrosis of the cranial floor who underwent neurosurgical decompression of the optic nerve complained of recurrent rhinorrhoea which could not be confirmed by endoscopy nor by imaging. Early endoscopic treatment of cerebrospinal fluid rhinorrhoea should be the first intention option as it preserves olfactive function, limits operative morbidity and mortality and leaves open the option of neurosurgery in case of failure. PMID:8729399

Coiffier, T; Cabanes, J; Visot, A; Dupuy, M; Freche, C; Chabolle, F

1995-01-01

282

Metachronous adrenal metastasis from operated contralateral renal cell carcinoma with adrenalectomy and iatrogenic Addison's disease.  

PubMed

Metachronous adrenal metastasis from contralateral renal cell carcinoma (RCC) surgery is an extremely rare condition. Iatrogenic Addison's disease occurring after metastasectomy (adrenalectomy) is an even rarer clinical entity. We present a case of a 68-year-old male with hematuria and left flank pain 9 years prior. The patient underwent left transperitoneal radical nephrectomy involving the ipsilateral adrenal glands due to a centrally-located, 75-mm in diameter solid mass lesion in the upper pole of the left kidney. The tumour lesion was confined within the renal capsule, and the histo-pathological examination revealed a Fuhrman nuclear grade II clear cell carcinoma. The patient underwent transperitoneal right adrenalectomy. The histopathological examination revealed metastasis of clear cell carcinoma. The patient was diagnosed with iatrogenic Addison's disease based on the measurement of serum cortisol levels and the adrenocorticotropic hormone (ACTH) stimulation test, after which glucocorticoid and mineralocorticoid replacement was initiated. The patient did not have local recurrence or new metastasis in the first year of the follow-up. The decision to perform ipsilateral adrenalectomy during radical nephrectomy constitutes a challenge, and the operating surgeon must consider all these rare factors. PMID:25408818

Ozturk, Hakan; Karaaslan, Serap

2014-09-01

283

Clinical outcome of simultaneous self-expandable metal stents for palliation of malignant biliary and duodenal obstruction  

Microsoft Academic Search

  Background: Previous studies have shown that self-expanding metal stents are an effective method for palliation of malignant\\u000a biliary or duodenal obstruction. We present our experience with the use of simultaneous self-expandable metal stents for palliation\\u000a of malignant biliary and duodenal obstruction. Methods: We performed a retrospective review of all patients undergoing simultaneous\\u000a biliary and duodenal self-expandable metal stent placement between

M. Kaw; S. Singh; H. Gagneja

2003-01-01

284

Gastrointestinal perforation associated with endoscopy in cats and dogs.  

PubMed

Gastrointestinal endoscopy is a minimally invasive diagnostic tool for cats and dogs with signs of gastrointestinal disease. This retrospective study examined the case records of six cats and one dog diagnosed with perforation secondary to gastrointestinal endoscopy. Gastrointestinal perforation occurred in 1.6% of cats and 0.1% of dogs that underwent endoscopy during the 17 yr study period (from 1993 to 2010). It can be difficult to predict what animals are at risk for gastrointestinal perforation but possible risk factors suggested by this study include small intestinal infiltrative disease in cats and preexisting gastrointestinal ulceration in both cats and dogs. Overall, gastrointestinal endoscopy is associated with a low rate of gastrointestinal perforation. PMID:25028434

Irom, Sara; Sherding, Robert; Johnson, Susan; Stromberg, Paul

2014-01-01

285

Pulmonary Artery Perforation Repair During Thrombectomy Using Microcoil Embolization  

SciTech Connect

A distal pulmonary artery perforation was successfully occluded by percutaneous microcoil embolization via a microcatheter. Microcoil embolization is a reasonable alternative therapeutic approach for this rare complication of pulmonary interventional procedures.

Tajima, Hiroyuki, E-mail: h-tajima@nms.ac.jp; Murata, Satoru; Kumazaki, Tatsuo; Abe, Yutaka; Takano, Teruo [Nippon Medical School, Department of Radiology/Center for Advanced Medical Technology, and Department of Internal Medicine I (Japan)

2006-02-15

286

Kyrle Disease and Acquired Perforating Collagenosis Secondary to Chronic Renal Failure and Diabetes Mellitus  

PubMed Central

A 59-year-old man with chronic renal failure and diabetes mellitus presented with pruritic crusted lesions which histologically were perforating disorders, showing features of both Kyrle disease and acquired perforating collagenosis. The mechanisms of transepidermal elimination and the classification of perforating disorders are briefly discussed. Additionally, we question the concept of perforation, as epidermal damage and exposure of subepidermal substances may artificially present as perforation. PMID:22087093

Schreml, Stephan; Hafner, Christian; Eder, Fabian; Landthaler, Michael; Burgdorf, Walter; Babilas, Philipp

2011-01-01

287

The rat endovascular perforation model of subarachnoid hemorrhage.  

PubMed

The rat endovascular perforation model is considered the closest replica of human condition. Since its development, this model has been extensively used to study early brain injury after subarachnoid hemorrhage (SAH). However, like any other animal model, it has advantages and limitations. The following is a brief review of the rat endovascular perforation SAH model. One section is dedicated to technical considerations that can be used to overcome the model limitations. PMID:25366645

Sehba, Fatima A

2015-01-01

288

Transient response of perforated plate matrix heat exchangers  

NASA Astrophysics Data System (ADS)

Perforated plate matrix heat exchangers are used in a number of applications such as helium liquefiers, Joule-Thompson cryocoolers operating with pure fluids and mixtures, etc. The time taken for cool down of cryocoolers is very critical in many applications, for example, those used in mobile applications (e.g. missiles). In this paper we study the effect of different parameters on the transient response of perforated plate matrix heat exchangers.

Ramesh, P.; Venkatarathnam, G.

289

Iatrogenic salivary duct injury in head and neck cancer patients: Report of four cases and review of the literature  

PubMed Central

Introduction: The lesions of the salivary ducts may be idiopathic, post- traumatic, or iatrogenic and lead to sialocele formation with persistent painful facial swelling or cutaneous fistula formation. No consensus on treatment of this condition exists: the options of treatment include needle aspiration, pressure dressings, antisialogogue therapy, radiotherapy, botulinum toxin and surgical approaches as duct repair, diversion, ligation, different drainage systems and even parotidectomy/submaxilectomy. The management and special features of iatrogenic salivary duct injury in patients with oral cancer who underwent head and neck reconstructive surgery has not been described yet. Material and Methods: We present four cases of iatrogenic lesions of salivary ducts and its management in patients with oral cancer. Conclusions: The iatrogenic lesions of salivary ducts are to be taken into account in patients with oral cancer as the distal ends of salivary ducts could be involved in the margins of surgical resection. Different options of treatment of this complication are described. Key words:Sialocele, oral cancer, salivary duct. PMID:25136433

Kulyapina, Alena; Ochandiano-Caicoya, Santiago; Navarro-Cuellar, Carlos; Navarro-Vila, Carlos

2014-01-01

290

Validity and generalizability of the Withdrawal Assessment Tool1 (WAT1) for monitoring iatrogenic withdrawal syndrome in pediatric patients  

Microsoft Academic Search

Critically ill pediatric patients frequently receive prolonged analgesia and sedation to provide pain relief and facilitate intensive care therapies. Iatrogenic withdrawal syndrome occurs when these drugs are stopped abruptly or weaned too rapidly. We investigated the validity and generalizability of the Withdrawal Assessment Tool-1 (WAT-1) in children during weaning of analgesics and sedatives. Of 308 children initially supported on mechanical

Linda S. Franck; Lisa A. Scoppettuolo; David Wypij; Martha A. Q. Curley

291

Perforator propeller flaps for sacral and ischial soft tissue reconstruction  

PubMed Central

The perforator-based flaps in the sacral and ischial region is designed according to the localization of perforators that penetrate the gluteus maximus muscle, reach the intra-fascial and supra-fascial planes with the overlying skin forming a rich vascular plexus. The perforator-based flaps described in this article are highly vascularized, have minimal donor site morbidity, and do not require the sacrifice of the gluteus maximus muscle. In a period between April 2008 and March 2009, six patients with sacral pressure sore were reconstructed with propeller flap method based on superior gluteal and parasacral artery perforators. One flap loss was noted. Three cases of ischial pressure sore were reconstructed with longitudinal propeller flap cover, based on inferior gluteal artery perforator. One flap suffered wound infection and dehiscence. Two cases of pilonidal sinus were reconstructed with propeller flap based on parasacral perforators. Both the flaps survived without any complications. Donor sites were closed primarily. In the light of this, they can be considered among the first surgical choices to re-surface soft tissue defects of the sacral and ischial regions. In the series of 11 patients, two patients (18%) suffered complications. PMID:21217972

Korambayil, Pradeoth M.; Allalasundaram, KV; Balakrishnan, TM

2010-01-01

292

Delayed Diagnosis of Pharyngeal Perforation following Exploding Tyre Blast Barotrauma  

PubMed Central

Introduction. Pharyngoesophageal perforation secondary to barotrauma is a rare phenomenon that can have serious complications if identified late. It is challenging to detect due to nonspecific symptoms. We present a case in which detection proved difficult leading to delayed diagnosis. Case Report. A 27-year-old mechanic presented with haemoptysis, dysphonia, and odynophagia after a car tyre exploded in his face. Flexible nasoendoscopy (FNE) revealed blood in the pharynx, thought to represent mucosal haemorrhage. Initial treatment consisted of IV dexamethasone and antibiotics. After 3 days, odynophagia persisted prompting a CT scan. This revealed a defect in the posterior hypopharynx and surgical emphysema in the deep neck tissues. Contrast swallow confirmed posterior hypopharyngeal leak. NG feeding was commenced until repeated contrast swallow confirmed resolution of the defect. Discussion. Prompt nonsurgical management of pharyngoesophageal perforation has good outcomes but untreated perforation can have serious complications. FNE should be performed routinely, but only a contrast swallow can diagnose a functional perforation. Clinicians should have a high index of clinical suspicion when patients present with barotrauma and odynophagia. Patients should be kept nil by mouth until perforation has been excluded. Conclusion. When faced with cases of facial barotrauma, clinicians should have a low threshold for further imaging to exclude pharyngoesophageal perforation. PMID:25525540

Field, Samantha M.; Manjaly, Joseph G.; Ramdoo, S. Krishan; Jones, Huw A. S.; Tatla, Taran S.

2014-01-01

293

Breast reconstruction using the lateral femoral circumflex artery perforator flap.  

PubMed

The development of microsurgical breast reconstruction has resulted in not only the lower abdomen as a source of donor site tissue but also interest in alternative donor sites. These have included perforator-based flaps at the sites of previously described myocutaneous flaps (e.g., superior or inferior gluteal arteries) and the use of myocutaneous flaps not previously used for breast reconstruction (e.g., gracilis or transverse upper gracilis). We present our experience with a unique form of the tensor fascia lata flap and describe the first reported use of the lateral femoral circumflex artery (LFCA) perforator flap for breast reconstruction. A patient with minimal abdominal fat but lipodystrophy of the upper lateral thighs presented for breast reconstruction. Perforator flaps based on the lateral femoral circumflex vessels were designed. The LFCA perforator flap from one side was successfully used for breast reconstruction. The flap on the contralateral side did not have a suitable perforator. The LFCA perforator flap offers another option for women seeking autogenous breast reconstruction. Advances in preoperative imaging will likely make this a more reliable option. PMID:21766271

Kind, Gabriel M; Foster, Robert D

2011-09-01

294

Melatonin inhibits alcohol-induced increases in duodenal mucosal permeability in rats in vivo.  

PubMed

Increased intestinal permeability is often associated with epithelial inflammation, leaky gut, or other pathological conditions in the gastrointestinal tract. We recently found that melatonin decreases basal duodenal mucosal permeability, suggesting a mucosal protective mode of action of this agent. The aim of the present study was to elucidate the effects of melatonin on ethanol-, wine-, and HCl-induced changes of duodenal mucosal paracellular permeability and motility. Rats were anesthetized with thiobarbiturate and a ~30-mm segment of the proximal duodenum was perfused in situ. Effects on duodenal mucosal paracellular permeability, assessed by measuring the blood-to-lumen clearance of ?¹Cr-EDTA, motility, and morphology, were investigated. Perfusing the duodenal segment with ethanol (10 or 15% alcohol by volume), red wine, or HCl (25-100 mM) induced concentration-dependent increases in paracellular permeability. Luminal ethanol and wine increased, whereas HCl transiently decreased duodenal motility. Administration of melatonin significantly reduced ethanol- and wine-induced increases in permeability by a mechanism abolished by the nicotinic receptor antagonists hexamethonium (iv) or mecamylamine (luminally). Signs of mucosal injury (edema and beginning of desquamation of the epithelium) in response to ethanol exposure were seen only in a few villi, an effect that was histologically not changed by melatonin. Melatonin did not affect HCl-induced increases in mucosal permeability or decreases in motility. Our results show that melatonin reduces ethanol- and wine-induced increases in duodenal paracellular permeability partly via an enteric inhibitory nicotinic-receptor dependent neural pathway. In addition, melatonin inhibits ethanol-induced increases in duodenal motor activity. These results suggest that melatonin may serve important gastrointestinal barrier functions. PMID:23639810

Sommansson, Anna; Saudi, Wan Salman Wan; Nylander, Olof; Sjöblom, Markus

2013-07-01

295

Neonatal gastric perforation: A single center experience  

PubMed Central

AIM: To determine the etiology and prognostic factors for neonatal gastric perforation (NGP), a rare but life-threatening disease. METHODS: Between 1980 and 2011, nine patients underwent surgical intervention for NGP at Seoul National University Children’s Hospital. The characteristics and prognosis of the patients were retrospectively analyzed. RESULTS: Among the nine patients, three (33.3%) were preterm babies and five (55.5%) had associated anomalies, which included diaphragmatic eventration (n = 2), congenital diaphragmatic hernia, esophageal atresia with tracheoesophageal fistula, and antral web. Three (33.3%) patients were born before 1990 and three (33.3%) had a birth weight < 2500 g. Pneumoperitoneum was found on preoperative images in six (66.7%) patients, and incidentally in the other three (33.3%) patients. Surgery was performed within 24 h after the onset of symptoms in seven (77.8%) patients. The overall mortality rate was 22.2% (2/9). The time between symptoms and surgical intervention was the only prognostic factor for survival, whereas premature birth and birth weight were not. CONCLUSION: Early detection and advances in neonatal intensive care may improve the prognosis of NGP. PMID:25161763

Byun, Jeik; Kim, Hyun Young; Noh, Seung Yeon; Kim, Soo Hong; Jung, Sung Eun; Lee, Seong Cheol; Park, Kwi Won

2014-01-01

296

A hypervelocity projectile launcher for well perforation  

SciTech Connect

Current oil well perforation techniques use low- to medium-velocity gun launchers for completing wells in soft rock. Shaped-charge jets are normally used in harder, more competent rock. A device to create a much higher velocity projectile was designed. This launcher will provide an alternative technique to be used when the conventional devices do not yield the maximum well performance. It is an adaptation of the axial cavity in a high explosive (HE) annulus design, with the axial cavity being filled with a low density foam material. Two configurations were tested; both had an HE annulus filled with organic foam, one had a projectile. Comparison of the two shots was made. A time sequence of Image Intensifier Camera photographs and sequential, orthogonal flash x-ray radiographs provided information on the propagation of the foam fragments, the first shock wave disturbance, the projectile motion and deformation, and the direct shock wave transmission from the main HE charge. DYNA2D calculations were made to assist in the experimental interpretation. 25 refs., 9 figs.

Albright, J.N.; Fugelso, L.E.; Lagner, G.C.; Burns, K.L.

1989-01-01

297

The effects of plate thickness and perforation diameter on the supporting vapor velocity for a perforated plate fractionating column  

E-print Network

. Supporting Velocity versus Liquid Iiei'ht by Dif. eront Definitions. 6A. Supporting Velocity versus Perforation ziamoter with Four Inohes of Water on the Plate 27 63. Supportin. Velocity versus Perforation Diameter with o. ' Inches oi' iqater on *he...- tion Diameters oith Two Inches of i'ater or. the Plate?. . . . . . . , 12. Supporting Velocity versus Plate Thickness i' or Licuids of 36 37 Various Surface Tensions. 13. Supporting Velocity versus Plate Thickness for Liquid. s of Page Various...

Cottle, John Ernest

1948-01-01

298

Embolization of Iatrogenic Vascular Injuries of Renal Transplants: Immediate and Follow-Up Results  

SciTech Connect

Purpose: To evaluate the outcome in seven patients in whom iatrogenic vascular complications were treated with catheter embolization. Methods: Angiography showed an arteriovenous fistula in six of the seven patients, a pseudoaneurysm in three patients, and an arteriocaliceal fistula in three patients. Embolization was performed with GAW coils or microcoils in all cases. In three patients enbucrilate, polyvinyl alcohol, or absorbable gelatin powder was administered as an adjunct to the coils. Results: Angiographic success with total occlusion of the vascular injury was achieved in five of the seven patients and clinical success was achieved in four of seven cases. In two cases, nephrectomy after embolization was necessary because of renal artery occlusion or acute hemorrhage at the renal artery anastomosis, respectively. Infarction of 30%-50% of the renal parenchyma was seen in two cases. Conclusion: Angiographically successful embolization is not necessarily associated with clinical success. The complication rate is high.

Dorffner, Roland; Thurnher, Siegfried; Prokesch, Rupert; Bankier, Alexander; Turetschek, Karl [Department of Radiology, University of Vienna, AKH, Waehringer Guertel 18-20, A-1090 Vienna (Austria); Schmidt, Alice [Department of Nephrology, University of Vienna, AKH, Waehringer Guertel 18-20, A-1090 Vienna (Austria); Lammer, Johannes [Department of Radiology, University of Vienna, AKH, Waehringer Guertel 18-20, A-1090 Vienna (Austria)

1998-03-15

299

Iatrogenic angioedema associated with ACEi, sitagliptin, and deficiency of 3 enzymes catabolizing bradykinin.  

PubMed

New concepts of idiopathic and iatrogenic angioedema underline the role of bradykinin, and the importance of catabolizing enzymes. A case is described of Angiotensin converting enzyme inhibitor (ACEi) and sitagliptin induced angioedema, where AO attacks decreased after the withdrawal of lisinopril but resolved only after the withdrawal of sitagliptin, an inhibitor of dipeptylpeptidase IV. ACE, aminopeptidase P and carboxypeptidase N were decreased down to 17%, 42%, 64% of median references values, and remained low one year after the interruption of these drugs: 56%, 28% and 50%, respectively. The combined deficiency of APP and CPN might enhance the inhibiting effect of the DPP IV inhibitor. The fact that this triple deficiency remained latent before and after the treatment indicates that searching for latent enzyme deficiencies should be carried out when there is intention to treat with a combination of drugs interfering with the bradykinin metabolism. PMID:24853572

Beaudouin, E; Defendi, F; Picaud, J; Drouet, C; Ponard, D; Moneret-Vautrin, D A

2014-05-01

300

Deep anterior lamellar keratoplasty for the management of iatrogenic keratectasia occurring after hexagonal keratotomy  

PubMed Central

Iatrogenic keratectasia has been reported subsequent to refractive surgery or trauma. Hexagonal keratotomy (HK) is a surgical incisional technique to correct hyperopia. A number of complications have been reported following this procedure, including irregular astigmatism, wound healing abnormalities and corneal ectasia. When visual acuity is poor because of ectasia or irregular astigmatism and contact lens fitting is not possible, penetrating or lamellar keratoplasty can be performed. Since incisions in refractive keratotomy are set at 90–95% depth of cornea, intraoperative microperforations are known to occur and lamellar keratoplasty may become difficult. We describe deep anterior lamellar keratoplasty (DALK) used to successfully manage keratectasia after HK. Pre DALK vision was 20/400 and post DALK vision was 20/30 two months after surgery. This report aims to show improved visual outcome in corneal ectasia secondary to HK. DALK can be a procedure of choice with proper case selection. PMID:22446912

Mehta, Paras; Rathi, Varsha M; Murthy, Somasheila I

2012-01-01

301

The iatrogenic cost of non-steroidal anti-inflammatory drug therapy.  

PubMed

The secondary gastrointestinal effects associated with the use of non-steroidal anti-inflammatory drugs (NSAIDs) are well documented in the medical literature. Less addressed is the 'iatrogenic' cost due to the treatment of these secondary effects. Epidemiologic and clinical studies report that the cost of NSAIDs is multiplied by a coefficient that ranges from 1.45 to 3, if the cost of treating the induced gastrointestinal complications is considered. A simple methodology incorporating the direct medical cost of treating complications has been developed to calculate a 'shadow price' of an NSAID, thus reflecting the real cost to the payer of NSAID therapy. The model has been used to compare three NSAIDs on the basis of their relative prices and gastroduodenal toxicity. PMID:7780675

De Pouvourville, G

1995-04-01

302

Iatrogenic suprascapular nerve injury after repair of type II SLAP lesion.  

PubMed

Suprascapular neuropathy after an arthroscopic repair of a SLAP lesion is theoretically possible, but it has been rarely reported. We present a case of suprascapular nerve injury at the spinoglenoid notch as a complication of an improperly inserted suture anchor after repair of a type II SLAP lesion. The diagnosis was confirmed by the magnetic resonance imaging findings and an electrodiagnostic study, and direct compression of the nerve was visualized under repeat arthroscopy. An anatomic study of the superior glenoid shows that the available bone stock of the superior glenoid rim for the anchor insertion is found to decrease posteriorly. During the repair of a SLAP lesion, surgeons should consider the possibility of an iatrogenic injury to the suprascapular nerve by an improperly inserted suture anchor. PMID:20620802

Kim, Sung-Hun; Koh, Yong-Gon; Sung, Chang-Hun; Moon, Hong-Kyo; Park, Young-Sik

2010-07-01

303

Iatrogenic molar borings in 18th and early 19th century Native American dentitions.  

PubMed

Six iatrogenic dental borings were identified in four individuals of a Native American skeletal collection from an 18th and early 19th century Middle Columbia River burial site. The borings, all in maxillary first molars with severe dental attrition and secondary dentin, demonstrate striated walls and associated periapical alveolar lesions. An ethnographic review of the subsistence pattern during the burial period indicates a diet that is consistent in dental attrition with other riverine fisher-hunter-gathers. Histological changes of dental pulp tissue during the process of attrition may result in dental necrosis. Access into the pulp chamber is a technique used to drain necrotic fluid. A common Euro-American therapeutic dental practice of the 18th and 19th centuries for diseases of the pulp was dental extraction. Multiple dental borings indicate that the practice of molar drilling into the pulp chamber was an effective and independent technique used by the Wishram and Wasco people. PMID:15486962

Seidel, John C; Colten, Roger H; Thibodeau, Edward A; Aghajanian, John G

2005-05-01

304

Computer simulation of flow and mixing at the duodenal stump after gastric resection  

PubMed Central

AIM: To investigate the flow and mixing at the duodenal stump after gastric resection, a computer simulation was implemented. METHODS: Using the finite element method, two different Billroth II procedure cases (A and B) were modeled. Case A was defined with a shorter and almost straight duodenal section, while case B has a much longer and curved duodenal section. Velocity, pressure and food concentration distribution were determined and the numerical results were compared with experimental observations. RESULTS: The pressure distribution obtained by numerical simulation was in the range of the recorded experimental results. Case A had a more favorable pressure distribution in comparison with case B. However, case B had better performance in terms of food transport because of more continual food distribution, as well as better emptying of the duodenal section. CONCLUSION: This study offers insight into the transport process within the duodenal stump section after surgical intervention, which can be useful for future patient-specific predictions of a surgical outcome. PMID:19399932

Filipovic, Nenad; Cvetkovic, Aleksandar; Isailovic, Velibor; Matovic, Zoran; Rosic, Mirko; Kojic, Milos

2009-01-01

305

Altered solid and liquid gastric emptying in patients with duodenal ulcer disease.  

PubMed Central

Alteration in gastric emptying has been implicated in duodenal ulcer disease. The precise abnormalities remain controversial. We have used a radionuclide technique to assess solid and liquid gastric emptying in 14 patients with endoscopically proven duodenal ulcer and 22 healthy controls. Solid gastric emptying values for the patient group fell within the normal range. The median time taken for 50% (T50) of the liquid marker to empty from the stomach was 12 minutes (range 6-23 minutes) which was significantly faster (p less than .005) than controls (median 18 minutes, range 11-35). In 10 of the 14 patients, however, the rate of liquid emptying was within the normal range. There was no significant difference in the T50 for gastric emptying of solids between the groups, but in duodenal ulcer patients food left the stomach significantly earlier than in controls (p less than .05). After this, however, the linear rate at which duodenal ulcer patients emptied solid food from the stomach was a median 0.75%/minutes (range 0.5-1.4 minutes), which was slower (p less than .0005) than controls, median 1.25/minutes (range 0.7-2.3). These results show that the pattern of gastric emptying of digestible solids and liquids in patients with duodenal ulcer disease, as a group, is significantly altered. PMID:4018631

Maddern, G J; Horowitz, M; Hetzel, D J; Jamieson, G G

1985-01-01

306

Polyneuropathy while on duodenal levodopa infusion in Parkinson's disease patients: we must be alert.  

PubMed

Some reports have emerged describing the occurrence of Guillain-Barré syndrome and polyneuropathy related to vitamin B(12) deficiency in some patients with Parkinson's disease (PD) treated with continuous duodenal levodopa infusion. We describe five PD patients who developed axonal polyneuropathy and vitamin B(12) deficiency while on treatment with duodenal levodopa infusion, review other cases reported in the literature, discuss potential etiologic factors, and suggest a possible algorithm for the management and prevention of this complication. One case of Guillain-Barré syndrome and at least 12 cases of polyneuropathy related to vitamin B(12) deficiency have been reported in PD patients treated with duodenal levodopa infusion. Levodopa gel infusion may induce a decrease in vitamin B(12) levels, leading to peripheral neuropathy. Additional pathogenetic mechanisms include alterations related to the metabolism of L: -dopa, abnormal L: -dopa absorption, and direct neurotoxicity of L: -dopa at high doses. Vitamin B(12) supplementation may need to be considered in PD patients on duodenal levodopa infusion therapy. Vitamin B(12) deficiency in patients on duodenal levodopa infusion therapy may be more frequent than the published data suggest. We must be alert. PMID:22270132

Santos-García, Diego; de la Fuente-Fernández, Raúl; Valldeoriola, Francesc; Palasí, Antonio; Carrillo, Fátima; Grande, Mónica; Mir, Pablo; De Fabregues, Oriol; Casanova, Jordi

2012-08-01

307

Coeliac-like duodenal pathology in orthotopic liver transplant patients on mycophenoloic acid therapy.  

PubMed

Introduction: Diarrhoea following orthotopic liver transplantation (OLT) is a significant clinical problem associated with mycophenoloic acid (MPA). The histological injury pattern associated with MPA in the large bowel is well documented in the literature, however, less extensively in the duodenum. Aims: To investigate the histological spectrum of duodenal injury specifically in symptomatic OLT patients on MPA and compare this with patients with coeliac and normal controls. Methods: We reviewed our pathology database for all duodenal biopsies in patients on the OLT list over 19 years. Medical records, anti-tTG IgA serology and histology were reviewed. Results: Of the 667 patients that underwent endoscopy, 127 patients had duodenal biopsies (152 biopsies). 87.5% were normal. 16 showed abnormal histology with 7 (43.8%) on MPA at the time of biopsy. Significant features included coeliac-like changes (shortened villi and increased intraepithelial lymphocyte counts) and novel findings included increased endocrine cell counts, apoptotic counts and lamina propria eosinophil counts in comparison to normal duodenal biopsies. Conclusions: Pathologists should be aware of the features of MPA-associated duodenal injury, including coeliac-like changes and increased apoptotic counts. In those with abnormal histology, a discontinuation or reduction in dosage of MPA should be discussed. This article is protected by copyright. All rights reserved. PMID:25195696

Cotter, Maura Brid; AbuShanab, Ahmed; Merriman, Raphael; McCormick, Aiden; Sheahan, Kieran

2014-09-01

308

Evaluation of non-ampullary duodenal polyps: Comparison of non-neoplastic and neoplastic lesions  

PubMed Central

AIM: To evaluate duodenal polyps, divided into non-neoplastic and neoplastic lesions. In addition, the clinical characteristics of duodenal hyperplastic polyps are determined. METHODS: We analyzed medical records of 50?114 consecutive patients submitted to for first diagnostic esophago-gastroduodenoscopy between January 2004 and December 2009. We excluded lesions on the ampulla of Vater and submucosal tumors. We studied 510 cases that were diagnosed endoscopically with duodenal polyps and enrolled a total of 221 cases that had undergone tissue biopsy. We analyzed the differences between non-neoplastic and neoplastic lesions, and determined the clinical features of duodenal hyperplastic polyps. RESULTS: Non-neoplastic lesions were found in 196 patients and neoplastic lesions in 25 patients. On univariate analysis, there were significant differences in shape, location, and size. Polyps more than 10 mm in diameter or polyps in the second portion had independent risk factors for being neoplastic lesions, as identified by multivariate analysis. In 23 cases of hyperplastic polyps (79.3%), they were accompanied by gastro-duodenal pathology, which was possibly associated with Helicobacter pylori. CONCLUSION: Polyps of more than 10 mm or polyps in the second portion of the duodenum should be evaluated by histological examination. PMID:21086567

Jung, Sung Hoon; Chung, Woo Chul; Kim, Eun Jung; Kim, Seol Hye; Paik, Chang Nyol; Lee, Bo In; Cho, Young Seok; Lee, Kang-Moon

2010-01-01

309

Analyses and applications of pressure, flowrate, and temperature measurements during a perforating run  

SciTech Connect

Perforating technology has undergone significant advances during the last decade. Tubing conveyed perforating (TCP), underbalanced perforating, high shot density guns, better shaped charges, and improved gun systems are some of the developments that have contributed to safer operations and improved productivity of the perforated completions. A recent development, described in this paper, is a perforating tool that makes real-time downhole measurements during a perforating run and has the capability of selectively firing a number of guns at different depths or times. These measurements include pressure, flow rate, temperature, GR, CCL, and cable tension. The simultaneous downhole measurements, in addition to providing better control of the perforating process, can in a single trip provide a production log, conventional well tests before and after perforating, and a fill-up or slug test soon after perforating for underbalanced conditions.

Tariq, S.M.; Ayestaran, L.

1986-01-01

310

Antacid maintenance therapy in the prevention of duodenal ulcer relapse.  

PubMed Central

The effectiveness of antacid maintenance therapy in preventing duodenal ulcer (DU) relapse was investigated. Two hundred and fifty one asymptomatic patients with healed DU were stratified into smokers and non-smokers and randomised to receive for one year either placebo, or Maalox TC three tablets (81 mmol) at bedtime (hs), or Maalox TC three tablets in the morning plus three tablets at bedtime (bd) (162 mmol), or cimetidine 400 mg at bedtime. A double dummy technique was used to render the study double blind. In 176 patients evaluable for efficacy, the cumulative relapse at one year was: placebo 57%; Maalox TC hs 39%; Maalox TC bd 23%; cimetidine 25%. Maalox TC bd and cimetidine were equally effective and superior to placebo (p less than 0.01) and bedtime Maalox TC (p less than 0.04). The benefit of treatment was significant for the overall sample and for the subgroup of smokers. The results for the non-smokers also supported efficacy for these two treatments but, perhaps because of small sample sizes, these comparisons were not significant. All 251 patients were assessed for safety. Approximately half the patients in each treatment group had adverse events, leading to withdrawal in three, seven, 12, and four patients on placebo, Maalox hs, Maalox bd, and cimetidine respectively. Diarrhoea occurred in 12 patients in Maalox TC bd and eight in each other group. Serum magnesium concentrations were unchanged; aluminium concentrations were higher than baseline at six and 12 months in both antacid groups and at 12 months in the cimetidine group but the differences were not significant. Maalox TC three tablets bd are as effective as cimetidine 400 mg at bedtime in reducing DU relapse and both are superior to placebo. PMID:3065157

Bardhan, K D; Hunter, J O; Miller, J P; Thomson, A B; Graham, D Y; Russell, R I; Sontag, S; Hines, C; Martin, T; Gaussen, L

1988-01-01

311

Association of Transjugular Intrahepatic Portosystemic Shunt with Embolization in the Treatment of Bleeding Duodenal Varix Refractory to Sclerotherapy  

Microsoft Academic Search

Background: Bleeding from duodenal varices are often severe (mortality as high as 40%), and more difficult to sclerose than esophageal varices. We report a patient with a bleeding duodenal varix, refractory to sclerotherapy, successfully treated by the association of portosystemic shunt placement and varix embolization, via the same transjugular intrahepatic route. Methods: A 40-year-old Black male underwent emergency TIPS and

Giulio Illuminati; Allaoua Smail; Daniel Azoulay; Denis Castaing; Henri Bismuth

2000-01-01

312

Double-blind randomised clinical trial of a pepsin-inhibitory pentapeptide (pepstatin) in the treatment of duodenal ulcer.  

PubMed Central

In a double-blind randomised clinical trial a specific inhibition of peptic activity with a pentapeptide, pepstatin, had no significant advantage over placebo in the ulcer healing and symptomatology of duodenal ulcer. Thus, the inhibition of pepsin in human gastric juice does not appear to have a major influence on the healing of duodenal ulcer. PMID:385457

Bonnevie, O; Svendsen, L B; Holst-Christensen, J; Johansen, T S; Søltoft, J; Christiansen, P M

1979-01-01

313

Endovenous Laser Ablation of Incompetent Perforator Veins: A New Technique in Treatment of Chronic Venous Disease  

SciTech Connect

The aim of this study was to assess the feasibility of endovenous laser ablation of incompetent perforator veins in a patient with incompetency of the small saphenous vein and multiple perforator veins. Two different methods were used to ablate seven perforator veins with a laser giving 50-60 J/cm energy. Total occlusion was observed in six perforators, and partial ablation in one perforator, at 1-month follow-up. To our knowledge, endovenous laser ablation of incompetent perforator veins is easy and a good therapeutic method.

Ozkan, Ugur, E-mail: radugur@yahoo.co [Baskent University, Faculty of Medicine, Department of Radiology (Turkey)

2009-09-15

314

Disconnect Between Incidence of Nonperforated and Perforated Appendicitis  

PubMed Central

Objective: Appendicitis has been declining in frequency for several decades. During the past 10 years, its preoperative diagnosis has been made more reliable by improved computed tomography (CT) imaging. Thresholds for surgical exploration have been lowered by the increased availability of laparoscopic exploration. These innovations should influence the number of appendectomies performed in the United States. We analyzed nationwide hospital discharge data to study the secular trends in appendicitis and appendectomy rates. Methods: All appendicitis and appendiceal operations reported to the National Hospital Discharge Survey (NHDS) 1970–2004 were classified as perforated, nonperforated, negative, and incidental appendectomies and analyzed over time and by various demographic measures. Secular trends in the population-based incidence rates of nonperforated and perforated appendicitis and negative and incidental appendectomy were examined. Results: Nonperforated appendicitis rates decreased between 1970 and 1995 but increased thereafter. The 25-year decreasing trend was accounted for almost entirely by a decreasing incidence in the 10–19 year age group. The rise after 1995 occurred in all age groups above 5 years and paralleled increasing rates of CT imaging and laparoscopic surgery on the appendix. Since 1995 the negative appendectomy rate has been falling, especially in women, and incidental appendectomies, frequent in prior decades, have been rarely performed. Despite these large changes, the rate of perforated appendicitis has increased steadily over the same period. Although perforated and nonperforated appendicitis rates were correlated in men, they were not significantly correlated in women nor were there significant negative correlations between perforated and negative appendectomy rates. Conclusion: The 25-year decline in nonperforated appendicitis and the recent increase in appendectomies coincident with more frequent use of CT imaging and laparoscopic appendectomies did not result in expected decreases in perforation rates. Similarly, time series analysis did not find a significant negative relationship between negative appendectomy and perforation rates. This disconnection of trends suggests that perforated and nonperforated appendicitis may have different pathophysiologies and that nonoperative management with antibiotic therapy may be appropriate for some initially nonperforated cases. Further efforts should be directed at identifying preoperative characteristics associated with nonperforating appendicitis that may eventually allow surgeons to defer operation for those cases of nonperforating appendicitis that have a low perforation risk. PMID:17522514

Livingston, Edward H.; Woodward, Wayne A.; Sarosi, George A.; Haley, Robert W.

2007-01-01

315

Ruptured duodenal varices successfully treated by mini-loop ligation: report of a case.  

PubMed

Bleeding from duodenal varices is a rare, but often fatal manifestation of portal hypertension and these ectopic varices are more common in extrahepatic portal venous obstruction. There are over 160 cases of duodenal varices reported in the English literature. A 47-year-old female presented with massive hematemesis and prolonged shock. Initial endoscopy revealed non-bleeding small esophageal varices and large varices in the first portion of the duodenum with spurting bleeding. Endoscopic hemostasis was obtained with 5 detachable nylon loops. Portal hypertension was caused by liver cirrhosis and postthrombotic portal cavernoma. To the best of our knowledge this is the first case of successful mini-loop ligation of bleeding duodenal varices reported in the literature. PMID:19943566

Ghidirim, Gh; Mishin, I; Dolghii, A; Zastavnitsky, Gh

2009-01-01

316

Wilkie's Syndrome and Left Adnexal Mass: Unusual Presentation of Duodenal Adenocarcinoma.  

PubMed

Duodenal adenocarcinoma (DACa) is a rare malignancy, the presenting symptoms of which are vague and nonspecific. We report the case of a patient presenting with symptoms of subacute small bowel obstruction whose CT scan revealed i) left adnexal mass and ii) compression of 3(rd) portion of duodenum with reduced aortomesentric angle consistent with Wilkie's syndrome (WS). Laparatomy in addition revealed a distal duodenal stricture, which showed a well differentiated DACa causing subtotal intestinal obstruction. The ovarian mass revealed adenocarcinoma with similar morphology. Immunophenotypic analysis revealed positive expression of CK 20 and CDX 2 and absence of CK 7 staining in the tumours consistent with Primary DACa with ovarian metastasis. We further concluded that the WS resulted from reduced mesenteric fat pad caused by DACa induced cachexia. The case highlights the elusive nature of duodenal malignancy and emphasises the importance of meticulous small bowel examination during exploration of ovarian masses. PMID:25302201

Devadass, Clement Wilfred; Okaly, Geetha V Patil; Hm, Sudha; Pai, Sreekar Agumbe; Sridher, H

2014-08-01

317

A 12-mm carcinoid tumor of the minor duodenal papilla with lymph node metastases.  

PubMed

Carcinoid tumors located in the minor duodenal papilla are extremely rare, with only a few cases reported in the literature. Herein, we report the case of a 71-year-old man with a 12-mm carcinoid tumor at the minor duodenal papilla with lymph node metastases. Multidetector-row computed tomography with contrast enhancement revealed a 12-mm well-enhanced tumor in the duodenum. Upper gastrointestinal endoscopy showed a 12-mm submucosal tumor at the minor papilla of the duodenum. Biopsy specimens revealed a carcinoid tumor, and a subtotal stomach-preserving pancreatoduodenectomy was performed. Carcinoid tumors at the minor duodenal papilla have a high prevalence of nodal disease, even for tumors <2 cm in diameter. Therefore, we believe that radical resection with tumor-free margins (i.e. pancreatoduodenectomy) is the treatment of choice. PMID:23136240

Fukami, Yasuyuki; Kurumiya, Yasuhiro; Mizuno, Keisuke; Sekoguchi, Ei; Kobayashi, Satoshi; Ito, Akira; Tomida, Akihiro; Onishi, Sakura; Shirotsuki, Ryo; Okubo, Kenji; Narita, Michihiko

2013-01-01

318

Alternative types of duodenal ulcer induced in mice by partial x irradiation of the thorax  

SciTech Connect

The present study extends our earlier observations on gastrointestinal pathology in thorax-irradiated female CFLP mice. It shows that exposure of the lower mediastinum to single doses of 14 to 30 Gy x rays results in the formation of the proximal duodenal ulcer accompanied frequently by erosion of the antral gastric mucosa. X irradiation of the lateral thoracic fields is responsible for single ulcers in the proximity of duodenal papilla, often associated with a circumscribed area of degeneration of the fundic mucosa of the stomach. In view of the small amount of radiation received by the subdiaphragmatic parts of the alimentary tract, these gastro-duodenal lesions represent abscopal effects of thoracic irradiation.

Michalowski, A.; Uehara, S.; Yin, W.B.; Burgin, J.; Silvester, J.A.

1983-07-01

319

Alternative types of duodenal ulcer induced in mice by partial X irradiation of the thorax  

SciTech Connect

The present study extends our earlier observations on gastrointestinal pathology in thorax-irradiated female CFLP mice. It shows that exposure of the lower mediastinum to single doses of 14-30 Gy X rays results in the formation of the proximal duodenal ulcer accompanied frequently by erosion of the antral gastric mucosa. X irradiation of the lateral thoracic fields is responsible for single ulcers in the proximity of duodenal papilla, often associated with a circumscribed area of degeneration of the fundic mucosa of the stomach. In view of the small amount of radiation received by the subdiaphragmatic parts of the alimentary tract, these gastro-duodenal lesions represent abscopal effects of thoracic irradiation.

Michalowski, A.; Uehara, S.; Yin, W.B.; Burgin, J.; Silvester, J.A.

1983-07-01

320

Effect of diet on amino-acid profile of duodenal digesta in the goat H Archimde D Sauvant M Dorlans JC Robert2  

E-print Network

Effect of diet on amino-acid profile of duodenal digesta in the goat H Archimède D Sauvant M Paris; 2 Rhbne Poulenc Nutrition Animale, 03600 Commentry, France Amino-acid profiles (AAP) of duodenal% (Met), and 90% (Val) of the variations in the relative proportions of the amino acids in the duodenal

Paris-Sud XI, Université de

321

Complex heel reconstruction with a sural fasciomyocutaneous perforator flap.  

PubMed

Reconstruction of weight-bearing surfaces at the foot and ankle is controversial. Free tissue transfer and local fasciocutaneous perforator flaps are preferred for plantar reconstruction, but high rates of flap breakdown and ulceration have caused unsatisfactory functional outcomes. We present a modified "sural fasciomyocutaneous perforator flap" and its functional outcome. Between January 2007 and September 2010, 19 patients were treated for soft-tissue defects in the weight-bearing area with sural fasciomyocutaneous perforator flaps. The gastrocnemius, preserved in the base of the flap, was applied as padding under the calcaneus. In follow-up from 9 to 25 months (mean 13.8 months), each patient's pain score, defect size, ulcer formation, protective sensation recovery, and normal footwear were analyzed. The majority of the flaps survived with satisfactory aesthetic and functional results. One case of partial flap loss and one case of delayed ulceration were noted. With partial weight bearing at 4 weeks, satisfactory gait recovery was obtained at 5 to 8 months (in conjunction with protective sensation recovery). Sural fasciomyocutaneous perforator flap is a reliable modality in heel construction, showing advantages of low ulceration rate, durability, and good protective sensation recovery compared with conventional free tissue transfer and local fasciocutaneous perforator flap. PMID:24163225

Lu, Shengdi; Chai, Yimin; Wang, Chunyang; Wen, Gen

2014-02-01

322

[Treatment of venous trophic ulcers, using echoscleroobliteration of perforant veins].  

PubMed

In 36 patients, suffering trophic ulcers on a chronic venous insufficiency background in a decompensated stage (C6 in accordance to CEAP), echoscleroobliteration of perforant veins, using a "foam-form" method in accordance to Tessari, was performed. In 29 patients postrombophlebitic syndrome in incomplete recanalization stage was diagnosed, in 7 recurrence of varicose disease of the lower extremities. In all the patients during echoscleroobliteration there was possible to obliterate the insufficient perforant veins, in 3 patients two perforant veins were obliterated in each of them. In a one week a pathological blood flow along perforant veins, in accordance to data of ultrasound duplex scanning, was absent. This effect lasted during 6 mo in 29 (80.6%) patients. In 25 (69.4%) patients a trophic ulcers healing was achieved in 1 - 3 mo. In a one year in 30 (83.3%) patients a stable obliteration was noted, in 3 (8.3%) - partial recanalization, in 3 (8.3%) - complete recanalization of perforant veins. PMID:24923110

Rusyn, V I; Korsak, V V; Boldizhar, P O; Borsenko, M I; Mytrovka, B A

2014-02-01

323

Perforated diverticulitis of the sigmoid colon causing a subcutaneous emphysema  

PubMed Central

INTRODUCTION Although diverticular disease of the colon is frequent, perforated diverticulitis causing subcutaneous emphysema is a uncommon entity. We wish to present this extremely rare case of perforated colonic diverticulum in the subcutaneous tissue, which is the first one that we have encountered in our practice, along with the accompanying diagnostic and therapeutic issues and a review of the literature. PRESENTATION OF CASE We report the case of an 83-year-old man who admitted to the emergency room due to an abdominal subcutaneous emphysema. Physical examination revealed a severe subcutaneous emphysema especially in the left iliac fossa and abdominal pain. An urgent contrast enhanced abdominal CT scan showed multiple diverticula in the sigmoid colon and multiple air bubbles in the subcutaneous tissue. The exploratory laparotomy identified a perforation of diverticular in subcutaneous tissue. Forty centimeters of colon were resected. The subcutaneous emphysema resolved without specific treatment. The postoperative period was uncomplicated. DISCUSSION Subcutaneous emphysema of anterior abdomen wall is an obvious physical sign but its etiology is complex to determine and may be potentially lethal. The pathophysiological mechanism involved is the emergence of a pressure gradient between the peritoneum and surrounding structures, causing rupture of the anterior abdominal wall, allowing gas from a perforation to diffuse along tissue planes. CONCLUSION This physical sign may be of especial value in elderly patient groups amongst whom perforation may be less clinically obvious. General surgeons should bear in mind this rare complication of colonic diverticulosis. PMID:25437673

Kassir, Radwan; Abboud, Karine; Dubois, Joelle; Baccot, Sylviane; Debs, Tarek; Favre, Jean-Pierre; Gugenheim, Jean; Gastaldi, Pauline; Amor, Imed Ben; Tiffet, Olivier

2014-01-01

324

Cascaded Perforates as One-Dimensional, Bulk Absorbers  

NASA Technical Reports Server (NTRS)

Porous cell honeycomb liners for aircraft engine nacelles offer the possibility of exploiting extended reaction effects to improve liner attenuation bandwidth as generally attributed to the performance of bulk absorbers. This paper describes an analytical procedure, starting with an impedance prediction model for a single perforated plate, to estimate the bulk-absorber parameters for a cascade of such perforates - a first step to modeling a porous wall honeycomb structure. The objective is to build confidence in a lumped element impedance model, when applied to a uniformly-spaced set of porous plates to predict its .bulk. absorber properties. The model is based upon a modified version of the two-parameter flow resistance model of the form A + BV(sub inc), where A and B are physics-based, semi-empirical parameters that are adjusted to provide an optimum fit to a composite dataset from three plate porosities of 2.5, 5 and 10%. The composite dataset is achieved by reformulating the two-parameter flow resistance model into a .reduced pressure drop coefficient. dependency on perforate hole Reynolds number. The resulting impedance model is employed to calculate surface impedance spectra for N and 2N-layer perforate cascades. The well-known two-thickness method for experimental determination of bulk-absorber parameters is then applied to these .synthesized. data sets to predict the characteristic impedance and propagation constant for the perforate cascades. These results are then compared with experimental results reported in a companion paper.

Parrott, T. L.; Jones, M. G.

2006-01-01

325

Increased tissue concentrations of histamine in the duodenal mucosa of children with coeliac disease.  

PubMed Central

Tissue concentrations of histamine have been estimated in peroral duodenal biopsy specimens from five children with coeliac disease while on a gluten-free diet and after a three-month gluten challenge. Histamine concentrations in the patients on a diet did not differ significantly from a group of control children. However after gluten challenge, histological relapse of the duodenal mucosa in each patient was associated with increased tissue concentrations of histamine. The findings suggest that histamine may be involved in the pathogenesis of the small intestinal mucosal changes in children with coeliac disease. PMID:7085909

Challacombe, D N; Dawkins, P D

1982-01-01

326

Pneumoperitoneum secondary to a perforated gastric ulcer in a cat.  

PubMed

A 7-year-old domestic cat was examined because of a history of weight loss, intermittent diarrhea, and anorexia of 6 months' duration. Results of physical examination were normal except for marked abdominal tension. Results of a CBC and serum biochemistry profile were unremarkable. Severe pneumoperitoneum was noted radiographically, and abdominocentesis yielded 640 mL of air. Abdominal distension recurred 1 day after abdominocentesis. Exploratory laparotomy was performed 3 days after recurrence of abdominal distension and revealed a gastric perforation along the greater curvature of the stomach with omental and pancreatic adhesions at the site of perforation. Mild local peritoneal inflammation was also noted. A partial gastrectomy was performed to resect the lesion, and histologic examination confirmed a severe perforating ulcer. The gastric wall adjacent to the ulcer was histologically normal. Aerobic and anaerobic bacteriologic cultures of abdominal swab specimens were negative for bacterial growth. The cat was discharged 4 days after surgery and clinically normal at suture removal. PMID:12830863

Lykken, Jennifer D; Brisson, Brigitte A; Etue, Sheila M

2003-06-15

327

Typhoid glomerulonephritis and intestinal perforation in a Nigerian child.  

PubMed

The number of children with renal complications following salmonella infection cannot be precisely defined in the sub-Saharan Africa due to scarcity of reliable data. We report a 3-year-old boy with glomerulonephritis secondary to typhoid infection and later intestinal perforation. He presented with fever, generalized body swelling, oliguria, coke- colored urine and hypertension and had been managed 3 weeks earlier for typhoid fever in a private hospital. Laboratory investigations showed proteinuria, hematuria with red cell casturia and azotemia. Abdominal X-ray done was suggestive of typhoid intestinal perforation that was confirmed at exploratory laparotomy. He was managed aggressively with antibiotics and was discharged on the 25 th day of admission. To the best of our knowledge, this is the first documented case report of acute glomerulonephritis and intestinal perforation as co-complications of salmonella infection in Nigeria. PMID:25244281

Odetunde, O I; Ezenwosu, O U; Odetunde, O A; Azubuike, J C

2014-01-01

328

Practical Considerations for Perforator Flap Thinning Procedures Revisited  

PubMed Central

Background A thin perforator flap is one of the best methods for covering defects. This study aimed to revisit and further test the rapidly advancing field of flap thinning techniques. Methods We performed two cadaveric studies to test the known flap thinning methods, and then applied these methods to a clinical series. In the first study, five cadavers were used to observe the anatomical relation of the perforator with the subdermal plexuses and the subcutaneous fat layer by injecting a colored latex solution. The second study was done on four cadavers independently from the first study. Last, a clinical series was performed on 15 patients. Results The areolar fat lobules of 10 anterolateral thigh perforator (ALT), seven deep inferior epigastric artery perforator (DIEAP), and six thoracodorsal artery perforator (TAP) flaps were dissected to reduce the flap thickness guided by the colored vascular pattern. On average, the ALT, DIEAP, and TAP flaps were reduced to 32.76%±9.76%, 37.01%±9.21%, and 35.42%±9.41%, respectively. In the second study, the areolar fat lobules were directly dissected in six ALT, six TAP, and four MSAP flaps, and an average reduction in flap thickness of 53.41%±5.64%, 52.30%±2.88%, and 47.87%±6.41%, respectively, was found. In the clinical series, 13 out of the 15 cases yielded satisfactory outcomes with an average thickness reduction of 37.91%±7.15%. Conclusions These multiple studies showed that the deep fat layer could be safely removed to obtain a thin yet viable perforator flap. This evidence suggests that the macroscopic flap thinning technique can achieve thin flaps. Surgeons should consider this technique before embracing the latest technique of supermicrosurgery. PMID:25396182

Bangun, Kristaninta; Buchari, Frank B; Rezkini, Putri

2014-01-01

329

[The dynamics of the indices of protein metabolic homeostasis and the status of duodenal mucosal regeneration during the etaden treatment of duodenal peptic ulcer].  

PubMed

The authors relate the results of examining 149 men suffering from duodenal ulcer. The main group was made up of 75 patients given parenteral etaden treatment combined with conventional therapy. A study was made of the dynamics of clinical manifestations, the level of total protein and its fraction in the blood, protein metabolism (by radionuclide technique). Pieces of the duodenal mucosa from the periulcerous area were examined under microscope. Scanning and electron microscopy was also performed. Based on the data obtained it is concluded that etaden had active influence on protein synthesis, which favoured more rapid regression of the ulcerous defect in the main group patients. Morphological studies have also shown the positive dynamics of the regenerative process. PMID:1509384

Korepanov, A M; Murashov, V S; Bazhenov, E L

1992-01-01

330

Chest tube perforation of esophagus following repair of esophageal atresia.  

PubMed

The two major acute thoracic complications of closed chest tube thoracostomy are pulmonary laceration and vascular compression. We have noted that closed chest tube thoracostomy can also perforate an esophageal anastomosis or myotomy site. Clinically, such a perforation produces a profuse discharge of gas and/or fluid through a chest tube positioned at the level of the anastomosis or myotomy site. Plain films demonstrate an accumulation of extrapleural gas and/or fluid adjacent to the distal portion of the chest tube. If untreated, these accumulations may form into an extrapleural abscess. PMID:2286887

Johnson, J F; Wright, D R

1990-12-01

331

Geometric control of failure behavior in perforated sheets  

NASA Astrophysics Data System (ADS)

Adding perforations to a continuum sheet allows new modes of deformation, and thus modifies its elastic behavior. The failure behavior of such a perforated sheet is explored, using a model experimental system: a material containing a one-dimensional array of rectangular holes. In this model system, a transition in failure mode occurs as the spacing and aspect ratio of the holes are varied: rapid failure via a running crack is completely replaced by quasistatic failure, which proceeds via the breaking of struts at random positions in the array of holes. I demonstrate that this transition can be connected to the loss of stress enhancement, which occurs as the material geometry is modified.

Driscoll, Michelle M.

2014-12-01

332

Acquired perforating dermatosis: a clinical and dermatoscopic correlation.  

PubMed

Acquired Perforating Dermatosis (APD) is a perforating disease characterized by transepidermal elimination of dermal material [1,2]. This disease usually develops in adulthood. APD has been reported to occur in association with various diseases, but is most commonly associated with dialysis-dependent chronic renal failure (CRF) or diabetes mellitus (DM) [1,2,3,4]. Morton et al found that APD occurs in up to 10% of patients undergoing hemodialysis [5]. Additionally, Saray et al found that sixteen of twenty-two cases with APD were associated with CRF [3]. PMID:24010504

Ramirez-Fort, Marigdalia K; Khan, Farhan; Rosendahl, Cliff O; Mercer, Stephen E; Shim-Chang, Helen; Levitt, Jacob O

2013-07-01

333

Unusual scintigraphic appearance of perforation of the common bile duct.  

PubMed

This report deals with the diagnosis of perforation of the common bile duct into the lesser sac by HIDA cholescintigraphy. The first hour images after injection were suggestive of biliary obstruction. Subsequent images demonstrated unusual accumulations of the activity into the lesser sac and retroperitoneal potential spaces. Careful correlation between scintigraphic and surgical findings were undertaken. The case is reported to demonstrate the scintigraphic findings in choledochal perforation and to stress the importance of carrying out late images when the initial ones are abnormal. PMID:6686097

Acevedo, M O; Tauxe, W N; Scott, J W; Aldrete, J S

1983-12-01

334

Non-invasive vascular imaging in perforator flap surgery.  

PubMed

Preoperative imaging using a range of imaging modalities has become increasingly popular for preoperative planning in plastic surgery, in particular in perforator flap surgery. Modalities in this role include ultrasound (US), magnetic resonance angiography (MRA), and computed tomographic angiography (CTA). The evidence for the use of these techniques has been reported in only a handful of studies. In this paper we conducted a non-systematic review of the literature to establish the role for each of these modalities. The role of state-of-the-art vascular imaging as an application in perforator flap surgery is thus offered. PMID:23125392

Saba, Luca; Atzeni, Matteo; Rozen, Warren Matthew; Alonso-Burgos, Alberto; Bura, Raffaella; Piga, Mario; Ribuffo, Diego

2013-02-01

335

Characterization of cardiac lead perforation risk via a dynamic simulated environment  

E-print Network

Delayed cardiac perforation is a serious medical condition where an implanted cardiac lead migrates through the heart wall, causing life-threatening complications. Where acute perforation occurs during implant, delayed ...

Rosario, Matthew J

2012-01-01

336

[Efficacy of galavit in patients with duodenal ulcer].  

PubMed

The aim of the study was to investigate clinical efficacy of the medical complex Galavit in patients with acute phase of duodenal ulcer (DU) in. The subjects were 60 DU patients aged 32 +/- 2 years with ulcerous defects of 0.4 to 1.3 cm in diameter. In patients receiving Galavit, pain was coped with by Mann-Whitney method in 2.5 +/- 0.2 days, p < 0.001; in the control group--in 5.7 +/- 0.1 days. In the Galavit group the ulcers healed in 11.3 +/- 0.2 days, p < 0.001; in the control group--17.8 +/- 0.3 days; in 4 cases (13.3%) the ulcerous defects healed with forming of rough scars. Galavit elevated T-lymphocyte rate from 53.1 +/- 0.6% to 65.1 +/- 0.2%, p < 0.001; T-helper inductor level--from 27.8 +/- 0.2% to 38.5 +/- 0.3%, p < 0.001; cytotoxic T-lymphocyte level--from 18.5 +/- 0.5% to 27.3 +/- 0.3%, p < 0.001; B-lymphocyte level--from 12.3 +/- 0.2% to 19.1 +/- 0.1%, p < 0.001. The therapy significantly lowered malonic aldehyde level by 23.5%, trienoic conjugate level--by 61.6%; superoxide dismutase level rose 1.6 times, catalase level--1.4 times, glutathion reductase level--from 19.03 +/- 1.17 to 27.01 +/- 1.24 optical density units/mg, p < 0.001. The study did not find any significant changes in the immune status and lipid peroxidative/antioxidative system of patients receiving basic therapy. The results show that Galavit has anti-inflammatory effect, improves immune status and anti-oxidative protection. It is appropriate to administer Galavit as a component of DU basic therapy. The results show that Galavit has anti-inflammatory effect, improves immune status and anti-oxidative protection. It is appropriate to administer Galavit as a component of DU basic therapy. PMID:16218370

Butorov, I V; Nikolenko, I A; Butorov, S I

2005-01-01

337

[Is iatrogenic vesico-renal reflux a negligible factor in the evolution of recurrent superficial tumors of the bladder?].  

PubMed

The electrocoagulation and resection of superficial tumors of the bladder leads to iatrogenic refluxes. The frequency of subsequent vesical recurrences may thus favor tumoral grafts in the upper urinary tract. Fives cases illustrate this risk. They were treated by ureteral resections and by one bilateral, and two unilateral nephroureterectomies. Should these refluxes be ignored or treated surgically in the event of repeated papillomatous recurrences? PMID:4015052

Rampal, M; Coulange, C; Lacoste, J; Gauvin, C; Ivaldi, A

1985-01-01

338

Fractional factorial design optimization of nontraditional completion fluid for perforation with underbalance  

Microsoft Academic Search

Optimal well performance is always associated with the creation of a clean and undamaged connection between wellbore and reservoir.\\u000a However, it is apparent that the use of shaped-charge perforating tends to produce perforation-induced formation damage. This\\u000a damage impairs fluid flow and decreases well productivity. To minimize and eliminate this damage, underbalance perforating\\u000a should be considered. Underbalance perforating has been considered

Munawar Khalil; Badrul Mohamed Jan; Abdul Aziz Abdul Raman

2010-01-01

339

Spontaneous Perforation of Pyometra Presented as an Acute Abdomen: A Case Report  

PubMed Central

Spontaneous perforation of pyometra is a rare pathologic condition that presents as diffuse peritonitis. This report describes an interesting case of spontaneous uterine perforation that mimicked gut perforation clinically and was finally diagnosed at exploratory laparotomy. Although rare, perforation of pyometra should be kept as one of the differential diagnosis in an elderly woman with an acute abdomen. A high index of suspicion is required to make a correct preoperative diagnosis, which allows early intervention, thus reducing morbidity and mortality. PMID:18324325

Saha, Pradip Kumar; Gupta, Pratiksha; Mehra, Reeti; Goel, Poonam; Huria, Anju

2008-01-01

340

Treatment-induced neuropathy of diabetes: an acute, iatrogenic complication of diabetes.  

PubMed

Treatment-induced neuropathy in diabetes (also referred to as insulin neuritis) is considered a rare iatrogenic small fibre neuropathy caused by an abrupt improvement in glycaemic control in the setting of chronic hyperglycaemia. The prevalence and risk factors of this disorder are not known. In a retrospective review of all individuals referred to a tertiary care diabetic neuropathy clinic over 5 years, we define the proportion of individuals that present with and the risk factors for development of treatment-induced neuropathy in diabetes. Nine hundred and fifty-four individuals were evaluated for a possible diabetic neuropathy. Treatment-induced neuropathy in diabetes was defined as the acute onset of neuropathic pain and/or autonomic dysfunction within 8 weeks of a large improvement in glycaemic control-specified as a decrease in glycosylated haemoglobin A1C (HbA1c) of ?2% points over 3 months. Detailed structured neurologic examinations, glucose control logs, pain scores, autonomic symptoms and other microvascular complications were measured every 3-6 months for the duration of follow-up. Of 954 patients evaluated for diabetic neuropathy, 104/954 subjects (10.9%) met criteria for treatment-induced neuropathy in diabetes with an acute increase in neuropathic or autonomic symptoms or signs coinciding with a substantial decrease in HbA1c. Individuals with a decrease in HbA1c had a much greater risk of developing a painful or autonomic neuropathy than those individuals with no change in HbA1c (P < 0.001), but also had a higher risk of developing retinopathy (P < 0.001) and microalbuminuria (P < 0.001). There was a strong correlation between the magnitude of decrease in HbA1c, the severity of neuropathic pain (R = 0.84, P < 0.001), the degree of parasympathetic dysfunction (R = -0.52, P < 0.01) and impairment of sympathetic adrenergic function as measured by fall in blood pressure on tilt-table testing (R = -0.63, P < 0.001). With a decrease in HbA1c of 2-3% points over 3 months there was a 20% absolute risk of developing treatment-induced neuropathy in diabetes, with a decrease in HbA1c of >4% points over 3 months the absolute risk of developing treatment-induced neuropathy in diabetes exceeded 80%. Treatment-induced neuropathy of diabetes is an underestimated iatrogenic disorder associated with diffuse microvascular complications. Rapid glycaemic change in patients with uncontrolled diabetes increases the risk of this complication. PMID:25392197

Gibbons, Christopher H; Freeman, Roy

2014-11-11

341

Iatrogenic cushing syndrome secondary to a probable interaction between voriconazole and budesonide.  

PubMed

Oral budesonide is commonly used for the management of Crohn's disease given its high affinity for glucocorticoid receptors and low systemic activity due to extensive first-pass metabolism through hepatic cytochrome P450 (CYP) 3A4. Voriconazole, a second-generation triazole antifungal agent, is both a substrate and potent inhibitor of CYP isoenzymes, specifically CYP2C19, CYP2C9, and CYP3A4; thus, the potential for drug-drug interactions with voriconazole is high. To our knowledge, drug-drug interactions between voriconazole and corticosteroids have not been specifically reported in the literature. We describe a 48-year-old woman who was receiving oral budesonide 9 mg/day for the management of Crohn's disease and was diagnosed with fluconazole-resistant Candida albicans esophagitis; oral voriconazole 200 mg every 12 hours for 3 weeks was prescribed for treatment. Because the patient experienced recurrent symptoms of dysphagia, a second 3-week course of voriconazole therapy was taken. Seven weeks after originally being prescribed voriconazole, she came to her primary care clinic with elevated blood pressure, lower extremity edema, and weight gain; she was prescribed a diuretic and evaluated for renal dysfunction. At a follow-up visit 6 weeks later with her specialty clinic, the patient's blood pressure was elevated, and her physical examination was notable for moon facies, posterior cervical fat pad prominence, and lower extremity pitting edema. Iatrogenic Cushing syndrome due to a drug-drug interaction between voriconazole and budesonide was suspected, and voriconazole was discontinued. Budesonide was continued as previously prescribed for her Crohn's disease. On reevaluation 2 months later, the patient's Cushingoid features had markedly regressed. To our knowledge, this is the first published case report of iatrogenic Cushing syndrome due to a probable interaction between voriconazole and oral budesonide. In patients presenting with Cushingoid features who have received these drugs concomitantly, clinicians should consider the potential drug interaction between these agents, and the risks and benefits of continued therapy must be considered. PMID:24757038

Jones, Whitney; Chastain, Cody A; Wright, Patty W

2014-07-01

342

Extrahepatic Pseudoaneurysms and Ruptures of the Hepatic Artery in Liver Transplant Recipients: Endovascular Management and a New Iatrogenic Etiology  

SciTech Connect

To characterize extrahepatic pseudoaneurysm regarding incidence and etiology and determine the effectiveness of endovascular management. A retrospective audit of 1,857 liver transplants in two institutions was performed (1996-2009). Recipients' demographics, clinical presentation, transplant type, biliary anastomosis, and presence of biliary endoprostheses were noted. Pseudoaneurysms were classified into iatrogenic (associated with biliary endoprosthesis or angioplasty) or spontaneous extrahepatic pseudoaneurysms. Spontaneous and iatrogenic pseudoaneurysms were compared for time from transplant, presenting symptoms, location in the arterial anatomy, and 3-month graft survival. Arterial patency and 6-month graft survival were calculated. Twenty pseudoaneurysms were found (1.1 %, 20/1,857): 9 (0.5 % of transplants, 9/1,857) were spontaneous and 11 (0.6 % of transplants, 11/1,857) were 'iatrogenic' (due to minimally invasive procedures: 4 angioplasty and 7 biliary endoprostheses). Sixty percent (12/20) underwent endovascular management (4 coil embolization and 8 stent-grafts). Technical success was 83 % (10/12) with a mean arterial patency of 70 % (follow-up mean, 4.9; range, 0-18 months). The 1-, 3-, and 6-month graft survival was 70, 40, and 35 %, respectively. Due to minimally invasive procedures, posttransplant extrahepatic pseudoaneurysms are no longer an exclusive complication of the transplant surgery itself. Endovascular management is effective to stabilize patients but has not improved historic postsurgical graft survival.

Saad, Wael E. A., E-mail: wspikes@yahoo.com; Dasgupta, Niloy; Lippert, Allison J.; Turba, Ulku C.; Davies, Mark G. [University of Virginia Health System, Division of Vascular Interventional Radiology, Department of Radiology (United States)] [University of Virginia Health System, Division of Vascular Interventional Radiology, Department of Radiology (United States); Kumer, Sean [University of Virginia Health System, Division of Solid Organ Transplantation, Department of Surgery (United States)] [University of Virginia Health System, Division of Solid Organ Transplantation, Department of Surgery (United States); Gardenier, Jason C.; Sabri, Saher S.; Park, Auh-Whan [University of Virginia Health System, Division of Vascular Interventional Radiology, Department of Radiology (United States)] [University of Virginia Health System, Division of Vascular Interventional Radiology, Department of Radiology (United States); Waldman, David L. [University of Rochester Medical Center, Department of Imaging Sciences (United States)] [University of Rochester Medical Center, Department of Imaging Sciences (United States); Schmitt, Timothy [University of Virginia Health System, Division of Solid Organ Transplantation, Department of Surgery (United States)] [University of Virginia Health System, Division of Solid Organ Transplantation, Department of Surgery (United States); Matsumoto, Alan H.; Angle, John F. [University of Virginia Health System, Division of Vascular Interventional Radiology, Department of Radiology (United States)] [University of Virginia Health System, Division of Vascular Interventional Radiology, Department of Radiology (United States)

2013-02-15

343

Effect of dopamine-related drugs on duodenal ulcer induced by cysteamine or propionitrile: prevention and aggravation may not be mediated by gastrointestinal secretory changes in the rat  

SciTech Connect

Dose- and time-response studies have been performed with dopamine agonists and antagonists using the cysteamine and propionitrile duodenal ulcer models in the rat. The experiments demonstrate that the chemically induced duodenal ulcer is prevented by bromocriptine, lergotrile and reduced by apomorphine or L-dopa. Aggravation of cysteamine-induced duodenal ulcer was seen especially after (-)-butaclamol, (-)-sulpiride, haloperidol and, less effectively, after other dopaminergic antagonists. The duodenal antiulcerogenic action of dopamine agonists was more prominent after chronic administration than after a single dose, whereas the opposite was found concerning the proulcerogenic effect of dopamine antagonists. In the chronic gastric fistula rat, both the antiulcerogens bromocriptine or lergotrile and the proulcerogens haloperidol, pimozide or (-)-N-(2-chlorethyl)-norapomorphine decreased the cysteamine- or propionitrile-induced gastric secretion. No correlation was apparent between the influence of these drugs on duodenal ulcer development and gastric and duodenal (pancreatic/biliary) secretions. In the chronic duodenal fistula rat, decreased acid content was measured in the proximal duodenum after haloperidol, and diminished duodenal pepsin exposure was recorded after bromocriptine. Furthermore, the aggravation by dopamine antagonists of experimental duodenal ulcer probably involves a peripheral component. The site of dopamine receptors and physiologic effects which modulate experimental duodenal ulcer remain to be identified, but their elucidation may prove to be an important element in the pathogenesis and treatment of duodenal ulcer.

Gallagher, G.; Brown, A.; Szabo, S.

1987-03-01

344

Apparatus and method for use in subsurface oil and gas well perforating device  

Microsoft Academic Search

An apparatus is described for perforating subsurface earth formations traversed by a borehole including a plurality of mechanically serially connected perforating guns, comprising: a first perforating gun member, the gun member including an elongated gun body having shaped charges cooperatively arranged thereon and a first length of detonator cord, for transferring an explosive wave to the shaped charges, traversing therethrough;

G. B. Mc Clure; G. R. Bartges

1987-01-01

345

Infectious keratitis with corneal perforation associated with corneal hydrops and contact lens wear in keratoconus  

Microsoft Academic Search

BACKGROUND: Corneal perforation is an uncommon complication associated with keratoconus. The first cases of infectious keratitis and corneal perforation associated with corneal hydrops and contact lens wear are reported in two keratoconus patients. METHODS: A retrospective chart review and histopathological examination were carried out. RESULTS: Both patients progressed to corneal perforation and emergency penetrating keratoplasty. One patient cultured Fusarium and

E D Donnenfeld; A Schrier; H D Perry; H J Ingraham; R Lasonde; A Epstein; B Farber

1996-01-01

346

Postoperative perforation of the Schneiderian membrane in maxillary sinus augmentation: a case report.  

PubMed

Perforation of the Schneiderian membrane constitutes a major intraoperative complication of maxillary sinus floor elevation with graft materials, but postoperative perforation of the sinus membrane is very rare. This case report demonstrates that conservative treatment involving drainage and the administration of systemic antibiotics can be used to successfully treat postoperative sinus membrane perforation with infection of the graft material. PMID:25020219

Jo, Kyu-Hong; Yoon, Kyu-Ho; Cheong, Jeong-Kwon; Jeon, In-Seong

2014-07-01

347

Modeling of Microwave Ovens with Perforated Metal Walls Erin M. Kiley and Vadim V. Yakovlev  

E-print Network

propagation through perforated shields (e.g., [3-4]), however, models of microwave ovens with perforated metalModeling of Microwave Ovens with Perforated Metal Walls Erin M. Kiley and Vadim V. Yakovlev - An applied technique is proposed for resolution of issues arising in computational modeling of microwave

Yakovlev, Vadim

348

Retained foreign body: associations with elevated lead levels, pica, and duodenal anomaly  

Microsoft Academic Search

A 14-month-old girl presented with elevated lead levels and a metallic foreign body was detected on abdominal radiograph. Subsequent evaluation, performed after the child failed to pass the foreign body with cathartics, revealed a bezoar proximal to a partial duodenal obstruction. The metallic foreign body was later removed and found to contain lead, however, the patient has subsequently had recurrent

J. D. Sprinkle; E. A. Hingsbergen

1995-01-01

349

Spontaneous intramural duodenal hematoma in type 2B von Willebrand disease  

PubMed Central

Intramural duodenal hematoma is a rare cause of a proximal gastrointestinal tract obstruction. Presentation of intramural duodenal hematoma most often occurs following blunt abdominal trauma in children, but spontaneous non-traumatic cases have been linked to anticoagulant therapy, pancreatitis, malignancy, vasculitis and endoscopy. We report an unusual case of spontaneous intramural duodenal hematoma presenting as an intestinal obstruction associated with acute pancreatitis in a patient with established von Willebrand disease, type 2B. The patient presented with abrupt onset of abdominal pain, nausea, and vomiting. Computed tomography imaging identified an intramural duodenal mass consistent with blood measuring 4.7 cm × 8.7 cm in the second portion of the duodenum abutting on the head of the pancreas. Serum lipase was 3828 units/L. Patient was managed conservatively with bowel rest, continuous nasogastric decompression, total parenteral nutrition, recombinant factor VIII (humateP) and transfusion. Symptoms resolved over the course of the hospitalization. This case highlights an important complication of an inherited coagulopathy. PMID:24222967

Eichele, Derrick D; Ross, Meredith; Tang, Patrick; Hutchins, Grant F; Mailliard, Mark

2013-01-01

350

Optical Markers in Duodenal Mucosa Predict the Presence of Pancreatic Cancer  

E-print Network

Optical Markers in Duodenal Mucosa Predict the Presence of Pancreatic Cancer Yang Liu,1 Randall E Shah,2 Curtis Hall,2 and Vadim Backman1 Abstract Purpose: Pancreatic cancer remains one of the most architecture of the epithe- lium.We propose a novel approach to predict pancreatic cancer through

Ottino, Julio M.

351

Effects of rapeseed oil duodenal infusion on dairy cow performances and blood metabolites during early lactation  

E-print Network

Effects of rapeseed oil duodenal infusion on dairy cow performances and blood metabolites during-oil was continuously infused (1.03 kg/d) into the duodenum of 6 multip- arous fistulated cows ('0 group'), from about 3. Neither plasma cholesterol, phospholip- ids or 3-OH-butyrate were affected by oil infusion. Preprandial

Boyer, Edmond

352

Effect of lactose hydrolysis on calcium absorption during duodenal milk perfusion  

E-print Network

Effect of lactose hydrolysis on calcium absorption during duodenal milk perfusion Ines BIRLOUEZ, Skala and Bakos, 1973). However, as yet there is little direct evidence that such hydrolysis show the role of lactose hydrolysis ; such a study was carried out by Debongnie et al. (1979), but only

Paris-Sud XI, Université de

353

Duodenal myotomy blocks reduction of meal size and prolongation of intermeal interval by cholecystokinin.  

PubMed

We have shown that vagotomy (VGX) attenuates the reduction of meal size (MS) produced by cholecystokinin (CCK) -8 and -33 and that celiaco-mesenteric ganglionectomy (CMGX) attenuates the prolongation of the intermeal interval (IMI) produced by CCK-33. Here, we report the following novel data. First, by determining the distribution of CCK(1) receptor messenger RNA, which mediates reduction of MS and prolongation of IMI by CCK, in seven regions of the gastrointestinal tract in the adult rat we found that the duodenum contains the highest concentration of this receptor in the gut. Second, based on the previous finding we performed a unique surgical technique known as duodenal myotomy (MYO), which severs all the nerves of the gut wall in the duodenum including vagus, splanchnic and enteric nerves. Third, we determined MS and IMI in duodenal MYO rats in responses to endogenous CCK-58 released by the non-nutrient, trypsin inhibitor, camostat and CCK-8 to test the possibility that the duodenum is the site of action for reduction of MS and prolongation of IMI. We found that, similar to the previous work reported by using CCK-8 and MS, duodenal MYO also blocked reduction of MS by camostat. Forth, duodenal MYO blocked prolongation of IMI by camostat. As such, our current results suggest that the duodenum is the gut site that communicates both feeding signals of endogenous CCK, MS and IMI, with the brain through vagal and splanchnic afferents. PMID:22047890

Lateef, Dalya M; Washington, Martha C; Raboin, Shannon J; Roberson, Allison E; Mansour, Mahmoud M; Williams, Carol S; Sayegh, Ayman I

2012-02-01

354

Determination of assay parameters for RNA analysis in bacterial and duodenal samples by spectrophotometry.  

E-print Network

bases (RNA eq), was carried out to measure microbial nitrogen flow in the ruminant duodenum. SeveralDetermination of assay parameters for RNA analysis in bacterial and duodenal samples was also determined using high performance liquid chromatography (HPLC). The proposed method (RNA eq

Paris-Sud XI, Université de

355

Effect of short-term cognitive psychotherapy on recurrence of duodenal ulcer: a prospective randomized trial.  

PubMed

The aim of this prospective, randomized trial was to assess whether short-term cognitive psychotherapy (10 sessions during 4 months) could reduce the 1-year recurrence rate of duodenal ulcer. One group received psychotherapy; one group was a control group. One hundred patients, aged 17 to 64 years, with duodenal ulcer were selected from March 1989 to May 1991. The main outcome measure was relapse of duodenal ulcer, which was verified by endoscopy. When psychotherapy started after cessation of antiulcer medication, the relapse-free time was significantly shorter in the therapy group than in the controls. When the protocol was modified so that psychotherapy and antiulcer medication were given concomitantly, there was no significant difference in recurrence rate between the groups at 1-year follow-up (84% in the therapy group and 92% in the control group). Symptoms of upper abdominal discomfort/pain, measured every second month, decreased significantly in the therapy group compared to the control group. Psychotherapy led to less neuroticism (Eysenck Personality Questionnaire) and less trait anxiety (Spielberger Trait Anxiety Scale) compared to controls at 4 months. At the 12-month follow-up, most of this gain was lost, but the psychotherapy group had lower scores on "concern about disapproval" on the Sociotropy-Autonomy Scale than the control group. There is no beneficial effect of short-term cognitive psychotherapy on the 1-year recurrence rate of duodenal ulcer. PMID:7809344

Wilhelmsen, I; Haug, T T; Ursin, H; Berstad, A

1994-01-01

356

Value of routine duodenal biopsy in diagnosing coeliac disease in patients with iron deficiency anaemia  

PubMed Central

Background: Iron deficiency anaemia (IDA) is a recognised feature of coeliac disease in adults and can be its only presentation. Objective: To determine the yield of routine distal duodenal biopsies in diagnosing coeliac disease in adult and elderly patients with IDA whose endoscopy revealed no upper gastrointestinal cause of iron deficiency. Study design: Prospective study in a teaching hospital endoscopy unit. Method: Altogether 504 consecutive patients with IDA, aged 16–80 years, attending for endoscopy were included in this study. At least two distal duodenal biopsies were taken if endoscopy revealed no cause of iron deficiency. Result: In nine (1.8%) patients duodenal biopsies revealed typical histological features of coeliac disease. Of these, five patients were above 65 years old. Conclusion: In adult and elderly patients undergoing endoscopy for IDA, the endoscopist should take distal duodenal biopsies to exclude coeliac disease if no upper gastrointestinal cause of anaemia is found. Coeliac disease is not an uncommon cause of IDA in patients >65 years of age and a history of chronic diarrhoea increases diagnostic yield in this age group. PMID:15299158

Mandal, A; Mehdi, I; Munshi, S; Lo, T

2004-01-01

357

Melatonin decreases duodenal epithelial paracellular permeability via a nicotinic receptor-dependent pathway in rats in vivo.  

PubMed

Intestinal epithelial intercellular tight junctions (TJs) provide a rate-limiting barrier restricting passive transepithelial movement of solutes. TJs are highly dynamic areas, and their permeability is changed in response to various stimuli. Defects in the intestinal epithelial TJ barrier may contribute to intestinal inflammation or leaky gut. The gastrointestinal tract may be the largest extrapineal source of endogenous melatonin. Melatonin released from the duodenal mucosa is a potent stimulant of duodenal mucosal bicarbonate secretion (DBS). The aim of this study was to elucidate the role of melatonin in regulating duodenal mucosal barrier functions, including mucosal permeability, DBS, net fluid flux, and duodenal motor activity, in the living animal. Rats were anesthetized with thiobarbiturate, and a ~30-mm segment of the proximal duodenum with an intact blood supply was perfused in situ. Melatonin and the selective melatonin receptor antagonist luzindole were perfused luminally or given intravenously. Effects on permeability (blood-to-lumen clearance of (51)Cr-EDTA), DBS, mucosal net fluid flux, and duodenal motility were monitored. Luminal melatonin caused a rapid decrease in paracellular permeability and an increase in DBS, but had no effect on duodenal motor activity or net fluid flux. Luzindole did not influence any of the basal parameters studied, but significantly inhibited the effects of melatonin. The nonselective and noncompetitive nicotinic acetylcholine receptor antagonist mecamylamine abolished the effect of melatonin on duodenal permeability and reduced that on DBS. In conclusion, these findings provide evidence that melatonin significantly decreases duodenal mucosal paracellular permeability and increases DBS. The data support the important role of melatonin in the neurohumoral regulation of duodenal mucosal barrier. PMID:23009576

Sommansson, Anna; Nylander, Olof; Sjöblom, Markus

2013-04-01

358

Diagnostic and therapeutic implications of a novel immunohistochemical panel detecting duodenal mucosal invasion by pancreatic ductal adenocarcinoma  

PubMed Central

Background: We investigated a series of pancreaticoduodenectomy and duodenal biopsies with a panel of immunohistochemical markers to identify duodenal mucosal invasion by pancreatic ductal adenocarcinoma (PDAC), including markers of poor prognosis and targets of promising novel immunotherapies. Materials and Methods: Eighteen consecutive pancreaticoduodenectomy specimens with duodenal mucosal invasion by PDAC were examined for expression of MUC1, MUC4, MUC5AC, MUC6, mesothelin, MUC2, CDX2, and DPC4 on formalin-fixed, paraffin-embedded sections of duodenal-ampullary-pancreatic junctions. Expression of all but MUC6 was also assessed in duodenal biopsies from 12 patients with duodenal mucosal invasion by PDAC. Results: The duodenal mucosa expressed MUC1 (crypts), MUC2 (goblet cells), MUC6 (Brunner glands), CDX2, and DPC4. PDACs in the duodenal mucosa from the resection (n=16-18) and biopsy (n=12) specimens were marked as follows: MUC1 100% (30/30), MUC4 83% (24/29), MUC5AC 83% (25/30), mesothelin 82% (23/28), MUC2 7% (2/30), and CDX2 36% (10/28). Loss of DPC4 expression was seen in 16 of 29 (55%) cases. Reactive mucosa adjacent to PDAC expressed MUC4, MUC5AC and mesothelin in 65% (17/26), 19% (5/27), and 19% (5/26) of cases, respectively. While MUC5AC and mesothelin had high diagnostic accuracy for detection of PDAC, MUC2, CDX2 and DPC4 expression demonstrated negative correlation with PDAC, with absent expression being highly specific for PDAC. Conclusion: Immunohistochemical labeling for PDAC biomarkers may aid the diagnosis of PDAC in duodenal biopsy, especially in situations where diagnosis of a pancreatic mass is challenging. PMID:24228110

Sopha, Sabrina C; Gopal, Purva; Merchant, Nipun B; Revetta, Frank L; Gold, David V; Washington, Kay; Shi, Chanjuan

2013-01-01

359

A novel dynamic scintigraphic technique for assessing duodenal contractions during gastric emptying in humans: a feasibility study.  

PubMed

Duodenal contractions are thought to play a role in the control of gastric emptying. Although noninvasive techniques, such as ultrasonography and MRI, have been proposed for studying duodenal contractile activity in humans, there are no reports on the use of scintigraphy for this purpose. This work aimed to describe a novel scintigraphic technique for assessing duodenal contractility during gastric emptying in humans, and to present preliminary data on the frequency and amplitude of contractions detected in three different duodenal segments. Fasted young healthy volunteers (N=12) were given either a liquid or a solid test meal of similar calorie content (400?kcal) labeled with Tc-phytate. Static images were collected to determine gastric emptying. Dynamic images of the anterior aspect of the abdomen (1?frame/s) were also acquired periodically in a standard position for 256?s at 15-30?min intervals. 'Activity versus time' curves were generated for regions of interest corresponding to the proximal, middle, and distal duodenal segments. Curves were digitally filtered and processed to estimate both dominant frequency (fast Fourier transform) and amplitude (mean ejection fraction) of postprandial duodenal contractions. There were no significant differences regarding dominant frequency among proximal, middle, and distal duodenal regions of interest. In addition, there were no significant differences between the liquid and the solid meal in terms of either frequency or amplitude of duodenal contractions. Characterization of duodenal contractions in humans using scintigraphy is feasible and yields consistent data for both the frequency and the amplitude of postprandial contractions, which seems to be rather independent of meal consistency. PMID:25299468

Kubo, Tadeu T A; Moraes, Eder R; Secaf, Marie; Troncon, Luiz E A

2015-01-01

360

Swallowed dental bridge causing ileal perforation: a case report  

Microsoft Academic Search

We report the case of a 53 year old gentleman who had accidentally swallowed his dental bridge. One week following this he experienced a sudden onset of generalised abdominal pain and underwent laparotomy. At operation he was found to have a distal ileal perforation and an ileocaecal resection was performed. Although most swallowed foreign bodies pass through the gastrointestinal tract

Farhan Rashid; John Simpson; G Ananthakrishnan; Gillian M Tierney

2008-01-01

361

Migrated biliary plastic stent causing double sigmoid colon perforation  

PubMed Central

A female patient was admitted to our hospital with sigmoid colon perforation caused by migrated biliary plastic stent, which was placed 2 months ago for the treatment of choledocholithiasis. The patient underwent sigmoid colon resection with primary anastomosis and was discharged on seventh postoperative day in good general condition. PMID:25487372

Konstantinidis, Christos; Varsos, Panagiotis; Kympouris, Sotirios; Volteas, Spyridon

2014-01-01

362

Effect of narcotic premedication of scintigraphic evaluation of gallbladder perforation  

Microsoft Academic Search

A case of gallbladder perforation is presented in which a small bile leak was demonstrated by cholescintigraphy while the patient was receiving meperidine, but not after meperidine was discontinued. The scintigrams obtained during meperidine therapy also showed a pattern of bile-duct obstruction. It is suggested that increased biliary pressure secondary to meperidine admininstration permitted visualization of the leak. Use of

D. M. Sefczek; P. Sharma; G. H. Isaacs; G. J. Jr. Brodmerkel; M. H. Adatepe; O. M. Powell; K. Nichols

1985-01-01

363

Incidence of inadvertent globe perforation during strabismus surgery  

Microsoft Academic Search

Visual loss following strabismus is rare and usually follows inadvertent perforation of the globe at the time of surgery. Previous studies have reported that the incidence of this complication occurs in 8% to 12.1% of patients undergoing conventional strabismus surgery, and higher incidences have been reported for posterior fixation sutures. We conducted a prospective study to determine the incidence of

R. J. Morris; P. H. Rosen; P. Fells

1990-01-01

364

Late corneal perforation after photorefractive keratectomy associated with topical diclofenac  

Microsoft Academic Search

ObjectiveTo report a case of a 50-year-old man who was initially seen with a corneal perforation in his right eye 2 months after a photorefractive keratectomy (PRK) procedure and to discuss the roles of topical diclofenac and matrix metalloproteinases (MMPs).

Eric E Gabison; Philippe Chastang; Suzanne Menashi; Samia Mourah; Serge Doan; Michelle Oster; Alain Mauviel; Thanh Hoang-Xuan

2003-01-01

365

[Aneurysm of the thoracic aorta with esophageal perforation].  

PubMed

Aneurysms of a chest department of an aorta with esophageal perforation two cases are presented and a lethal outcome. Difficulties in diagnostics have been caused by rare occurrence of the given pathology, insufficient experience of clinical physicians, and also absence during supervision of characteristic attributes Aortoesophageal Fistula. PMID:20731170

Timen, L Ia; Shertsinger, A G; Zhigalova, S B; Chikunova, B Z; Markarov, A E; Fedotov, E V; Nazar'ev, P I

2010-01-01

366

Efficiency of perforated breakwater and associated energy dissipation  

E-print Network

The flow field behavior in the vicinity of a perforated breakwater and the efficiency of the breakwater under regular waves were studied. To examine the efficiency of the structure thirteen types of regular wave conditions with wave periods T = 1, 1...

Ariyarathne, Hanchapola Appuhamilage

2008-10-10

367

Efficiency of perforated breakwater and associated energy dissipation  

E-print Network

The flow field behavior in the vicinity of a perforated breakwater and the efficiency of the breakwater under regular waves were studied. To examine the efficiency of the structure thirteen types of regular wave conditions with wave periods T = 1, 1...

Ariyarathne, Hanchapola Appuhamilage

2009-05-15

368

A fibrin sealant for perforated and preperforated corneal ulcers.  

PubMed Central

Fibrin sealant is used to close perforated or preperforated corneal ulcers. In addition to the usual advantages of cyanoacrylates it is degraded physiologically and provides a good support for corneal healing. Corneal grafting can be avoided when contraindicated or postponed when conditions allow. This technique has been successful in nine eyes of eight patients. Images PMID:2804032

Lagoutte, F M; Gauthier, L; Comte, P R

1989-01-01

369

ROOT GROWTH: HOMOGENIZATION IN DOMAINS WITH TIME DEPENDENT PARTIAL PERFORATIONS  

E-print Network

ROOT GROWTH: HOMOGENIZATION IN DOMAINS WITH TIME DEPENDENT PARTIAL PERFORATIONS YVES CAPDEBOSCQ AND MARIYA PTASHNYK Abstract. In this article we derive a macroscopic model for root length density evolution, starting from a discrete mesh of roots, using homogenization techniques. In the microscopic model each root

Rheinisch-Westfälische Technische Hochschule Aachen (RWTH)

370

Basilar Artery Perforation as a Complication of Endoscopic Third Ventriculostomy  

Microsoft Academic Search

The morbidity and mortality associated with third ventriculostomy has decreased significantly over the past 75 years since its introduction by Walter Dandy. Now more commonly performed using an endoscopic method, the significant morbidity of third ventriculostomy has dropped to approximately 5%; essentially that associated with ventriculoscopy in general. However, the possible complication of massive subarachnoid hemorrhage resulting from perforation of

Keyvan Abtin; B. Gregory Thompson; Marion L. Walker

1998-01-01

371

[Inverted caloric nystagmus of perforated ears upon air caloric stimulation].  

PubMed

It is well known that inverted caloric nystagmus is seen during air caloric testing in cases of chronic otitis media. The mechanism of inversion and its clinical significance are discussed here. Temperature changes in the tympanic cavity and external ear canal were measured with a microthermister and a digital tester in seventeen ears with tympanic membrane perforation, during bithermal air caloric testing. The tympanic cavity mucosa was cooled by hot stimulation because of the evaporation of heat. When the perforation was closed or humidified air was used, the tympanic cavity mucosa was not cooled by hot stimulation and the inverted caloric nystagmus changed to a normal response. Inverted caloric nystagmus occurred in 30.4% of 335 ears affected by chronic otitis media with perforation. Inverted caloric nystagmus occurred in 90 ears with hot stimulation and in 12 ears with cold stimulation. Inverted caloric nystagmus turned to normal response after myringoplasty in all of 10 ears. The cooling effect caused by evaporation of water from the moist middle ear mucosa during dry air blowing and direct thermal conduction to the vestibulum through a perforation of the ear drum and inversion of the endolymphatic convection seemed to cause the inversion. PMID:2040915

Koide, C

1991-03-01

372

Neonatal perforated Amyand's hernia presenting as an enterocutaneous scrotal fistula.  

PubMed

Perforation of the vermiform appendix in a septic neonate with an Amyand's hernia resulted in the formation of a scrotal enterocutaneous fistula. In conclusion from this exceptional complication, active parental awareness for any neonatal scrotal swelling is required, and an early operative policy for the neonatal inguinal hernia is significant. PMID:24751296

Panagidis, Antonios; Sinopidis, Xenophon; Zachos, Konstantinos; Alexopoulos, Vasileios; Vareli, Anastasia; Varvarigou, Anastasia; Georgiou, George

2014-04-18

373

Jejunal perforation due to porcupine quill ingestion in a horse  

PubMed Central

An 8-month-old Andalusian filly was treated for jejunal perforations due to ingestion of a porcupine quill. During exploratory laparotomy, 2 separate stapled side-to-side jejunojejunal resection and anastomoses were performed. Post-operative complications after 2 years follow-up included mild incisional herniation following incisional infection and chronic intermittent colic. PMID:24489394

Anderson, Stacy L.; Panizzi, Luca; Bracamonte, Jose

2014-01-01

374

Comparative Study of Prions in Iatrogenic and Sporadic Creutzfeldt-Jakob Disease  

PubMed Central

Differentiating iatrogenic Creutzfeldt-Jakob disease (iCJD) from sporadic CJD (sCJD) would be useful for the identification and prevention of human-to-human prion transmission. Currently, the diagnosis of iCJD depends on identification of a recognized source of contamination to which patients have been exposed, in addition to fulfilling basic requirements for the establishment of diagnosis of CJD. Attempts to identify differences in clinical manifestations, neuropathological changes and pathological prion protein (PrPSc) between iCJD and sCJD have been unsuccessful. In the present study, using a variety of more sophisticated methods including sucrose step gradient sedimentation, conformational stability immunoassay, protein misfolding cyclic amplification (PMCA), fragment-mapping, and transmission study, we show no significant differences in gel profiles, oligomeric state, conformational stability and infectivity of PrPSc between iCJD and sCJD. However, using PMCA, we find that convertibility and amplification efficiency of PrPSc is greater in iCJD than in sCJD in a polymorphism-dependent manner. Moreover, two protease-resistant PrP C-terminal fragments (termed PrP-CTF12/13) were detected in all 9 cases of sCJD but not in 6 of 8 cases of iCJD tested in this study. The use of fragment mapping- and PMCA-based assays thus provides a means to distinguish most cases of iCJD from sCJD. PMID:25419482

Xiao, Xiangzhu; Yuan, Jue; Qing, Liuting; Cali, Ignazio; Mikol, Jacqueline; Delisle, Marie-Bernadette; Uro-Coste, Emmanuelle; Zeng, Liang; Abouelsaad, Mai; Gazgalis, Dimitris; Martinez, Manuel Camacho; Wang, Gong-Xian; Brown, Paul; Ironside, James W.; Gambetti, Pierluigi; Kong, Qingzhong; Zou, Wen-Quan

2014-01-01

375

Recognition and management of iatrogenically induced opioid dependence and withdrawal in children.  

PubMed

Opioids are often prescribed to children for pain relief related to procedures, acute injuries, and chronic conditions. Round-the-clock dosing of opioids can produce opioid dependence within 5 days. According to a 2001 Consensus Paper from the American Academy of Pain Medicine, American Pain Society, and American Society of Addiction Medicine, dependence is defined as "a state of adaptation that is manifested by a drug class specific withdrawal syndrome that can be produced by abrupt cessation, rapid dose reduction, decreasing blood level of the drug, and/or administration of an antagonist." Although the experience of many children undergoing iatrogenically induced withdrawal may be mild or goes unreported, there is currently no guidance for recognition or management of withdrawal for this population. Guidance on this subject is available only for adults and primarily for adults with substance use disorders. The guideline will summarize existing literature and provide readers with information currently not available in any single source specific for this vulnerable pediatric population. PMID:24379233

Galinkin, Jeffrey; Koh, Jeffrey Lee

2014-01-01

376

Iatrogenic epidemics of puerperal fever in the 18th and 19th centuries.  

PubMed

The epidemics of puerperal fever in the 18th and 19th centuries began soon after the creation of Lying-in hospitals in the mid-18th century. The primary purpose of these hospitals was to provide physicians with training in obstetrics in general and in forceps deliveries in particular. The first reports describing epidemics of puerperal fever, its contagiousness and control were made by British physicians in the latter half of the 18th century. Alexander Gordon provided epidemiological evidence of contagion in 1792, and Oliver Wendell Holmes in the USA reviewed these reports in his paper on outbreaks of puerperal fever around Boston in 1843. Ignaz Semmelweis in Vienna, unaware of previous work on this disease, re-discovered the actions required to control the contagion in 1847, but published his paper much later in 1861. A few enlightened doctors struggled to prove that puerperal fever was contagious and could be spread by doctors and midwives. Their peers and colleagues predominantly displayed apathy and ignorance until forced to act by the weight of evidence. However, it was the multitude of parturient women who paid the ultimate price for these iatrogenic epidemics. PMID:8757690

Bridson, E Y

1996-06-01

377

Superselective Renal Artery Embolization in the Treatment of Iatrogenic Bleeding into the Urinary Tract  

PubMed Central

Background The aim of this study was to evaluate the efficacy of superselective renal artery embolization in patients with bleeding into the urinary system. Material/Methods From 2007 to 2012, 20 patients were treated with superselective renal artery embolization for bleeding after percutaneous nephrolithotomy (PCNL), nephron-sparing surgery (NSS), including 1 patient with AVF after PCNL. During the procedure, embolization material was injected through a microcatheter to stop the bleeding. Embolization materials included a mixture of cyanoacrylate and lipiodol, embolization coils, and Spongostan. Clinical evaluation included remission of hematuria and normalization of blood morphotic elements. Results The cause of bleeding into the urinary tract was damage to vessels (all cases): with coexisting false aneurism (8 cases); with coexisting arterio-venus fistula (1 case); and with coexisting intrarenal hematoma (3 cases). The bleeding occurred 2–5 days after PCNL and NSS, and 10 days after PCNL with AVF. The mean hematocrit level was 22%–24%. Technical success was achieved in 20 cases. Clinical success was achieved in 19 cases. One patient with hematuria after PCNL with AVF needed a second endovascular treatment to stop bleeding. Conclusions Superselective renal artery embolization is an effective procedure in the treatment of iatrogenic bleeding into the urinary tract after PCNL and NSS. PMID:25627580

Z?bkowski, Tomasz; Piasecki, Piotr; Zieli?ski, Henryk; Wieczorek, Andrzej; Brzozowski, Krzysztof; Zi?cina, Piotr

2015-01-01

378

Iatrogenic Anetoderma of Prematurity: A Case Report and Review of the Literature  

PubMed Central

Anetoderma is a skin disorder characterized by focal loss of elastic tissue in the mid dermis, resulting in localized areas of macular depressions or pouchlike herniations of skin. An iatrogenic form of anetoderma has been rarely described in extremely premature infants and has been related to the placement of monitoring devices on the patient skin. Because of the increasing survival of extremely premature infants, it is easy to foresee that the prevalence of anetoderma of prematurity will increase in the next future. Although it is a benign lesion, it persists over time and can lead to significant aesthetic damage with need for surgical correction. Sometimes the diagnosis can be difficult, especially when the atrophic lesions become evident after discharge. Here, we report on a premature infant born at 24 weeks of gestation, who developed multiple anetodermic patches of skin on the trunk at the sites where electrocardiographic electrodes were previously applied. The knowledge of the disease can encourage a more careful management of the skin of extremely premature babies and aid the physicians to diagnose the disease when anetoderma patches are first encountered later in childhood. PMID:25374702

Maffeis, Laura; Pugni, Lorenza; Pietrasanta, Carlo; Ronchi, Andrea; Fumagalli, Monica; Gelmetti, Carlo; Mosca, Fabio

2014-01-01

379

Superselective renal artery embolization in the treatment of iatrogenic bleeding into the urinary tract.  

PubMed

Background The aim of this study was to evaluate the efficacy of superselective renal artery embolization in patients with bleeding into the urinary system. Material and Methods From 2007 to 2012, 20 patients were treated with superselective renal artery embolization for bleeding after percutaneous nephrolithotomy (PCNL), nephron-sparing surgery (NSS), including 1 patient with AVF after PCNL. During the procedure, embolization material was injected through a microcatheter to stop the bleeding. Embolization materials included a mixture of cyanoacrylate and lipiodol, embolization coils, and Spongostan. Clinical evaluation included remission of hematuria and normalization of blood morphotic elements. Results The cause of bleeding into the urinary tract was damage to vessels (all cases): with coexisting false aneurism (8 cases); with coexisting arterio-venus fistula (1 case); and with coexisting intrarenal hematoma (3 cases). The bleeding occurred 2-5 days after PCNL and NSS, and 10 days after PCNL with AVF. The mean hematocrit level was 22%-24%. Technical success was achieved in 20 cases. Clinical success was achieved in 19 cases. One patient with hematuria after PCNL with AVF needed a second endovascular treatment to stop bleeding. Conclusions Superselective renal artery embolization is an effective procedure in the treatment of iatrogenic bleeding into the urinary tract after PCNL and NSS. PMID:25627580

Z?bkowski, Tomasz; Piasecki, Piotr; Zieli?ski, Henryk; Wieczorek, Andrzej; Brzozowski, Krzysztof; Zi?cina, Piotr

2015-01-01

380

Iatrogenic Exserohilum infection of the central nervous system: mycological identification and histopathological findings.  

PubMed

An outbreak of fungal infections has been identified in patients who received epidural injections of methylprednisolone acetate that was contaminated with environmental molds. In this report, we present the mycological and histopathological findings in an index case of Exserohilum meningitis and vasculitis in an immunocompetent patient, who received a cervical spine epidural steroid injection for chronic neck pain 1 week before the onset of fulminant meningitis with subsequent multiple brain and spinal cord infarcts. The fungus was recovered from two separate cerebrospinal fluid specimens collected before initiation of antifungal therapy and at autopsy on standard bacterial and fungal culture media. The mold was identified phenotypically as Exserohilum species. DNA sequencing targeting the internal transcribed spacer region and D1/D2 region of 28S ribosomal DNA enabled further speciation as E. rostratum. Gross examination at autopsy revealed moderate brain edema with bilateral uncal herniation and a ventriculostomy tract to the third ventricle. The brainstem, cerebellum, and right orbitofrontal cortex were soft and friable, along with hemorrhages in the cerebellar vermis and thalamus. Microscopic examination demonstrated numerous fungi with septate hyphae invading blood vessel walls and inducing acute necrotizing inflammation. The leptomeninges were diffusely infiltrated by mixed inflammatory cells along with scattered foci of fungal elements. This is the first report of iatrogenic E. rostratum meningitis in humans. This report describes the microbiological procedures and histopathological features for the identification of E. rostratum (a pigmented vascularly invasive fungi), the cause of a current nationwide outbreak of fatal fungal meningitis. PMID:23222492

Bell, W Robert; Dalton, Justin B; McCall, Chad M; Karram, Sarah; Pearce, David T; Memon, Warda; Lee, Richard; Carroll, Karen C; Lyons, Jennifer L; Gireesh, Elakkat D; Trivedi, Julie B; Cettomai, Deanna; Smith, Bryan R; Chang, Tiffany; Tochen, Laura; Ratchford, John N; Harrison, Daniel M; Ostrow, Lyle W; Stevens, Robert D; Chen, Li; Zhang, Sean X

2013-02-01

381

Iatrogenic Biliary Injuries: Multidisciplinary Management in a Major Tertiary Referral Center  

PubMed Central

Background. Iatrogenic biliary injuries are considered as the most serious complications during cholecystectomy. Better outcomes of such injuries have been shown in cases managed in a specialized center. Objective. To evaluate biliary injuries management in major referral hepatobiliary center. Patients & Methods. Four hundred seventy-two consecutive patients with postcholecystectomy biliary injuries were managed with multidisciplinary team (hepatobiliary surgeon, gastroenterologist, and radiologist) at major Hepatobiliary Center in Egypt over 10-year period using endoscopy in 232 patients, percutaneous techniques in 42 patients, and surgery in 198 patients. Results. Endoscopy was very successful initial treatment of 232 patients (49%) with mild/moderate biliary leakage (68%) and biliary stricture (47%) with increased success by addition of percutaneous (Rendezvous technique) in 18 patients (3.8%). However, surgery was needed in 198 patients (42%) for major duct transection, ligation, major leakage, and massive stricture. Surgery was urgent in 62 patients and elective in 136 patients. Hepaticojejunostomy was done in most of cases with transanastomotic stents. There was one mortality after surgery due to biliary sepsis and postoperative stricture in 3 cases (1.5%) treated with percutaneous dilation and stenting. Conclusion. Management of biliary injuries was much better with multidisciplinary care team with initial minimal invasive technique to major surgery in major complex injury encouraging early referral to highly specialized hepatobiliary center. PMID:25435672

Salama, Ibrahim Abdelkader; Shoreem, Hany Abdelmeged; Saleh, Sherif Mohamed; Hegazy, Osama; Housseni, Mohamed; Abbasy, Mohamed; Badra, Gamal; Ibrahim, Tarek

2014-01-01

382

History of Helicobacter pylori, duodenal ulcer, gastric ulcer and gastric cancer  

PubMed Central

Helicobacter pylori (H. pylori) infection underlies gastric ulcer disease, gastric cancer and duodenal ulcer disease. The disease expression reflects the pattern and extent of gastritis/gastric atrophy (i.e., duodenal ulcer with non-atrophic and gastric ulcer and gastric cancer with atrophic gastritis). Gastric and duodenal ulcers and gastric cancer have been known for thousands of years. Ulcers are generally non-fatal and until the 20th century were difficult to diagnose. However, the presence and pattern of gastritis in past civilizations can be deduced based on the diseases present. It has been suggested that gastric ulcer and duodenal ulcer both arose or became more frequent in Europe in the 19th century. Here, we show that gastric cancer and gastric ulcer were present throughout the 17th to 19th centuries consistent with atrophic gastritis being the predominant pattern, as it proved to be when it could be examined directly in the late 19th century. The environment before the 20th century favored acquisition of H. pylori infection and atrophic gastritis (e.g., poor sanitation and standards of living, seasonal diets poor in fresh fruits and vegetables, especially in winter, vitamin deficiencies, and frequent febrile infections in childhood). The latter part of the 19th century saw improvements in standards of living, sanitation, and diets with a corresponding decrease in rate of development of atrophic gastritis allowing duodenal ulcers to become more prominent. In the early 20th century physician’s believed they could diagnose ulcers clinically and that the diagnosis required hospitalization for “surgical disease” or for “Sippy” diets. We show that while H. pylori remained common and virulent in Europe and the United States, environmental changes resulted in changes of the pattern of gastritis producing a change in the manifestations of H. pylori infections and subsequently to a rapid decline in transmission and a rapid decline in all H. pylori-related diseases. PMID:24833849

Graham, David Y

2014-01-01

383

Duodenal calcium uptake, femur ash, and eggshell quality decline with age and increase following molt.  

PubMed

An experiment was conducted to test the hypothesis that the decline in eggshell quality over time during egg production, and its improvement after molting, paralleled the rate of calcium uptake by the duodenum of the laying hen. In vitro duodenal calcium uptake rate and femur ash (percentage of femur weight) were determined at 37, 45, 51, 58, 68, and 72 wk of age. Percentage shell and shell thickness (millimeters) were determined at 22, 29, 36, 44, 50, 57, and 71 wk of age. Molt was induced at 63 wk of age. Three commercial strains DeKalb XL-Link, ISA/Babcock B-300V, and Hy-Line W-36 were compared. There were no differences in duodenal calcium uptake rate among strains. There was a significant decline (P < .01) in duodenal calcium uptake from 408 pmol/mg tissue per min at 37 wk of age to 329 pmol/mg per min at 58 wk of age. Femur ash decreased (P < .01) from 50.8% at 37 wk of age to 47.6% at 58 wk of age. Percentage shell and shell thickness declined (P < .01) from 9.79% and .403 mm at 22 wk of age to 8.88% and .373 mm at 57 wk of age, respectively. After the induced molt, duodenal calcium uptake increased (P < .01) to 402 pmol/mg tissue per min, and percentage shell and shell thickness increased (P < .01) to 10.23% and .389 mm, respectively. Duodenal calcium uptake increased immediately postmolt, whereas femur ash did not increase until 72 wk of age (P < .01). PMID:7816734

al-Batshan, H A; Scheideler, S E; Black, B L; Garlich, J D; Anderson, K E

1994-10-01

384

Cat scratch disease, a rare cause of hypodense liver lesions, lymphadenopathy and a protruding duodenal lesion, caused by Bartonella henselae.  

PubMed

A 46-year-old woman presented with right upper abdominal pain and fever. At imaging, enlarged peripancreatic and hilar lymph nodes, as well as hypodense liver lesions, were detected, suggestive of malignant disease. At endoscopy, the mass adjacent to the duodenum was seen as a protruding lesion through the duodenal wall. A biopsy of this lesion, taken through the duodenal wall, showed a histiocytic granulomatous inflammation with necrosis. Serology for Bartonella henselae IgM was highly elevated a few weeks after presentation, consistent with the diagnosis of cat scratch disease. Clinical symptoms subsided spontaneously and, after treatment with azithromycin, the lymphatic masses, liver lesions and duodenal ulceration disappeared completely. PMID:25355744

van Ierland-van Leeuwen, Marloes; Peringa, Jan; Blaauwgeers, Hans; van Dam, Alje

2014-01-01

385

Factors Associated with Gastrointestinal Perforation in a Cohort of Patients with Rheumatoid Arthritis  

PubMed Central

Objective To estimate the incidence and risk factors for gastrointestinal (GI) perforation among patients with rheumatoid arthritis (RA). Methods Claims from employer health insurance plans were used to identify RA patients and those hospitalized for upper or lower GI perforation. GI perforation cases were identified using both a sensitive and specific definition. A Cox model using fixed and time-varying covariates was used to evaluate risk of GI perforation. Results Among 143,433 RA patients, and using a maximally sensitive GI perforation definition, 696 hospitalizations with perforation were identified. The rate of perforation was 1.70 per 1000 person years (PYs) [95% CI, 1.58–1.83] and most perforations (83%) occurred in the lower GI tract. The rate of perforation was lower when a more specific GI perforation definition was used (0.87, 95% CI, 0.78–0.96 per 1,000 PYs). Age and diverticulitis were among the strongest risk factors for perforation (diverticulitis hazard ratio=14.5 [95% CI, 11.8–17.7] for more sensitive definition, hazard ratio=3.9 [95% CI, 2.5–5.9] for more specific definition). Among various RA medication groups, and compared to methotrexate, the risk of GI perforation was highest among patients with exposure to concomitant non-biologic disease-modifying antirheumatic drugs and glucocorticoids. Biologics without glucocorticoid exposure was not a risk factor for perforation. Conclusion GI perforation is a rare but serious condition that affects patients with RA, most frequently in the lower GI tract. Clinicians should be aware of risk factors for GI perforation when managing RA patients, including age, history of diverticulitis, and use of glucocorticoids or NSAIDs. PMID:22730417

Curtis, Jeffrey R.; Lanas, Angel; John, Ani; Johnson, David A.; Schulman, Kathy L.

2012-01-01

386

Eradication of Helicobacter pylori infection did not lead to cure of duodenal mucosa-associated lymphoid tissue lymphoma.  

PubMed

Duodenal mucosa-associated lymphoid tissue (MALT) lymphoma is very rare, and little is known about its clinical course or association with Helicobacter pylori infection. This report describes the case of a 76-year-old man with a polypoid mass in the duodenal bulb, diagnosed as low-grade MALT lymphoma. H. pylori infection in the duodenal mucosa was confirmed by histology with silver stain. Endoscopic examination showed that the gross lesion regressed after the eradication of H. pylori despite its histopathologic persistence. Ten months later, however, cervical and intraperitoneal lymphadenopathy and bone marrow involvement was observed, and the pathologic diagnosis of the cervical lymph node was identical with that of the duodenal lesion. PMID:10192204

Kim, J S; Jung, H C; Shin, K H; Song, I S; Kim, C W; Kim, C Y

1999-02-01

387

Monosaccharide composition of fundic and duodenal mucins in sheep infected with Haemonchus contortus or Teladorsagia circumcincta.  

PubMed

The effects on the monosaccharide composition of fundic and duodenal mucins of parasitism by Haemonchus contortus or Teladorsagia circumcincta were investigated in sheep at 4, 6 and 9 months of age. Infected sheep were euthanased at days 21 and 28 post-infection respectively, together with uninfected controls. Fundic and duodenal mucins were purified by gel filtration and CsCl density gradient centrifugation and monosaccharides were released by heating at 95 degrees C for 6h in 2M HCl. Thin-layer chromatography identified fucose, glucosamine, galactose and galactosamine in both mucins, as well as very small amounts of sialic acids. Neither N-acetylglucosamine nor N-acetylgalactosamine was present, as these are deacetylated during acid hydrolysis to glucosamine and galactosamine, respectively. Fucose, glucosamine, galactose and galactosamine were separated and quantified by High Performance Anion Exchange Chromatography on a CarboPac PA-20 column. Sialic acids were determined by the thiobarbiturate assay. Over the age range of 4-9 months, the principal changes in the monosaccharide composition of mucins in non-infected sheep were increasing fucosylation and decreasing sialylation, as observed in other mammals. In duodenal mucins, there was a statistically significant increase in fucosylation and a decrease in sialylation (p=0.043 and 0.014, respectively), while similar trends were seen in fundic mucins. Other modifications with age in sheep mucins were decreased acetylglucosamine (N-acetylglucosamine) in the fundus and galactosamine (N-acetylgalactosamine) in the duodenum. The effects of H. contortus and T. circumcincta infection on fundic mucin monosaccharide composition were not identical, although both parasites decreased fucosylation and sialylation. Both parasites caused the same effects on duodenal mucins, however, these differed from the changes in the fundus. H. contortus infection increased the proportions of glucosamine and galactose in fundic and duodenal mucins, respectively. Mucins from the fundus of H. contortus-infected sheep had similar monosaccharide profiles at all ages, but this was not the case for T. circumcincta, in which there were lesser changes on mucins in 9 months old sheep, apart from decreased sialylation. This may indicate immunity to T. circumcincta from previous exposure in the field. The effect on duodenal mucins was similar for the two infections (decreased sialic acids, fucose and N-acetylgalactosamine and increased galactose), suggesting it may result from the immune response to the presence of worms in the abomasum. Mucin profiles from organs more accessible than the gastrointestinal tract may be useful markers for the host immune response and identify resistant, resilient or susceptible individuals. PMID:20211529

Hoang, V C; Williams, M A K; Simpson, H V

2010-06-24

388

A Novel Duodenal Iron-Regulated Transporter, IREG1, Implicated in the Basolateral Transfer of Iron to the Circulation  

Microsoft Academic Search

Iron absorption by the duodenal mucosa is initiated by uptake of ferrous Fe(II) iron across the brush border membrane and culminates in transfer of the metal across the basolateral membrane to the portal vein circulation by an unknown mechanism. We describe here the isolation and characterization of a novel cDNA (Ireg1) encoding a duodenal protein that is localized to the

Andrew T McKie; Paola Marciani; Andreas Rolfs; Karen Brennan; Kristina Wehr; Dalna Barrow; Silvia Miret; Adrian Bomford; Timothy J Peters; Farzin Farzaneh; Matthias A Hediger; Matthias W Hentze; Robert J Simpson

2000-01-01

389

Prospective multicentre study of risk factors associated with delayed healing of recurrent duodenal ulcers (RUDER). RUDER Study Group  

Microsoft Academic Search

Risk factors for delayed duodenal ulcer healing during treatment with ranitidine (300 mg daily) were examined in a multicentre German study of 1923 patients with endoscopically proved, recurrent duodenal ulceration. Healing rates, per protocol, were 39.5% at two weeks, 70.9% at four weeks, and 93.2% at eight weeks. Prospective testing of five, predefined risk factors indicated that smoking (p =

D Armstrong; R Arnold; M Classen; M Fischer; H Goebell; A L Blum

1993-01-01

390

Pseudoaneurysm of the proper hepatic artery with duodenal fistula appearing as a late complication of blunt abdominal trauma.  

PubMed

Posttraumatic pseudoaneurysms of the hepatic artery are rare and usually occur as a complication of open abdominal trauma. Even less common is the coexisting presence of enteric fistulization. We report a patient with upper gastrointestinal hemorrhage occurring 3 years after blunt abdominal trauma resulting from a pseudoaneurysm of the proper hepatic artery with duodenal fistulization. The patient was treated successfully by ligation of the proper hepatic artery and closure of the duodenal opening. PMID:8576975

Aboujaoude, M; Noel, B; Beaudoin, M; Ghattas, G; Lalonde, L; The Bao Bui; Oliva, V L

1996-01-01

391

Echocardiographic evaluation of iatrogenic atrial septal defect after catheter-based mitral valve clip insertion.  

PubMed

The geometries and sizes of persistent iatrogenic atrial septal defects (IASDs) after transseptal puncture during catheter-based mitral valve clip insertion (MVCI) have not been detailed. In this study, 11 IASDs were investigated in 10 patients who underwent MVCI using a guide catheter (24Fr proximally and 22Fr at the atrial septum). The diameters of the long and short axes and the area at maximum and minimum during a cardiac cycle were measured after MVCI using real-time 3-dimensional (RT3D) transesophageal echocardiography (TEE). A circular shape was assumed on 2-dimensional TEE, resulting in an area calculation of ? × (dimension/2)(2). The anatomic geometries of IASDs were visualized in a 3-dimensional en face view of the atrial septum. Furthermore, 1 month after MVCI, IASDs were evaluated using echocardiography. The IASDs had a variety of irregular geometries. The mean long-axis diameter was 1.0 ± 0.24 cm, the mean short-axis diameter was 0.51 ± 0.22 cm, and the mean area was 0.40 ± 0.24 cm(2) on RT3D TEE. The diameters and area changed significantly between the maximal and minimal values during the cardiac cycle. Importantly, 2-dimensional TEE underestimated the maximal diameters of IASDs (0.54 ± 0.17 vs 1.0 ± 0.24 cm by RT3D TEE, p <0.01) and the maximal areas of IASDs (0.25 ± 0.15 vs 0.40 ± 0.23 cm(2) by RT3D TEE, p <0.05). One month after MVCI, the smallest and the second smallest IASDs had closed, and the other 9 remained open. In conclusion, RT3D TEE is useful to assess the irregular geometries of IASDs created during MVCI. PMID:22475361

Saitoh, Takeji; Izumo, Masaki; Furugen, Azusa; Tanaka, Jun; Miyata-Fukuoka, Yoko; Gurudevan, Swaminatha V; Tolstrup, Kirsten; Siegel, Robert J; Kar, Saibal; Shiota, Takahiro

2012-06-15

392

Evaluation of endoscopically obtained duodenal biopsy samples from cats and dogs in an adapter-modified Ussing chamber  

PubMed Central

This study was conducted to evaluate an adapter-modified Ussing chamber for assessment of transport physiology in endoscopically obtained duodenal biopsies from healthy cats and dogs, as well as dogs with chronic enteropathies. 17 duodenal biopsies from five cats and 51 duodenal biopsies from 13 dogs were obtained. Samples were transferred into an adapter-modified Ussing chamber and sequentially exposed to various absorbagogues and secretagogues. Overall, 78.6% of duodenal samples obtained from cats responded to at least one compound. In duodenal biopsies obtained from dogs, the rate of overall response ranged from 87.5% (healthy individuals; n = 8), to 63.6% (animals exhibiting clinical signs of gastrointestinal disease and histopathological unremarkable duodenum; n = 15), and 32.1% (animals exhibiting clinical signs of gastrointestinal diseases and moderate to severe histopathological lesions; n = 28). Detailed information regarding the magnitude and duration of the response are provided. The adapter-modified Ussing chamber enables investigation of the absorptive and secretory capacity of endoscopically obtained duodenal biopsies from cats and dogs and has the potential to become a valuable research tool. The response of samples was correlated with histopathological findings. PMID:24378587

DeBiasio, John V.; Suchodolski, Jan S.; Newman, Shelley; Musch, Mark W.; Steiner, Jörg M.

2014-01-01

393

An acoustic beam shifter with enhanced transmission using perforated metamaterials  

NASA Astrophysics Data System (ADS)

We experimentally demonstrate an acoustic beam shifter with enhanced transmission based on subwavelength perforated metamaterials with a wide working frequency range from 2.8 to 4.6 kHz. An oblique perforation angle allows a flexible beam shifting distance and negative refraction for one side of incidence angles. While the beam shifting action is broadband due to the geometric nature of design, beam shifting with enhanced efficiency is found at the frequency with Fabry-Pérot (FP) resonance through a two-dimensional pressure field mapping. Such a method in combining extraordinary transmission and beam shifting with properly designed metamaterials, enables designing flexible and also transformation acoustic devices with high transmission efficiency in a general context.

Wei, Pengjiang; Liu, Fu; Liang, Zixian; Xu, Yan; Tak Chu, Sai; Li, Jensen

2015-01-01

394

Blind loop perforation after side-to-side ileocolonic anastomosis.  

PubMed

Blind loop syndrome after side-to-side ileocolonic anastomosis is a well-recognized entity even though its incidence and complication rates are not clearly defined. The inevitable dilation of the ileal cul-de-sac leads to stasis and bacterial overgrowth which eventually leads to mucosal ulceration and even full-thickness perforation. Blind loop syndrome may be an underestimated complication in the setting of digestive surgery. It should always be taken into account in cases of acute abdomen in patients who previously underwent right hemicolectomy. We herein report 3 patients who were diagnosed with perforative blind loop syndrome a few years after standard right hemicolectomy followed by a side-to-side ileocolonic anastomosis. PMID:25161764

Valle, Raffaele Dalla; Zinicola, Roberto; Iaria, Maurizio

2014-08-27

395

Apparatus and method for sealing perforated well casing  

DOEpatents

Perforations and other openings in well casings, liners and other conduits may be substantially blocked or sealed to prevent fluid flow between the casing or liner interior and an earth formation by placing a radially expansible sleeve adjacent the perforations or openings and urging the sleeve into forcible engagement with the casing or inner wall using an explosive charge. An apparatus including a radially contracted sleeve formed by a coiled plate member or a tubular member having flutes defined by external and internal folds, may be deployed into a well casing or liner through a production or injection tubing string and on the end of a flexible cable or coilable tubing. An explosive charge disposed on the apparatus and within the sleeve may be detonated to urge the sleeve into forcible engagement with the casing inner wall. 17 figs.

Blount, C.G.; Benham, R.A.; Brock, J.L.; Emerson, J.A.; Ferguson, K.R.; Scheve, D.F.; Schmidt, J.H.; Schuler, K.W.; Stanton, P.L.

1997-03-25

396

Apparatus and method for sealing perforated well casing  

DOEpatents

Perforations and other openings in well casings, liners and other conduits may be substantially blocked or sealed to prevent fluid flow between the casing or liner interior and an earth formation by placing a radially expansible sleeve adjacent the perforations or openings and urging the sleeve into forcible engagement with the casing or inner wall using an explosive charge. An apparatus including a radially contracted sleeve formed by a coiled plate member or a tubular member having flutes defined by external and internal folds, may be deployed into a well casing or liner through a production or injection tubing string and on the end of a flexible cable or coilable tubing. An explosive charge disposed on the apparatus and within the sleeve may be detonated to urge the sleeve into forcible engagement with the casing inner wall.

Blount, Curtis G. (Wasilla, AK); Benham, Robert A. (Albuquerque, NM); Brock, Jerry L. (Los Lunas, NM); Emerson, John A. (Albuquerque, NM); Ferguson, Keith R. (Anchorage, AK); Scheve, Donald F. (Anchorage, AK); Schmidt, Joseph H. (Anchorage, AK); Schuler, Karl W. (Albuquerque, NM); Stanton, Philip L. (Albuquerque, NM)

1997-01-01

397

Aortoesophageal perforation following ingestion of razorblades with massive haemothorax.  

PubMed

Aortoesophageal fistula is a rare complication of foreign body ingestion. Typically having ingested a fish or chicken bone, the patient complains of chest pain or discomfort and/or may present with massive gastrointestinal bleeding, which in all but rare cases is fatal. The pathological mechanism may involve perforation and direct communication of oesophagus and aorta usually at the level of the aortic arch; or more usually following oesophageal perforation, the subsequent mediastinal abscess leads to necrosis of the aortic wall. Torrential haemothorax as a result of such a process has not been previously described, though it has undoubtedly occurred. We present a case of massive haemothorax following deliberate ingestion of razorblades that highlights clinically and radiologically the natural course of such a tragic action. PMID:17346984

Hunt, Ian; Hartley, Sarah; Alwahab, Yasir; Birkill, Guy J

2007-05-01

398

Ventricular perforation by pacemaker lead repaired with two hemostatic devices  

PubMed Central

INTRODUCTION Cardiac perforation is a rare, but potentially serious, complication of pacemaker implantation that may develop days or weeks after implantation. PRESENTATION OF CASE In the current case, 92-year-old man underwent permanent pacemaker implantation, but he presented 3 weeks later with severe symptoms. Computed tomography showed protrusion of the tip of the ventricular electrode through the right ventricle and into the chest wall. During an urgent surgical intervention, the lead was disconnected and extracted. A sealing hemostatic device and an hemostatic patch were applied to repair the ventricle; the procedure was uneventfull. DISCUSSION This case demonstrates how the correct diagnosis of ventricular perforation is crucial, and should be followed immediately by surgical planning. CONCLUSION The hemostatic patch is a valuable alternative to sutures in patients with thin and fragile ventricular wall, unable to undergo stitching. PMID:25460433

Prestipino, Filippo; Nenna, Antonio; Casacalenda, Adele; Chello, Massimo

2014-01-01

399

Pseudoxanthoma elasticum with periumbilical perforation in a nullipara.  

PubMed

Pseudoxanthoma elasticum (PXE) is an inherited multisystem disorder that primarily affects the skin and is characterized by progressive calcification and degeneration of the elastic fibers. PXE has recently been found to be caused by mutations in the ATP-binding cassette transporter C6 (ABCC6) or the multidrug resistance-associated protein 6 (MRP6) genes. Perforating PXE is a rare presentation that is usually seen in the periumbilical area in obese multiparous black women; it has distinct clinical and histopathological features and there may or may not be systemic manifestations. We report an unusual case of PXE in a nulliparous woman, with perforation in the periumbilical area and without any systemic involvement. PMID:22707774

Kumar, Parimalam; Sivasubramanian, Athilakshmi; Vadivel, Sampath; Krishnaswamy, Manoharan

2012-05-01

400

Directional bending wave propagation in periodically perforated plates  

NASA Astrophysics Data System (ADS)

We report on the investigation of wave propagation in a periodically perforated plate. A unit cell with double-C perforations is selected as a test article suitable to investigate two-dimensional dispersion characteristics, group velocities, and internal resonances. A numerical model, formulated using Mindlin plate elements, is developed to predict relevant wave characteristics such as dispersion, and group velocity variation as a function of frequency and direction of propagation. Experimental tests are conducted through a scanning laser vibrometer, which provides full wave field information. The analysis of time domain wave field images allows the assessment of plate dispersion, and the comparison with numerical predictions. The obtained results show the predictive ability of the considered numerical approach and illustrate how the considered plate configuration could be used as the basis for the design of phononic waveguides with directional and internal resonant characteristics.

Andreassen, Erik; Manktelow, Kevin; Ruzzene, Massimo

2015-01-01

401

Rare vascular perforation complicating radial approach to percutaneous coronary angioplasty  

PubMed Central

A transradial arterial approach to coronary angiography and percutaneous coronary intervention has become increasingly embraced by cardiologists as it is associated with decreased vascular complications and allows early mobilisation of patients when compared with transfemoral arterial access. Major vascular complication post-transradial access is uncommon. We describe a very rare case of perforation of the costocervical trunk (a branch of the right subclavian artery at the site of the thoracic inlet) presenting shortly after percutaneous transradial coronary intervention. The resulting rapidly expanding cervical haematoma caused airway compromise necessitating emergent intubation in the catheter laboratory recovery area. Transfemoral catheter coil embolisation of the feeder artery was successful in obliterating blood flow to the perforated vessel with eventual resolution of the neck haematoma. PMID:23362057

Farooqi, Fahad; Alexander, John; Sarma, Aditya

2013-01-01

402

Poverty of the Stimulus? A Rational Approach Amy Perfors1 (perfors@mit.edu), Joshua B. Tenenbaum1 (jbt@mit.edu),  

E-print Network

Poverty of the Stimulus? A Rational Approach Amy Perfors1 (perfors@mit.edu), Joshua B. Tenenbaum1, MIT; 2 Department of Psychology, University of Chicago Abstract The Poverty of the Stimulus (Po that these generalizations can best be explained by innate knowledge, known as the argument from the Poverty of the Stimulus

Tenenbaum, Josh

403

Perforation of clamped, woven E-glass\\/polyester panels  

Microsoft Academic Search

Analytical solutions to predict the perforation of fully clamped, woven E-glass\\/polyester panels subjected to static indentation by a blunt cylinder were derived. Three panel aspect ratios of 12.5, 25 and 50 were considered in order to show how modes of failure vary with panel flexibility. The analytical solutions for the deformation and interlaminar shear stresses compared well to finite element

Michelle S. Hoo Fatt; Chunfu Lin

2004-01-01

404

Vortex lattice melting in perforated Nb\\/(Cu-Mn) multilayers  

Microsoft Academic Search

We report the results of transport measurements in perforated superconducting (Nb)-spin-glass (Cu-Mn) multilayers. Current-voltage (I - V) characteristics were measured as a function of the temperature T, magnetic field H and sample anisotropy 0. The noise and the hysteresis in the I-V curves were observed only for certain values of temperature and magnetic field, dependent on the anisotropy value. Outside

C. Attanasio; T. di Luccio; L. V. Mercaldo; S. L. Prischepa; R. Russo; M. Salvato; L. Maritato; S. Barbanera

2000-01-01

405

Vortex lattice melting in perforated Nb\\/(Cu-Mn) multilayers  

Microsoft Academic Search

We report the results of transport measurements in perforated superconducting (Nb)-spin-glass (Cu-Mn) multilayers. Current-voltage (I-V) characteristics were measured as a function of the temperature T, magnetic field H and sample anisotropy gamma0. The noise and the hysteresis in the I-V curves were observed only for certain values of temperature and magnetic field, dependent on the anisotropy value. Outside these values

C. Attanasio; T. di Luccio; L. V. Mercaldo; S. L. Prischepa; R. Russo; M. Salvato; L. Maritato; S. Barbanera

2000-01-01

406

Evaluation of six fracture models in high velocity perforation  

Microsoft Academic Search

A systematic evaluation of six ductile fracture models is performed to identify the most suitable fracture criterion for high velocity perforation problems. Included in the paper are the Wilkins, the Johnson–Cook, the maximum shear stress, the modified Cockcroft–Latham, the constant fracture strain, and the Bao–Wierzbicki fracture models. These six fracture models are implemented into ABAQUS\\/Explicit by means of a user

X. Teng; T. Wierzbicki

2006-01-01

407

Acquired Perforating Dermatosis in a Patient with Poland Syndrome  

Microsoft Academic Search

Acquired perforating dermatosis (APD) is characterized by umbilicated 1- to 10-mm-measuring papulonodules with a central adherent oystershell-like keratotic plug, typically on the dorsa of the hands, forearms and over the knees. APD is associated with systemic diseases, especially diabetes mellitus and\\/or renal failure. Histologically the lesions show transepidermal elimination of altered dermal components into a cup-shaped epidermal depression. We present

Susanna K. Fistarol; Peter H. Itin

2003-01-01

408

Perforated monolayers. Progress report, July 1, 1991--Mar 31, 1992  

SciTech Connect

Our research over this past grant period has focused on (1) developing methods for making in situ permeation measurements at the air-water interface, (2) defining the structural and conformational behavior of selected calix[4]arenes, (3) defining the metal complexation properties of certain upper-rim functionalized calix[4]arenes, and (4) synthesizing a broad series of polymerizable calixarenes, to be used for constructing perforated monolayers and multilayers.

Regen, S.L.

1992-05-01

409

Tension pneumoperitoneum due to gastric perforation in a cat.  

PubMed

A 14-year-old spayed female cat weighing 2.3 kg developed tension pneumoperitoneum that progressed for 6 hr. Abdominocentesis was performed and 1.3 L of gas was aspirated after which the cat's respiratory condition improved. The next day, the cat's abdomen redistended, and laparotomy was performed. A gastric perforation was noted and sutured after the margin was resection. The cat showed a good physical condition without any gastrointestinal signs at 6 months after surgery. PMID:15997192

Itoh, Teruo; Nibe, Kazumi; Naganobu, Kiyokazu

2005-06-01

410

Temperature Driven Annealing of Perforations in Bicellar Model Membranes  

SciTech Connect

Bicellar model membranes composed of 1,2-dimyristoylphosphatidylcholine (DMPC) and 1,2-dihexanoylphosphatidylcholine (DHPC), with a DMPC/DHPC molar ratio of 5, and doped with the negatively charged lipid 1,2-dimyristoylphosphatidylglycerol (DMPG), at DMPG/DMPC molar ratios of 0.02 or 0.1, were examined using small angle neutron scattering (SANS), {sup 31}P NMR, and {sup 1}H pulsed field gradient (PFG) diffusion NMR with the goal of understanding temperature effects on the DHPC-dependent perforations in these self-assembled membrane mimetics. Over the temperature range studied via SANS (300-330 K), these bicellar lipid mixtures exhibited a well-ordered lamellar phase. The interlamellar spacing d increased with increasing temperature, in direct contrast to the decrease in d observed upon increasing temperature with otherwise identical lipid mixtures lacking DHPC. {sup 31}P NMR measurements on magnetically aligned bicellar mixtures of identical composition indicated a progressive migration of DHPC from regions of high curvature into planar regions with increasing temperature, and in accord with the 'mixed bicelle model' (Triba, M. N.; Warschawski, D. E.; Devaux, P. E. Biophys. J.2005, 88, 1887-1901). Parallel PFG diffusion NMR measurements of transbilayer water diffusion, where the observed diffusion is dependent on the fractional surface area of lamellar perforations, showed that transbilayer water diffusion decreased with increasing temperature. A model is proposed consistent with the SANS, {sup 31}P NMR, and PFG diffusion NMR data, wherein increasing temperature drives the progressive migration of DHPC out of high-curvature regions, consequently decreasing the fractional volume of lamellar perforations, so that water occupying these perforations redistributes into the interlamellar volume, thereby increasing the interlamellar spacing.

Nieh, Mu-Ping [University of Connecticut, Storrs; Raghunathan, V.A. [Raman Research Institute, India; Pabst, Georg [Austrian Academy of Sciences, Graz, Austria; Harroun, Thad [Brock University, St. Catharines, ON, Canada; Nagashima, K [University of Toronto, Mississauga, ON, Canada; Morales, H [University of Toronto, Mississauga, ON, Canada; Katsaras, John [ORNL; Macdonald, P [University of Toronto, Mississauga, ON, Canada

2011-01-01

411

[Emergency interventions for perforation and bleeding in esophageal cancer patients].  

PubMed

Bleeding and perforation in esophageal cancer patients are rare but associated with a high morbidity and mortality. Because of disappointing results after primary surgical exploration and resection endoscopic intervention was introduced as the primary treatment option with an improved outcome. Aortoesophageal and esophagobronchial fistulas may occur spontaneously or secondary to stenting of the esophagus. They are uncommon but fatal if untreated. The first option is prompt placement of a stent graft as a bridging solution followed by surgical treatment. PMID:22878577

König, A M; Hofmann, B T; Groth, S; Izbicki, J R

2012-08-01

412

Gall-bladder perforation after long-term dapsone therapy.  

PubMed

A 65-year-old man on maintenance dapsone therapy for dermatitis herpetiformis for 30 years was admitted to hospital with acute abdominal pain and vomiting. Investigations revealed a Heinz body haemolytic anaemia. Worsening symptoms prompted an emergency laparotomy that revealed a perforated gall bladder with pigmented biliary calculi. In previous reviews of the haematological abnormalities associated with dapsone therapy, life-threatening cholecystitis has not been described. PMID:2266352

Choy, A M; Lang, C C

1990-10-01

413

Effect of narcotic premedication of scintigraphic evaluation of gallbladder perforation  

SciTech Connect

A case of gallbladder perforation is presented in which a small bile leak was demonstrated by cholescintigraphy while the patient was receiving meperidine, but not after meperidine was discontinued. The scintigrams obtained during meperidine therapy also showed a pattern of bile-duct obstruction. It is suggested that increased biliary pressure secondary to meperidine admininstration permitted visualization of the leak. Use of narcotic drugs may be a useful pharmocologic intervention in cases of peritonitis due to small obscure bile leaks.

Sefczek, D.M.; Sharma, P.; Isaacs, G.H.; Brodmerkel, G.J. Jr.; Adatepe, M.H.; Powell, O.M.; Nichols, K.

1985-01-01

414

Membrane perforation and recovery dynamics in microbubble-mediated sonoporation.  

PubMed

Transient sonoporation can essentially be epitomized by two fundamental processes: acoustically induced membrane perforation and its subsequent resealing. To provide insight into these processes, this article presents a new series of direct evidence on the membrane-level dynamics during and after an episode of sonoporation. Our direct observations were obtained from anchored fetal fibroblasts whose membrane topography was imaged in situ using real-time confocal microscopy. To facilitate controlled sonoporation at the single-cell level, microbubbles that can passively adhere to the cell membrane were first introduced at a 1:1 cell-to-bubble ratio. Single-pulse ultrasound exposure (1-MHz frequency, 10-cycle pulse duration, 0.85-MPa peak negative pressure in situ) was then applied to trigger microbubble pulsation/collapse, which, in turn, instigated membrane perforation. With this protocol, five membrane-level phenomena were observed: (i) localized perforation of the cell membrane was synchronized with the instant of ultrasound pulsing; (ii) perforation sites with temporal peak area <30 ?m(2) were resealed successfully; (iii) during recovery, a thickened pore rim emerged, and its temporal progression corresponded with the pore closure action; (iv) membrane resealing, if successful, would generally be completed within 1 min of the onset of sonoporation, and the resealing time constant was estimated to be below 20 s; (v) membrane resealing would fail for overly large pores (>100 ?m(2)) or in the absence of extracellular calcium ions. These findings serve to underscore the spatiotemporal complexity of membrane-level dynamics in sonoporation. PMID:24063956

Hu, Yaxin; Wan, Jennifer M F; Yu, Alfred C H

2013-12-01

415

Down syndrome: Molecular mapping of the congenital heart disease and duodenal stenosis  

SciTech Connect

Down syndrome (DS) is a major cause of congenital heart and gut disease and mental retardation. DS individuals also have characteristic facies, hands, and dermatoglyphics, in addition to abnormalities of the immune system, and increased risk of leukemia, and an Alzheimer-like dementia. Although their molecular basis is unknown, recent work on patients with DS and partial duplications of chromosome 21 has suggested small chromosomal regions located in band q22 that are likely to contain the genes for some of these features. The authors now extend these analyses to define molecular markers for the congenital heart disease, the duodenal stenosis, and an 'overlap' region for the facial and some of the skeletal features. They report the clinical, cytogenetic, and molecular analysis of two patients. These studies provide the molecular basis for the construction of a DS phenotypic map and focus the search for genes responsible for the physical features, congenital heart disease, and duodenal stenosis of DS.

Korenburg, J.R. (University of California, Los Angeles (United States)); Bradley, C.; Disteche, C.M. (University of Washington, Seattle (United States))

1992-02-01

416

Delayed duodenal obstruction after intramural hematoma in a patient with paroxysmal nocturnal hemoglobinuria: A case report  

PubMed Central

INTRODUCTION Paroxysmal nocturnal hemoglobinuria (PNH) is a clonal stem cell disorder of hematopoietic cells. Gastrointestinal complications of PNH are rare and mostly related with intravascular thrombosis or intramural hematoma. PRESENTATION OF CASE We describe a case of a man with PNH complicated by intramural duodenal hematoma initially treated with supportive care. Three months after his first admission; he was admitted to the emergency department with abdominal pain, nausea and vomiting. He had undergone to surgery because of duodenal obstruction was treated with duodenojejunal by-pass surgery. DISCUSSION Patients were healed from gastrointestinal complications could suffer from gastrointestinal strictures, which cause wide spread symptoms ranging from chronic abdominal pain and anorexia to intestinal obstruction. CONCLUSION We report a rare intestinal obstruction case caused by stricture at the level of ligamentum Treitz with PNH. The possibility simply has to be borne in mind that strictures can be occurring at hematoma, ischemia or inflammation site of gastrointestinal tract. PMID:25123648

Tezcaner, Tugan; Ekici, Yahya; K?rnap, Mahir; Kural, Feride; Moray, Gökhan

2014-01-01

417

How diet and lifestyle affect duodenal ulcers. Review of the evidence.  

PubMed Central

OBJECTIVE: To demonstrate the role of diet in reducing or aggravating risk of duodenal ulcer (DU). QUALITY OF EVIDENCE: MEDLINE was searched from January 1966 to December 2001 for articles on the relationship between diet and lifestyle and DU using the key words duodenal ulcer and diet, fibre, or lifestyle. Evidence that these factors are associated with DU arose mainly from three case-control and three prospective studies (level II evidence) and from expert opinion (level III evidence). MAIN MESSAGE: A high-fibre diet appears to reduce risk of DU; soluble fibre might be associated with reduced risk also. Vitamin A intake is associated with lower risk of DU. Little evidence indicates that fat, type of fat, protein intake, or consumption of alcohol or caffeine affect the etiology of DU. CONCLUSION: A high-fibre diet, particularly if the fibre comes from fruit and vegetables, could reduce risk of DU; vitamin A might also be beneficial. PMID:15171675

Ryan-Harshman, Milly; Aldoori, Walid

2004-01-01

418

Gastric emptying of combined liquid-solid meals in healed duodenal ulcer  

SciTech Connect

The gastric emptying rates of combined liquid and solid radioisotopically labeled meals in 47 healed duodenal ulcer subjects and 17 healthy control subjects are compared. No significant differences were found between the groups in emptying slopes and the emptying half-times or in the percent retention values at any of the counting intervals for either the liquid or solid meals. These results are compatible with the observation that the rapid gastric emptying in many patients with duodenal ulcer is associated with the disease and that healing results in a return to normal gastric emptying rates. However, since gastric emptying rates during active ulceration were not determined in our patients, a more definitive interpretation awaits a study comparing emptying rates obtained during and after healing of active ulceration in the same patient.

Moore, J.G.; McIntyre, B.; Alazraki, N.

1985-12-01

419

Computed tomography attenuation values of ascites are helpful to predict perforation site  

PubMed Central

AIM: To evaluate the effect of computed tomography (CT) attenuation values of ascites on gastrointestinal (GI) perforation site prediction. METHODS: The CT attenuation values of the ascites from 51 patients with GI perforations were measured by volume rendering to calculate the mean values. The effect of the CT attenuation values of the ascites on perforation site prediction and postoperative complications was evaluated. RESULTS: Of 24 patients with colorectal perforations, the CT attenuation values of ascites were significantly higher than those in patients with perforations at other sites [22.5 Hounsfield units (HU) vs 16.5 HU, respectively, P = 0.006]. Colorectal perforation was significantly associated with postoperative complications (P = 0.038). The prediction rate of colorectal perforation using attenuation values as an auxiliary diagnosis improved by 9.8% compared to that of CT findings alone (92.2% vs 82.4%). CONCLUSION: The CT attenuation values of ascites could facilitate the prediction of perforation sites and postoperative complications in GI perforations, particularly in cases in which the perforation sites are difficult to predict by CT findings alone. PMID:25663776

Seishima, Ryo; Okabayashi, Koji; Hasegawa, Hirotoshi; Tsuruta, Masashi; Hoshino, Hiroki; Yamada, Toru; Kitagawa, Yuko

2015-01-01

420

Iatrogenic implantation of giant cell tumor at bone graft donor site and clinical recommendations to prevent "a rare avoidable complication".  

PubMed

The treatment of giant cell tumor of bone is directed toward local control without sacrificing joint function. This is achieved by intralesional curettage. When autograft is used for the reconstruction of the curetted cavity, there is always a theoretical risk of contamination of graft donor site. We report a case of iatrogenic implantation of giant cell tumor at the bone graft donor site after intralesional curettage and bone grafting of giant cell tumor of distal femur. Patient was treated with repeat intralesional curettage and excision of implantation lesion at bone graft donor site. We recommend precautionary measures to prevent this avoidable complication. PMID:23412188

Gulia, Ashish; Puri, Ajay; Salunke, Abhijeet; Desai, Subhash; Jambhekar, N A

2013-08-01

421

Percutaneous Closure of an Iatrogenic Ventricular Septal Defect Following Concomitant Septal Myectomy at the Time of Aortic Valve Replacement  

PubMed Central

A 77-year-old female patient underwent aortic valve replacement (AVR) with concomitant septal myectomy and tricuspid annuloplasty. Her symptoms did not improve after a successful operation. Echocardiogram demonstrated the presence of an iatrogenic ventricular septal defect (VSD). It was muscular in location and not the usual AVR with membraneous type of VSD, suggesting a complication from the myectomy. Percutaneous closure of the VSD remained the only feasible option due to her poor overall medical status. A 14-mm Amplazter VSD occluder was deployed successfully, by means of the trans-septal technique. She has improved very well postoperatively. PMID:24497890

Ryu, Il Hwan; Kim, Won Ho; Ryu, Ah Jeong; Kim, Min Gyu; Jeon, Jae Woong; Kim, Joo Seok; Lee, Jae Joon

2014-01-01

422

An unusual presentation of perforating metastatic calcinosis cutis.  

PubMed

A 37-year-old white man diagnosed with multiple myeloma was admitted for respiratory distress. He was found to have hypercalcemia (13.1 mg/dL), hyperphosphatemia (7.2 mg/dL), hyponatremia (121 mEq/L), and acute renal failure (serum urea nitrogen, 116 mg/dL; creatinine, 4.9 mg/dL). On hospital day 7, skin lesions over his elbows, wrists, and fingers were noticed and the dermatology department was consulted. Physical examination revealed 0.5- to 3.0-cm erythematous denuded patches with yellow crusts at the periphery that were localized to the bilateral interdigital web spaces, medial elbows, and volar wrists (Figure 1 and Figure 2). No oral mucosal or conjunctival findings were present. Results from skin biopsies of the lesions revealed focal epidermal necrosis with zones of amorphous basophilic material that focally appeared to perforate the epidermis (Figure 3). Results from Congo red and Verhoeff-van Gieson stains were negative, and results from Von Kossa stain were positive, confirming the perforating material as calcium. Ten days after initial dermatology examination, the patient's respiratory distress worsened and he subsequently died. Autopsy revealed diffuse pulmonary calcinosis and renal tubular calcification. As a result of the autopsy findings, the patient was diagnosed with perforating metastatic calcinosis cutis. PMID:24340476

Livingood, Matthew; Newman, Sabrina A

2013-01-01

423

A rare complication of tracheal intubation: tongue perforation.  

PubMed

Aim. To describe the subsequent treatment of airway trauma sustained during laryngoscopy and endotracheal intubation. Methods. A rare injury occurring during laryngoscopy and endotracheal intubation that resulted in perforation of the tongue by an endotracheal tube and the subsequent management of this unusual complication are discussed. A 65-year-old female with intraparenchymal brain hemorrhage with rapidly progressive neurologic deterioration had the airway secured prior to arrival at the referral institution. The endotracheal tube (ETT) was noted to have pierced through the base of the tongue and entered the trachea, and the patient underwent operative laryngoscopy to inspect the injury and the ETT was replaced by tracheostomy. Results. Laryngoscopy demonstrated the ETT to perforate the base of the tongue. The airway was secured with tracheostomy and the ETT was removed. Conclusions. A wide variety of complications resulting from direct and video-assisted laryngoscopy and tracheal intubation have been reported. Direct perforation of the tongue with an ETT and ability to ventilate and oxygenate subsequently is a rare injury. PMID:23056962

Lollo, Loreto; Meyer, Tanya K; Grabinsky, Andreas

2012-01-01

424

[Modified infarct exclusion technique of postinfarction ventricular septal perforation].  

PubMed

Ventricular septal perforation is one of the most serious complications of acute myocardial infarction, and is often fatal unless treated surgically. Despite the development of various surgical techniques for repair of postinfarction ventricular septal perforation, the operative mortality remains high. We report 3 consecutive cases in which a modified infarct exclusion technique was used to repair ventricular septal rupture after anterior myocardial infraction. The septal rupture was closed by the 1st pericardial patch with buttressed mattress sutures. Then buttressed mattress sutures were passed sequentially through the septal portion of the 2nd patch, the ventricular septum, and the free wall of the right ventricle to exclude the infarcted myocardium and septal perforation. The pericardial patch was sutured to the free wall of the left ventricle with a continuous suture for reconstruction of the left ventricular cavity. The ventriculotomy was closed with buttressed mattress sutures and a continuous suture. All 3 patients had an acceptable postoperative course and were discharged in satisfactory conditions. This technique seems to achieve satisfactory early results when used in the acute phase of myocardial infarction. PMID:23445645

Niino, Tetsuya; Unozawa, Satoshi; Kimura, Haruka

2013-03-01

425

Perforated plates for cryogenic regenerators and method of fabrication  

DOEpatents

Perforated plates (10) having very small holes (14) with a uniform diameter throughout the plate thickness are prepared by a "wire drawing" process in which a billet of sacrificial metal is disposed in an extrusion can of the plate metal, and the can is extruded and restacked repeatedly, converting the billet to a wire of the desired hole diameter. At final size, the rod is then sliced into wafers, and the wires are removed by selective etching. This process is useful for plate metals of interest for high performance regenerator applications, in particular, copper, niobium, molybdenum, erbium, and other rare earth metals. Er.sub.3 Ni, which has uniquely favorable thermophysical properties for such applications, may be incorporated in regions of the plates by providing extrusion cans (20) containing erbium and nickel metals in a stacked array (53) with extrusion cans of the plate metal, which may be copper. The array is heated to convert the erbium and nickel metals to Er.sub.3 Ni. Perforated plates having two sizes of perforations (38, 42), one of which is small enough for storage of helium, are also disclosed.

Hendricks, John B. (Huntsville, AL)

1994-01-01

426

Plasminogen initiates and potentiates the healing of acute and chronic tympanic membrane perforations in mice  

PubMed Central

Background Most tympanic membrane (TM) perforations heal spontaneously, but approximately 10-20% remain open as chronic TM perforations. Chronic perforations can lead to an impaired hearing ability and recurrent middle ear infections. Traditionally, these perforations must be surgically closed, which is costly and time consuming. Therefore, there is a need for simpler therapeutic strategies. Previous studies by us have shown that plasminogen (plg) is a potent pro-inflammatory regulator that accelerates cutaneous wound healing in mice. We have also shown that the healing of TM perforations is completely arrested in plg-deficient (plg-/-) mice and that these mice develop chronic TM perforations. In the present study, we investigated the therapeutic potential of local plg injection in acute and chronic TM perforation mice models. Methods Plg-/- mice and wild-type mice were subjected to standardized TM perforations followed by local injection of plg into the soft tissue surrounding the TM. TM perforations with chronic characteristics were induced by leaving TM perforations in plg-/- mice untreated for 9 days before treatment. The healing process was observed through otomicroscope and finally confirmed by immunostaining. The quality of TM healing was evaluated based on the morphology of the TM. Result Daily local injections of plg into the soft tissue surrounding the TM restored the ability to heal TM perforations in plg-/- mice in a dose-dependent manner, and potentiated the healing rate and quality in wild-type mice. A single local injection of plg initiated the healing of the chronic-like TM perforations in these mice, resulting in a closed TM with a continuous but rather thick outer keratinocyte layer. However, three plg injections led to a completely healed TM with a thin keratinizing squamous epithelium covering a connective tissue layer. Conclusion Our data suggests that plg is a promising drug candidate for the treatment of chronic TM perforations in humans. PMID:24393366

2014-01-01

427

Induction of oesophageal and forestomach carcinomas in rats by reflux of duodenal contents.  

PubMed Central

A study was designed to determine whether oesophageal carcinomas can be induced through reflux of duodenal contents. Male Wistar rats weighing 230-250 g were divided into three groups according to the surgical procedure performed: (1) the duodenal contents were directed into the forestomach through a stoma (duodeno-forestomach reflux); (2) the duodenal contents were regurgitated into the forestomach through the glandular stomach (duodeno-glandular-forestomach reflux); and (3) a sham operation was performed as a control. Animals were fed standard CRF-1 solid food and tap water that was not exposed to carcinogens and were sacrificed 50 weeks post-operatively. While no neoplasia was observed in any of the 32 control rats, 4/11 (36%) with duodeno-forestomach reflux and 3/18 (17%) animals with duodeno-glandular-forestomach reflux developed carcinomas in the lower oesophagus and forestomach. The incidence in each group was significantly higher than in the controls (P < 0.01 and P < 0.05 respectively). Six of the seven lesions consisted of squamous cell carcinomas, and one was a mucinous adenocarcinoma. Oesophageal columnar epithelial metaplasia was observed in two (18%) of the animals with duodeno-forestomach reflux. Carcinomas were always surrounded by chronic inflammatory changes, including regenerative thickening, basal cell hyperplasia and dysplasia. Additional well-differentiated adenocarcinomas were observed in the prepyloric antrum of 6/18 (33%) animals with duodeno-glandular-forestomach reflux. These findings indicate that chronic reflux of duodenal contents may cause oesophageal carcinoma. Images Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 PMID:8054264

Miwa, K.; Segawa, M.; Takano, Y.; Matsumoto, H.; Sahara, H.; Yagi, M.; Miyazaki, I.; Hattori, T.

1994-01-01

428

Rumen metabolism and duodenal nutrient flow as affected by ration composition and antimicrobials in sheep  

E-print Network

in sheep H Fébel, I Zsolnai Harczi, S Huszar Research Institute of Animal Breeding and Nutrition, Dept in this 2 x3 factorial design experiment using six rumen and duodenal cannulated wether sheep. Diets were). Additives were provided at 0.75 mg/kg BW. Sheep were fed diets at a rate of 60 g DM/kg BW075 for 133 d

Paris-Sud XI, Université de

429

Evaluation of antiulcer potential of Mimusops hexandra in experimental gastro duodenal ulcers.  

PubMed

The study was aimed to investigate antiulcer effects of acetone extract and its different fractions Mimusops hexandra against experimental gastro-duodenal ulcers. 80% acetone extract of stem bark of Mimusops hexandra (Extract A, p.o.) and its different fractions namely diethyl ether (Extract A1, p.o.), ethyl acetate (Extract A2, p.o.) and aqueous (Extract A3, p.o.) were tested for the presence of preliminary phytoconstituents and were screened for their antiulcer potential in experimental animals using ethanol-HCl and aspirin-induced gastric damage at the dose of 500 mg kg-1p.o. Extract A2 being the most active fraction amongst all the fractions tested was also studied at different doses to find its ED50. Further, to establish the mechanism of action, Extract A2 was also tested for its effects in acetic acid-induced gastric ulcer models and cysteamine-induced duodenal ulcer. The effect was compared with cimetidine. Flavonoids (quercetin), procyanidins, saponins and triterpenoids were found to be present in bark. Oral administration of Extract A2 inhibited formation of gastric lesions induced by aspirin in a dose dependent manner. Elevated level of lipid peroxidation due to ethanol-HCl and aspirin induced gastric damage was significantly (p<0.05) reduced by the treatment with Extract A2. Further, Extract A2 at the dose of 100 mg kg-1 (p.o.) reduced extent of acetic acid induced gastric ulcer in experimental animals. Moreover, protection afforded by Extract A2 against cysteamine-induced duodenal lesions was evident from dose dependent decrease in ulcer index (p<0.05), score for intensity (p<0.05) and total lesion area (p<0.05), when compared with the control group. The antiulcer activity shown by Extract A2 in experimental gastro-duodenal ulcer could be attributed to decrease in gastric acid secretory activity along with strengthening of mucosal defensive mechanisms. PMID:22944719

Modi, Karuna P; Lahiri, Suman K; Goswami, Sunita S; Santani, Dev D; Shah, Mamta B

2012-01-01

430

Total duodenectomy with enteric duct drainage: a rescue operation for duodenal complications occurring after pancreas transplantation.  

PubMed

Duodenal graft complications (DGC) occur frequently after pancreas transplantation but rarely cause graft loss. Graft pancreatectomy, however, may be required when DGC compromise recipient's safety. We herein report on two patients with otherwise untreatable DGC in whom the entire pancreas was salvaged by means of total duodenectomy with enteric drainage of both pancreatic ducts. The first patient developed recurrent episodes of enteric bleeding, requiring hospitalization and blood transfusions, starting 21 months after transplantation. The disease causing hemorrhage could not be defined, despite extensive investigations, but the donor duodenum was eventually identified as the site of bleeding. The second patient was referred to us with a duodenal stump leak, 5 months after transplantation. Two previous surgeries had failed to seal the leak, despite opening a diverting stoma above the duodenal graft. Thirty-nine and 16 months after total duodenectomy with dual duct drainage, respectively, both patients are insulin-independent and free from abdominal complaints. Magnetic resonance pancreatography shows normal ducts both basal and after intravenous injection of secretin. The two cases presented herein show that when DGC jeopardize pancreas function or recipient safety, total duodenectomy with enteric duct drainage may become an option. PMID:20121744

Boggi, U; Vistoli, F; Del Chiaro, M; Moretto, C; Croce, C; Signori, S; D'Imporzano, S; Amorese, G; Campani, D; Calabrese, F; Capocasale, E; Marchetti, P

2010-03-01

431

Marked decrease in serum pepsinogen II levels resulting from endoscopic resection of a large duodenal tumor.  

PubMed

Studies have indicated that serum pepsinogen (PG) levels are not only markers for chronic atrophic gastritis but also predictive risk factors for gastric cancer. However, serum PG levels can change because of pathological conditions other than gastritis. We report the first case in which abnormally high serum PG II levels (168.8 ng/mL) led to the discovery of a large tumor covering a wide area in the duodenum, and after resection of the tumor, the serum PG II levels markedly decreased. Because endoscopic and histopathological examinations showed no indications of atrophic changes, inflammation of the gastric mucosa, or Helicobacter pylori infection, the serum PG II levels eventually returned to normal (10.1 ng/mL). The preoperative abnormally high PG II levels were probably caused by the large duodenal tumor that prevented PG II (which is produced by the duodenal Brunner's glands) from being secreted into the lumen, a condition that increased the amount transferred to the bloodstream. No previous reports have investigated serum PG II levels before and after resection of a large duodenal tumor. We believe this case provides valuable insight regarding the dynamics of PG II in the body and has important diagnostic implications. PMID:25376543

Yada, Tomoyuki; Ito, Koichi; Suzuki, Keigo; Okubo, Koki; Aoki, Yoichiro; Akazawa, Naoki; Koizuka, Hitohiko; Ishida, Tsuyoshi; Uemura, Naomi

2014-12-01

432

Efficacy of ilaprazole in the treatment of duodenal ulcers: A meta-analysis  

PubMed Central

AIM: To compare the efficacy and tolerance of ilaprazole compared with other proton pump inhibitors (PPIs) in the treatment of duodenal ulcer. METHODS: An electronic database search of Medline, Embase, the Cochrane controlled trials register, Web of Science, PubMed, and the Chinese Biomedical Literature Database (updated to July 2013), and manual searches were conducted. A meta-analysis of randomized controlled trials comparing the efficacy and tolerance of ilaprazole and other PPIs in the treatment of duodenal ulcers was performed. RESULTS: Five articles involving 1481 patients were included. The meta-analysis showed no difference in the 4-wk healing rate between ilaprazole and other PPIs [89.7% vs 87.0%; relative risk (RR) = 1.02; 95%CI: 0.98-1.06; Z = 1.00; P = 0.32]. The results did not change in the sensitivity analyses. The meta-analysis indicated that the adverse effect rate in the ilaprazole group was lower than that in the control group, but the difference was not significant (9.7% vs 13.0%; RR = 0.81; 95%CI: 0.60-1.07; Z = 1.47; P = 0.14). CONCLUSION: Ilaprazole is a highly effective and safe PPI in the treatment of duodenal ulcers. Ilaprazole can be recommended as a therapy for acid-related disorders, especially in Asian populations. PMID:24803828

Ji, Xi-Qing; Du, Jun-Feng; Chen, Gang; Chen, Guang; Yu, Bo

2014-01-01

433

Surgical management of pancreatico-duodenal tumors in multiple endocrine neoplasia syndrome type 1  

PubMed Central

Pancreatico-duodenal tumors are the second most common endocrinopathy in multiple endocrine neoplasia syndrome type 1, and have a pronounced effect on life expectancy as the principal cause of disease-related death. Previous discussions about surgical management have focused mainly on syndromes of hormone excess and, in particular, the management of multiple endocrine neoplasia syndrome type 1-related Zollinger–Ellison syndrome. Since hormonal syndromes tend to occur late and indicate the presence of metastases, screening with biochemical markers and endoscopic ultrasound is recommended for early detection of pancreatico-duodenal tumors, and with early surgery before metastases have developed. Surgery is recommended in patients with or without hormonal syndromes in the absence of disseminated liver metastases. The suggested operation includes distal 80% subtotal pancreatic resection together with enucleation of tumors in the head of the pancreas, and in cases with Zollinger–Ellison syndrome, excision of duodenal gastrinomas together with clearance of regional lymph node metastases. This strategy, with early and aggressive surgery before metastases have developed, is believed to reduce the risks for tumor recurrence and malignant progression. PMID:22584725

Åkerström, Göran; Stålberg, Peter; Hellman, Per

2012-01-01

434

Duodenal application of Li+ in a submaximal therapeutic dose inhibits exocrine pancreatic secretion and modulates gastro-duodenal myoelectrical activity in a conscious pig model.  

PubMed

This study tested whether duodenal application of lithium inhibits gastroduodenal motility, and whether it suppresses secretion from the exocrine pancreas. Five suckling pigs, 16-18 days old, were surgically fitted with 3 serosal electrodes on the wall of the gastric antrum and the duodenum for electromyography of smooth muscles, and with a pancreatic duct catheter and a duodenal T-cannula for collection and re-entrant flow of pancreatic juice. After the recovery period, on alternative days, each animal was tested once with an intraduodenal infusion of Li+ (100 mmol·L(-1) C3H5LiO3, 10 mL·kg(-1)·h(-1)) for 1 h, and once with an intraduodenal infusion of NaCl (154 mM, 10 ml·kg(-1)·h(-1)), also for 1 h, with the first treatment, i.e., Li+ or NaCl, randomly assigned. Individual pigs served as their own controls, with data recorded prior to a treatment being used as the baseline. Li+ increased the duration of quiescence (P < 0.05) and activity phase (P < 0.05) in the antrum, thus increasing (P < 0.05) the duration of antral myoelectrical cycles. Li+ shortened (P < 0.05) phase I, but it did not affect phase II or phase III or the MMC in the duodenum. Li+ inhibited pancreatic juice outflow as well as pancreatic enzyme and bicarbonate output (P < 0.05 for all pancreatic parameters). PMID:23984933

Naughton, Violetta; Hedemann, Mette S; Naughton, Patrick J; McSorley, Emeir; Laerke, Helle N

2013-09-01

435

[The emergency plastic reconstruction of the tympanic membrane defects of post-traumatic and iatrogenic etiology with the application of the nanostructured bioplastic material].  

PubMed

The objective of the present study was to estimate the effectiveness of the application of the nanostructured bioplastic material for the plastic reconstruction of tympanic defects of post-traumatic and iatrogenic etiology. The authors report the results of the emergency plastic reconstruction of tympanic defects of post-traumatic and iatrogenic nature with the application of the nanostructured bioplastic material (giamatrix). The analysis of the results of the study prfovidd definitive evidence of the effectiveness of plastic reconstruction of tympanic defects with the application of the nanostructured bioplastic material. PMID:25588474

Zabirov, R A; Kar'kaeva, S M; Shchetinin, V N; Akimov, A V

2014-01-01

436

The gluteal perforator-based flap for repair of sacral pressure sores.  

PubMed

A gluteal perforator-based flap employing the gluteus maximus muscle perforators located around the sacrum is described. A cadaveric study disclosed the existence of several significant perforators all around the gluteal region. Among these, the parasacral perforators originating from the internal pudendal artery and lateral sacral artery have proven useful for the repair of sacral pressure sores. A total of eight decubitus in seven patients were treated with gluteal perforator-based flaps. There were no postoperative complications, such as flap necrosis and wound infection, with the exception of fistula formation in one case. This flap requires no transection or sacrifice of the gluteus maximus muscle, and elevation time for the flap is short. However, the perforators are located at various sites and thus require some careful dissection. PMID:8446721

Koshima, I; Moriguchi, T; Soeda, S; Kawata, S; Ohta, S; Ikeda, A

1993-04-01

437

Squamous cell carcinoma of the small bowel manifesting as a jejunal perforation: a case report  

PubMed Central

Squamous cell carcinoma arising from the small intestine is rare and difficult to identify as a primary or metastatic feature. We report a case of small intestinal squamous cell carcinoma manifesting as subacute peritonitis due to perforation. An 80-year-old man was admitted to our hospital with intermittent postprandial abdominal pain. He was diagnosed with acute peritonitis due to gastrointestinal perforation. During explorative laparotomy, a perforation site was detected in the jejunum and segmental resection to correct the perforation was performed including the perforation site located at the 70 cm inside the jejunum from the Treitz ligament. The pathology results revealed squamous cell carcinoma in the resected segment of the jejunum with two perforation sites. PMID:25337289

Sun, Der Sheng; Shin, Ok Ran; Ku, Young Mi; Kim, Young-Seok; Seo, Kyung-Jin

2014-01-01

438

Treatment of iatrogenic Cushing's syndrome in dogs with electroacupuncture stimulation of stomach 36.  

PubMed

This study was conducted to evaluate the effectiveness of electroacupuncture (EA) on the recovery of adrenocortical function from Iatrogenic Cushings Syndrome (ICS) in dogs. Experiment I: Selection of the most effective Acupuncture point to treat ICS--Six healthy adult female dogs were treated bilaterally with EA for 15 minutes at loci BL22 + BL23 + BL24, ST36, or a non-locus control point on M. brachialis. Each dog was tested at all three sites in rotation. Blood samples were collected before and 0, 15 and 60 minutes after EA, and the serum cortisol levels were measured by radioimmunoassay. The data showed that EA at ST36 resulted in the highest response of serum cortisol levels among the three treatments. Experiment II: Evaluation of the effectiveness of EA ST36 in the treatment of ICS in dogs--Eight healthy adult female dogs were given prednisolone acetate 2mg/kg/day IM for 3 weeks. They were then randomly divided into ST36 and control groups of 4 dogs each. In the ST36 group, ST36 was treated bilaterally with EA for 30 minutes, 3 times per week, for 3 consecutive weeks. For the control, a non-locus point on M. brachialis was treated bilaterally with the same protocol. After the first week of EA, the serum cortisol levels of the ST36 and control groups were 0.9 +/- 0.1 and 0.5 +/- 0.1 micrograms/dl (P less than 0.005) baseline and 2.5 +/- 0.2 and 1.4 +/- 0.4 micrograms/dl (p less than 0.05) and after ACTH stimulation test, respectively. After the third week of EA treatment, the results were 1.0 +/- 0.1 and 0.6 +/- 0.2 micrograms/dl (p less than 0.05) baseline and 4.0 +/- 0.5 and 1.7 +/- 0.5 micrograms/dl (p less than 0.001) after ACTH stimulation respectively. These data indicated that EA at ST36 could restore the adrenocortical hypofunction resulting from ICS in dogs. PMID:1897497

Lin, J H; Su, H L; Chang, S H; Shien, Y S; Wu, L S

1991-01-01

439

A Dosimetric Model of Duodenal Toxicity After Stereotactic Body Radiotherapy for Pancreatic Cancer  

SciTech Connect

Introduction: Dose escalation for pancreas cancer is limited by the tolerance of adjacent normal tissues, especially with stereotactic body radiotherapy (SBRT). The duodenum is generally considered to be the organ at greatest risk. This study reports on the dosimetric determinants of duodenal toxicity with single-fraction SBRT. Methods and Materials: Seventy-three patients with locally advanced unresectable pancreatic adenocarcinoma received 25 Gy in a single fraction. Dose-volume histogram (DVH) endpoints evaluated include V{sub 5} (volume of duodenum that received 5 Gy), V{sub 10}, V{sub 15}, V{sub 20}, V{sub 25}, and D{sub max} (maximum dose to 1 cm{sup 3}). Normal tissue complication probability (NTCP) was evaluated with a Lyman model. Univariate and multivariate analyses were conducted with Kaplan-Meier and Cox regression models. Results: The median time to Grade 2-4 duodenal toxicity was 6.3 months (range, 1.6-11.8 months). The 6- and 12-month actuarial rates of toxicity were 11% and 29%, respectively. V{sub 10}-V{sub 25} and D{sub max} all correlated significantly with duodenal toxicity (p < 0.05). In particular, V{sub 15} {>=} 9.1 cm{sup 3} and V{sub 15} < 9.1 cm{sup 3} yielded duodenal toxicity rates of 52% and 11%, respectively (p = 0.002); V{sub 20} {>=} 3.3 cm{sup 3} and V{sub 20} < 3.3 cm{sup 3} gave toxicity rates of 52% and 11%, respectively (p = 0.002); and D{sub max} {>=} 23 Gy and D{sub max} < 23 Gy gave toxicity rates of 49% and 12%, respectively (p = 0.004). Lyman NTCP model optimization generated the coefficients m = 0.23, n = 0.12, and TD{sub 50} = 24.6 Gy. Only the Lyman NTCP model remained significant in multivariate analysis (p = 0.001). Conclusions: Multiple DVH endpoints and a Lyman NTCP model are strongly predictive of duodenal toxicity after SBRT for pancreatic cancer. These dose constraints will be valuable in future abdominal SBRT studies.

Murphy, James D.; Christman-Skieller, Claudia; Kim, Jeff; Dieterich, Sonja; Chang, Daniel T. [Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA (United States); Koong, Albert C., E-mail: akoong@stanford.ed [Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA (United States)

2010-12-01

440

Metachronous adrenal metastasis from operated contralateral renal cell carcinoma with adrenalectomy and iatrogenic Addison’s disease  

PubMed Central

Metachronous adrenal metastasis from contralateral renal cell carcinoma (RCC) surgery is an extremely rare condition. Iatrogenic Addison’s disease occurring after metastasectomy (adrenalectomy) is an even rarer clinical entity. We present a case of a 68-year-old male with hematuria and left flank pain 9 years prior. The patient underwent left transperitoneal radical nephrectomy involving the ipsilateral adrenal glands due to a centrally-located, 75-mm in diameter solid mass lesion in the upper pole of the left kidney. The tumour lesion was confined within the renal capsule, and the histo-pathological examination revealed a Fuhrman nuclear grade II clear cell carcinoma. The patient underwent transperitoneal right adrenalectomy. The histopathological examination revealed metastasis of clear cell carcinoma. The patient was diagnosed with iatrogenic Addison’s disease based on the measurement of serum cortisol levels and the adrenocorticotropic hormone (ACTH) stimulation test, after which glucocorticoid and mineralocorticoid replacement was initiated. The patient did not have local recurrence or new metastasis in the first year of the follow-up. The decision to perform ipsilateral adrenalectomy during radical nephrectomy constitutes a challenge, and the operating surgeon must consider all these rare factors. PMID:25408818

Ozturk, Hakan; Karaaslan, Serap

2014-01-01

441

The influence of anatomic and iatrogenic root surface characteristics on bacterial colonization and periodontal destruction: a review.  

PubMed

PERIODONTITIS IS A MULTIFACTORIAL infectious disease affecting primarily a subset of subjects and a subset of sites. Recent microbiological data have acknowledged that before disease progression can occur, a susceptible host and site are required, in addition to the presence of pathogenic bacteria. This review discusses factors affecting periodontal disease progression and focuses in particular on the influence of anatomic and iatrogenic root surface characteristics. Retrospective studies clearly suggest a strong association between anatomic aberrations and periodontal attachment loss. Cemental tear seems to have the potential to initiate an aseptic, rapid, site-specific periodontal breakdown in a non-infected environment, illustrating the complexity of the attachment loss process. Recent experimental findings, furthermore, demonstrate a significant influence of root surface instrumentation roughness upon subgingival plaque formation and gingival tissue reactions, as well as a significant and positive relationship between subgingival plaque accumulation and inflammatory cell mobilization. These results indicate that subgingivally located irregularities may form stagnant sites or ecological niches which favor both retention and growth of organisms. Such events in addition to the progressive inflammatory changes may critically influence the subgingival environment by turning a stable site into an unstable or active periodontitis site. Thus, local anatomic and iatrogenic root surface characteristics may have a more profound effect on gingival health than previously assumed, particularly on a site level. PMID:9203093

Leknes, K N

1997-06-01