Sample records for iatrogenic duodenal perforation

  1. Iatrogenic perforation of perivaterian duodenal diverticulum: report of a case

    PubMed Central

    Cavanagh, James E.

    1996-01-01

    The author reports a case of iatrogenic perforation of a duodenal diverticulum, an extremely rare occurrence, during percutaneous radiologic extraction of a retained common-bile-duct stone. Perforation was related to the perivaterian location of the duodenal diverticulum. Because an inflammatory reaction was present, tube duodenostomy was chosen over excision, closure and drainage to prevent the complication of lateral duodenal fistula and sepsis. Whenever iatrogenic duodenal perforation is suspected, prompt radiologic documentation and early surgical consultation should be sought. PMID:8697327

  2. Expandable stents for iatrogenic perforation of esophageal malignancies

    Microsoft Academic Search

    Russell E. White; Caesar Mungatana; Mark Topazian

    2003-01-01

    The management of patients with iatrogenic perforation of esophageal cancers is controversial. We reviewed the management\\u000a of perforated esophageal malignancies at a single institution with a large volume of patients with esophageal cancer. Cases\\u000a of iatrogenic perforation of the esophagus occurring during a 3-year period were identified from the hospital endoscopy database.\\u000a Inpatient and outpatient records were reviewed, and subjects

  3. Perforated Duodenal Ulcer in a Cow

    PubMed Central

    Fatimah, I.; Butler, D. G.; Physick-Sheard, P. W.

    1982-01-01

    A case report of perforated duodenal ulcer in a ten year old Holstein cow is presented. On three occasions, sudden anorexia and rapidly progressing abdominal fluid distension were associated with metabolic alkalosis, hypochloremia and hypokalemia. Rumen fluid at the time of the second episode was acidic and contained an excessive amount of chloride ion. An abdominal mass dorsal to the abomasum involving the pylorus and several loops of small bowel was identified but not corrected at surgery. Necropsy confirmed a 1.5 cm diameter duodenal ulcer 6 cm distal to the pylorus. PMID:17422146

  4. Duodenal perforation in an infant with rotavirus gastroenteritis

    PubMed Central

    Stabell, Niklas; Klingenberg, Claus; Rushfeldt, Christian

    2013-01-01

    We describe for the first time a case of an infant with rotavirus gastroenteritis complicated by a duodenal perforation. Awareness of the perforation risk may prevent severe or lethal outcomes in this common infection among infants and children. PMID:23592811

  5. The Management of Endoscopic Retrograde Cholangiopancreatography-Related Duodenal Perforation

    PubMed Central

    2014-01-01

    Uneventful duodenal perforation during endoscopic retrograde cholangiopancreatography (ERCP) is an uncommon but occasionally fatal complication. ERCP-related perforations may occur during sphincterotomy and improper manipulation of the equipment and scope. Traditionally, duodenal perforation has been treated with early surgical repair. Recently, nonoperative early endoscopic management techniques including clips or fibrin glue have been reported. In the present paper we review the literature pertaining to the treatment of perforations. PMID:25133122

  6. Thyroid Storm Precipitated by Duodenal Ulcer Perforation

    PubMed Central

    Natsuda, Shoko; Nakashima, Yomi; Horie, Ichiro; Kawakami, Atsushi

    2015-01-01

    Thyroid storm is a rare and life-threatening complication of thyrotoxicosis that requires prompt treatment. Thyroid storm is also known to be associated with precipitating events. The simultaneous treatment of thyroid storm and its precipitant, when they are recognized, in a patient is recommended; otherwise such disorders, including thyroid storm, can exacerbate each other. Here we report the case of a thyroid storm patient (a 55-year-old Japanese male) complicated with a perforated duodenal ulcer. The patient was successfully treated with intensive treatment for thyroid storm and a prompt operation. Although it is believed that peptic ulcer rarely coexists with hyperthyroidism, among patients with thyroid storm, perforation of a peptic ulcer has been reported as one of the causes of fatal outcome. We determined that surgical intervention was required in this patient, reported despite ongoing severe thyrotoxicosis, and reported herein a successful outcome.

  7. Iatrogenic gastric perforation during laparoscopy presenting on anaesthesia monitor.

    PubMed

    Parvaiz, M A; Pervaiz, M A

    2014-07-01

    Unfortunately, in the era of minimal access surgery, visceral injuries due to laparoscopic port insertion are common. Most such injuries are diagnosed on direct vision through a laparoscope camera. We report a case of iatrogenic gastric perforation during laparoscopy, presenting in an unusual way in the form of a very high carbon dioxide output on the anaesthesia monitor. This atypical presentation should be borne in mind while performing laparoscopy. PMID:24992404

  8. Duodenal Perforation with an Unusual Presentation: A Case Report

    PubMed Central

    Sarmast, Arif Hussain; Parray, Fazl Q.; Showkat, Hakim Irfan; Lone, Yasir A.; Bhat, Naseer A.

    2011-01-01

    A young female presented with classical complaints suggestive of peptic ulcer disease leading to signs of peritonitis. The said patient after being subjected to baseline workup was subjected to laparotomy which proved to be a surgical surprise. A live ascaris lumbricoides worm was seen pouting out of a duodenal perforation. PMID:22567473

  9. Duodenal perforation caused by an inferior vena cava filter.

    PubMed

    Bae, Mi Ju; Chung, Sung Woon; Lee, Chung Won; Kim, Sangpil; Song, Seunghwan

    2012-02-01

    The inferior vena cava (IVC) filter is known as an effective and safe method for preventing fatal pulmonary thromboembolism in patients with deep vein thrombosis. Usually, the remaining IVC filters are asymptomatic and do not cause clinical problems. We report a case of duodenal perforation caused by a remaining IVC filter. PMID:22363914

  10. Perforated duodenal diverticulum: Surgical treatment and literature review

    PubMed Central

    Costa Simões, Vitor; Santos, Bruno; Magalhães, Sara; Faria, Gil; Sousa Silva, Donzília; Davide, José

    2014-01-01

    INTRODUCTION Duodenum is the second most frequent location for a diverticulum in the digestive tract. Complications are rare and perforation was only reported in less than 200 cases. PRESENTATION OF CASE A 79-year-old female was admitted to Emergency Department with abdominal pain and vomiting for the last 24 h. A CT scan was performed and moderated extra-luminal air was identified. During surgery a fourth portion perforated duodenal diverticulum was diagnosed and duodenal resection was performed. DISCUSSION First reported in 1710, the incidence of duodenal diverticula can be as high as 22%. Nevertheless complications are extremely rare and include haemorrhage, inflammation, compression of surrounding organs, neoplastic progression, cholestasis and perforation. As perforations are often retroperitoneal, symptoms are nonspecific and rarely include peritoneal irritation, making clinical diagnose a challenge. CT scan will usually present extra-luminal retroperitoneal air and mesenteric fat stranding, providing clues for the diagnosis. Although non-operative treatment has been reported in selected patients, standard treatment is surgery and alternatives are diverse including diverticulectomy or duodenopancreatectomy. CONCLUSION Perforated diverticula of the fourth portion of the duodenum are extremely rare and current evidence still supports surgery as the primary treatment modality. PMID:25016082

  11. Laparoscopic repair of perforated duodenal ulcer

    Microsoft Academic Search

    M. L. Druart; R. Van Hee; J. Etienne; G. B. Cadière; J. F. Gigot; M. Legrand; J. M. Limbosch; B. Navez; M. Tugilimana; E. Van Vyve; L. Vereecken; E. Wibin; J. P. Yvergneaux

    1997-01-01

    Background: A series of 100 consecutive patients with perforated peptic ulcer were prospectively evaluated in a multicenter study. The\\u000a feasibility of the laparoscopic repair was evaluated.\\u000a \\u000a \\u000a \\u000a \\u000a Methods: All patients had peritonitis, 20% were in septic shock, and 57% had delayed perforation. Conversion to laparotomy was necessary\\u000a in eight patients. The morbidity rate was 9% and mortality rate 5%.\\u000a \\u000a \\u000a \\u000a \\u000a Results: The

  12. Perforated duodenal diverticulae: importance for the surgeon and gastroenterologist.

    PubMed

    Haboubi, Danya; Thapar, Ankur; Bhan, Chetan; Oshowo, Ayo

    2014-01-01

    We present the case of a 78-year-old woman who was admitted for an elective left hemicolectomy for diverticular disease. Two days following the elective procedure, bilious fluid was noted in her pelvic drain. The patient returned to theatre, where a perforated duodenal diverticulum was excised and the defect primarily repaired. The patient then developed a low output enterocutaneous fistula which was treated conservatively with nasojejunal feeding and resolved spontaneously. PMID:25270157

  13. Spontaneous Duodenal Perforation as a Complication of Kawasaki Disease

    PubMed Central

    Forouzan, Arash; Saidi, Hossein; Javaherizadeh, Hazhir; Khavanin, Ali; Bahadoram, Mohammad

    2015-01-01

    Kawasaki disease is generally known as a systemic vasculitis that often concerns doctors due to its serious cardiac complications; however, other visceral organs may get involved as well. Surgical manifestations of the intestinal tract in Kawasaki disease are rare. In this report, we describe the case of a 2.5-year-old boy with typical Kawasaki disease who presented with GI bleeding and surgical abdomen. The diagnosis of duodenal perforation was confirmed.

  14. Iatrogenic Perforation of Upper Pouch in Pure Esophageal Atresia: A Rare Complication and Review of Literature

    PubMed Central

    Parelkar, Sandesh; Mundada, Dinesh; Joshi, Prashant; Sanghvi, Beejal; Kapadnis, Satish; Oak, Sanjay

    2013-01-01

    Iatrogenic perforation of the neonate's pharynx and esophagus with normal anatomy was first described by Eklöf et al in 1968. It typically occurs in severely premature neonates who have undergone repeated traumatic attempts at endotracheal intubation or passage of orogastric tubes. It may also mimic esophageal atresia (EA). Perforation of upper pouch in tracheoesophageal fistula with EA was rarely reported. We report a 1,400?g (32 weeks) neonate with pure EA and iatrogenic perforation of upper pouch due to use of catheter for diagnostic radiography.

  15. Duodenal perforation: unusual complication of gastrostomy tube replacement.

    PubMed

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

    2014-06-01

    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

  16. Diagnosis and management of iatrogenic endoscopic perforations: European Society of Gastrointestinal Endoscopy (ESGE) Position Statement.

    PubMed

    Paspatis, Gregorios A; Dumonceau, Jean-Marc; Barthet, Marc; Meisner, Søren; Repici, Alessandro; Saunders, Brian P; Vezakis, Antonios; Gonzalez, Jean Michel; Turino, Stine Ydegaard; Tsiamoulos, Zacharias P; Fockens, Paul; Hassan, Cesare

    2014-08-01

    This Position Paper is an official statement of the European Society of Gastrointestinal Endoscopy (ESGE). It addresses the diagnosis and management of iatrogenic perforation occurring during diagnostic or therapeutic digestive endoscopic procedures. Main recommendations 1 ESGE recommends that each center implements a written policy regarding the management of iatrogenic perforation, including the definition of procedures that carry a high risk of this complication. This policy should be shared with the radiologists and surgeons at each center. 2 In the case of an endoscopically identified perforation, ESGE recommends that the endoscopist reports: its size and location with a picture; endoscopic treatment that might have been possible; whether carbon dioxide or air was used for insufflation; and the standard report information. 3 ESGE recommends that symptoms or signs suggestive of iatrogenic perforation after an endoscopic procedure should be carefully evaluated and documented, possibly with a computed tomography (CT) scan, in order to prevent any diagnostic delay. 4 ESGE recommends that endoscopic closure should be considered depending on the type of perforation, its size, and the endoscopist expertise available at the center. A switch to carbon dioxide insufflation, the diversion of luminal content, and decompression of tension pneumoperitoneum or tension pneumothorax should also be done. 5 After closure of an iatrogenic perforation using an endoscopic method, ESGE recommends that further management should be based on the estimated success of the endoscopic closure and on the general clinical condition of the patient. In the case of no or failed endoscopic closure of the iatrogenic perforation, and in patients whose clinical condition is deteriorating, hospitalization and surgical consultation are recommended. PMID:25046348

  17. Simple diversion by duodenojejunostomy for a retroperitoneal perforation of the second portion of the duodenal diverticulum.

    PubMed

    Fujisaki, Shigeru; Takashina, Motoi; Sakurai, Kenichi; Tomita, Rhyouichi; Takayama, Tadatoshi

    2014-01-01

    Abstract We herein describe that a Roux-en-Y duodenojejunostomy is a simple and secure procedure for perforated diverticulum in the second portion of the duodenum. The surgical technique for perforated duodenal diverticulum can be adaptable when it is difficult to achieve closure of the perforated site easily. Patients who undergo the operation may be able to eat meals, even if duodenal fistula occurs in the postoperative course. PMID:25216433

  18. An unusual case of duodenal perforation caused by a lollipop stick: a case report.

    PubMed

    Cho, Eun Ae; Lee, Du Hyeon; Hong, Hyoung Ju; Park, Chang Hwan; Park, Seon Young; Kim, Hyun Soo; Choi, Sung Kyu; Rew, Jong Sun

    2014-03-01

    Most ingested foreign bodies often pass through the gastrointestinal tract uneventfully; however, complications such as perforation do occur. Most cases of perforation are caused by thin, pointed objects such as needles, toothpicks, or fish and chicken bones. Herein, we report an unusual case of duodenal perforation caused by a lollipop stick with blunt ends. A 23-year-old woman was admitted to the emergency department complaining of epigastric and right upper quadrant pain for the last 2 days. Abdominal computed tomography scans confirmed the presence of a foreign body in the duodenum, with signs of duodenal perforation and inflammation. The patient was not aware of ingesting the foreign body. Endoscopy revealed the presence of a lollipop stick in the duodenum, which was removed with forceps. The duodenal perforation was successfully managed by using hemoclips and a detachable snare. PMID:24765603

  19. Laparoscopic endoloop technique – A novel approach of managing iatrogenic caecal perforation and literature review

    PubMed Central

    Merali, N.; Hussain, A.

    2015-01-01

    Introduction An iatrogenic caecal perforation is rare, but a serious complication associated with significant morbidity and mortality. We present a 4 min and 50 s video on a new improvisation undertaken during laparoscopic management of post-polypectomy caecal perforation. Presentation of case Our patient presented with an acute abdomen following endoscopic polypectomy. At surgery, the site of caecal perforation was close to the appendicular base with devitalization tissue, secondary to diathermy usage. The hallmark of safety within this novel technique included fresh healthy tissue margins within the endoloop (detachable snare ligation) and ensuring no ischemic tissue was gathered. Complete freeing of the appendix and meso-appendicular base was required and securing three endoloops proximal to the site of perforation. The post-operative course was uneventful. Discussion The World Society of Emergency Surgery (WSES) 2013 guidelines suggested an early laparoscopic approach is a safe and effective treatment for colonoscopy-related colonic perforation. There are no national guidelines and the management is dictated by the clinical condition of the patient, co-morbidity, size and site of perforation as well as the scale of bowel preparation, and surgical experience. Conclusion The endoloop technique described, undertaken during a laparoscopy is a novel approach. It is a simple and effective method, reminding clinicians to adapt techniques when necessary. Nevertheless, it is only limited to perforations around the appendicular base. PMID:25723744

  20. Graft Duodenal Perforation due to Internal Hernia after Simultaneous Pancreas-Kidney Transplantation: Report of a Case

    Microsoft Academic Search

    Yuichi Fumimoto; Masahiro Tanemura; Yoshihiko Hoshida; Toshirou Nishida; Yoshiki Sawa; Toshinori Ito

    2008-01-01

    Although complications including graft thrombosis, graft pancreatitis, and rejection have been well documented after pancreas transplantation, the occurrence of graft duodenal perforation is uncommon. In this article, we report a case of graft duodenal perforation due to internal hernia after simultaneous pancreas-kidney transplantation (SPK). A patient with type I diabetes mellitus and diabetic nephropathy had undergone SPK from a cadaveric

  1. Iatrogenic gall bladder perforations in laparoscopic cholecystectomy: an audit of 200 cases.

    PubMed

    Zubair, M; Habib, L; Mirza, M R; Channa, M A; Yousuf, M

    2010-07-01

    This study was done to evaluate the frequency of iatrogenic gall bladder perforation (IGBP) in laparoscopic cholecystectomy and to determine its association with gender, adhesions in right upper quadrant and types of gall bladder. This retrospective descriptive study included 200 patients who underwent laparoscopic cholecystectomy for symptomatic cholelithiasis at Jamal Noor Hospital and Hamdard University Hospital, Karachi from January 2007 to January 2009. Video recording of all 200 laparoscopic cholecystectomies were analyzed for the IGBP. The different factors; sex of the patient, type of gall bladder, presence of adhesions in the right upper quadrant, timing of perforation, site of perforation, cause of perforation and spillage of stones were recorded. Data was entered and analyzed on SPSS 15. Pearson Chi Square test was applied to check the significance of these factors in IGBP where applicable. In this study there were 173 females and 27 male patients. IGBP occurred in 51 patients (25.5%) and among them 40(23.12%) were females and 11(40.74%) males. Statistical analysis failed to prove male gender a significant factor in the IGBP (p=0.051). Spillage of stones occurred in 23 patients (11.5% in total study population). In 32(18.49%) patients with chronic calculus cholecystitis IGBP occured while in other cluster of 27 patients suffering from acute cholecystitis, empyema & mucocele, 19(70.37%) had IGBP. Hence the condition of gall bladder (acute cholecystitis, empyema and mucocele) was proved statistically a significant factor in IGBP (p=0.000). Adhesiolysis in right upper quadrant was required in 109 patients in whom 31 patients (28.44%) had IGBP while in 91 patients in whom no adhesiolysis was required, 20 patients (21.98%) had IGBP. Statistically no significant difference was present regarding this factor (p=0.296). In total of 51 patients of IGBP, fundus of gall bladder was the commonest site of perforation in 21(41.18%), followed by body of gall bladder in 18(35.29%) and Hartman's pouch in 12(23.53%) patients. In 27(52.94%) patients, diathermy hook was the cause of perforation followed by grasping forceps in 24(47.06%) patients. In 33(64.71%) patients perforations occurred during dissection of gall bladder from liver bed, in 2(3.92%) during adhesiolysis and in 16(31.37%) during retraction maneuvers. Perforation of gall bladder occurred in 25.5% of patients during laparoscopic cholecystectomy and acutely inflamed and over distended gall bladders were proved significant factor for this intraoperative event. PMID:20639837

  2. Iatrogenic uterine perforation and bowel penetration using a Hohlmanipulator: A case report?

    PubMed Central

    Akdemir, Ali; Cirpan, Teksin

    2014-01-01

    INTRODUCTION Adequate exposure is a vital factor in total laparoscopic hysterectomy, and uterine manipulators have been used in achieving that. The Hohl uterine manipulator has been considered to be one of the safer manipulators. Beside adequate exposure, it is associated with lower intraoperative complications. However, we report a case of iatrogenic uterine rupture with the Hohl manipulator which also caused bowel penetration. PRESENTATION OF CASE A 52-year-old woman with endometrial hyperplasia was scheduled for total laparoscopic hysterectomy. Prior to entering into the abdomen, the Hohl uterine manipulator was introduced into the uterine cavity without force. During the laparoscopic exploration, we noted that the tip of the Hohl manipulator had perforated the posterior uterine fundus and penetrated the bowel. Therefore, laparotomy was performed, and the bowel injury was repaired by a colorectal surgeon. DISCUSSION The Hohl uterine manipulator is safe and easy to use, and is associated with decreased intraoperative injuries. However, the complications observed due to the improper use of an uterine manipulator can overshadow any advantages of manipulator. In the present report, we describe a case of uterine perforation and bowel penetration caused by the Hohl uterine manipulator during total laparoscopic hysterectomy, which required conversion to laparotomy. The cause for this complication is associated with improper usage of the uterine manipulator. CONCLUSION Uterine manipulator may cause uterine perforation and bowel penetration at the beginning of the hysterectomy procedure. These types of complications can be prevented by proper application of the Hohl manipulator into the uterus under direct pelvic visualization. PMID:24721564

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

    PubMed Central

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

    2014-01-01

    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

  4. Perforated duodenal diverticulum, a rare complication of a common pathology: A seven-patient case series.

    PubMed

    Rossetti, Andrea; Christian, Buchs Nicolas; Pascal, Bucher; Stephane, Dominguez; Philippe, Morel

    2013-03-27

    Duodenal diverticula (DD) are frequently encountered and are usually asymptomatic, with an incidence at autopsy of 22%. Perforation of DD is a rare complication (around 160 cases reported) with potentially dramatic consequences. However, little evidence regarding its treatment is available in the literature. The aim of this study was to review our experience of perforated DD, with a focus on surgical management. Between January 2001 and June 2011, all perforated DD were retrospectively reviewed at a single centre. Seven cases (5 women and 2 men; median age: 72.4 years old, rang: 48-91 years) were found. The median American Society of Anesthesiologists' score in this population was 3 (range: 3-4). The perforation was located in the second portion of duodenum (D2) in six patients and in the third portion (D3) in one patient. Six of these patients were treated surgically: five patients underwent DD resection with direct closure and one was treated by surgical drainage and laparostomy. One patient was treated conservatively. One patient died and one patient presented a leak that was successfully treated conservatively. The median hospital stay was 21.1 d (range: 15-30 d). Perforated DD is an uncommon presentation of a common pathology. Diverticular excision with direct closure seems to offer the best chance of survival and was associated with a low morbidity, even in fragile patients. PMID:23556061

  5. Identification of Perforators in Patients with Duodenal Varices by Endoscopic Ultrasound—A Case Series [with video

    PubMed Central

    Sharma, Malay; Mohan, Pazhanivel; Rameshbabu, Chittapuram S.; Jayanthi, Venkataraman

    2012-01-01

    Background/Aims Duodenal varices (DV) are ectopic varices which can cause massive gastrointestinal bleeding. The diagnosis of DV may be difficult; sometimes they can be hidden behind duodenal folds. The aim of the study was to evaluate DV by endoscopic ultrasound. Methods Endoscopic ultrasound was done in patients detected or suspected to be having DV. The para duodenal varices were identified and subsequently hemodynamic evaluation of DV was done. Results Endoscopic ultrasound identified perforators in seven cases of DV. Conclusion The endoscopic ultrasound can help in detection of DV underlying thickened folds. It can also help in hemodynamic evaluation of DV.

  6. Endoscopic rendez-vous after damage control surgery in treatment of retroperitoneal abscess from perforated duodenal diverticulum: a techinal note and literature review

    PubMed Central

    2013-01-01

    Introduction The duodenum is the second seat of onset of diverticula after the colon. Duodenal diverticulosis is usually asymptomatic, but duodenal perforation with abscess may occur. Case presentation Woman, 83 years old, emergency hospitalised for generalized abdominal pain. On the abdominal tomography in the third portion of the duodenum a herniation and a concomitant full-thickness breach of the visceral wall was detected. The patient underwent emergency surgery. A surgical toilette of abscess was performed passing through the perforated diverticula and the Petzer’s tube drainage was placed in the duodenal lumen; the duodenostomic Petzer was endoscopically removed 4 months after the surgery. Discussion A review of medical literature was performed and our treatment has never been described. Conclusion For the treatment of perforated duodenal diverticula a sequential two-stage non resective approach is safe and feasible in selected cases. PMID:23866674

  7. The successful use of simple tube duodenostomy in large duodenal perforations from varied etiologies

    PubMed Central

    Kutlu, Onur C.; Garcia, Steven; Dissanaike, Sharmila

    2012-01-01

    INTRODUCTION Tube decompression of the duodenum is an old but underutilized technique known to decrease morbidity and mortality in patients with difficult to manage duodenal injuries. Broad arrays of techniques have been described in the literature and are reviewed, but most are complex procedures not appropriate for the management of an unstable patient. PRESENTATION OF CASE In this paper we describe the technique of tube duodenostomy and the successful application in three cases of large defects (>3 cm) which two of these cases had failed previous repair attempts. The defects were caused by very different etiologies, including blunt trauma, peptic ulcer disease and erosion from cancer. All were finally managed by application of tube duodenostomy with success. DISCUSSION Patients with “difficult to manage duodenum” usually present with hemodynamic instability with hostile abdomen. Complex procedures in an unstable patient are associated with adverse outcomes. In patients with significant comorbidities and instability the damage control principle of trauma surgery is gaining popularity. Tube duodenostomy technique described in this paper fits in well with that principle. CONCLUSION Application of tube duodenostomy instead of a complex procedure in an unstable patient provides an opportunity to stabilize the patient, converting an impending catastrophe to a future scheduled surgery. PMID:23357008

  8. A preliminary study of reliability of impedance measurement to detect iatrogenic initial pedicle perforation (in the porcine model)

    Microsoft Academic Search

    Ciaran Bolger; C. Carozzo; T. Roger; Linda McEvoy; Jabir Nagaria; Gerard Vanacker; Maurice Bourlion

    2006-01-01

    Accidental perforation of the vertebral pedicle wall is a well-known complication associated with standard approach of pedicle\\u000a screw insertion. Depending on detection criteria, more than 20% of screws are reported misplaced. Serious clinical consequences,\\u000a from dysesthesia to paraplegia, although not common, may result from these misplaced screws. Many techniques have been described\\u000a to address this issue such as somatosensory evoked

  9. 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.

  10. Complete duodenogastric reflux: A scintigraphic sign of significant duodenal pathology

    SciTech Connect

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

    1989-09-01

    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.

  11. Iatrogenic Sinistral Hypertension Complicating Screening Colonoscopy

    PubMed Central

    Ziff, Oliver J.; Shapiro, A. M. James

    2013-01-01

    Colonoscopy is widely accepted as the gold-standard screening technique for detecting malignancies in the distal gastrointestinal tract in patients with symptoms suggestive of colon cancer. However, this procedure is not without risk, including colonic perforation. We report a patient who was managed conservatively after colonoscopy induced perforation. Eighteen months after appearing to make a full recovery, he presented with an upper gastrointestinal bleed. Oesophago-gastro-duodenoscopy (OGD) revealed large gastric fundal varices and computed tomography (CT) revealed splenic vein thrombosis. The ensuing left-sided (sinistral) hypertension explains the development of the fundal varices in the presence of normal liver function. At surgery, a persistent abscess cavity was identified and cultures from this site grew Streptococcus anginosus. Curative splenectomy was performed and the patient made a full recovery. We advocate more prompt operative intervention in selected cases of iatrogenic colonic perforation with primary repair to prevent late complications. PMID:24024063

  12. Future directions of duodenal endoscopic submucosal dissection

    PubMed Central

    Matsumoto, Satohiro; Miyatani, Hiroyuki; Yoshida, Yukio

    2015-01-01

    Endoscopic therapies for lesions of the duodenum are technically more difficult than those for lesions of the other parts of the gastrointestinal tract due to the anatomical features of the duodenum, and the incidence rate of complications such as perforation and bleeding is also higher. These aforementioned trends were especially noticeable for the case of duodenal endoscopic submucosal dissection (ESD). The indication for ESD of duodenal tumors should be determined by assessment of the histopathology, macroscopic morphology, and diameter of the tumors. The three types of candidate lesions for endoscopic therapy are adenoma, carcinoma, and neuroendocrine tumors. For applying endoscopic therapies to duodenal lesions, accurate preoperative histopathological diagnosis is necessary. The most important technical issue in duodenal ESD is the submucosal dissection process. In duodenal ESD, a short needle-type knife is suitable for the mucosal incision and submucosal dissection processes, and the Small-caliber-tip Transparent hood is an important tool. After endoscopic therapies, the wound should be closed by clipping in order to prevent complications such as secondary hemorrhage and delayed perforation. At present, the criteria for selection between ESD and EMR vary among institutions. The indications for ESD should be carefully considered. Duodenal ESD should have limitations, such as the need for its being performed by experts with abundant experience in performing the procedure.

  13. Management of complicated duodenal diverticula.

    PubMed

    Oukachbi, N; Brouzes, S

    2013-06-01

    The duodenum is the second most common location of intestinal diverticula after the colon. Duodenal diverticulum (DD) is usually located in the second portion of the duodenum (D2), close to the papilla. Most duodenal diverticula are extraluminal and acquired rather than congenital; more rare is the congenital, intraluminal diverticulum. DD is usually asymptomatic and discovered incidentally, but can become symptomatic in 1% to 5% of cases when complicated by gastroduodenal, biliary and/or pancreatic obstruction, by perforation or by hemorrhage. Endoscopic treatment is the most common first-line treatment for biliopancreatic complications caused by juxtapapillary diverticula and also for bleeding. Conservative treatment of perforated DD based on fasting and broad-spectrum antibiotics may be offered in some selected cases when diagnosis is made early in stable patients, or in elderly patients with comorbidities who are poor operative candidates. Surgical treatment is currently reserved for failure of endoscopic or conservative treatment. The main postoperative complication of diverticulectomy is duodenal leak or fistula, which carries up to a 30% mortality rate. PMID:23810155

  14. 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 . ...

  15. Rare cause of oesophagus perforation

    PubMed Central

    Sabuncuoglu, Mehmet Zafer; Benzin, Mehmet Fatih; Dandin, Ozgur; Cakir, Tugrul; Sozen, Isa; Sabuncuoglu, Aylin; Teomete, Uygar

    2014-01-01

    INTRODUCTION Oesophagus perforations, which are generally caused by iatrogenic injuries, are a serious clinical event. There are still high rates of mortality and morbidity and there is no gold standard of surgical treatment. PRESENTATION OF CASE The case is here presented of a 54-year old female with complaints of dysphagia after having swallowed a bone in food, who was determined with oesophagus perforation on CT examination. DISCUSSION Oesophagus perforation generally occurs secondary to interventional procedures and rarely develops associated with foreign bodies. Treatment depends on the perforation site and dimension. CONCLUSION While conservative primary surgical repair may be chosen for cervical lesions, more aggressive approaches such as resection and delayed reconstruction are recommended for thoracic lesions. Early determination and appropriate treatment are life-saving. PMID:25541369

  16. Evolving Options in the Management of Esophageal Perforation

    Microsoft Academic Search

    Clayton J. Brinster; Sunil Singhal; Lawrence Lee; M. Blair Marshall; Larry R. Kaiser; John C. Kucharczuk

    2004-01-01

    Esophageal perforation remains a devastating event that is difficult to diagnose and manage. The majority of injuries are iatrogenic and the increasing use of endo- scopic procedures can be expected to lead to an even higher incidence of esophageal perforation in coming years. Accurate diagnosis and effective treatment depend on early recognition of clinical features and accurate interpretation of diagnostic

  17. Diagnosis and management of duodenal injuries in children.

    PubMed

    Shilyansky, J; Pearl, R H; Kreller, M; Sena, L M; Babyn, P S

    1997-06-01

    Traumatic duodenal perforations in children pose a diagnostic and therapeutic challenge. To identify specific diagnostic criteria and define an optimal therapeutic protocol, we reviewed all duodenal injuries treated at our institution in the past 10 years. There were 14 hematomas and 13 perforations. The diagnosis was confirmed by computed tomography (CT), ultrasound scan (US), upper gastrointestinal contrast studies (UGI), or at laparotomy. The clinical findings and CT findings of the two groups were compared. Children with suspected duodenal hematomas were treated expectantly, and children with duodenal perforations were treated surgically. Twenty-five associated injuries (10 pancreatic) occurred in 19 children. Children with perforations had higher injury severity scores (ISS) (25 v 9), but the two groups could not be differentiated based on presenting signs, symptoms, or laboratory findings. CT findings of retroperitoneal air or contrast were seen in 9 of 9 perforations and in 0 of 10 hematomas. CT findings of intraabdominal or retroperitoneal fluid, mesenteric enhancement, and thickened duodenal wall did not differentiate the two groups. Duodenojejunostomy was performed in one patient, and primary repair was performed in 11 children who had perforation. In five children, duodenostomy tube drainage with feeding jejunostomy or gastrojejunostomy were added. Complications occurred in three of four children in the first 5 years of the study and in two of nine children in the last 5 years. The decreased morbidity rate correlated with reduced time to definitive therapy (28 v 7.8 hours). Duodenal fistulae resulted in three of seven children treated without duodenostomy tube drainage and zero of five treated with drainage. Enteral feeds resumed faster (average, 12 v 27 days) if repair of perforation was combined with feeding jejunostomy or pyloric exclusion and gastrojejunostomy. Children with duodenal hematoma resumed eating an average of 16 days after injury. Only one child required surgery for persistent obstruction. The findings of retroperitoneal air and contrast extravasation on CT accurately distinguish duodenal perforation from hematoma. Conservative management of hematoma is safe and effective. Primary repair of perforation with duodenal drainage results in fewer postoperative complications, and gastrojejunostomy or feeding jejunostomy shorten the time to resumption of feeds. PMID:9200092

  18. A rare case of accidental esophageal perforation in an extremely low birth weight neonate.

    PubMed

    Suryawanshi, Pradeep; Dahat, Amit; Nagpal, Rema; Malshe, Nandini; Kalrao, Vijay

    2014-06-01

    Spontaneous perforation of esophagus in neonates is a rare occurrence. However iatrogenic perforation of the esophagus is not that uncommon, and is most frequently seen in preterm and low birth weight infants. In premature infants, an esophageal perforation (EP) mainly occurs while inserting an orogastric tube. The commonly reported symptoms of EP are sudden onset respiratory distress, due to the pleural effusion and pneumothorax. In our case neonate presented with apnea requiring ventilation. We present a rare case of an Extremely Low Birth Weight (ELBW) neonate with an iatrogenic esophageal perforation who presented with recurrent apneas, outlining aspects of diagnosis and management. PMID:25121037

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

    PubMed Central

    Prabhu, V; Shivani, A

    2014-01-01

    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

  20. Duodenal stents for malignant duodenal strictures.

    PubMed Central

    Johnston, S. D.; McKelvey, S. T. D.; Moorehead, R. J.; Spence, R. A. J.; Tham, T. C. K.

    2002-01-01

    Duodenal obstruction may be caused by inoperable malignant disease. Symptoms of nausea and vomiting have been traditionally palliated by surgery. The aim of the study was to determine the efficacy of the endoscopic placement of metal self expanding duodenal stents for the palliation of malignant duodenal obstruction. Four patients with malignant gastric outlet obstruction are described. One patient had a history of oesophagectomy for oesophageal adenocarcinoma and presented with further dysphagia. At endoscopy the recurrent oesophageal tumour and an adenocarcinoma involving the pylorus were both stented. In the other three patients there was a previous history of colonic carcinoma, cholangiocarcinoma and oesophageal adenocarcinoma respectively. All four patients were successfully stented with good palliation of their symptoms. Duodenal Wallstents are a useful alternative to surgery in patients with inoperable malignant duodenal obstruction or those who are unfit for surgery. Images Fig 1 Fig 2 PMID:12137161

  1. Oesophageal perforation following perioperative transoesophageal echocardiography.

    PubMed

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

    2000-05-01

    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

  2. Esophageal perforation

    MedlinePLUS

    ... a non-harmful dye can help pinpoint the location of the perforation. You may also have chest ... You may need surgery, depending on the location and size of the ... to have it within 24 hours of when the perforation occurred. ...

  3. Gastroduodenal perforation.

    PubMed

    Nirula, Raminder

    2014-02-01

    The cause and management of gastroduodenal perforation have changed as a result of increasing use of nonsteroidal antiinflammatories and improved pharmacologic treatment of acid hypersecretion as well as the recognition and treatment of Helicobacter pylori. As a result of the reduction in ulcer recurrence with medical therapy, the surgical approach to patients with gastroduodenal perforation has also changed over the last 3 decades, with ulcer-reducing surgery being performed infrequently. PMID:24267494

  4. Wellbore perforating

    SciTech Connect

    Dunn, M.D.

    1988-08-02

    This patent describes a method for perforating at least one mineral producing zone in a wellbore in the earth wherein at least one perforating gun is set in the wellbore adjacent at least one zone and then detonated to perforate at least one zone. The wellbore initially containing a wellbore liquid therein adjacent at least one zone, the improvement comprising providing an assembly comprising a packer having a hollow sub fixed thereto which extends below the packer, at least one of the packer and sub having latch means for fixing the sub to production tubing which extends from the sub to the earth's surface. The sub having ports therein below the packer for admitting liquid from the exterior of the sub to the interior of the sub, the sub carrying below the ports seal means for sealing around injection tubing which passes through the interior of the production tubing and is inserted into hollow interior of the sub, the sub carrying below the seal means a hollow housing in essentially longitudinally axial alignment with the sub. The housing being adapted to receive and support internally thereof at least one perforating gun, the housing being sized so that space is provided in at least one location to allow liquid flow from the interior of the sub below the seal means through the space and out from a lower portion of the housing into the wellbore, lowering the assembly into the wellbore on the production tubing, actuating the packer to fix the assembly in the wellbore so that at least one perforating gun in the assembly is adjacent at least one zone to be perforated and so that the portion of the wellbore below the packer is separated in a liquid tight manner from the portion of the wellbore above the packer.

  5. [Post-traumatic intramural duodenal hematoma as a cause of high ileus in a child].

    PubMed

    Soudek, K; Husek, J; Randa, V; Dan?k, J

    1989-04-01

    The authors describe the case of an intramural duodenal haematoma caused a high ileus after a seven-day post-traumatic interval. The authors recommend surgical revision, in particular in children because the mechanism of injury is the same in intramural haematoma and in duodenal perforation. Only thus it is possible to prevena a fatal course, while the operation is easy and healing after drainage of the haematoma is rapid. PMID:2749389

  6. Duodenal exclusion for management of lateral duodenal fistulas.

    PubMed

    Eckhauser, F E; Strodel, W E; Knol, J A; Guice, K S

    1988-03-01

    The first clinical application of pyloric occlusion with gastrojejunostomy (duodenal exclusion) for management of lateral duodenal fistulas was reported by Berg in 1907. More recently Berne et al. applied this procedure to treat patients with complex pancreaticoduodenal trauma and modified it to include antrectomy with Billroth II reconstruction and tube duodenostomy. Over time the indications for duodenal exclusion have gradually been expanded to include management of actual or anticipated duodenal fistulas arising from operative injury or as a complication of inflammatory or neoplastic diseases. Our recent success using duodenal exclusion and/or diverticularization to manage one patient with duodenal trauma and two patients with nontraumatic forms of duodenal injury resulting in lateral duodenal fistulas caused us to reevaluate the efficacy of this procedure and forms the basis for this report. PMID:3348552

  7. Endovascular Stent-Graft Applications in Iatrogenic Vascular Injuries

    SciTech Connect

    Baltacioglu, Feyyaz, E-mail: fbaltaci@yahoo.com; Cimit, N. Cagatay [MarmaraUniversity School of Medicine, Istanbul, Department of Radiology (Turkey); Cil, Barbaros; Cekirge, Saruhan [HacettepeUniversity School of Medicine, Ankara, Department of Radiology (Turkey); Ispir, Selim [Marmara University School of Medicine, Istanbul, Department of Vascular Surgery (Turkey)

    2003-09-15

    Purpose: To report the results of covered stent applications in iatrogenic vascular injuries. Methods: We report 17 patients (11 men, 6 women; age range 20-59 years, mean age 40 years) who underwent repair of differentiatrogenic vascular lesions by means of endovascular covered stents.The patient population consisted of 8 femoral arteriovenous fistulae, 4 common femoral artery pseudoaneurysms, 1 subclavian artery pseudoaneurysm, 1 abdominal aortic aneurysm, 1 iliac artery perforation, 2 porto-biliary fistulae that developed during TIPS procedure. Balloon-expandable stent-grafts were used in all patients except one. Control studies were performed with angiography. Results: Technical success was achieved in all 17 patients.The mean clinical follow-up period for all 17 patients was 8 months.There were no signs of stent migration or leaks in the control studies.Only one patient developed a hemodynamically insignificant stenosis at the proximal end of the stent. There have been no stent deformations or related complications during the follow-up period. Conclusion: Our short-term results suggest that endovascular treatment is a low-risk procedure and appears less invasive than surgery for the treatment of different types of iatrogenic vascular injuries. Intermediate and long-term results are not available.

  8. Management of iatrogenic ureteral injury.

    PubMed

    Burks, Frank N; Santucci, Richard A

    2014-06-01

    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

  9. Management of iatrogenic ureteral injury

    PubMed Central

    Burks, Frank N.

    2014-01-01

    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

  10. Perforated monolayers

    SciTech Connect

    Regen, S.L.

    1992-12-01

    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.

  11. [Tympanic membrane perforation ].

    PubMed

    Sinkkonen, Saku T; Jero, Jussi; Aarnisalo, Antti A

    2014-01-01

    Tympanic membrane perforation may be caused by, e.g., trauma or acute or chronic middle ear infection. Perforation causes conductive hearing loss. Since it predisposes to infections, it is important to keep the ear dry. In most cases traumatic perforations heal spontaneously. Perforations caused by acute middle ear infections are treated with antibiotics. Chronic perforation due to chronic middle ear infection or cholesteatoma will usually not heal without surgery. Most perforation cases can be taken care of in primary care. ENT consultation is needed when alarming signs, such as continuous pain, vertigo or facial paralysis exist, or if the perforation persists. PMID:24822331

  12. [Surgical treatment of duodenal injuries].

    PubMed

    Sukhodolia, A I; Petrushenko, V V; Kozak, I O; Chubar, I V; Sukhodolia, S A

    2014-01-01

    In was analyzed diagnostics and treatment results of 32 victims with duodenal injuries. The authors used 3% hydrogen peroxide solution for duodenal rupture diagnosis. Suggested surgical technique includes intestine intersection where it was broken and anastomosis with a loop of small intestine by using of Roux's method. Also it was done duodenal passage temporary shutdown by using of catgut purse-string suture on pyloric part of stomach. PMID:25146537

  13. Surgical approach to iatrogenic complications of endodontic therapy: a report of 2 cases.

    PubMed

    Brki?, Amila; Gürkan-Köseo?lu, Banu; Olgac, Vakur

    2009-05-01

    Iatrogenic complications in endodontics are not irrelevant. One of the most seen is overfilling of the root canal, which has a negative effect on prognosis for endodontically treated teeth. Although more than a half of the overfilled teeth heal satisfactorily after proper endodontic therapy, in some cases, such as injury of the inferior alveolar nerve or presence of filling material in soft tissues or sinus spaces, surgical procedure is more suitable and effective. The purpose of this article is to present 2 clinical cases of iatrogenic complications of endodontically treated teeth and the approach to them by surgical procedure. In the first case, extruded endodontic filling material was present in the periapical region of lower second premolar tooth causing anesthesia of the mental nerve; in the second case, extruded material was found to have perforated the cortical bone of maxilla and passed through the mucoperiosteum to the muscle fibers. PMID:19426908

  14. Repair of an Extensive Furcation Perforation with CEM Cement: A Case Study

    PubMed Central

    Eghbal, Mohammad Jafar; Fazlyab, Mahta; Asgary, Saeed

    2014-01-01

    Iatrogenic perforation of the furcation area in multi-rooted molars during preparation of the access cavity can potentially lead to tooth extraction. The present case report describes the nonsurgical endodontic management of an extensive pulp chamber floor perforation in a first mandibular molar with calcium enriched mixture (CEM) cement. The perforation was chemically cleaned and then physically sealed with CEM cement. Root canal therapy was completed and the tooth was then restored with amalgam. A one-year follow-up revealed the absence of symptoms of infection/inflammation as well as clinical and radiographic signs/symptoms and therefore, can be interpreted as a favorable treatment outcome. PMID:24396381

  15. Acute phlegmonous gastritis complicated by delayed perforation.

    PubMed

    Min, Sun Young; Kim, Yong Ho; Park, Won Seo

    2014-03-28

    Here, we report on a case of acute phlegmonous gastritis (PG) complicated by delayed perforation. A 51-year-old woman presented with severe abdominal pain and septic shock symptoms. A computed tomography scan showed diffuse thickening of the gastric wall and distention with peritoneal fluid. Although we did not find definite evidence of free air on the computed tomography (CT) scan, the patient's clinical condition suggested diffuse peritonitis requiring surgical intervention. Exploratory laparotomy revealed a thickened gastric wall with suppurative intraperitoneal fluid in which Streptococcus pyogenes grew. There was no evidence of gastric or duodenal perforation. No further operation was performed at that time. The patient was conservatively treated with antibiotics and proton pump inhibitor, and her condition improved. However, she experienced abdominal and flank pain again on postoperative day 10. CT and esophagogastroduodenoscopy showed a large gastric ulcer with perforation. Unfortunately, although the CT showed further improvement in the thickening of the stomach and the mucosal defect, the patient's condition did not recover until a week later, and an esophagogastroduodenoscopy taken on postoperative day 30 showed suspected gastric submucosal dissection. We performed total gastrectomy as a second operation, and the patient recovered without major complications. A pathological examination revealed a multifocal ulceration and necrosis from the mucosa to the serosa with perforation. PMID:24696618

  16. Inhalational Steroids and Iatrogenic Cushing's Syndrome.

    PubMed

    A V, Raveendran

    2014-01-01

    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. PMID:25674177

  17. [Our concept concerning treatment of septal perforations (author's transl)].

    PubMed

    Masing, H; Gammert, C; Jaumann, M P

    1980-01-01

    There are still some problems of the surgical treatment of septal perforations (s.p.). Only patients with s.p. having complaints i.e. bleeding, crusting, whistling and headache should be treated. More than 60% of 61 operated patients had an iatrogenic perforation. The complete closure of the s.p. is not abosulutely necessary. More important seems to be the protection of the posterior circumference of the s.p. In small perforations (up to 5 mm) an interposition of fascia combined with a rotating mucosa flap is a safe technique. In middle size s. p. (up to 15 mm) a two stage technique is recommended by using a vestibular-conchal flap which gives satisfactory results in 80% of the operated patients. In great s. p. (more than 15 mm) a septal button is preferred. PMID:7392740

  18. [Iatrogenic injury of peripheral nerves].

    PubMed

    Horiuchi, Yukio

    2014-12-01

    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

  19. [Extracorporeal shockwave lithotripsy in gallstone perforation].

    PubMed

    Jakobeit, C

    1992-04-01

    A 78-year-old man with rheumatoid arthritis, arteriosclerosis and cardiac arrhythmias (Lown grade IVb) was admitted to hospital because of haematemesis. Gastroscopy revealed a narrow, deformed duodenal bulb with a bleeding ulcer crater on the posterior wall and a mucosal protrusion 1 cm in diameter. In the course of the illness the duodenal bulb obstruction increased further and there was recurrent vomiting. Repeat gastroscopy 7 days later showed a gallstone, about 4 cm in diameter, which had perforated into the duodenal bulb and could not be removed endoscopically. Because of the serious nature of the other diseases an operation was not undertaken, but an ultrasound-guided extracorporeal shockwave lithotripsy was performed. In three sessions this succeeded without complication to break up the stone, the larger fragments of which were then removed endoscopically while the small ones passed through the gut spontaneously. Subsequent ultrasonography demonstrated a shrunk, stone-free gallbladder with a cholecystoduodenal fistula. Afterwards the patient was again able to take food by mouth without any problems. PMID:1555501

  20. Major duodenal injuries in children: diagnosis, operative management, and outcome.

    PubMed

    Pokorny, W J; Brandt, M L; Harberg, F J

    1986-07-01

    The diagnosis, treatment, and outcome of ten children less than 13 years old operated on for major duodenal injuries is reviewed. Three had gun shot wounds with perforation and seven had blunt trauma resulting in duodenal disruption. Of those with blunt trauma, three had massive injuries requiring immediate operation, and four had what appeared to be lesser injuries. The symptoms of those children with lesser injuries were initially vague and delayed in onset, resulting in a delay of 24 hours to 7 days from time of injury to admission. At the time of admission, all four had tenderness localized to the right lower quadrant and an unclear preoperative diagnosis. Eight had associated injuries, most commonly to the pancreas. The single death occurred within 48 hours of injury and was the result of an associated head injury. The surviving nine patients left the hospital between the 11th and 22nd postoperative day doing well. One patient with a transected pancreas and extensive duodenal injury underwent a pancreaticoduodenectomy with a Whipple type reconstruction. Two patients with an extensive blowout injury to the duodenum and one with a crush injury to the pancreas underwent a pyloric exclusion and gastrojejunostomy. These patients did well with no fistula formation. The remaining seven children underwent debridement and primary closure of the duodenal injury. Four developed fistulae; however, two were pancreatic, one was jejunal, and only one was duodenal. All drained less than 250 mL per 24 hours and all except the jejunal fistula were closed by the 17th postoperative day. All were supported nutritionally either intravenously or more recently with a jejunal catheter placed at operation.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:3525803

  1. Endoscopic duodenal "windsock" diverticulotomy.

    PubMed

    Stevens, Tyler; Chand, Bipan; Winans, Charles

    2013-04-01

    A 49-year-old woman presented with a 3-month history of nausea, vomiting, and weight loss. Her symptoms were severe, and she required total parenteral nutrition for nutrition support. Both CT and barium upper GI series demonstrated a large "windsock" diverticulum that obstructed the duodenal lumen. The patient was referred to undergo a surgical diverticulectomy. After a multidisciplinary discussion, a less invasive endoscopic diverticulotomy was recommended, and the patient agreed. The linked video demonstrates the endoscopic findings and therapeutic technique. Upper endoscopy showed the diverticulum arising from the proximal duodenum. The scope could not traverse the true lumen due to compression by the diverticulum. A guidewire was passed to delineate the true lumen. At that point, the diverticulum spontaneously inverted into a proximal position. The tip of the diverticulum was then clipped to the duodenal wall to increase exposure and to allow a more controlled incision. Clips were placed on the vascular pedicle of the diverticulum to prevent bleeding. An incremental incision was performed using a needle-knife to divide the diverticulum completely. Mild bleeding occurred twice and was managed with clips. A complete diverticulotomy was accomplished, allowing easy passage of the endoscope. The patient had an uneventful postprocedural recovery and was discharged the same day with instructions for dietary advancement. After 2 months, the patient reported complete symptom resolution. She was eating well, had gained weight, and had discontinued total parenteral nutrition. A repeat endoscopy confirmed a patent lumen and no recurrence of the diverticulum. This case demonstrates the feasibility and effectiveness of endoscopic diverticulotomy performed from a proximally inverted position. This "top-down" approach provided very good exposure for the incision and easy treatment of bleeding complications. PMID:23076458

  2. The duodenal mucosal bicarbonate secretion.

    PubMed

    Sjöblom, Markus

    2005-01-01

    The duodenal lumen is exposed to aggressive factors with a high potential to cause damage to the mucosa. Bicarbonate secretion by the duodenal mucosa is accepted as the primary important defense mechanism against the hydrochloric acid intermittently expelled from the stomach. The present work concerns both the influence of the central nervous system and the effects of the hormone melatonin on duodenal bicarbonate secretion in anesthetized rats in vivo as well as effects of melatonin on intracellular calcium signaling by duodenal enterocyte in vitro examined in tissues of both human and rat origin. The main findings were as follows: Melatonin is a potent stimulant of duodenal mucosal bicarbonate secretion and also seems to be involved in the acid-induced stimulation of the secretion. Stimulation elicited in the central nervous system by the alpha1-adrenoceptor agonist phenylephrine induced release of melatonin from the intestinal mucosa and a four-fold increase in alkaline secretion. The melatonin antagonist luzindole abolished the duodenal secretory response to administered melatonin and to central nervous phenylephrine but did not influence the release of intestinal melatonin. Central nervous stimulation was also abolished by synchronous ligation of the vagal trunks and the sympathetic chains at the sub-laryngeal level. Melatonin induced release of calcium from intracellular stores and also influx of extracellular calcium in isolated duodenal enterocytes. Enterocytes in clusters functioned as a syncytium. Overnight fasting rapidly and profoundly down-regulated the responses to the duodenal secretagogue orexin-A and the muscarinic agonist bethanechol but not those to melatonin or vasoactive intestinal polypeptide. PMID:16075893

  3. Treatment for superficial non-ampullary duodenal epithelial tumors

    PubMed Central

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

    2014-01-01

    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

  4. Abdominal wall defect with large duodenal disruption treated by a free tissue flap with a help of temporary expandable metallic stent

    PubMed Central

    Park, Jung-Hoon; Song, Ho-Young; Kim, Eun Key; Lee, Sung Koo; Jung, Yooun Joong

    2013-01-01

    Abdominal wall defect with large duodenal disruption after penetrating abdominal injury is a rare emergency situation that can result in life-threatening complications. We report on a 64-year-old man who had abdominal wall defect with large duodenal disruption after penetrating abdominal injury. The patient presented with intra-abdominal exsanguinating bleeding, duodenal disruption, and multiple small bowel perforation. The rarity of this complex injury and its initial presentation as a posttraumatic large duodenal disruption with abdominal wall defect warrant its description. The present case indicates that combining a free tissue flap with a covered expandable metallic stent can effectively and successfully repair an abdominal wall defect that is associated with a large duodenal disruption. PMID:24266016

  5. Duodenal carcinoma from a duodenal diverticulum mimicking pancreatic carcinoma.

    PubMed

    Furukawa, Masashi; Izumi, Sadanobu; Tsukuda, Kazunori; Tokumo, Masaki; Sakurai, Jun; Mano, Shohey

    2012-01-01

    An 81-year-old man was found to have a pancreatic head tumor on abdominal computed tomography (CT) performed during a follow-up visit for sigmoid colon cancer. The tumor had a diameter of 35mm on the CT scan and was diagnosed as pancreatic head carcinoma T3N0M0. The patient was treated with pylorus-preserving pancreaticoduodenectomy. Histopathological examination showed that the tumor had grown within a hollow structure, was contiguous with a duodenal diverticulum, and had partially invaded the pancreas. Immunohistochemistry results were as follows:CK7 negative, CK20 positive, CD10 negative, CDX2 positive, MUC1 negative, MUC2 positive, MUC5AC negative, and MUC6 negative. The tumor was diagnosed as duodenal carcinoma from the duodenal diverticulum. Preoperative imaging showed that the tumor was located in the head of the pancreas and was compressing the common bile duct, thus making it appear like pancreatic cancer. To the best of our knowledge, this is the second report of a case of duodenal carcinoma from a duodenal diverticulum mimicking pancreatic carcinoma. PMID:23093061

  6. Successful Conservative Management in Iatrogenic Tracheobronchial Injury

    Microsoft Academic Search

    Abel Gómez-Caro Andrés; Francisco Javier Moradiellos Díez; Pilar Ausín Herrero; Vicente Díaz-Hellín Gude; Emilio Larrú Cabrero; Eduardo de Miguel Porch; José Luis Martín De Nicolás

    2005-01-01

    Background. The aim of this study was to describe and to assess the effectiveness of conservative treatment as the chosen treatment for managing iatrogenic tracheo- bronchial injuries (ITBI). Methods. Between January 1993 and December 2003, 33 tracheobronchial injuries were treated in our hospital. Eighteen (54.5%) were ITBI and 15 (45.5%) were trau- matic noniatrogenic injuries. Of the ITBI patients, sex

  7. "Death by a thread" - Peritonitis due to visceral perforation by a guide wire, during proximal femur osteosynthesis with DHS: A fatal case and legal implications.

    PubMed

    Durão, Carlos; Barros, André; Guerreiro, Rui; Pedrosa, Frederico

    2015-04-01

    Iatrogenic intestinal perforations in orthopaedic surgery are very rare. Reports of iatrogenic lesions caused by a guide wire during femur fracture osteosynthesis are even scarcer. There are no similar reports in recent literature. As opposed to what is normally described the lesion documented in this case report was not identified on time resulting in death by peritonitis. The forensic autopsy allowed the identification of an intestinal perforation with faecal leakage to peritoneal space in association with a vesical perforation enabling the reproduction of the guide wire path. In view of the increasing number of osteosynthesis it is essential for the surgeon to be aware of possible complications due to guide wire perforations. Cases like this go unnoticed if the forensic pathologist is not familiarized with the surgical technique which may explain the rarity of such descriptions in literature. PMID:25701153

  8. Imaging of duodenal diverticula and their complications.

    PubMed

    Bittle, Michelle M; Gunn, Martin L; Gross, Joel A; Rohrmann, Charles A

    2012-01-01

    Duodenal diverticula are common and are often incidentally found during routine imaging. Complications can occur but few require surgical intervention. We present a review of duodenal diverticula and their complications. PMID:22085659

  9. Acute Pancreatitis Due to a Duodenal Ulcer

    PubMed Central

    Pyeon, Sung Ik; Kim, Yong Tae; Lee, Ban Seok; Lee, Sang Ho; Lee, Jae Nam; Cheong, Jae Hoon; Oh, Kong Jin

    2014-01-01

    Duodenal ulcers and acute pancreatitis are two of the most commonly encountered gastrointestinal diseases among the general population. However, duodenal ulcer-induced pancreatitis is very rarely reported worldwide. This report elaborates on a distinct medical treatment that contributes to partial or complete treatment of acute pancreatitis induced by a duodenal ulcer scar. PMID:25505728

  10. An unusual presentation of chest pain: needle perforation of the right ventricle.

    PubMed

    Thanavaro, Kristin L; Shafi, Sadia; Roberts, Charlotte; Cowley, Michael; Arrowood, James; Cassano, Anthony; Abbate, Antonio

    2013-01-01

    Foreign bodies in the heart are a rare occurrence and can result from intravenous drug abuse, trauma or iatrogenic causes. There are no current guidelines for the treatment of a cardiac foreign body. We hereby present a brief review of the available literature and report a case of a woman with chest pain subsequently complicated by cardiogenic shock due to tamponade secondary to a needle fragment perforating her right ventricular free wall. PMID:23541456

  11. Novel transcatheter closure of an iatrogenic perimembranous ventricular septal defect.

    PubMed

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

    2015-01-01

    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

  12. Portland cement use in dental root perforations: a long term followup.

    PubMed

    Borges, Alvaro 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

    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

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

    PubMed Central

    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

    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

  14. Gastric and Duodenal Stents: Follow-Up and Complications

    SciTech Connect

    Pinto Pabon, Isabel Teresa; Paul Diaz, Laura [Vascular and Interventional Radiology Department, Hospital Universitario de Getafe, Ctra de Toledo km. 12500, E-28905 Getafe, Madrid (Spain); Ruiz de Adana, Juan Carlos; Lopez Herrero, Julio [Digestive Surgery Department, Hospital Universitario de Getafe, Ctra de Toledo km. 12500, E-28905 Getafe, Madrid (Spain)

    2001-05-15

    Purpose: To assess the efficacy of self-expanding metallic stents in treating inoperable gastric and duodenal stenoses during follow-up and to evaluate the complications encountered.Methods: A total of 31 patients suffering from gastroduodenal obstruction (29 malignant, 2 benign) were treated with a self-expanding metallic stent (Wallstent). In 24 cases insertion was by the peroral route, in seven cases via gastrostomy.Results: All the strictures were successfully negotiated under fluoroscopic guidance without having to resort to endoscopy. A total of 27 patients (87%) were able to resume a regular diet, a soft diet, or a liquid diet orally. Complications included one case of stent malpositioning, one case of leakage of ascitic fluid through the gastrostomy orifice, one case of perforation and fistula to the biliary tree, and two cases of hematemesis. In two patients (6%) additional stents were implanted to improve patency. In all patients follow-up was maintained until death. Recurrence of symptoms immediately before death occurred in seven cases (23%). Mean survival time of patients was 13.3 weeks (SE {+-} 4.6).Conclusions: The deployment of gastroduodenal stents resulted in good palliation of inoperable gastric and duodenal stenoses. Certain technical aspects, e.g., adaptation of stents to bowel morphology, is critical to proper stent function and avoidance of complications.

  15. Management of the intermediate severity duodenal injury.

    PubMed

    Kashuk, J L; Moore, E E; Cogbill, T H

    1982-10-01

    The management of intermediate severity duodenal injuries remains a controversial issue. This report details our experience with 34 patients who underwent operations for duodenal trauma in the past 3 years. Seventy-two percent had penetrating injuries. Seven patients (28%) were managed with by duodenorrhaphy and Penrose drainage, nine (36%) with duodenal diversion (pyloric exclusion with gastrojejunostomy), two (8%) with resection and anastomosis, and one (4%) with pancreaticoduodenectomy. A comparison with a previous report from our institution. in 1978 discloses (1) more severe injuries in the current series, (2) more frequent use of duodenal diversion with a corresponding decreased use of tube decompression, (3) increased nutritional support, and (4) fewer complications. Based on this experience we advocate the use of duodenal diversion and needle catheter jejunostomy for intermediate severity duodenal wounds. PMID:7123496

  16. Iatrogenic lumbar meningocoele: report of three cases

    PubMed Central

    Rinaldi, Italo; Hodges, Thomas O.

    1970-01-01

    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

  17. Abdominal compartment syndrome from bleeding duodenal diverticulum.

    PubMed

    Tchantchaleishvili, Vakhtang; Groth, Shawn S; Leon, Jorge A; Mohr, William J

    2012-04-01

    Duodenal diverticuli are acquired false diverticuli of unknown etiology. Although mostly asymptomatic, they can occasionally cause upper gastrointestinal hemorrhage, rarely with massive bleeding. In this report, we present (to the best of our knowledge) the first reported case of duodenal diverticular bleeding, causing abdominal compartment syndrome. Albeit a rare event, duodenal diverticular bleeding should be included in the differential diagnosis of upper gastrointestinal bleeding. As with our case, a multidisciplinary approach to managing such patients is crucial. PMID:22787350

  18. Duodenal prostaglandin synthesis and acid load in health and in duodenal ulcer disease

    SciTech Connect

    Ahlquist, D.A.; Dozois, R.R.; Zinsmeister, A.R.; Malagelada, J.R.

    1983-09-01

    We sought to test the hypothesis that duodenal ulcer disease results from an imbalance between duodenal acid load, an injurious force, and mucosal prostaglandin generation, a protective factor. Ten patients with duodenal ulcer and 8 healthy controls were studied. The duodenal acid load after an amino acid soup was quantified by a double-marker technique. Mucosal biopsy specimens were taken endoscopically from the duodenal bulb before and after the test meal. Prostaglandin synthesis activity was measured by incubating biopsy homogenates in excess (/sup 14/C)arachidonic acid. Although mean duodenal acid load was higher in duodenal ulcer, ranges overlapped. Neither the qualitative nor quantitative profile of mucosal prostaglandin synthesis activities differed significantly between test groups. Prostaglandin synthesis activities, however, tended to increase post cibum in controls, but change little or decrease in duodenal ulcer. Only by comparing the responses with a meal of both parameters together (duodenal acid load and the change in prostaglandin synthesis activities) was there complete or nearly complete separation of duodenal ulcer from controls. Greatest discrimination was observed with prostacyclin (6-keto-PGF1 alpha). We conclude that in health, mucosal prostaglandin generation in the duodenum is induced post cibum in relation to duodenal acid load; this may be a physiologic example of adaptive cytoprotection. In duodenal ulcer there may be a defect in such a mechanism.

  19. Iatrogenic traumatic brain injury during tooth extraction.

    PubMed

    Troxel, Mark

    2015-01-01

    An 8 yr old spayed female Yorkshire terrier was referred for evaluation of progressive neurological signs after a routine dental prophylaxis with tooth extractions. The patient was circling to the left and blind in the right eye with right hemiparesis. Neurolocalization was to the left forebrain. MRI revealed a linear tract extending from the caudal oropharynx, through the left retrobulbar space and frontal lobe, into the left parietal lobe. A small skull fracture was identified in the frontal bone through which the linear tract passed. Those findings were consistent with iatrogenic trauma from slippage of a dental elevator during extraction of tooth 210. The dog was treated empirically with clindamycin. The patient regained most of its normal neurological function within the first 4 mo after the initial injury. Although still not normal, the dog has a good quality of life. Traumatic brain injury is a rarely reported complication of extraction. Care must be taken while performing dental cleaning and tooth extraction, especially of the maxillary premolar and molar teeth to avoid iatrogenic damage to surrounding structures. PMID:25695556

  20. Is gastric emptying abnormal in duodenal ulcer?

    Microsoft Academic Search

    Stephen Holt; Robert C. Heading; Thomas V. Taylor; John A. Forrest; Peter Tothill

    1986-01-01

    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

  1. A Retrospective Review of Iatrogenic Skin and Soft Tissue Injuries

    PubMed Central

    Lee, Tae Geun; Chung, Seum

    2012-01-01

    Background Even though the quality of medical and surgical care has improved remarkably over time, iatrogenic injuries that require surgical treatment including injuries caused by cast and elastic bandage pressure, extravasation, and dopamine-induced ischemia still frequently occur. The goal of this study was to estimate the incidence and analyze the distribution of iatrogenic injuries referred to our department. Methods A retrospective clinical review was performed from April 2006 to November 2010. In total, 196 patients (116 females and 80 males) were referred to the plastic surgery department for the treatment of iatrogenic injuries. We analyzed the types and anatomic locations of iatrogenic complications, along with therapeutic results. Results An extravasation injury (65 cases, 37.4%) was the most common iatrogenic complication in our study sample, followed by splint-induced skin ulceration, dopamine-induced necrosis, prefabricated pneumatic walking brace-related wounds and elastic bandage-induced wounds. Among these, prefabricated pneumatic walking brace-related complication incidence increased the most during the 5-year study period. Conclusions The awareness of the very common iatrogenic complications and its causes may allow physicians to reduce their occurrence and allow for earlier detection and referral to a plastic surgeon. We believe this is the first study to analyze iatrogenic complications referred to a plastic surgery department in a hospital unit. PMID:22872847

  2. Tricholithobezoar Causing Gastric Perforation

    PubMed Central

    Santos Valenciano, Juliana; Nonose, Ronaldo; Bragattini Cruz, Rodrigo; Tiemi Sato, Daniela; Monteiro Fernandes, FelipeCappellette; Fabrício Nascimento, Enzo; Real Martinez, Carlos Augusto

    2012-01-01

    A bezoar is an intraluminal mass formed by the accumulation of undigested material in the gastrointestinal tract. Trichobezoar is a rare condition seen almost exclusively in young women with trichotillomania and trichotillophagia. When not recognized, the trichobezoar continues to grow, which increases the risk of severe complications such as gastric ulceration and even perforation. Formation of a gallstone within the trichobezoar (tricholithobezoar) is an event that has not yet been described. We report the case of a 22-year-old woman admitted to the emergency room with signals and symptoms of an epigastric mass and perforative acute abdomen. Radiological study revealed bilateral pneumoperitoneum. Personal history revealed depressive syndrome, trichotillomania and trichophagia. With a diagnosis of visceral perforation, an urgent exploratory laparotomy was performed. This confirmed the diagnosis of gastric perforation due to a large trichobezoar with the formation of a gastrolith that was removed by anterior gastrotomy. Biochemical study of the gastric stone revealed that it was composed of bile salts. There were no complications. The patient was discharged on the 5th postoperative day and was referred for psychiatric treatment. PMID:22379468

  3. Shaped charge perforating device

    Microsoft Academic Search

    Ayers

    1986-01-01

    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

  4. Perforated diode neutron sensors

    NASA Astrophysics Data System (ADS)

    McNeil, Walter J.

    A novel design of neutron sensor was investigated and developed. The perforated, or micro-structured, diode neutron sensor is a concept that has the potential to enhance neutron sensitivity of a common solid-state sensor configuration. The common thin-film coated diode neutron sensor is the only semiconductor-based neutron sensor that has proven feasible for commercial use. However, the thin-film coating restricts neutron counting efficiency and severely limits the usefulness of the sensor. This research has shown that the perforated design, when properly implemented, can increase the neutron counting efficiency by greater than a factor of 4. Methods developed in this work enable detectors to be fabricated to meet needs such as miniaturization, portability, ruggedness, and adaptability. The new detectors may be used for unique applications such as neutron imaging or the search for special nuclear materials. The research and developments described in the work include the successful fabrication of variant perforated diode neutron detector designs, general explanations of fundamental radiation detector design (with added focus on neutron detection and compactness), as well as descriptive theory and sensor design modeling useful in predicting performance of these unique solid-state radiation sensors. Several aspects in design, fabrication, and operational performance have been considered and tested including neutron counting efficiency, gamma-ray response, perforation shapes and depths, and silicon processing variations. Finally, the successfully proven technology was applied to a 1-dimensional neutron sensor array system.

  5. Iatrogenic hypospadias--a preventable injury?

    PubMed

    Andrews, H O; Nauth-Misir, R; Shah, P J

    1998-03-01

    Iatrogenic hypospadias is a preventable injury to the ventral male urethra produced by the downward pressure of an indwelling urethral catheter. In spite of avoiding long-term urethral catheterisation, we have acquired 16 patients with this injury in the last 9 years either in our unit or discovered in patients referred to our unit. Although not a life endangering complication, the majority of such patients find the penile appearance so produced unacceptable. We have reconstructed any penis that has more than meatal cleavage in a total of six patients, with good results. The majority of patients have been fully investigated so that an alternative therapy to catheterisation may be provided. Where possible a catheter free state has been achieved. If not, a suprapubic catheter has been inserted. Those not reconstructed were due to reasons of ill health, and in two instances, due to patient choice. PMID:9554017

  6. Iatrogenic dural arteriovenous fistula and aneurysmal subarachnoid hemorrhage.

    PubMed

    Vadivelu, Sudhakar; Xin, Xin; Loven, Tina; Restrepo, Guillermo; Chalif, David J; Setton, Avi

    2012-05-01

    The authors present the case of a patient who presented acutely with aneurysmal subarachnoid hemorrhage (SAH) and a contralateral iatrogenic dural arteriovenous fistula (DAVF). Diagnostic angiography was performed, revealing a right-sided middle cerebral artery (MCA) aneurysm and a left-sided DAVF immediately adjacent to the entry of the ventriculostomy and bur hole site. A craniotomy was performed for clipping of the ruptured MCA aneurysm, and the patient subsequently underwent endovascular obliteration of the DAVF 3 days later. The authors present their treatment of an iatrogenic DAVF in a patient with an aneurysmal SAH, considerations in management options, and a literature review on the development of iatrogenic DAVFs. PMID:22537118

  7. Duodenal Chemosensing and Mucosal Defenses

    PubMed Central

    Akiba, Yasutada; Kaunitz, Jonathan D.

    2011-01-01

    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

  8. Adenocarcinoma of the Minor Duodenal Papilla: Report of a Case

    PubMed Central

    Takami, Kazuhiro; Moriya, Takuya; Kamiga, Takahiro; Abe, Tomoya; Miseki, Tetsuya; Oku, Takatomi; Aoki, Yasutaka; Tominaga, Tsuyoshi

    2011-01-01

    An 81-year-old male was found to have a duodenal tumor by screening upper gastrointestinal endoscopy. The tumor was located in the minor duodenal papilla. Pathological examination of the biopsy specimen revealed adenocarcinoma, and endoscopic ultrasound showed an elevated hypoechoic mass in the minor duodenal papilla. The preoperative diagnosis was therefore considered to be either adenocarcinoma of the minor duodenal papilla or duodenal cancer. We performed a subtotal stomach-preserving pancreaticoduodenectomy. Histopathological examination of the resected specimen showed the tumor cells to be primarily located in the submucosa of the minor duodenal papilla, with slight invasion into the pancreatic parenchyma through the accessory pancreatic duct. We therefore diagnosed a primary adenocarcima of the minor duodenal papilla. Adenocarcinoma of the minor duodenal papilla is considered to be a rare disease, but it may be underestimated because of the difficulty in distinguishing advanced adenocarcinoma of the minor duodenal papilla from primary duodenal cancer and cancer of the pancreatic head. PMID:21552440

  9. Congenital duodenal obstruction associated with Down's syndrome presenting with hematemesis

    PubMed Central

    Al Shahwani, Noora; Mandhan, Parkash; Elkadhi, Abdelrahman; Ali, Mansour J.; Latif, Abdel

    2013-01-01

    Congenital duodenal obstruction is usually characterized by onset of early vomiting due to high bowel obstruction. Presentation of congenital duodenal obstruction with acute gastrointestinal bleeding is very uncommon. We present an unusual case of congenital intrinsic duodenal obstruction associated with the Down's syndrome presenting with hematemesis secondary to duodenitis. This is a rare presentation of congenital duodenal obstruction associated with Down's syndrome in addition to seven cases previously reported in the English literature. PMID:24968438

  10. Inhalational Steroids and Iatrogenic Cushing’s Syndrome

    PubMed Central

    A.V, Raveendran

    2014-01-01

    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. PMID:25674177

  11. Gastric conduit perforation.

    PubMed

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

    2014-08-16

    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

  12. Gastric conduit perforation

    PubMed Central

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

    2014-01-01

    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

  13. [Psychological factors in duodenal ulcers].

    PubMed

    Bauer, B; Bergmann, M

    1981-01-01

    With the aid of a clinical questionnaire and the I-N-R-personality test of Eysenck (as modified by Böttcher), we examined 127 male patients with clinically and radiologically proven ulcer compared to 145 age-matched persons without gastric affections. The features extraversion, neuroticism (emotional lability) and rigidity were determined and the question of an association with symptoms, age at onset of disease as well as occupational and familial factors statistically analyzed. With high significance, duodenal ulcer patients are more often emotionally labile and psychically more rigid. In the event the disease manifests under the age of 30, in ulcer patients introversion too is pronounced with highly significant frequency. Those patients complaining of conflicts with collaborators, lack of sleep, occupational overexertion, noise, draught at work place, present, compared to others without these complaints, a frequently emotional lability with high significance. PMID:7341221

  14. Iatrogenic intradural lumbosacral cyst following epiduroscopy.

    PubMed

    Ryu, Kyeong-Sik; Rathi, Nitesh Kumar; Kim, Geol; Park, Chun-Kun

    2012-11-01

    We report a rare complication of iatrogenic spinal intradural following minimally invasive extradural endoscopic procedues in the lumbo-sacral spines. To our knowledge, intradural cyst following epiduroscopy has not been reported in the literature. A 65-year-old woman with back pain related with previous lumbar disc surgery underwent endoscopic epidural neuroplasty and nerve block, but her back pain much aggravated after this procedure. Postoperative magnetic resonance imaging revealed a large intradural cyst from S1-2 to L2-3 displacing the nerve roots anteriorly. On T1 and T2-weighted image, the signal within the cyst had the same intensity as cerebrospinal fluid. The patient underwent partial laminectomy of L5 and intradural exploration, and fenestration of the cystic wall was accomplished. During operation, the communication between the cyst and subarachnoid space was not identified, and the content of the cyst was the same as that of cerebrospinal fluid. Postoperatively, the pain attenuated immediately. Incidental durotomy which occurred during advancing the endoscope through epidural space may be the cause of formation of the intradural cyst. Intrdural cyst should be considered, if a patient complains of new symptoms such as aggravation of back pain after epiduroscopy. Surgical treatment, simple fenestration of the cyst may lead to improved outcome. All the procedures using epiduroscopy should be performed with caution. PMID:23323173

  15. Iatrogenic Intradural Lumbosacral Cyst Following Epiduroscopy

    PubMed Central

    Ryu, Kyeong-Sik; Rathi, Nitesh Kumar; Kim, Geol

    2012-01-01

    We report a rare complication of iatrogenic spinal intradural following minimally invasive extradural endoscopic procedues in the lumbo-sacral spines. To our knowledge, intradural cyst following epiduroscopy has not been reported in the literature. A 65-year-old woman with back pain related with previous lumbar disc surgery underwent endoscopic epidural neuroplasty and nerve block, but her back pain much aggravated after this procedure. Postoperative magnetic resonance imaging revealed a large intradural cyst from S1-2 to L2-3 displacing the nerve roots anteriorly. On T1 and T2-weighted image, the signal within the cyst had the same intensity as cerebrospinal fluid. The patient underwent partial laminectomy of L5 and intradural exploration, and fenestration of the cystic wall was accomplished. During operation, the communication between the cyst and subarachnoid space was not identified, and the content of the cyst was the same as that of cerebrospinal fluid. Postoperatively, the pain attenuated immediately. Incidental durotomy which occurred during advancing the endoscope through epidural space may be the cause of formation of the intradural cyst. Intrdural cyst should be considered, if a patient complains of new symptoms such as aggravation of back pain after epiduroscopy. Surgical treatment, simple fenestration of the cyst may lead to improved outcome. All the procedures using epiduroscopy should be performed with caution. PMID:23323173

  16. Understanding placebo, nocebo, and iatrogenic treatment effects.

    PubMed

    Bootzin, Richard R; Bailey, Elaine T

    2005-07-01

    Placebo and nonplacebo treatments have both positive and negative effects on patient outcomes. To better understand the patterning of treatment effects, three specific interventions will be discussed that are reported to produce more harm than benefit: critical incident stress debriefing, group therapy for adolescents with conduct disorders, and psychotherapy for dissociative identity disorder. In each case, there is an interaction between mechanisms thought to underlie both placebo and specific treatment effects. Mechanisms hypothesized to underlie placebo and nocebo effects include patient expectancy, self-focused attention to symptoms, motivation to change, and sociocultural role-enactment cues. In the three treatments discussed, specific mechanisms interact with nonspecific mechanisms to produce iatrogenic effects. To advance knowledge, it is important both to specify the theory of treatment and its expected outcomes and to put the theory to test. Only with attention to the empirical findings from programmatic research of specific and nonspecific effects and their interaction is it possible to improve the outcomes of treatment beyond the status quo. PMID:15827995

  17. Iatrogenic causes of salivary gland dysfunction

    SciTech Connect

    Schubert, M.M.; Izutsu, K.T.

    1987-02-01

    Saliva is important for maintaining oral health and function. There are instances when medical therapy is intended to decrease salivary flow, such as during general anesthesia, but most instances of iatrogenic salivary gland dysfunction represent untoward or unavoidable side-effects. The clinical expression of the salivary dysfunction can range from very minor transient alteration in saliva flow to a total loss of salivary function. The most common forms of therapy that interfere with salivation are drug therapies, cancer therapies (radiation or chemotherapy), and surgical therapy. These therapies can affect salivation by a number of different mechanisms that include: disruption of autonomic nerve function related to salivation, interference with acinar or ductal cell functions related to salivation, cytotoxicity, indirect effects (vasoconstriction/dilation, fluid and electrolyte balance, etc.), and physical trauma to salivary glands and nerves. A wide variety of drugs is capable of increasing or decreasing salivary flow by mimicking autonomic nervous system actions or by directly acting on cellular processes necessary for salivation: drugs can also indirectly affect salivation by altering fluid and electrolyte balance or by affecting blood flow to the glands. Ionizing radiation can cause permanent damage to salivary glands, damage that is manifest as acinar cell destruction with subsequent atrophy and fibrosis of the glands. Cancer chemotherapy can cause changes in salivation, but the changes are usually much less severe and only transient. Finally, surgical and traumatic injuries interfere with salivation because of either disruption of gland innervation or gross physical damage (or removal) of glandular tissue (including ducts).

  18. Duodenal Obstruction in Polycystic Kidney Disease

    Microsoft Academic Search

    Linda F. Fried; Paul M. Palevsky; James R. Johnston

    1998-01-01

    Polycystic kidney disease in a common inherited disorder accounting for 8–10% of cases of end-stage renal disease. The enlarged kidneys often produce pain and hematuria but rarely obstruction of surrounding organs. We report a case of autosomal dominant polycystic kidney disease producing symptomatic duodenal obstruction and malnutrition. Duodenal obstruction should be considered in the differential diagnosis of a patient with

  19. Gastric emptying abnormal in duodenal ulcer

    SciTech Connect

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

    1986-07-01

    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.

  20. Prosthetic rehabilitation and management of an MTA-treated maxillary central incisor with root perforation and severe internal resorption.

    PubMed

    Abuabara, Allan; Costa, Rogério G; Morais, Eduardo C; Furuse, Adilson Y; Gonzaga, Carla C; Filho, Flares Baratto

    2013-07-01

    Root canal perforation and root resorption are challenging clinical conditions to correctly diagnose and treat, especially when they occur in anterior teeth. This clinical report describes the computed tomography findings, endodontic treatment, prosthetic rehabilitation, and clinical outcome of an iatrogenic root perforation and internal resorption in a maxillary central incisor. The case management consisted of endodontic retreatment, periodontal surgery, and prosthetic rehabilitation. Gray mineral trioxide aggregate (MTA) was used to fill the resorption space and seal the perforation. The prosthetic treatment was performed with glass fiber-reinforced dowels and all-ceramic crowns. No signs or symptoms, including discomfort, pain, or esthetic defects were observed in 30 months of follow-up. PMID:23387526

  1. First successful treatment of a circumferential intramural esophageal dissection with perforation in a patient with eosinophilic esophagitis using a partially covered self-expandable metal stent.

    PubMed

    Fischer, Andreas; Höppner, Jens; Richter-Schrag, Hans-Jürgen

    2015-02-01

    Intramural esophageal dissection (IED) is a rare disease characterized by a partial (PIED) or circumferential (CIED) mucosal rupture. Whereas PIED responds well to nonoperative treatment, complicated courses have been reported necessitating surgery, up to the point of esophagectomy despite complex endoscopic interventions, in CIED. We report the first case of an iatrogenic CIED with perforation in a young patient with underlying eosinophilic esophagitis treated successfully by endoscopy alone, using a partially covered self-expandable metal stent. PMID:25683073

  2. Gastric and duodenal neuroendocrine tumours.

    PubMed

    O'Toole, Dermot; Delle Fave, Gianfranco; Jensen, Robert T

    2012-12-01

    Gastric neuroendocrine neoplasms (NENs) are increasing in frequency and have a varied spectrum with regard to histology, clinicopathologic background, stage, and prognosis. They are usually discovered incidentally, are for the most part benign and are associated with hypergastrinaemia (secondary either to chronic atrophic gastritis or rarely Zollinger-Ellison syndrome; types 1 and 2, respectively) or more rarely sporadic type 3. Applications of recent staging and grading systems - namely using Ki-67 proliferative indices - (from ENETS and WHO 2010) can be particularly helpful in further categorising these tumours. The natural history of Type 1 gastric carcinoids is generally (>95%) favourable and simple surveillance is usually recommended for small (<1 cm) T1 tumours, with local (endoscopic or surgical) resection for larger lesions. Other potential therapies such as somatostatin analogues and gastrin receptor antagonists may offer newer therapeutic possibilities. Rarely, gastric NENs have a malignant course and this is usually confined to Type 2 and especially Type 3 tumours; the latter mimic the biological course of gastric adenocarcinoma and require radical oncological therapies. Most duodenal NENs, apart from gastrinomas (that are not dealt with here) are sporadic and non functional. They are also increasing in frequency probably due to incidental discovery at endoscopy or imaging for other reasons and this may account for their overall good prognosis. Peri-ampullary and ampullary NENs may have a more aggressive outcome and should be carefully appraised and treated (often with surgical resection). PMID:23582915

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

    PubMed Central

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

    2015-01-01

    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. PMID:25663777

  4. Iatrogenic nerve injuries in common upper extremity procedures.

    PubMed

    Zimmermann, Matthew S; Abzug, Joshua M; Chang, James; Stern, Peter J; Osterman, A Lee

    2014-01-01

    Iatrogenic nerve injuries frequently occur during procedures around the hand and wrist, although they are not always recognized at the time of injury or in the immediate postoperative period. Because preventing injuries is of paramount importance, extensive knowledge of the anatomy of the at-risk nerves is critical. Best results occur after immediate repair because a substantial delay before secondary surgery diminishes the chances for recovery from motor or sensory nerve dysfunction and relief from pain. It is helpful to review iatrogenic nerve injuries associated with common hand surgical procedures. PMID:24720298

  5. Iatrogenic Displacement of a Foreign Body into the Periapical Tissues

    PubMed Central

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

    2014-01-01

    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

  6. Perforated Muffler Manifold Catalyst

    NASA Astrophysics Data System (ADS)

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

    1998-12-01

    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.

  7. Duodenal diverticula: potential complications and common imaging pitfalls.

    PubMed

    Schroeder, T C; Hartman, M; Heller, M; Klepchick, P; Ilkhanipour, K

    2014-10-01

    A duodenal diverticulum is a commonly encountered entity in gastrointestinal radiology with a wide variety of appearances. The purpose of this review is to describe the normal anatomy and embryology of the duodenum, discuss the differences between a true versus intraluminal duodenal diverticulum, and to highlight the normal appearance, potential complications, and imaging pitfalls of duodenal diverticula. PMID:25110301

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

    PubMed

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

    2008-01-01

    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

  9. Duodenal obstruction following acute pancreatitis caused by a large duodenal diverticular bezoar.

    PubMed

    Kim, Ji Hun; Chang, Jae Hyuck; Nam, Sung Min; Lee, Mi Jeong; Maeng, Il Ho; Park, Jin Young; Im, Yun Sun; Kim, Tae Ho; Park, Il Young; Han, Sok Won

    2012-10-14

    Bezoars are concretions of indigestible materials in the gastrointestinal tract. It generally develops in patients with previous gastric surgery or patients with delayed gastric emptying. Cases of periampullary duodenal divericular bezoar are rare. Clinical manifestations by a bezoar vary from no symptom to acute abdominal syndrome depending on the location of the bezoar. Biliary obstruction or acute pancreatitis caused by a bezoar has been rarely reported. Small bowel obstruction by a bezoar is also rare, but it is a complication that requires surgery. This is a case of acute pancreatitis and subsequent duodenal obstruction caused by a large duodenal bezoar migrating from a periampullary diverticulum to the duodenal lumen, which mimicked pancreatic abscess or microperforation on abdominal computerized tomography. The patient underwent surgical removal of the bezoar and recovered completely. PMID:23082068

  10. Acute pancreatitis with pancreatic abscess secondary to sealed jejunal diverticular perforation.

    PubMed

    King, Angela; Peters, Christopher John; Shorvon, Philip

    2012-01-01

    Although most cases of acute pancreatitis are attributed to gallstones or alcohol, many remain idiopathic. The authors describe a case of acute pancreatitis in a 75-year-old gentleman who presented with acute epigastric pain, fevers and shortness of breath. Serum amylase was 2164. CT showed free mesenteric air, and a partly cystic/partly gas-containing mass in the uncinate lobe of the pancreas. Gastrograffin meal revealed duodenal and jejunal diverticular disease, but no contrast leak. Further CT analysis pinpointed fine tracts of air leading from a jejunal diverticulum up toward the pancreas, suggesting causation by a sealed jejunal diverticular perforation. He responded well to intravenous antibiotics and conservative management. Although small bowel diverticular disease is linked to chronic pancreatitis, evidence for association with acute pancreatitis is scarce. The authors believe this is the first reported case of jejunal diverticular disease causing acute pancreatitis, and it highlights micro-perforation as a potential disease mechanism. PMID:22665561

  11. Large gallstone impaction at a Meckel's diverticulum causing perforation and localized peritonitis: report of a case.

    PubMed

    Maclean, William; Szentpáli, Karoly

    2013-01-01

    We are reporting a successful laparoscopic resection of a perforated Meckel's Diverticulum (MD) causing localized peritonitis due to an impacted gallstone. MD is a small benign pouch on the wall of the small intestine that is present in ?2% of the population. It results from a failure of complete obliteration of the omphalomesenteric duct. MD is mainly lined by ileal mucosa; however, other ectopic tissue types can be found including gastric, duodenal, colonic, pancreatic, Brunner's glands, hepatobiliary tissue and endometrial mucosa. Most reported complications include bleeding, infection and obstruction. With relevance to this report, we can find no more than two reports of a large gallstone impacting the neck of the MD and causing ileus, and we were unable to find any reports that mention perforation due to impaction at the neck of an MD. PMID:24968430

  12. 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...

  13. Spontaneous Hepaticoduodenal and Choledochoduodenal Fistula Mimicking Duodenal Ulcer Perforation, a Very Rare Complication of Transarterial Chemoembolization

    PubMed Central

    Prachayakul, Varayu; Aswakul, Pitulak

    2015-01-01

    Spontaneous bilo-enteric fistula is a rare complication following surgery or some therapeutic interventions such as transarterial chemoembolization (TACE). The present case was a young man, a known case of chronic hepatitis B with multiple recurrent hepatocellular carcinoma, who presented with clinical sepsis and jaundice. Computed tomography showed dilated proximal left intrahepatic ducts which suspected anastomotic stricture. He underwent endoscopic retrograde cholangiopancreatography, but the endoscopic view showed a deep ulcer covered by yellowish debris tissue. After re-evaluation it was found to be hepaticoduodenostomy and choledochoduodenostomy tracts. In the present case the fistula was suspected to be related to a previous TACE procedure.

  14. Perforated Appendicitis: Is Laparoscopy Safe?

    PubMed Central

    Tirabassi, Michael V.; Tashjian, David B.; Konefal, Stanley H.; Courtney, Richard A.; Sachs, Barry F.

    2004-01-01

    Objective: The purpose of this study was to demonstrate the safety and efficacy of laparoscopy in children with perforated appendicitis. Methods: This is a retrospective review of consecutive patients under the age of 18, operated on for perforated appendicitis between September 1997 and December 1999. Results: Sixty-nine patients were operated on for perforated appendicitis. Eleven appendectomies were performed laparoscopically. Fifty-four patients underwent an open appendectomy. Four laparoscopic appendectomies were converted to an open procedure. The mean operative time was 79 minutes for the laparoscopic group, and 87 minutes for the open group. The mean length of hospital stay was 5.4 days versus 7.6 days for the laparoscopic and open groups, respectively. Neither of these differences was statistically significant. Conclusions: The above data support the use of laparoscopy in the management of perforated appendicitis in children. In conclusion, laparoscopy is as safe as open appendectomy. Laparoscopy is an effective alternative with a shorter length of hospital stay compared with that for an open appendectomy for perforated appendicitis in children. PMID:15119659

  15. Iatrogenic cushing's syndrome in children following nasal steroid

    PubMed Central

    Oluwayemi, Isaac Oludare; Oduwole, Abiola Olufunmilayo; Oyenusi, Elizabeth; Onyiriuka, Alphonsus Ndidi; Abdullahi, Muhammad; Fakeye-Udeogu, Olubunmi Benedicta; Achonwa, Chidozie Jude; Kouyate, Moustapha

    2014-01-01

    Cushing syndrome is a hormonal disorder caused by prolonged exposure of body tissue to cortisol. We report two cases of iatrogenic Cushing's syndrome in two Nigerian children following intranasal administration of aristobed-N (Betamethasone + Neomycin) given at a private hospital where the children presented with feature of adenoidal hypertrophy. Two months into treatment children were noticed to have developed clinical and laboratory features of iatrogenic Cushing's syndrome with critical adrenal suppression. Serum cortisol (at presentation): 1st patient: 12nmol/L (reference range 240-618), 2nd Patient: 1.69nmol/L. Serum cortisol (3 months after weaning off steroid): 343.27 nmol/L (within normal range for the first patient; second patient newly presented and has just begun steroid weaning off process. The serum cortisol level one month into weaninig off process was 128 nmol/L). Unsupervised topical steroid administration in children can cause adrenal suppression with clinical features of Cushing's syndrome. PMID:25170381

  16. A case of chronic adrenocortical insufficiency with iatrogenic anasarca

    Microsoft Academic Search

    C. Parlapiano; E. Campana; P. Pantone; T. Giovanniello; M. C. Borgia

    2000-01-01

    The decrease in active hormones that characterizes chronic adrenal insufficiency results in hypovolemia. In some patients,\\u000a residual adrenal function, mineralocorticoid therapy, and concomitant heart or liver failure, or both, can paradoxically provoke\\u000a edema. The case report that follows describes a patient with iatrogenically induced anasarca resulting from the unhappy confluence\\u000a of usually appropriate therapy and coexisting medical conditions.

  17. Iatrogenic nocturnal eneuresis- an overlooked side effect of anti histamines?

    PubMed

    Italiano, D; Italiano, F; Genovese, C; Calabro, R S

    2015-01-01

    Nocturnal enuresis is a common disorder in childhood, but its pathophysiological mechanisms have not been fully elucidated. Iatrogenic nocturnal enuresis has been described following treatment with several psychotropic medications. Herein, we describe a 6-year-old child who experienced nocturnal enuresis during treatment with the antihistamine cetirizine. Drug rechallenge was positive. Several neurotransmitters are implicated in the pathogenesis of nocturnal enuresis, including noradrenaline, serotonin and dopamine. Antihistamine treatment may provoke functional imbalance of these pathways resulting in incontinence. PMID:25766344

  18. Laparoscopic treatment of perforated appendicitis

    PubMed Central

    Lin, Heng-Fu; Lai, Hong-Shiee; Lai, I-Rue

    2014-01-01

    The use of laparoscopy has been established in improving perioperative and postoperative outcomes for patients with simple appendicitis. Laparoscopic appendectomy is associated with less wound pain, less wound infection, a shorter hospital stay, and faster overall recovery when compared to the open appendectomy for uncomplicated cases. In the past two decades, the use of laparoscopy for the treatment of perforated appendicitis to take the advantages of minimally invasiveness has increased. This article reviewed the prevalence, approaches, safety disclaimers, perioperative and postoperative outcomes of the laparoscopic appendectomy in the treatment of patients with perforated appendicitis. Special issues including the conversion, interval appendectomy, laparoscopic approach for elderly or obese patient are also discussed to define the role of laparoscopic treatment for patients with perforated appendicitis. PMID:25339821

  19. Perforating disseminated necrobiosis lipoidica diabeticorum.

    PubMed

    Lozanova, Paula; Dourmishev, Lyubomir; Vassileva, Snejina; Miteva, Ljubka; Balabanova, Maria

    2013-01-01

    Perforating necrobiosis lipoidica is a very rare clinical variant which consists of degeneration and transepidermal elimination of the collagen with few cases reported in the literature. In two-thirds of the patients it associates with diabetes, with no relation with the glucose control. We present a 42-year-old female patient with a 7-year history of diabetes on insulin therapy, referred to our clinic with a 3-year history of multiple asymptomatic firm plaques disseminated on the upper and lower extremities. The clinical and histological findings proved the diagnosis of perforating necrobiosis lipoidica. PMID:23533835

  20. Perforating Disseminated Necrobiosis Lipoidica Diabeticorum

    PubMed Central

    Dourmishev, Lyubomir; Vassileva, Snejina; Miteva, Ljubka; Balabanova, Maria

    2013-01-01

    Perforating necrobiosis lipoidica is a very rare clinical variant which consists of degeneration and transepidermal elimination of the collagen with few cases reported in the literature. In two-thirds of the patients it associates with diabetes, with no relation with the glucose control. We present a 42-year-old female patient with a 7-year history of diabetes on insulin therapy, referred to our clinic with a 3-year history of multiple asymptomatic firm plaques disseminated on the upper and lower extremities. The clinical and histological findings proved the diagnosis of perforating necrobiosis lipoidica. PMID:23533835

  1. [Unique duodenal hamartomatous polyp--case report].

    PubMed

    Alecu, L; Tulin, A; Ursut, Beatrice; Ursut, B; Oproiu, A; Obrocea, F

    2012-01-01

    Duodenal tumors are very rare tumors, with the lower incidence among the tumors of the small bowel, whose frequence is less than 5 % of all digestive tumors. In most of the cases these tumors remain asymptomatic, sometimes the entire life. When they become symptomatic, their first manifestation is the loss of digested blood (melena), secondary anemia and obstructive symptomatology. Early diagnosis of these tumors is difficult because of the unsystematic symptomatology and becomes easy when the complications appear. In most of the cases the diagnosis is establish by the superior digestive endoscopy, followed by barium contrast studies, CT and ultrasound. We present a case of duodenal hamartomatous polip, unique, at the level of D3, in a female patient 66 years old, addressing to our service for superior digestive hemorrhage exteriorizated by melena, secondary anemia and physical asthenia; we operated the patient procedeeing a polypectomy by a duodenotomy. PMID:22712356

  2. A Complex Growth Factor in Duodenal Tissue

    Microsoft Academic Search

    C. J. ACKERMAN

    A commercial preparation of dry duodenal tissue was hydrolyzed and fractionated to determine whether this material contained thyroid hormones. Five fractions, capable of reinstating growth of growth-arrested, sulfaguanidine-fed rats, were obtained. All were stable to acid hydrolysis and insoluble in 0.1 N HC1. They differed from each other with respect to their solubility in benzene, acetone and methanol, and their

  3. Glove Perforations During Interventional Radiological Procedures

    SciTech Connect

    Leena, R. V., E-mail: leenarv_76@yahoo.co.uk; Shyamkumar, N. K. [Christian Medial College, Department of Radiodiagnosis (India)

    2010-04-15

    Intact surgical gloves are essential to avoid contact with blood and other body fluids. The objective of this study was to estimate the incidence of glove perforations during interventional radiological procedures. In this study, a total of 758 gloves used in 94 interventional radiological procedures were examined for perforations. Eleven perforations were encountered, only one of which was of occult type. No significant difference in the frequency of glove perforation was found between the categories with varying time duration.

  4. [Esophageal, gastric and duodenal motility in patients with cholelithiasis].

    PubMed

    Polous, Iu M; Borshch, I V; Shidlovski?, V A

    1989-10-01

    Disturbed motility of the upper gastrointestinal tract presenting with phasic derangement (the absence of all motor phases or peristaltic duodenal contraction, abnormal duration of phases) has been found out in all cholelithiasis patients examined. The findings should in no way be viewed as isolated chronic duodenal insufficiency. Impairment of esophageal, gastric and duodenal motility needs identification and correction in combined treatment, rehabilitation and prevention of cholelithiasis. PMID:2615319

  5. Russell body duodenitis with immunoglobulin kappa light chain restriction.

    PubMed

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

    2015-01-16

    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

  6. Russell body duodenitis with immunoglobulin kappa light chain restriction

    PubMed Central

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

    2015-01-01

    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

  7. How to avoid perforating problems

    Microsoft Academic Search

    Sparlin

    1987-01-01

    This article cautions that the literature on perforating technology can be confusing when you try to apply it to a real situation. Most of the basic information is easy to understand. But as more lab studies and computer modeling studies are published, it becomes more difficult to decide what parameters are important. A review of the current literature can lead

  8. Tubal perforation by ESSURE microinsert

    Microsoft Academic Search

    Véronique Thoma; Irene Chua; Olivier Garbin; Michel Hummel; Arnaud Wattiez

    2006-01-01

    Female tubal sterilization remains the most widely used method of permanent contraception worldwide. Recent studies have shown the new sterilization technique by ESSURE microinsert to be an effective method with decided advantages for the patient in terms of morbidity associated to a quick recovery.We discuss the possible hysteroscopic signs of tubal perforation and the right measures to take if a

  9. Epidemiology of perforated colonic diverticular disease

    PubMed Central

    Morris, C; Harvey, I; Stebbings, W; Speakman, C; Kennedy, H; Hart, A

    2002-01-01

    Perforated colonic diverticular disease results in considerable mortality and morbidity. This review appraises existing evidence on the epidemiology and mechanisms of perforation, highlights areas of further study, and suggests an epidemiological approach towards preventing the condition. Computerised searches were used to identify published articles relating to the epidemiology, pathophysiology, and clinical features of perforated colonic diverticular disease. Several drug and dietary exposures have potential biological mechanisms for causing perforation. Of these only non-steroidal anti-inflammatory drugs have been consistently identified as risk factors in aetiological studies. The causes of perforated colonic diverticular disease remain largely unknown. Further aetiological studies, looking specifically at perforation, are required to investigate whether cause-effect relationships exist for both drug and dietary exposures. The identification of risk factors for perforation would allow primary public health prevention, secondary risk factor modification, and early prophylactic surgery to be aimed at people at high risk. PMID:12496319

  10. [Complicated postbulbar duodenal ulcers: the characteristics of the diagnosis and of the surgical procedure and management].

    PubMed

    Gr?dinaru, V; Seicaru, T; Horeang?, D; Miron, A

    1991-01-01

    The paper reports on the authors' experience used on 164 patients with complicated postbulbar ulcers (12% of the duodenal ulcers) with hemorrhage (52 cases), perforation (9 cases), duodenal stenosis (13 cases), stenosis and penetration (36 cases) and pancreatic-biliary penetrations (36 cases). The frequency of hemorrhagic complication was of 31%. As the hemorrhage due to postbulbar ulcer is favoured by vascular fistula, the severe character of the hemorrhage and the frequency of the recurrence, mainly the cataclysmic one, impose the radical surgery as early as possible. The following were used: large Reichel-Polya's gastrectomy (26 cases with 7 deaths) Péan's gastro-duodenectomy (12 cases), Péan's hemigastrectomy+vagotomy (4 cases), gastrectomy for exclusion with hemostasis in situ and ligature of gastroduodenal artery (8 cases, of which 1 with vagotomy and 2 deaths) and pyloroplasty with vagotomy and hemostasis (2 cases). The postsurgical mortality was of 17%. In 9 cases with perforation: Reichel-Polya's gastrectomy in 5 patients (1 death), Péan's gastrectomy in 2 cases, excision pyloroplasty and suture of the perforation in one case, respectively, were used. In the postbulbar ulcers penetrating into the pancreas or into the hepatic pedicle associated with stenosis (36 cases) the following were performed: Reichel-Polya's gastrectomy (7 cases), Péan's gastrectomy (7 cases of which 2 with vagotomy) gastrectomy for exclusion of ulcer in 19 cases, of which 5 with vagotomy, Péan's hemigastrectomy+vagotomy (3 cases). The 36 cases of ulcers penetrating into pancreas were solved as follows: gastrectomy for exclusion (16 cases of which 5 with vagotomy), Reichel-Polya's gastrectomy (10 cases of which 1 with vagotomy), Péan's gastrectomy (10 cases of which 2 with vagotomy). In 13 patients with stenosed ulcers, Reichel's-Polya's gastric resection (10 cases), Péan's gastrectomy, gastrectomy for exclusion and gastrojejunostomy (in one case each) were performed. The conclusions may be drawn that the postbulbar ulcers are complicated ulcers that require differentiated surgical treatment, as early as possible, for diminishing the postsurgical morbidity and mortality (7.5% mortality). PMID:1688127

  11. Delayed recognition of an uncommon cause of iatrogenic pneumothorax.

    PubMed

    Scharf, Michael L; Kommuri, Anand

    2015-04-01

    The images enclosed from our case report show the subtle radiographic findings on the plain film, less subtle findings on computed tomographic scan, and what we believe is the first to be reported 3-dimensional reconstructed image of an acupuncture needle remaining in the chest after treatment. The case highlights the importance of looking for subtle abnormalities on imaging and the importance of history taking to finally establish a cause. We consider this an instructive case for internists and respirologists who should ask about this potential iatrogenic form of penetrating chest trauma when evaluating a patient for pneumothorax. PMID:25887016

  12. Iatrogenic aortic dissection during right coronary artery stenting.

    PubMed

    Cebi, Niyazi; Tanriverdi, Süleyman; Karabulut, Ahmet

    2008-01-01

    Aortic dissection limited to one sinus of Valsalva has been observed as an iatrogenic complication during coronary intervention. We report on a 65-year-old female patient who had a diagnosis of acute inferior myocardial infarction and experienced type A aortic dissection during stenting of the right coronary artery (RCA). Dissection was seen during aortic injection. There were no associated diseases in the sinuses of Valsalva or the aortic valve. An opening was seen intraoperatively in the right sinus of Valsalva. The opening was immediately and successfully sutured. The RCA was bypassed. PMID:18583289

  13. Electromagnetic measurements of duodenal digesta flow in cannulated sheep

    E-print Network

    Paris-Sud XI, Université de

    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 to frequent oscillation of the digesta. It was concluded that accurate quantitative electromagnetic

  14. Thoracic endovascular aortic repair after iatrogenic aortic dissection and false lumen stent grafting.

    PubMed

    Schrimpf, Claudia; Teebken, Omke E; Wilhelmi, Mathias

    2015-04-01

    Iatrogenic aortic dissections are a severe complication after thoracic endovascular aortic repair, and treatment guidelines do not exist. Herein, we report a patient who experienced an iatrogenic type B aortic dissection during elective thoracic endovascular aortic repair and suggest an interventional treatment option. PMID:25841835

  15. Duodenal bulb tumour of unknown origin

    PubMed Central

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

    2014-01-01

    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. PMID:25653733

  16. Cephalic Pancreaticoduodenectomy for Bleeding Duodenal Arteriovenous Malformation

    PubMed Central

    Ortiz, Ruben; Dominguez, Eva; Barrena, S.; Martinez, Leopoldo; Prieto, Gerardo; Burgos, Emilio; Tovar, Juan Antonio

    2014-01-01

    Introduction?Treatment of recurrent severe gastrointestinal bleeding due to arteriovenous malformations may require complex resections. In some particular locations, extensive surgery is the only way out, as shown in this report. Case Report?A 2.5-year-old child suffered repeated episodes of upper gastrointestinal bleeding since the first month of life. After an extensive diagnostic workout, the diagnosis of duodenal arteriovenous malformation was established. Cephalic pancreaticoduodenectomy with pyloric preservation was performed and no further episodes of bleeding occurred in the ensuing 2 years. Conclusion?Bleeding malformations located in the pancreaticoduodenal area can be effectively treated in children by pylorus-preserving cephalic pancreaticoduodenectomy. PMID:25755960

  17. Superficial ulnar artery perforator flap.

    PubMed

    Schonauer, Fabrizio; Marlino, Sergio; Turrà, Francesco; Graziano, Pasquale; Dell'Aversana Orabona, Giovanni

    2014-09-01

    Superficial ulnar artery is a rare finding but shows significant surgical implications. Its thinness and pliability make this flap an excellent solution for soft tissue reconstruction, especially in the head and neck region. We hereby report a successful free superficial ulnar artery perforator forearm flap transfer for tongue reconstruction. A 64-year-old man presenting with a squamous cell carcinoma of the left tongue underwent a wide resection of the tumor, left radical neck dissection, and reconstruction of the tongue and the left tonsillar pillar with the mentioned flap. No complications were observed postoperatively. The flap survived completely; no recurrence at 6 months of follow-up was detected. Superficial ulnar artery perforator flap has shown to be a safe alternative to other free tissue flaps in specific forearm anatomic conditions. PMID:25102397

  18. Gastric perforation after cardiopulmonary resuscitation.

    PubMed

    Jalali, Sayed Mahdi; Emami-Razavi, Hassan; Mansouri, Asieh

    2012-11-01

    Gastric rupture is a rare complication after cardiopulmonary resuscitation (CPR). In most cases, incorrect management of airways during CPR is the main cause. Therefore, a medical emergency becomes a surgical emergency also. We present a case of gastric perforation in a middle-aged patient after CPR performed by his family. He eventually presented with bloody vomitus and a tympanic abdomen. When faced with a patient with abdominal signs post-CPR, surgical complications of CPR should be considered. PMID:22867822

  19. Endovascular Management of Iatrogenic Native Renal Arterial Pseudoaneurysms

    SciTech Connect

    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

    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.

  20. Infectious prion diseases in humans: cannibalism, iatrogenicity and zoonoses.

    PubMed

    Haïk, Stéphane; Brandel, Jean-Philippe

    2014-08-01

    In contrast with other neurodegenerative disorders associated to protein misfolding, human prion diseases include infectious forms (also called transmitted forms) such as kuru, iatrogenic Creutzfeldt-Jakob disease and variant Creutzfeldt-Jakob disease. The transmissible agent is thought to be solely composed of the abnormal isoform (PrP(Sc)) of the host-encoded prion protein that accumulated in the central nervous system of affected individuals. Compared to its normal counterpart, PrP(Sc) is ?-sheet enriched and aggregated and its propagation is based on an autocatalytic conversion process. Increasing evidence supports the view that conformational variations of PrP(Sc) encoded the biological properties of the various prion strains that have been isolated by transmission studies in experimental models. Infectious forms of human prion diseases played a pivotal role in the emergence of the prion concept and in the characterization of the very unconventional properties of prions. They provide a unique model to understand how prion strains are selected and propagate in humans. Here, we review and discuss how genetic factors interplay with strain properties and route of transmission to influence disease susceptibility, incubation period and phenotypic expression in the light of the kuru epidemics due to ritual endocannibalism, the various series iatrogenic diseases secondary to extractive growth hormone treatment or dura mater graft and the epidemics of variant Creutzfeldt-Jakob disease linked to dietary exposure to the agent of bovine spongiform encephalopathy. PMID:24956437

  1. Duodenal iron proteins in idiopathic hemochromatosis.

    PubMed Central

    Whittaker, P; Skikne, B S; Covell, A M; Flowers, C; Cooke, A; Lynch, S R; Cook, J D

    1989-01-01

    This study was undertaken to assess the relationship between iron absorption and the concentration of duodenal iron proteins in normal subjects and patients with idiopathic hemochromatosis (IH). Biopsies were obtained endoscopically from the duodenum in 17 normal subjects, 3 of whom were mildly iron deficient, and 7 patients with untreated IH. The absorption of both heme and nonheme iron was increased in IH despite a 20-fold elevation in serum ferritin. Immunoassays using MAb were used to measure transferrin, H-rich ferritin, and L-rich ferritin in mucosal samples. Mucosal transferrin concentrations in normal subjects did not correlate with either iron status or iron absorption, indicating that mucosal transferrin plays no physiological role in iron absorption. Mucosal transferrin was significantly lower in IH, presumably because of a decrease in mucosal transferrin receptors. Mucosal H and L ferritin concentrations were directly related to body iron stores and inversely related to iron absorption in normal subjects. In IH, mucosal H and L ferritin failed to increase in parallel with the serum ferritin, but were appropriate for the level of iron absorption. The relationship of mucosal H/L ferritin in IH did not differ from that observed in normal subjects. Our findings indicate that the major abnormality in duodenal iron proteins in IH is a parallel decrease in the concentration of H- and L-rich ferritin. It is not evident whether this is the result or the cause of the absorptive abnormality. PMID:2910911

  2. Histopathology of the minor duodenal papilla.

    PubMed

    Suda, Koichi

    2010-01-01

    The minor duodenal papilla, which is the orifice of the accessory, or dorsal, pancreatic duct/Santorini duct, mostly accompanied by pancreatic tissue, is situated about 2 cm ventroproximal to the major duodenal papilla. The patency of the terminal accessory pancreatic duct (APD) is recognized in about half or more of cases, and is related to the degree of fibrosis. The APD is lined with simple columnar epithelium and encircled by a smooth muscle layer. It is still controversial whether or not these muscle tissues comprise a sphincter muscle. Pancreatic tissue was found in about 80% of cases in the minor papilla. Among these cases, pancreatic tissue was continuous and/or closely related to the proper pancreas in about 40% of cases, and might have the same exocrine and endocrine morphologies/functions, suggesting that it is a portion of the dorsal pancreas and not an ectopic one. Endocrine cell micronests are frequently found in the ductal wall/surrounding area of the terminal APD, and predominantly consist of somatostatin- and/or pancreatic-polypeptide-containing cells. In cases of pancreas divisum, inadequate pancreatic juice drainage from the minor papilla might occur, resulting in dorsal pancreatitis. In the minor papilla, all ductal tumors may occur, such as an intraductal papillary mucinous neoplasms and invasive ductal carcinoma, but carcinoid tumors are rare. PMID:20551659

  3. Underbalance criteria for minimum perforation damage

    SciTech Connect

    Behrmann, L.A.

    1995-12-31

    A simple viscous drag force equation has been applied to single shot laboratory perforation/flow experimental data to obtain perforation damage skin versus underbalance. The equations are applicable for oil wells in consolidated, nonsanding formations and are a function of reservoir porosity, permeability and diameter of the perforation tunnel in the rock. The equations are independent of oil compressibility and viscosity. The dependency on perforation diameter suggests that larger charges are more damaging than small charges and that big hole charges are more damaging than equal size deep penetrating charges. The equations can be used to calculate an optimum underbalance or a single shot perforation skin for less than optimum underbalance. The single shot skin can be used in well flow analysis simulators to obtain a well perforation skin.

  4. Underbalance criteria for minimum perforation damage

    SciTech Connect

    Behrmann, L.A.

    1996-09-01

    A simple viscous drag force equation has been applied to single-shot laboratory perforation/flow experimental data to obtain perforation damage skin vs. underbalance. The equations are applicable for oil wells in consolidated, nonsanding formations and are a function of reservoir porosity, permeability, and diameter of the perforation tunnel in the rock. The equations are independent of oil compressibility and viscosity. The dependency on perforation diameter suggests that larger charges are more damaging than small charges and that big hole charges are more damaging than equal-size deep penetrating charges. The equations can be used to calculate an optimum underbalance or a single-shot perforation skin for less than optimum underbalance. The single-shot skin can be used in well-flow analysis simulators to obtain a well perforation skin.

  5. The morphology of central tympanic membrane perforations.

    PubMed

    Nepal, A; Bhandary, S; Mishra, S C; Singh, I; Kumar, P

    2007-12-01

    The objective of this study was to assess the extent of conductive hearing loss in relation to different sizes and sites of simple central tympanic membrane perforations. Total 100 cases attending ENT OPD, BPKIHS during period of April 2003 to Mar 2004 without any discrimination of sex, race and religion were taken for the cross sectional prospective study. Dry, clean central tympanic membrane perforations due to various causes like chronic suppurative otitis media-tubotympanic, post acute suppurative otitis media residual perforations or simple traumatic perforations with conductive hearing loss and without preexisting hearing loss were clinicoaudiologically evaluated and analyzed. Hearing loss was found to be directly proportional to the size of perforation irrespective of their cause, which was statistically significant. Hearing loss in the study was found to range from negligible to 53dB. Overall, perforations involving posterioinferior quadrant were found to have maximum hearing loss. PMID:18298012

  6. Posterior thigh perforator flaps: an anatomical study to localize and classify posterior thigh perforators.

    PubMed

    Hupkens, Pieter; Ozturk, Ekin; Wittens, Sabine; Hoevenaren, Ingrid A; Kooloos, Jan G M; Ulrich, Dietmar J O

    2013-07-01

    In the last decade perforator flaps have been used increasingly for different indications. Many regions may serve as donor site. In this respect the posterior thigh region (PTR) has been neglected as a potential donor site for many years. The purpose of this study was to provide complete mapping of perforators supplying the posterior thigh region. Twelve fresh cadaver thighs were prepared injecting diluted acrylic paint into the iliac artery. Thereafter the posterior thighs were dissected from medial to lateral, distinguishing the perforators at the level of the superficial fascia. The perforators were localized and origin, source, length and diameter of the perforators were documented. Analysis occurred using ANOVA and the two proportion Z test. The distribution of musculocutaneous and septocutaneous perforators was respectively 69.1% and 30.9% (P = 0.002). The PTR was divided in thirds. Most perforators (53.2%) were found in de middle third of the PTR. The deep femoral artery (DFA) was the main origin of perforators (61.7%), followed by the superficial femoral artery (SFA) (27.7%) and the popliteal artery (PA) (10.6%). The DFA perforators were the longest with a mean length of 13.7 ± 4,69 cm, the SFA perforators were 9.79 ± 3.76 cm and the PA perforators were 8.6 ± 3.37 cm. The PTR offers a sufficient number of suitable perforators to serve as an adequate donorsite for pedicled and free flaps. PMID:23716194

  7. Iatrogenic Superficial External Pudendal Artery Pseudoaneurysm: Treatment with Doppler US-Guided Compression

    PubMed Central

    Algin, Oktay; Mustafayev, Assanaly; Ozmen, Evrim

    2014-01-01

    Pseudoaneurysms rarely occur as a serious complication following incomplete hemostasis of an arterial puncture site. As a result of the increase in diagnostic and therapeutic angiography, the frequency of iatrogenic pseudoaneurysm has increased as well. Iatrogenic pseudoaneurysms associated with angiographic catheterization occur most commonly in the common femoral artery. Here we report a case of iatrogenic superficial external pudendal artery (SEPA) pseudoaneurysm following cardiac catheterization, which was diagnosed with Doppler ultrasound (US) and multidetector computed tomographic angiography (MDCTA) before Doppler US-guided compression therapy. To the best of our knowledge, iatrogenic SEPA pseudoaneurysm, which is an unusual vessel location for pseudoaneurysm occurrence, has not been reported in the literature. In patients in whom anticoagulant-thrombolytic therapy or therapeutic catheterization with larger sized sheath is planned, determination of the precise localization of arterial puncture site is important for the prevention of iatrogenic pseudoaneurysm development. Arterial puncture guided with Doppler US might reduce complications. When suspected, MDCTA is useful in the diagnosis and demonstration of iatrogenic pseudoaneurysms. Treatment of US-guided compression should be the first choice for iatrogenic pseudoaneurysms. Interventional radiologists and cardiologists should have enough experience about the catheterization complications and their treatment in order to decrease the morbidity and mortality related to the intervention. PMID:25035706

  8. Iatrogenic cerebrospinal fluid leak and intracranial hypotension after gynecological surgery.

    PubMed

    Tu, Albert; Creedon, Kerry; Sahjpaul, Ramesh

    2014-09-01

    Perineural cysts are common lesions of the sacral spine. They have rarely been reported in a presacral location, leading to their misdiagnosis as a gynecological lesion. The authors report the second such case, in a patient undergoing fenestration of what was presumed to be a benign pelvic cyst, and the resultant high-flow CSF leak that occurred. They describe the clinical presentation and manifestations of intracranial hypotension, as well as the pertinent investigations. They also review the literature for the best management options for this condition. Although they are uncommon, large perineural cysts should be included in the differential diagnosis when examining patients with a pelvic lesion. Appropriate imaging investigations should be performed to rule out a perineural cyst. The CSF leak that occurs from iatrogenic cyst fenestration may not respond to traditional first-line treatments for intracranial hypotension and may require early surgical intervention. The authors would recommend neurosurgical involvement prior to definitive treatment. PMID:24905389

  9. Iatrogenic Submandibular Duct Rupture Complicating Sialography: A Case Report

    PubMed Central

    Sharouny, Hadi; Omar, Rahmat Bin

    2014-01-01

    Introduction: Sialolithiasis is the most common disease of salivary glands. Sialography is particularly important for the assessment of the outflow tract and in diagnosing obstructive salivary gland lesions including calculi. Case Presentation: We report on a 38-year-old female with sialolithiasis whom had Wharton’s duct perforation, complicating the sialography. She was treated conservatively with a course of co-amoxiclav, oral prednisolone for three days and pain-killers. The patient was clinically well on follow-up reassessments at the end of the first week and three weeks post procedure. Conclusions: Perforation of salivary duct complicating the sialography is rare. Awareness of this potential complication and utilizing a good sialography technique need to be advocated amongst radiologists. Response to treatment by conservative management is preferred as illustrated in this case. PMID:25593739

  10. Comparison of quantitative and qualitative duodenal fluid versus duodenal mucosa cultures in German Shepherd Dogs with spontaneous small bowel bacterial overgrowth

    E-print Network

    Delles, Edward Kevin

    1993-01-01

    of Texas A8 M University in partial fulfillment of the requirements for the degree of MASTER OF SCIENCE August 1993 Major Subject: Veterinary Medicine and Surgery COMPARISON OF QUANTITATIVE AND QUALITATIVE DUODENAL FLUID VERSUS DUODENAL MUCOSA...' . Rogers ( ember) John R. A st (Head of Department) August 1993 ABSTRACT Comparison of Quantitative and Qualitative Duodenal Fluid Versus Duodenal Mucosa Cultures in German Shepherd Dogs with Spontaneous Small Bowel Bacterial Overgrowth. (August...

  11. Dimensional scaling for impact cratering and perforation

    NASA Technical Reports Server (NTRS)

    Watts, Alan; Atkinson, Dale; Rieco, Steve

    1993-01-01

    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.

  12. Shear buckling of square perforated plates

    NASA Technical Reports Server (NTRS)

    Grosskurth, J. F., Jr.; White, R. N.; Gallagher, R. H.; Thomas, G. R.

    1974-01-01

    The behavior of thin square perforated plates under the action of uniform shear deformation is studied experimentally and analytically using finite element analysis. Elastic Shear buckling strength is established as a function of the diameter of a round, centrally located hole in the plate. Post buckling behavior and the behavior of perforated plates with various ring stiffeners are also studied experimentally.

  13. High power laser perforating tools and systems

    SciTech Connect

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

    2014-04-22

    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.

  14. Spontaneous Perforation of Gallbladder with Intrahepatic Bilioma

    PubMed Central

    Taneja, Sunil; Sharma, Arun; Duseja, Ajay K; Kalra, Naveen; Chawla, Yogesha

    2012-01-01

    Spontaneous perforation of gallbladder is uncommon. We report a rare case of perforation of the gallbladder due to gallstone disease with formation of a large intrahepatic bilioma. The patient was managed conservatively with percutaneous drainage of the intrahepatic collection followed by endoscopic retrograde cholangiopancreatography (ERCP) and cholecystectomy.

  15. Laparoscopic diverticulectomy for massive hemorrhage in a duodenal diverticulum.

    PubMed

    Dan, Dilip; Bascombe, Nigel; Maharaj, Ravi; Hariharan, Seetharaman; Naraynsingh, Vijay

    2012-02-01

    Hemorrhagic duodenal diverticula are rare and are treated by endoscopy or open diverticulectomy, especially when there is a massive hemorrhage. We report what we believe to be the first instance of urgent laparoscopic diverticulectomy of a large, inflamed duodenal diverticulum with massive hemorrhage. An elderly patient had a screening colonoscopy and additional upper gastrointestinal endoscopy because of vague upper gastrointestinal symptoms; however, both were reported to be normal. She subsequently developed massive hematemesis. Clinical examination revealed a tender right upper quadrant mass and imaging confirmed a large duodenal diverticulum with surrounding inflammatory changes. Urgent laparoscopic diverticulectomy was performed with an uneventful recovery and follow-up. Laparoscopic diverticulectomy should be considered in managing hemorrhagic duodenal diverticula. PMID:22318077

  16. Neonatal duodenal obstruction with emphasis on cases with Down's syndrome

    E-print Network

    1986-01-01

    In the past 31 years, 47 cases of duodenal obstruction were admitted to the Royal Belfast Hospital for Sick Children. Thirty-sLx per cent of these had Down's syndrome. The crude mortality was 48 % but this figure was reduced to 33 % in the last five years of the study. The combination of duodenal obstruction, Down's syndrome and any other abnormality carried an 89 % risk of mortality.

  17. Severe duodenal injuries. Treatment with pyloric exclusion and gastrojejunostomy.

    PubMed

    Martin, T D; Feliciano, D V; Mattox, K L; Jordan, G L

    1983-05-01

    During a 12-year period, 313 patients with duodenal injuries were treated. Primary repair, pyloric exclusion, and gastrojejunostomy were used in 128 patients (41%) with severe duodenal and pancreaticoduodenal injuries, to reduce "duodenal" morbidity and mortality. The duodenal fistula rate was 2.2% overall, and 5.5% in the patients undergoing exclusion. Only two deaths were due to fistulas. Forty-two patients underwent upper gastrointestinal tract examinations after operation. In patients examined 21 days or more after operation, 94% had a patent pylorus. Marginal ulceration was infrequent (four patients), as were complications associated with the procedure (3%). Pyloric exclusion with gastrojejunostomy is a quick and simple procedure that allows return of pyloric patency and is associated with a low incidence of duodenal fistulas. When fistulas do develop, they are usually easily controlled and are associated with a low mortality. We believe pyloric exclusion with gastrojejunostomy to be the procedure of choice in patients with severe duodenal and pancreaticoduodenal trauma. PMID:6838368

  18. Effect of the hexapeptide dalargin on ornithine decarboxylase activity in the duodenal mucosa of rats with experimental duodenal ulcer

    SciTech Connect

    Yarygin, K.N.; Shitin, A.G.; Polonskii, V.M.; Vinogradov, V.A.

    1987-08-01

    The authors study the effect of dalargin on ornithine decarboxylase in homogenates of the duodenal ulcer from rats with experimental duodenal ulcer induced by cysteamine. Activity of the enzyme was expressed in pmoles /sup 14/CO/sub 2//mg protein/h. Protein was determined by Lowry's method. The findings indicate that stimulation of ornithine decarboxylase and the antiulcerative effect of dalargin may be due to direct interaction of the peptide with cells of the intestinal mucosa and with enterocytes.

  19. Massive thoracoabdominal aortic thrombosis in a patient with iatrogenic Cushing syndrome.

    PubMed

    Kim, Dong Hun; Choi, Dong-Hyun; 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

    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

  20. Endoscopic Diagnosis of Duodenal Stenosis in a 5-Month-Old Male Infant

    PubMed Central

    Nicholson, Maribeth R.; Acra, Sari A.; Chung, Dai H.

    2014-01-01

    Duodenal stenosis and duodenal atresia are well-known gastrointestinal anomalies in patients with Down syndrome. Although duodenal atresia presents early and classically with vomiting in the immediate neonatal period, the presentation of duodenal stenosis can be significantly more subtle and the diagnosis delayed. Here, we describe the case of a 5-month-old male infant with Down syndrome and delayed presentation of high-grade duodenal stenosis diagnosed endoscopically. Pediatric gastroenterologists should include duodenal stenosis in the differential diagnosis of older infants and children with vomiting and should be familiar with the endoscopic appearance of this lesion. PMID:25505725

  1. Feasibility of Endoscopic Resection for Sessile Nonampullary Duodenal Tumors: A Multicenter Retrospective Study

    PubMed Central

    Park, Sung Min; Ham, Joo Ho; Kim, Byung-Wook; Kim, Chang Whan; Kim, Jin Il; Lim, Chul Hyun; Oh, Jung Hwan

    2015-01-01

    Objectives. Sessile nonampullary duodenal tumors (SNADTs) are relatively rare and endoscopic resection of these lesions is considered more challenging than in other parts of the gastrointestinal tract. The aim of this study was to evaluate the feasibility of endoscopic resection for SNADT. Methods. Medical records including endoscopic resection for SNADT from July 2002 to July 2013 from 5 centers affiliated to The Catholic University of Korea were reviewed retrospectively. Demographic features and clinical outcomes such as complete resection and complications were analyzed. Results. A total of 56 lesions from 54 patients were enrolled in this study. Forty-five lesions were resected by endoscopic mucosal resection (EMR), 6 lesions by endoscopic submucosal dissection (ESD), and 5 lesions by simple polypectomy. Histologic examination after endoscopic resection revealed adenocarcinoma in 2, low grade adenoma in 25, high grade adenoma in 11, and carcinoid tumor in 18 lesions. En bloc resection rates and histological complete resection rates were 78.6% (44/56) and 80.0% (28/35), respectively. Bleeding which required additional endoscopic intervention occurred in 1.8% (1/56) and perforation in 7.1% (4/56). There was no procedure-related mortality. Conclusions. Endoscopic resection techniques including ESD might be safe and effective modalities for the management of SNADT.

  2. Offshore sandstone reservoir perforating practices used in Saudi Arabia

    SciTech Connect

    Benedyczak, C.; Al-Towailib, A.A.

    1983-03-01

    Perforating wells for production has been a widely accepted industry practice for nearly 50 years. Today many producing wells are completed with metal casings cemented across the hydrocarbon bearing zones for controlling oil, gas, water and solid particles entry into the wellbores. Reservoir fluid flow into wellbores is obtained through perforation tunnels made in casings, cement sheath and reservoir rock. Perforation technology and methods of evaluating perforation efficiencies have been advanced greatly by the industry during the past 50 years. The resulting selection of well perforating devices and perforating methods is vast. However, only few studies have been published addressing field assessment of well perforation efficiencies. The inability of many oil producing wells to flow to surface hampers their perforation effectiveness evaluation. Saudi Arabian offshore oil production is obtained from flowing wells. This situation readily lends itself for analysis of well production profiles and perforation flow efficiencies. This paper examines perforation efficiencies of jet guns in the flowing oil wells.

  3. Iatrogenic possibilities of orthodontic treatment and modalities of prevention

    PubMed Central

    Meeran, Nazeer Ahmed

    2013-01-01

    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

  4. Traumatic tympanic membrane perforations: complications and management.

    PubMed

    Kristensen, S; Juul, A; Gammelgaard, N P; Rasmussen, O R

    1989-07-01

    There is great diversity in the methods of treating traumatic perforations of the tympanic membrane. To elucidate the controversy, we present a long-term follow-up study of 37 patients. On the basis of our present study and available relevant data in the literature, we emphasize that early surgical intervention of a traumatic myringeal perforation is not indicated, as most of these perforations (an average of 88%) do heal spontaneously without complications. However, we stress the importance of performing a meticulous auditory and vestibular examination with close follow-up and repeat audiograms in all patients with acute traumatic myringoruptures to provide enough information for diagnosis of a major perilymph leak that would warrant operation. Myringeal perforations or major conductive hearing losses persisting 3 months after injury warrant tympanotomy and appropriate reconstruction. PMID:2676466

  5. Transcytosis of gastric leptin through the rat duodenal mucosa.

    PubMed

    Cammisotto, Philippe G; Gingras, Diane; Bendayan, Moïse

    2007-10-01

    Leptin is secreted into the gastric juice by epithelial Chief cells and reaches the duodenum in a biologically intact active form. We assessed the possibility that this gastric leptin crosses the intestinal mucosa by transcytosis through enterocytes to reach blood circulation. Endogenous gastric leptin secretion was triggered by cholinergic stimulation. In another set of experiments, recombinant leptin was inserted in vivo into the duodenal lumen. Plasma levels of leptin were assessed by enzyme immunoassay and Western blot, and duodenal tissue was processed for immunocytochemistry. We first observed that leptin was found inside duodenal enterocytes from fed rats but not inside those from fasted ones. Stimulation of gastric secretion by a cholinergic agent led to rapid increases in plasma leptin levels (202 +/- 39%) except when the pylorus was clamped. Insertion of recombinant leptin into the duodenal lumen raised plasma leptin concentrations (558 +/- 34%) quite rapidly, whereas carrier solution without leptin had no effect. The use of FITC-tagged leptin reinforced these results. Light and electron microscopy revealed the cellular compartments involved in its transcytosis, namely, the enterocyte microvilli, the endocytotic vesicles, the Golgi complex, and the basolateral interdigitations. Leptin was also present in the lamina propria, in capillary endothelial cell plasmalemmal vesicles, and in capillary lumina. These results demonstrate that gastric exocrine leptin is internalized by duodenal enterocytes and delivered to the lamina propria and blood circulation. It may thus be able to play important paracrine and endocrine functions for the control of gastric emptying and nutrient absorption. PMID:17673543

  6. Percutaneous Management of Postoperative Duodenal Stump Leakage with Foley Catheter

    SciTech Connect

    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

    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.

  7. Surface studies of duodenal lesions induced by thoracic irradiation

    SciTech Connect

    Carr, K.E.; Ellis, S.; Michalowski, A.

    1986-01-01

    Acute duodenal ulcers are produced in mice as a remote (abscopal) effect of irradiation to the lower mediastinum. Such lesions have been examined with scanning electron microscopy at 5, 8 and 28 days after irradiation with 18 Gy of X-rays. All the ulcers occur within the first 1 cm long segment of the duodenum which is endowed with Brunner's glands. The single lesions vary in size, shape and position. The damaged area often includes much of the duodenal circumference and is distinguished by conical or rudimentary villi, or even by the complete absence of villi. In contrast, around the periphery of the ulcer the villi are mostly vertical. Although the floor of these lesions appears to be covered with a continuous epithelial layer, during the first 4 weeks after irradiation the severity of the focal duodenal damage seems to increase gradually with time. The lesions have been compared with specimens from unirradiated mice and also with samples taken 3 days after partial thoracic irradiation when little damage is seen. The pattern of fully developed duodenal lesions differs greatly from that seen after direct irradiation where damage has not included localised ulceration in the samples of jejunum so far examined. The lesions induced by partial thoracic irradiation may be related to radiation injury to vascular or autonomic nerve targets in the lower mediastinum. Such injury could result in malfunction of the pyloric sphincter or could alter the secretion by Brunner's glands and thus lead to duodenal ulceration.

  8. Perforation of Meckel's diverticulum by foreign body.

    PubMed

    Okur, Mehmet Hanifi; Arslan, Mehmet Serif; Aydogdu, Bahattin; Uygun, Ibrahim; Goya, Cemil; Tokgöz, Orhan; Otcu, Selcuk

    2014-07-01

    Meckel's diverticulum (MD) is a congenital disorder of the gastrointestinal tract that is usually asymptomatic. Perforation of an MD by foreign bodies is an extremely rare cause of acute abdomen in children. We present a rare case of perforation of an MD in a child after eating melon seeds. The patient was treated successfully with segmental resection and primary anastomosis and had an uneventful postoperative recovery. PMID:25255595

  9. Lead explantation late after atrial perforation.

    PubMed

    Trigano, A J; Caus, T

    1996-08-01

    This report describes the case of a patient in whom atrial perforation with penetration of the thoracic wall was diagnosed 2 years after the implantation of an Accufix lead. Despite this complication, atrial detection in the bipolar mode and ventricular pacing were normal. Digital fluoroscopy detected a fracture with extrusion of a short segment of the retention wire. The rupture of the retention wire might have been the result, but was not the cause of the perforation. PMID:8865228

  10. Upper gastrointestinal barium evaluation of duodenal pathology: A pictorial review.

    PubMed

    Gupta, Pankaj; Debi, Uma; Sinha, Saroj Kant; Prasad, Kaushal Kishor

    2014-08-28

    Like other parts of the gastrointestinal tract (GIT), duodenum is subject to a variety of lesions both congenital and acquired. However, unlike other parts of the GIT viz. esophagus, rest of the small intestine and large intestine, barium evaluation of duodenal lesions is technically more challenging and hence not frequently reported. With significant advances in computed tomography technology, a thorough evaluation including intraluminal, mural and extramural is feasible in a single non-invasive examination. Notwithstanding, barium evaluation still remains the initial and sometimes the only imaging study in several parts of the world. Hence, a thorough acquaintance with the morphology of various duodenal lesions on upper gastrointestinal barium examination is essential in guiding further evaluation. We reviewed our experience with various common and uncommon barium findings in duodenal abnormalities. PMID:25170399

  11. Serum gastrin and the family environment in duodenal ulcer disease.

    PubMed

    Wolcott, D L; Wellisch, D K; Robertson, C R; Arthur, R J

    1981-12-01

    The study investigated the relationships between specific demographic, psychosocial, and physiological variables and the severity of duodenal ulcer disease in a population of patients with proved duodenal ulcer. Intercorrelations between psychosocial and physiological variables were also studied. The study design was cross sectional and retrospectively assessed life change units and DUD severity during the previous 6 months in 39 male ulcer clinic outpatients. Anxiety, depression, life change units, the family environment, ABO blood type, secretor status, serum pepsinogen, and serum fasting gastrin were evaluated. A DUD severity score was calculated from self-reported ulcer pain symptoms and ulcer complications. Gastrin levels correlated significantly with three Family Environment Scale (FES) subscales, including: (a) independence, (b) achievement orientation, and (c) expressiveness. Duodenal ulcer disease severity scores correlated with Zung SDS scores, but not with state or trait anxiety, life change units, or the FES. PMID:6976585

  12. Upper gastrointestinal barium evaluation of duodenal pathology: A pictorial review

    PubMed Central

    Gupta, Pankaj; Debi, Uma; Sinha, Saroj Kant; Prasad, Kaushal Kishor

    2014-01-01

    Like other parts of the gastrointestinal tract (GIT), duodenum is subject to a variety of lesions both congenital and acquired. However, unlike other parts of the GIT viz. esophagus, rest of the small intestine and large intestine, barium evaluation of duodenal lesions is technically more challenging and hence not frequently reported. With significant advances in computed tomography technology, a thorough evaluation including intraluminal, mural and extramural is feasible in a single non-invasive examination. Notwithstanding, barium evaluation still remains the initial and sometimes the only imaging study in several parts of the world. Hence, a thorough acquaintance with the morphology of various duodenal lesions on upper gastrointestinal barium examination is essential in guiding further evaluation. We reviewed our experience with various common and uncommon barium findings in duodenal abnormalities. PMID:25170399

  13. Diagnosis and management of duodenal adenocarcinomas: a comprehensive review for the radiologist.

    PubMed

    Suh, Chong Hyun; Tirumani, Sree Harsha; Shinagare, Atul B; Kim, Kyung Won; Rosenthal, Michael H; Ramaiya, Nikhil H; Baheti, Akshay D

    2014-11-27

    Duodenal adenocarcinomas are the most common duodenal tumors, and represent 15-25% of small bowel carcinomas. Their management differs from other small bowel tumors, with imaging playing a very important role. In this article, we provide a comprehensive review of the diagnosis and management of duodenal adenocarcinomas, emphasizing the role of the radiologist in the same. PMID:25427987

  14. Duodenal mucosal protection by bicarbonate secretion and its mechanisms.

    PubMed

    Konturek, S J; Konturek, P C; Pawlik, T; Sliwowski, Z; Ochma?ski, W; Hahn, E G

    2004-07-01

    Proximal portion of duodenum is exposed to intermittent pulses of gastric H(+) discharged by the stomach. This review summarizes the mechanisms of duodenal mucosal integrity, mainly the role of mucus-alkaline secretion and the mucous barrier protecting surface epithelium against gastric H(+). The mucous barrier protects the leaky duodenal epithelium against each pulse of gastric H(+), which penetrates this barrier and diffuses into duodenocytes, but fails to damage them due to; a) an enhanced expression of cyclooxygenase-1 (COX-1), with release of protective prostaglandins (PG) and of nitric oxide (NO) synthase (NOS) with, however, production of NO, stimulating duodenal HCO(3)(-) secretion and b) the release of several neurotransmitters also stimulating HCO(3)(-) secretion such as vasoactive intestinal peptide (VIP), pituitary adenylate-cyclase activating polypeptide (PACAP), acetylcholine, melatonin, leptin and ghrelin released by enteric nerves and mucosal cells. At the apical duodenocyte membrane at least two HCO(3)(-)/Cl(-) anion exchangers operate in response to luminal H(+) to provide adequate extrusion of HCO(3)(-) into duodenal lumen. In the basolateral portion of duodenocyte membrane, both non-electrogenic (NBC) and electrogenic (NBC(n)) Na(+) HCO(3)(-) cotransporters are activated by the exposure to duodenal acidification, causing inward movement of HCO(3)(-) from extracellular fluid to duodenocytes. There are also at least three Na(+)/H(+) (NHE1-3) amiloride-sensitive exchangers, eliminating H(+)which diffused into these cells. The Helicobacter pylori (Hp) infection and gastric metaplasia in the duodenum with bacterium inoculating metaplastic mucosa and inhibiting HCO(3)(-) secretion by its endogenous inhibitor, asymmetric dimethyl arginine (ADMA), may result in duodenal ulcerogenesis. PMID:15608357

  15. Proper Management for Morbid Iatrogenic Retroperitoneal Barium Insufflation

    PubMed Central

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

    2014-01-01

    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

  16. Duodenal adenocarcinoma presenting as a mass with aneurismal dilatation.

    PubMed

    Mama, Nadia; Ben Slama, Aïda; Arifa, Nadia; Kadri, Khaled; Sriha, Badreddine; Ksiaa, Mehdi; Jemni, Hela; Tlili-Graiess, Kalthoum

    2014-01-01

    Duodenal adenocarcinoma is frequent. Aneurysmal dilatation of the small bowel is reported to be a lymphoma characteristic imaging finding. A 57-year-old male was found to have a duodenal adenocarcinoma with aneurismal dilatation on imaging which is an exceptional feature. On laparotomy, the wall thickening of the dilated duodenum extended to the first jejunal loop, with multiple mesenteric lymph nodes and ascites. Segmental palliative resection with gastro-entero-anastomosis was done. Histopathology revealed a moderately differentiated adenocarcinoma with neuro-endocrine differentiation foci. Wide areas of necrosis and vascular emboli were responsible for the radiological feature of the dilated duodenum with wall thickening. PMID:24411203

  17. Volar perforators of common digital arteries: an anatomical study.

    PubMed

    Gasiunas, V; Valbuena, S; Valenti, P; Le Viet, D

    2015-03-01

    The palmar triangle is an area vascularized by perforator arteries arising from the common digital palmar arteries. The aim of this article was to perform an anatomical study of common digital palmar arteries perforators. Twelve injected specimens were included in this study. The purpose was to quantify the number of perforator arteries of each common digital palmar arteries in the 2nd, 3rd, and 4th intermetacarpal space, measure distances between them, between the distal perforator and corresponding commissure, and the distance between the proximal perforator and the superficial palmar arch. Four to eight perforators were arising from common digital palmar arteries of the 2nd, 3rd, and 4th intermetacarpal space. The average distance between perforator arteries was 6.5 mm, between superficial palmar arch and proximal perforator artery - 8.2 mm, between the distal perforator artery and corresponding commissure - 6.3 mm. PMID:24664162

  18. Colonoscopic Perforation in Inflammatory Bowel Disease

    PubMed Central

    Makkar, Rohit

    2013-01-01

    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

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

    PubMed Central

    2014-01-01

    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. PMID:25653980

  20. Iatrogenic cushing syndrome to facial nerve palsy: via intracranial tuberculoma-an interesting journey.

    PubMed

    Chakrabarti, Subrata

    2014-12-01

    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. PMID:25653980

  1. Hypothalamic-Pituitary-Adrenal Suppression and Iatrogenic Cushing's Syndrome as a Complication of Epidural Steroid Injections

    PubMed Central

    2013-01-01

    Epidural steroid injections are well accepted as a treatment for radicular back pain in appropriate candidates. While overall incidence of systemic side effects has not been well established, at least five biochemically proven cases of iatrogenic Cushing's Syndrome have been reported as complications of epidural steroid treatment. We present an additional case of iatrogenic Cushing's Syndrome and adrenal suppression in a middle-aged woman who received three epidural steroid injections over a four-month period. We review this case in the context of previous cases and discuss diagnostic and management issues. PMID:23991341

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

    PubMed Central

    2013-01-01

    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

  3. 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...

  4. [Duodenal duplication revealed by acute pancreatitis: endoscopic treatment].

    PubMed

    Le Baleur, Yann; Dhalluin-Venier, Valérie; Thirot-Bidault, Anne; Rangheard, Anne-Sophie; Boytchev, Isabelle; Choury, André-Daniel; Fritsch, Jacques; Pelletier, Gilles; Buffet, Catherine

    2007-01-01

    We report the case of a 17 year old man who presented with several episodes of acute pancreatitis due to a duodenal duplication. This was successfully treated by an incision by sphincterotome during interventional duodenoscopy. The patient is symptom free without recurrence 20 months after endoscopic treatment. PMID:17925766

  5. Duodenal cryptococcus infection in an AIDS patient: retrospective clinical analysis.

    PubMed

    Li, Jiamin; Wang, Ningfang; Hong, Qunying; Bai, Chunxue; Hu, Bijie; Tan, Yunshan

    2015-03-01

    Cryptococcal infection primarily affects the lung or the central nervous system and rare cases have been reported involving the gastrointestinal tract. However, among patients with HIV/AIDS, the gastrointestinal involvement is increasing. According to the PubMed search results, there were seven cases reported involving duodenal cryptococcosis combined with AIDS in five reports. Here, we report the case of a patient found to have AIDS combined with duodenal, pulmonary, and subsequent neurological cryptococcal infection simultaneously. The duodenal cryptococcosis was diagnosed on the basis of PET/computed tomography, which showed intense captation of glucose metabolism in duodenum (maximum standardized uptake value 16.53); a positive serum cryptococcal latex agglutination test; and upper gastrointestinal endoscopy-guided duodenal biopsy that confirmed Cryptococcus neoformans yeast. The patient's HIV screen test was positive. Because of refusal of lumbar puncture and the difficulty of performing transbronchial lung biopsy, the pulmonary and neurological involvements were the only clinical diagnoses. This case indicates that when cryptococcosis exists in a rare location, AIDS should be considered and when cryptococcosis occurs in the HIV-infected patient, disseminated disease is more common. PMID:25629567

  6. Review article Estimation of the duodenal flow of microbial nitrogen

    E-print Network

    Paris-Sud XI, Université de

    Review article Estimation of the duodenal flow of microbial nitrogen in ruminants based kilogram of dry matter (DM) intake, which is the yield of microbial protein (YMP). The estimation was based,isapoorindicationfortheduodenalflowofmicrobialN(g·kg­1 DMintake)inruminants fed diets with forages only. rumen / microbial nitrogen / legumes / grasses

  7. Duodenal Adenocarcinoma: Clinicopathologic Analysis and Implications for Treatment

    PubMed Central

    Poultsides, George A.; Huang, Lyen C.; Cameron, John L.; Tuli, Richard; Lan, Leslie; Hruban, Ralph H.; Pawlik, Timothy M.; Herman, Joseph M.; Edil, Barish H.; Ahuja, Nita; Choti, Michael A.; Wolfgang, Christopher L.; Schulick, Richard D.

    2013-01-01

    Background Duodenal adenocarcinoma is a rare cancer usually studied as a group with periampullary or small bowel adenocarcinoma; therefore, its natural history is poorly understood. Methods Patients with duodenal adenocarcinoma were identified from a single-institution pancreaticoduodenectomy database. Patients with adenocarcinoma arising from the ampulla of Vater were excluded. Univariate and multivariate analyses were performed to identify clinicopathologic variables associated with survival and recurrence after resection. Results From 1984 to 2006, a total of 122 patients with duodenal adenocarcinoma underwent pancreaticoduodenectomy. Overall survival after resection was 48% at 5 years and 41% at 10 years. Five-year survival decreased as the number of lymph nodes involved by metastasis increased from 0 to 1–3 to ?4 (68%, 58%, 17%, respectively, P < 0.01) and as the lymph node ratio increased from 0 to >0–0.2 to >0.2–0.4 to >0.4 (68%, 57%, 14%, 14%, respectively, P < 0.01). Lymph node metastasis was the only independent predictor of decreased survival in multivariate analysis. Recurrence after resection was predominantly distant (81%). Adjuvant chemoradiation did not decrease local recurrence or prolong overall survival; however, patients who received chemoradiation more commonly had nodal metastasis (P = 0.03). Conclusions The prognostic significance of both the absolute number and ratio of involved lymph nodes emphasizes the need for adequate lymphadenectomy to accurately stage duodenal adenocarcinoma. The mostly distant pattern of recurrence underscores the need for the development of effective systemic therapies. PMID:22167476

  8. Adenocarcinoma of the minor duodenal papilla: report of a case.

    PubMed

    Hoshino, Arichika; Nakamura, Yoshiharu; Suzuki, Hideyuki; Mizutani, Satoshi; Ishii, Hideaki; Watanabe, Masanori; Bou, Hideki; Yoshino, Masanori; Komine, Osamu; Uchida, Eiji

    2013-01-01

    We report a rare case of adenocarcinoma of the minor papilla of the duodenum treated with transduodenal minor papillectomy. A 64-year-old woman was treated for an asymptomatic duodenal tumor detected on gastroduodenoscopy. Endoscopy showed a 15-mm sessile mass in the descending duodenum proximal to the major papilla. The major papilla was a villous 24-mm-diameter polypoid tumor. Histopathologic examination of the biopsy specimen showed tubular adenoma with moderate epithelial atypia. Transduodenal major and minor papillectomies were performed. The orifice of the duct of Santorini and the pancreatic duct were re-approximated to the duodenal wall to prevent acute pancreatitis caused by scarring and stenosis of the duct orifice. Histological findings were consistent with well-differentiated adenocarcinoma limited to the minor duodenal papilla, without infiltration of the duodenal wall submucosa, and confirmed complete resection. The patient had an uneventful postoperative course and has remained asymptomatic, without evidence of tumor recurrence or stenosis of the pancreatic duct orifice, for 4 years. PMID:23657071

  9. Duodenal Toxicity After Fractionated Chemoradiation for Unresectable Pancreatic Cancer

    SciTech Connect

    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

    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.

  10. Perforated diverticulitis sigmoidei after laparoscopic cholecystectomy.

    PubMed

    Eljaja, Salameh; Hadi, Sabah; El-Hussuna, Alaa

    2015-01-01

    We present a case of 47-year-old healthy man who underwent an uneventful elective laparoscopic cholecystectomy. Despite the postoperative analgesia with non-steroidal anti-inflammatory drugs (NSAIDs), the patient developed diffuse abdominal pain culminating on the second postoperative day when the patient also had rebound tenderness. A diagnostic laparoscopy showed diverticular perforation, which was treated with laparoscopic lavage and drain. The patient's condition continued to deteriorate and the drain output resembled faecal material necessitating an emergency sigmoidium resection. The histopathological examination confirmed inflammation and perforation in the diverticulosis-bearing segment. The use of NSAID can be a reason for perforation, and may be for diverticulitis. NSAID should be used with caution in patients with a previous history or endoscopic-verified diverticulosis. PMID:25770142

  11. Perforated diverticulitis sigmoidei after laparoscopic cholecystectomy

    PubMed Central

    Eljaja, Salameh; Hadi, Sabah; El-Hussuna, Alaa

    2015-01-01

    We present a case of 47-year-old healthy man who underwent an uneventful elective laparoscopic cholecystectomy. Despite the postoperative analgesia with non-steroidal anti-inflammatory drugs (NSAIDs), the patient developed diffuse abdominal pain culminating on the second postoperative day when the patient also had rebound tenderness. A diagnostic laparoscopy showed diverticular perforation, which was treated with laparoscopic lavage and drain. The patient's condition continued to deteriorate and the drain output resembled faecal material necessitating an emergency sigmoidium resection. The histopathological examination confirmed inflammation and perforation in the diverticulosis-bearing segment. The use of NSAID can be a reason for perforation, and may be for diverticulitis. NSAID should be used with caution in patients with a previous history or endoscopic-verified diverticulosis. PMID:25770142

  12. Perforated peptic ulcer in an infant.

    PubMed

    Feng, C Y; Hsu, W M; Chen, Y

    2001-02-01

    We describe a case of perforated peptic ulcer (PPU) in a 9-month-old boy. Abdominal distension was the first clinical sign of PPU. Before he developed abdominal distension, the patient had suffered from an upper respiratory tract infection with fever for about 2 weeks, which was treated intermittently with ibuprofen. A plain abdominal radiograph revealed pneumoperitoneum with a football sign. At laparotomy, a 0.8-cm perforated hole was found over the prepyloric area. Simple closure with omental patching was performed after debridement of the perforation. Pathologic examination showed chronic peptic ulcer with Helicobacter pylori infection. The postoperative course and outcome were satisfactory. The stress of underlying disease, use of ibuprofen, blood type (A), and H. pylori infection might have contributed to the development of PPU in this patient. PPU in infancy is rare and has a high mortality rate; early recognition and prompt surgical intervention are key to successful management. PMID:11393101

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

    PubMed Central

    Sayir, Fuat; Cobanoglu, Ufuk; Sehitogullari, Abidin

    2012-01-01

    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. PMID:25610214

  14. Nonsurgical closure of nasal septal perforations.

    PubMed

    Facer, G W; Kern, E B

    1979-01-01

    Seventy-three patients had medical-grade Silastic buttons inserted transnasally (between June 1972 and June 1976) into a perforation of the nasal septum. This nonsurgical technique was done as an office procedure on 67 of the patients with the use of topically applied 5% cocaine solution. The Silastic button has remained in place in 72.6% of the entire study group; follow-up times for this group range from six months to four years. This mechanical covering of the perforation substantially reduced crusting and epistaxis, and it improved nasal respiration in many cases. PMID:760710

  15. [Acute duodenal obstruction due to incomplete duodenal diaphragm and foreign bodies in a two-year old child (author's transl)].

    PubMed

    Ruiz Jiménez, J I; Gualda Cantón, J; Sánchez, E B

    1977-03-01

    A case of congenital incomplete duodenal diaphragm associated to foreign bodies, in a 28 months child with Down's syndrom is reported. This case had an acute beginning of the symptoms and a severe clinical picture. We discuss the clinical features diagnostic and therapeutic aspects. PMID:145197

  16. Author's personal copy Perforated diode neutron detector modules fabricated from

    E-print Network

    Shultis, J. Kenneth

    Author's personal copy Perforated diode neutron detector modules fabricated from high Perforated detectors Perforated diodes a b s t r a c t Compact neutron detectors are being designed and tested for use as low-power real-time personnel dosimeters. The neutron detectors are pin diodes

  17. Laparoscopic oxidized cellulose (Surgicel) application for small uterine perforations

    Microsoft Academic Search

    J. B. Sharma; M. Malhotra; P. Pundir

    2003-01-01

    Objectives: To test the efficacy and safety of laparoscopic oxidized cellulose application at the uterine perforation site. Methods: In a prospective study over a 3.5-year period a total of 30 women undergoing combined surgical termination of pregnancy and laparoscopic sterilization who had a small uterine perforation were recruited. Oxidized cellulose (Surgicel) was inserted and attached to the perforation site with

  18. [Endovascular closure of iatrogenic arteriovenous anastomosis of the iliac artery and vein].

    PubMed

    Sin'kov, M A; Murashkovski?, A L; Pogorelov, E A; Golovin, A A; Kalinichenko, N A; Khaes, B L; Kokov, A N; Kheraskov, V Iu; Evtushenko, S A; Popov, V A; Barbarash, L S

    2014-01-01

    The presented herein clinical case report concerns successful endovascular closure of a iatrogenic lesion of the iliac artery and inferior vena cava with formation of a pathological arteriovenous anastomosis manifesting itself by venous thromboembolic syndrome and severe right-ventricular insufficiency. PMID:24722024

  19. From cysteamine to MPTP: structure-activity studies with duodenal ulcerogens

    SciTech Connect

    Szabo, S.; Cho, C.H.

    1988-01-01

    Cysteamine is the first chemical identified that induces acute and chronic duodenal ulcers in rodents. Structure-activity studies with cysteamine, propionitrile and their derivatives, as well as with analogues of toluene, revealed numerous alkyl and aryl duodenal ulcerogens. Among these, one of the most interesting from an etiologic and pathogenetic point of view is the dopaminergic neurotoxin MPTP, which shows structural similarities with toluene. The chemically-induced duodenal ulcers are similar and localized on the anterior and posterior wall of the duodenal bulb. Both cysteamine and MPTP affect endogenous dopamine; MPTP is especially potent in depleting central dopamine and inducing lesions in the substantia nigra. MPTP given in high doses induces Parkinson's disease-like syndrome and gastric ulcers. Cysteamine and propionitrile also cause dyskinesia in large and multiple doses. The motility disorders and duodenal ulcers are abolished by dopamine agonists. Cysteamine and MPTP have been known to increase and decrease gastric acid secretion, respectively. However, both compounds induced duodenal dysmotility, decreased bicarbonate production, and reduced its delivery from distal to proximal duodenum. These factors decrease acid neutralization in the duodenal bulb and contribute to duodenal ulceration. Thus, studies with animal models may reveal endogenous mediators and specific receptors which might be involved in the pathogenesis of duodenal ulceration. Specific structure-activity studies in toxicology may lead to new insights in the pathogenesis and pharmacology of a poorly understood human disorder such as duodenal ulceration. 39 references.

  20. Decorative crystal balls causing intestinal perforation

    PubMed Central

    Mirza, Bilal; Ijaz, Lubna; Sheikh, Afzal

    2011-01-01

    Crystal jelly balls are used for decorative purpose in homes and offices. They swell on contact with water. We managed a patient with a clinical diagnosis of acute abdomen. At surgery, there was fecal peritonitis and three ileal perforations caused by previously ingested decorative crystal balls. PMID:21897572

  1. Perforating globe injury from Taser trauma.

    PubMed

    Teymoorian, Savak; San Filippo, Ashley N; Poulose, Abraham K; Lyon, David B

    2010-01-01

    We report a case of a blinding, perforating globe injury from Taser trauma. There have been other instances involving similar circumstances, but this traumatic event resulted in the loss of all meaningful vision and eventual enucleation. Despite meticulous planning and intervention, however, Taser trauma can result in devastating ocular injury. PMID:20551855

  2. Dimensional scaling for impact cratering and perforation

    Microsoft Academic Search

    Alan J. Watts; Dale Atkinson

    1995-01-01

    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

  3. Landing gear noise control using perforated fairings

    NASA Astrophysics Data System (ADS)

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

    2010-05-01

    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.

  4. [Small bowel perforation caused by magnetic toys].

    PubMed

    Schroepfer, E; Siauw, C; Hoecht, B; Meyer, T

    2010-06-01

    Accidental ingestion of foreign bodies is a common problem in infants and childhood, but ingestion of magnetic construction toys is very rare. In the case of ingestion of multiple parts of these magnetic construction toys, they may attract each other through the intestinal walls, causing pressure necrosis, perforation, fistula formation or intestinal obstruction. A 20-month-old boy presented with a three-day history of abdominal pain and bilious vomiting. Physical examination revealed a slighted distended abdomen. The -white blood cell count was increased, but the C-reactive protein was normal. Ultrasound and X-ray of the abdomen showed a distended bowel loop in the right upper quadrant, a moderate amount of free intraperitoneal liquid and 4 foreign bodies. Emergency laparotomy was performed and 2 perforations in the ileum were detected. The perforations were caused by a magnetic construction toy and 2 iron globes. The fourth foreign body was a glass marble. The foreign bodies were removed, both perforations were primarily sutured. The child was discharged on postoperative day 10 after an uneventful recovery. Parents should be warned against the potential dangers of children's constructions toys that contain these kinds of magnets. PMID:20549590

  5. Thermometers and rectal perforations in the neonate

    Microsoft Academic Search

    J D Frank; S Brown

    1978-01-01

    Three neonates with rectal perforations probably caused by the use of the rectal thermometer, are reported. The dangers of this condition and the difficulty of diagnosis even at laporatomy are emphasised. It is suggested that since the axillary temperature in the neonate is an adequate reflection of the core temperature the routine use of the rectal thermometer, except in exceptional

  6. Postvaginal Delivery Caecal Volvulus and Perforation

    PubMed Central

    Abdullah Agha, M. M.

    2012-01-01

    Intestinal obstruction is an uncommon complication of pregnancy and pueperium. It has different etiologies and voluvlus is one of the common causes. High index of suspicion is needed to diagnose it as initial presentation is nonspecific and that is critical to avoid adverse outcomes. We presented here one of these cases that followed vaginal delivery and ended with caecal perforation and hemicolectomy. PMID:22567529

  7. Iatrogenic infections in urological practice: concepts of pathogenesis, prevention and management.

    PubMed

    Shokeir, Ahmed A; Al Ansari, Abdulla A

    2006-01-01

    In this paper we review the pathogenesis, prevention and management of iatrogenic infection in urological practice. A systematic literature search was conducted using MEDLINE. The topics discussed include the commonest home-care, outpatient, endourologic and open surgical procedures. In addition, we discuss iatrogenic urinary infections associated with special situations, including urinary diversion, urologic prostheses, diabetes mellitus, dialysis, kidney transplantation and complicated urinary tract infections (UTIs). The findings of the literature review are as follows. Prophylactic antibiotics are not recommended with clean intermittent catheterization. With prolonged catheterization, antibiotics should not be used unless symptoms of pyelonephritis or septicemia become apparent. With transrectal prostate biopsy, infection can be prevented by rectal cleansing, use of smaller needles and administration of antimicrobial prophylaxis before and after the procedure. With ureteral stents, antibiotics should be restricted to patients with clinical signs of infection and high-risk patients. Infections after transurethral resection of the prostate can be prevented by avoiding risk factors and using perioperative antibiotics. In endourological procedures, antibiotic prophylaxis is indicated in cases of infected stones, preoperative UTIs or prolonged procedures. Antibiotics are not recommended for clean wounds, as prophylaxis for clean-contaminated wounds or as therapy for contaminated and dirty wounds. In patients with urinary diversion, the objective is to prevent pyelonephritis by avoiding both reflux and obstruction of the upper urinary tract. In patients with urological prostheses, the most important measure to overcome iatrogenic infection is prevention. In dialysis patients, iatrogenic infections can be prevented by the development of new catheter materials that are less susceptible to biofilms. In kidney transplant recipients, iatrogenic infections can be prevented by treating all types of infection prior to transplantation and by using peri- and postoperative prophylactic antibiotics. PMID:16608804

  8. [Management of septal perforations by rotationplasty of the septal mucosa].

    PubMed

    Rettinger, G; Masing, H; Heinl, W

    1986-11-01

    A unilateral mucosal flap from the septum with a wide pedicle and an axial blood supply was used for closure of septal perforations. In special cases this procedure was combined with a labial-buccal flap. 18 patients with perforations of different sizes were treated resulting in a permanent and complete closure in 12 cases. Relief of complaints was also noticed in the six patients with residual perforations. We therefore conclude that diminution and shifting of the perforation may be sufficient to relieve symptoms. The technique proved to be a safe and physiological procedure for the patients with septal perforations. PMID:3542912

  9. High degree of duodenal inflammation in Nigerians with functional dyspepsia

    PubMed Central

    Nwokediuko, Sylvester Chuks; Ijoma, Uchenna N; Obienu, Olive; Anigbo, Gideon E; Okafor, Okechukwu

    2014-01-01

    Background Functional dyspepsia (FD) is a heterogeneous disorder associated with diverse pathophysiological mechanisms, including immune activation and low-grade mucosal inflammation. Genetic factors, physiological functions, and environmental factors may determine the relative importance of various pathophysiological mechanisms. This study was designed to determine the histological alterations in the duodenal mucosa of Nigerian patients with FD. Methods Consecutive patients with dyspepsia seen over a 27-month period in two gastrointestinal endoscopy facilities in Enugu, South-East Nigeria were further evaluated with upper gastrointestinal endoscopy and duodenal mucosal biopsies if no lesion was found in the upper gastrointestinal tract. Patients with heartburn and/or regurgitation who did not have any dyspeptic symptoms and did not have any lesion in the upper gastrointestinal tract on endoscopy were presumed to have non-erosive reflux disease (NERD) and they served as controls. The control subjects also had duodenal biopsies. The histopathological findings in the cases and controls were compared. Results There were 68 patients with FD and 52 patients with NERD. The total inflammatory score was 242 in FD and 66 in NERD (Mann-Whitney U =1168, P=0.0011). Similarly, the scores for chronic inflammation, gastric metaplasia, neutrophilic activity, eosinophilic infiltration, and Helicobacter pylori were significantly higher in FD than NERD. Conclusion Functional dyspepsia is associated with a high degree of inflammation in the duodenal mucosa. This may reflect the high prevalence of gastrointestinal infections in a tropical environment such as Nigeria. These findings may have therapeutic potential that further studies might elucidate. PMID:24403840

  10. Ulcerative duodenitis with luminal constriction in two horses.

    PubMed

    Ettlinger, J J; Ford, T; Palmer, J E

    1990-05-15

    Proximal enteritis was diagnosed on the basis of clinical signs of disease in 2 Standard-bred yearlings from the same farm. Large volumes of fluid were repeatedly obtained during gastric decompression. The horses did not respond to treatment with IV administered fluids, antimicrobial agents, cimetidine, and metoclopramide. Postmortem findings confirmed severe focal chronic active duodenitis with stricture formation. An etiologic agent was not identified. PMID:2347756

  11. [Factors effecting recurrence of duodenal ulcers after highly selective vagotomy].

    PubMed

    Fibak, J; Onyszkiewicz, A J; S?owi?ski, K; Burchardt, W; Kolasi?ski, J

    Recurrence of duodenal ulcer was diagnosed in 15 patients who underwent highly selective vagotomy before 6-13 years, i.e. in 12.2%. Factors possibly contributing to such a recurrence were analysed. Patients with ulcer recurrence were: 1) non-qualified workers, 2) tobacco smokers, 3) heavy drinkers, 4) users of ulcerogenic medicines, and 5) were involved into conflict situations. PMID:1669456

  12. Duodenal gangliocytic paraganglioma: A case report and literature review

    PubMed Central

    Loftus, Tyler J.; Kresak, Jesse L.; Gonzalo, David H.; Sarosi, George A.; Behrns, Kevin E.

    2015-01-01

    Introduction Gangliocytic paraganglioma is a rare tumor that is most commonly located in the duodenum. At presentation, it may be confused with a gastrointestinal stromal tumor (GIST), but distinguishing between these tumors is critical because the natural history and treatment of these two tumors differs markedly. Duodenal gangliocytic paraganglioma typically exhibits benign behavior with occasional regional lymph node metastasis and no reports of tumor associated deaths. Recurrence after resection is rare. Presentation of case A 50 year-old male presented with melena and hemoglobin concentration of 4.6 g/dl. Esophagogastroduodenoscopy demonstrated a submucosal mass in the third portion of the duodenum with no active bleeding. CT scan identified no regional lymphadenopathy or distant metastasis. The tumor was resected through a longitudinal duodenotomy with negative margins. Discussion Endoscopic resection of duodenal gangliocytic paraganglioma appears to be safe and effective when tumor may be removed in its entirety by this method. If the tumor is not suspended by a stalk or there is suspicion for regional lymph node disease then surgical management is preferred. Radiation oncologists at high volume centers have endorsed utilization of adjuvant radiotherapy to the postsurgical bed in cases involving lymph node metastasis. Utilization of chemotherapy for management of this disease has not been reported. Conclusion Localized duodenal gangliocytic paragangliomas are best managed by resection with negative margins. In cases in which the tumor is resected with negative margins, it appears to be safe to embark on a course of surveillance and forego adjuvant therapy. PMID:25600615

  13. Splenosis mimicking an extramural duodenal mass: A case report

    PubMed Central

    DENG, YILEI; JIN, YANWEN; LI, FUYU; ZHOU, YONG

    2014-01-01

    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

  14. Splenosis mimicking an extramural duodenal mass: A case report.

    PubMed

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

    2014-12-01

    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

  15. Groove pancreatitis and pancreatic heterotopia in the minor duodenal papilla.

    PubMed

    Chatelain, Denis; Vibert, Eric; Yzet, Thierry; Geslin, Guillaume; Bartoli, Eric; Manaouil, David; Delcenserie, Richard; Brevet, Marie; Dupas, Jean-Louis; Regimbeau, Jean-Marc

    2005-05-01

    Groove pancreatitis is a rare form of segmental chronic pancreatitis that involves the anatomic space between the head of the pancreas, the duodenum, and the common bile duct. We report 2 cases of groove pancreatitis with pancreatic heterotopia in the minor papilla. Patients were a 44-year-old woman and a 47-year-old man. Both had a past history of alcohol consumption and presented with abdominal pain, vomiting, and weight loss caused by duodenal stenosis. Abdominal computed tomography revealed thickening of the duodenal wall and enlargement of the pancreatic head in both patients. In 1 patient, ultrasound endoscopy showed a dilated duct in the head of the pancreas. Pancreaticoduodenectomy was performed to rule out pancreatic adenocarcinoma and because of the severity of the symptoms. In both cases, gross and microscopic examinations showed fibrous scar of the groove area. The Santorini duct was dilated and contained protein plugs in both patients, with abscesses in 1 of them. In both cases, there were microscopic foci of heterotopic pancreas with mild fibrosis in the wall of the minor papilla. Groove pancreatitis is often diagnosed in middle-aged alcoholic men presenting with clinical symptoms caused by duodenal stenosis. The pathogenesis of this rare entity could be because of disturbance of the pancreatic secretion through the minor papilla. Pancreatitis in heterotopic pancreas located in the minor papilla and chronic consumption of alcohol seem to be important pathogenic factors. PMID:15841034

  16. Silymarin attenuates mycophenolate mofetil-induced duodenal disorders in rats

    PubMed Central

    Malekinejad, Hassan; Sheikhzadeh, Sanaz; Hobbenaghi, Rahim

    2014-01-01

    Objective: The protective effect of silymarin (SMN) on mycophenolate mofetil (MMF)–induced duodenal disorders was investigated. Materials and Methods: Forty-two Wistar rats were assigned to seven groups including control and test groups. The control animals received saline and the test animals were treated with MMF (30 mg/kg, orally) and saline, MMF and SMN (25, 50, and 100 mg/kg, orally), MMF and Celecoxib (CLX, 50 mg/kg, orally), and MMF and SMN plus CLX for 14 consecutive days. The antioxidant status and myeloperoxidase activity were determined and the histopathological examinations on duodenal section also were performed. Results: Biochemical analyses revealed that SMN and CLX individually and in combination therapy could reduce the MMF-increased nitric oxide (NO) content, myeloperoxidase (MPA) activity, and malondialdehyde (MDA) level, while the MMF-reduced level of total thiol molecules (TTM) was increased significantly (p<0.05) by given compounds. Concurrent administration of SMN and CLX resulted in a synergistic effect on the reduction of MDA level and MPO activity. SMN and CLX were able to improve the MMF-induced histopathological damages including the villus atrophy and inflammatory cells infiltration. Conclusion: Our data suggest that the MMF-induced duodenal disorders may attribute to the elevated NO and MDA levels and myeloperoxidase activity that resulted in pathological injuries. Moreover, the biochemical alterations and histopathological injuries due to MMF administration were reduced by SMN alone or in combination with CLX indicating its protective effect. PMID:25050315

  17. The Perforation-Operation time Interval; An Important Mortality Indicator in Peptic Ulcer Perforation

    PubMed Central

    Surapaneni, Sushama; S, Rajkumar; Reddy A., Vijaya Bhaskar

    2013-01-01

    Objective: To find out the significance of the Perforation-Operation Interval (POI) with respect to an early prognosis, in patients with peritonitis which is caused by peptic ulcer perforation. Study Design: Case series. Place and Duration of the Study: Department of General Surgery, Konaseema Institute of Medical Sciences and RF Amalapuram, Andhra Pradesh, India from 2008-2011. Materials and Method: This study included 150 patients with generalized peritonitis, who were diagnosed to have Perforated Peptic Ulcers (PPUs). The diagnosis of the PPUs was established on the basis of the history , the clinical examination and the radiological findings. The perforation-operation interval was calculated from the time of onset of the symptoms like severe abdominal pain or vomiting till the time the patient was operated. Result: Out of the 150 patients 134 were males and 16 were females, with a male : female ratio of 9:1. Their ages ranged between 25-70 years. Out of the 150 patients, 65 patients (43.3%) presented within 24 hours of the onset of severe abdominal pain (Group A), 27 patients (18%) presented between 24-48 hours of the onset of severe abdominal pain (Group B) and 58 patients (38.6%) presented after 48 hours. There was no mortality in Group A and the morbidity was more in Group B and Group C. There were 15 deaths in Group C. Conclusion: The problem of peptic ulcer perforation with its complication, can be decreased by decreasing the perforation –operation time interval, which as per our study, appeared to be the single most important mortality and morbidity indicator in peptic ulcer perforation. PMID:23814733

  18. Analysis of 22 Posterior Ulnar Recurrent Artery Perforator Flaps: A Type of Proximal Ulnar Perforator Flap

    PubMed Central

    Mateev, Musa A.; Trunov, Leonid; Hyakusoku, Hiko; Ogawa, Rei

    2010-01-01

    Background: The proximal ulnar artery has several branches, including perforators that are directly derived from the ulnar artery and anterior/posterior recurrent arteries. There are only a few reports of flaps that use the anterior/posterior recurrent arteries, and flaps employing their perforators as a main pedicle are yet to be reported. In this study, posterior ulnar recurrent artery perforator (PURAP) flaps were employed for elbow and forearm reconstruction. Methods: The 22 cases of reconstruction by PURAP flaps were analyzed in terms of the cause of injury, the recipient site, the vascular pedicle of the flap, flap size and survival, and the quality of the outcome. Donor-site morbidity, including the development of scars and numbness, was also evaluated. Results: All flaps were vascular pedicled island flaps. The perforator used was the medial and posterior perforator in 14 (63.6%) and 8 (36.4%) cases, respectively. The average flap size was 10 × 5 cm. Six months after the operation, the outcomes were judged to be excellent in 15 cases (68.2%), good in 6 cases (27.3%), and poor in 1 case (4.5%) because of partial necrosis of the distal part of the flap. Conclusions: PURAP flaps can be harvested with 2 types of perforator pedicles (the medial or posterior perforator) and offer greater safety and flexibility, and less donor-site morbidity, than existing flaps used for elbow and forearm reconstruction. The ability to close the donor site primarily is a significant benefit of this flap. PMID:20076784

  19. Recurrent duodenal diverticulitis after surgical resection of the diverticulum: a case report and literature review.

    PubMed

    Razdan, Rishi; Oatis, Kristi; Specht, Neil

    2011-09-01

    Duodenal diverticulitis has been considered a rare entity. The diagnosis with computed tomography has become a fast and noninvasive means of detection and guide to management. Cases of surgically resected duodenal diverticula reforming and reinfecting are rarer yet, often presenting with similar symptoms. Duodenal diverticulitis can present with a wide range of symptoms mimicking anything from gastritis to acute abdomen, or as in the case of our patient, as mid abdominal pain with newly developed liver abscess. According to the literature, duodenal diverticula are incidentally discovered at a rate of 5% to 10% in living adults and in up to 22% at autopsy. PMID:21980677

  20. The therapeutic strategy for autoimmune pancreatitis is subject to the endoscopic features of the duodenal papilla.

    PubMed

    Kubota, Kensuke; Nakajima, Atushi

    2010-11-01

    Autoimmune pancreatitis (AIP) often presents with a swollen duodenal papilla, however, the clinical significance of the duodenal papilla in AIP has not been fully elucidated. Data have shown swollen duodenal papillae shaped like a pear and/or with a submucosal tumor having IgG4-bearing plasma cells. Immunohistopathology has potentially verified duodenal papillitis associated with AIP. FOXP3-positive lymphocytes are also recognized in AIP. AIP has shown spontaneous remission and relapse irrelevance to corticosteroid therapy. The results of a multivariate analysis revealed the absence of a swollen duodenal papilla as the only significant independent factor predictive of spontaneous remission in AIP cases. In addition, the results of another multivariate analysis revealed the presence of a swollen duodenal papilla and the presence of extrapancreatic lesions as the significant independent factors predictive of relapse in these cases. Results suggest that the lack of a swollen duodenal papilla is a predictive factor for spontaneous remission, and thus negates the need to administer corticosteroids in those AIP patients. In contrast, a swollen duodenal papilla and the presence of extrapancreatic lesions are risk factors for relapse, and those AIP patients are candidates for maintenance corticosteroid therapy to reduce relapse. Therefore, the therapeutic strategy such as the indication for corticosteroid administration is subject to the endoscopic features of the duodenal papilla. PMID:21180617

  1. Predicting the amount of intraperitoneal fluid accumulation by computed tomography and its clinical use in patients with perforated peptic ulcer.

    PubMed

    Ishiguro, Toru; Kumagai, Youichi; Baba, Hiroyuki; Tajima, Yusuke; Imaizumi, Hideko; Suzuki, Okihide; Kuwabara, Koki; Matsuzawa, Takeaki; Sobajima, Jun; Fukuchi, Minoru; Ishibashi, Keiichiro; Mochiki, Erito; Ishida, Hideyuki

    2014-01-01

    Abstract The correlation between the amount of peritoneal fluid and clinical parameters in patients with perforated peptic ulcer (PPU) has not been investigated. The authors' objective was to derive a reliable formula for determining the amount of peritoneal fluid in patients with PPU before surgery, and to evaluate the correlation between the estimated amount of peritoneal fluid and clinical parameters. We investigated 62 consecutive patients who underwent emergency surgery for PPU, and in whom prediction of the amount of accumulated intraperitoneal fluid was possible by computed tomography (CT) using the methods described by Oriuchi et al. We examined the relationship between the predicted amount of accumulated intraperitoneal fluid and that measured during surgery, and the relationship between the amount of fluid predicted preoperatively or measured during surgery and several clinical parameters. There was a significant positive correlation between the amount of fluid predicted by CT scan and that measured during surgery. When patients with gastric ulcer and duodenal ulcer were analyzed collectively, the predicted amount of intraperitoneal fluid and the amount measured during surgery were each associated with the period from onset until CT scan, perforation size, the Mannheim peritoneal index, and the severity of postoperative complications according to the Clavien-Dindo classification. Our present results suggest that the method of Oriuchi et al is useful for predicting the amount of accumulated intraperitoneal fluid in patients with PPU, and that this would be potentially helpful for treatment decision-making and estimating the severity of postoperative complications. PMID:25437594

  2. Perforated Arc-Tabs for Jet Control

    NASA Astrophysics Data System (ADS)

    Chand, Dharmahinder Singh; Thanigaiarasu, S.; Elangovan, S.; Rathakrishnan, E.

    2011-06-01

    This paper presents the effectiveness of perforated arc tabs to enhance the mixing of axi-symmetric subsonic and sonic jets. Measurements of centerline velocity decay and velocity distribution in the directions along and normal to the tabs were carried out in the controlled jet, from a convergent nozzle with two arc-tabs placed at diametrically opposite locations at the nozzle exit, were carried out. Similar measurements were done for the uncontrolled jets, for comparison. Mach 0.6, 0.7, 0.9 and sonic jet at nozzle pressure ratios 2 and 3 were tested. It is found that the perforated arc-tabs greatly enhance the jet mixing of both subsonic and sonic jets. The core length comes down by 65%, 66%, 62% and 75%, for Mach 0.6, 0.7, 0.9 and correctly expanded Mach 1 jets, respectively.

  3. [Perforated peptic ulcer disease in the elderly].

    PubMed

    Kondoh, Yasumasa

    2010-11-01

    There has been a marked decrease in elective surgery for peptic ulcer disease following introduction of medical therapies including H2-receptor antagonists (H2-RA) and proton pump inhibitors (PPI). By contrast, the incidence of emergency surgery for perforated peptic ulcer(PPU) has remained relatively unchanged, and potentially increased. Conservative treatment of PPU should be selected based on the physical condition of the patient. Open and laparoscopic repair of PPU are made with peritoneal lavage and omental patch closure of perforation. Laparoscopic repair of PPU seems better than open repair for low-risk patients. However, open repair for high-risk patients of PPU should not be delayed, and prognosis is affected primarily by concomitant medical comorbidity in the elderly. PMID:21061540

  4. Perforating devices for use in wells

    DOEpatents

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

    2002-01-01

    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.

  5. Discharge planning for children with perforated appendicitis.

    PubMed

    Birken, G A; Schropp, K P; Boles, E T; King, D R

    1986-07-01

    Optimal management of children with perforated appendicitis remains a controversial clinical problem. Until very recently, the criteria for hospital discharge on our surgical service included the absence of fever and leukocytosis for a period of 48 hours following completion of antimicrobial therapy, uncomplicated wound healing, a normal rectal examination, and unimpaired gastrointestinal function. With the introduction of cost-containment programs, the necessity for the period of inpatient observation following cessation of antibiotics was questioned. The records of 87 consecutive children with perforated appendicitis were analyzed prospectively in order to determine if our discharge policies were medically sound and cost-effective. Seventy-five patients (86%) recovered uneventfully while 12 children required prolonged hospitalization for management of various postoperative complications. The 12 patients who developed complications were all identifiable early in the postoperative period because of persistent fever, leukocytosis, and elevated band counts. Of the 75 children who recovered uneventfully, all met standard discharge criteria on the final day of antibiotic therapy with the exception of completing the mandatory 48-hour period of inpatient observation. These children were maintained in the hospital a total of 142 additional days following discontinuation of antibiotics. The average cost per patient day for children with perforated appendicitis during the study period was $506.32, which represented unnecessary hospital charges of $71,897.44. It was concluded that inpatient observation following cessation of antibiotic therapy in children who experience an uneventful recovery from perforated appendicitis is neither necessary nor cost-effective.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:3090226

  6. Socio-demographic and clinical features of Irish iatrogenic hepatitis C patients: a cross-sectional survey

    Microsoft Academic Search

    Olivia McKenna; Caitriona Cunningham; Catherine Blake

    2009-01-01

    BACKGROUND: A discrete sub-group of iatrogenically-acquired hepatitis C virus (HCV)-infected individuals exists in the Irish population on whom limited current research data is available. The aim of this study was to establish a current profile of the socio-demographic and clinical characteristics of the Irish iatrogenic hepatitis C population and to determine factors predicting symptoms experienced. METHODS: An anonymous, national, cross-sectional

  7. Perforation of thin unreinforced concrete slabs

    SciTech Connect

    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

    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.

  8. Occult glove perforation during ophthalmic surgery.

    PubMed Central

    Apt, L; Miller, K M

    1992-01-01

    We examined the latex surgical gloves used by 56 primary surgeons in 454 ophthalmic surgical procedures performed over a 7-month period. Of five techniques used to detect pinholes, air inflation with water submersion and compression was found to be the most sensitive, yielding a 6.80% prevalence in control glove pairs and a 21.8% prevalence in postoperative study glove pairs, for a 15.0% incidence of surgically induced perforations (P = 0.000459). The lowest postoperative perforation rate was 11.4% for cataract and intraocular lens surgery, and the highest was 41.7% for oculoplastic procedures. Factors that correlated significantly with the presence of glove perforations as determined by multiple logistic regression analysis were oculoplastic and pediatric ophthalmology and strabismus surgical procedures, surgeon's status as a fellow in training, operating time, and glove size. The thumb and index finger of the nondominant hand contained the largest numbers of pinholes. These data suggest strategies for reducing the risk of cross-infection during ophthalmic surgery. PMID:1494836

  9. Acute Iatrogenic Polycythemia Induced by Massive Red Blood Cell Transfusion During Subtotal Abdominal Colectomy

    PubMed Central

    Chiapaikeo, David; Rohani, Pejman

    2015-01-01

    A 46 year old man was transfused ten units of packed red blood cells during subtotal colectomy after intraoperative point-of-care testing values demonstrated hemoglobin values less than seven grams per deciliter (g/dL). A postoperative hemoglobin analyzed in a standard hematologic laboratory revealed a hemoglobin value of 27.8 g/dL. He underwent emergent red blood cell depletion therapy which decreased his hemoglobin to 7.5 g/dL. The physiologic consequences of iatrogenic polycythemia caused by massive transfusion during major abdominal surgery must take into account the fluid shifts that interplay between the osmotic load, viscosity of blood, and postoperative third spacing of fluid. Treatment of acute iatrogenic polycythemia can be effectively accomplished by red blood cell depletion therapy. However, fluid shifts caused by massive transfusion followed by rapid red cell depletion produce a unique physiologic state that is without a well-described algorithm for management.

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

    PubMed

    Bergenholtz, G

    1991-04-01

    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

  11. Mesenchymal stem cells in iatrogenic facial nerve paralysis: a possible role in the future

    Microsoft Academic Search

    Refik Caylan; Devrim Bektas; Tamer Dikmen; Ozlen Bektas; Serdar B. Omay; Ercument Ovali

    2006-01-01

    Iatrogenic facial nerve paralysis is one of the major and drastic complications of ear surgery. We report a case of a 20-year-old female patient with simple chronic otitis media who underwent mastoidectomy and tympanoplasty. During the mastoidectomy process the facial nerve was unintentionally destroyed, leaving a gap of 8–10 mm in the third segment of the intratemporal facial nerve. The nerve

  12. A nationally representative survey of hospital malnutrition: the Italian PIMAI (Project: Iatrogenic MAlnutrition in Italy) study

    Microsoft Academic Search

    Lucio Lucchin; Amleto D’Amicis; Maria Gabriella Gentile; Nino Carlo Battistini; Maria Antonia Fusco; Augusta Palmo; Maurizio Muscaritoli; Franco Contaldo; Emanuele Cereda

    2009-01-01

    Hospital malnutrition is high in every country it was investigated, but no nationally representative prevalence study, considering\\u000a potential geographical interfering factors, has yet been performed. We designed a multidisciplinary, cross-sectional, nation-wide\\u000a survey: the PIMAI study (Project: Iatrogenic MAlnutrition in Italy). Adult (>18 years old) patient inclusion was managed on\\u000a a four-strata randomisation model according to sex and age (<65 and

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

    PubMed Central

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

    2013-01-01

    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

  14. Iatrogenic Iliac Artery Rupture: Emergency Management by Longer Stent-Graft on a Shorter Balloon

    SciTech Connect

    Trehan, Vijay; Nigam, Arima; Ramakrishnan, S. [G. B. Pant Hospital, Department of Cardiology (India)], E-mail: ramakgmc@rediffmail.com

    2007-02-15

    Rupture of an iliac artery during percutaneous transluminal coronary angioplasty is a rare but potentially devastating complication. We report a case of iatrogenic external iliac artery rupture that was successfully treated by temporary balloon occlusion followed by endovascular stent graft placement in an unusual manner. Limited availability of the hardware necessitated the use of a longer bare stent graft mounted on a relatively shorter balloon.

  15. An Unusual Presentation of Neurofibroma Masquerading as a Vascular Hamartoma, Post-Iatrogenic Intervention

    PubMed Central

    Dash, Siba Prasad; Das, Subhabrata P; Rangan, Vasundhara S; Bhartiya, Subhash Chandra

    2015-01-01

    Neurofibroma is a localized discrete mass of benign nerve sheath tumour in the peripheral nervous system. Mostly present as skin lesions. Solitary neurofibroma may occur in deep soft tissue or subcutaneous plane in rare cases associated with syndromes like NF1. The neurofibroma most commonly present as skin lesions as isolated soft papules or nodules arising in any cutaneous site. Present case depicts unusual presentation of a neurofibroma as a vascular hamartoma post an iatrogenic intervention. PMID:25738032

  16. [A clinical study of traumatic tympanic membrane perforation].

    PubMed

    Yamazaki, Kazuharu; Ishijima, Ken; Sato, Hiroaki

    2010-08-01

    We reviewed 165 cases of traumatic tympanic membrane perforation treated in the last 9 years (2000-2008). Of these, 103 sustained direct injury and 62 indirect injury. Ear picking accounted for 90.3% of direct injuries. Perforation size followed the classification of Yoshikawa, with Grade I perforation the most common, according for 129 (78.2%). The anteroinferior quadrant perforation site was the most common, with 98 (59.4%). Of the 165, 66 were lost during followup. Of the remaining 99, perforations closed spontaneously in 85 (85.9%), within a mean 25.9 days. Tympanoplasty was done in 14, in whom postoperative hearing improved in 12. The remaining 2 had ossicular fractures associated with perilymph fistula. In the 14 undergoing surgery, tympanic membrane perforation relapsed in 4 and 2 developed cholesteatoma as tympanoplasty sequelae. PMID:20845710

  17. Otoscope fogging: examination finding for perforated tympanic membrane.

    PubMed

    Naylor, Jason F

    2014-01-01

    The author reports a recently recognised physical examination finding, otoscope fogging, for perforated tympanic membrane. Otoscope fogging is defined as condensation forming in the view field of the otoscope while inspecting the ear. In the setting of occult perforation secondary to the inability to visualise the entire tympanic membrane, otoscope fogging may provide the clinician with valuable information since medical management may differ if perforation is present. PMID:24879720

  18. Conservative Treatment of a Large Facial Midroot Perforation

    PubMed Central

    Bronnec, François

    2015-01-01

    Aim. To report on the endodontic and periodontal management of a root and alveolar process perforation in a maxillary front tooth. Summary. Perforation during access cavity preparation is an infrequent complication during endodontic therapy, leading to potential periodontal tissue breakdown. The case described the two-stage management of a massive facial root perforation requiring a connective tissue graft to correct a mucosal fenestration persisting after orthograde repair of the root defect with MTA.

  19. Effect of marrow perforation on the sheep temporomandibular joint.

    PubMed

    Ishimaru, J I; Kurita, K; Handa, Y; Goss, A N

    1992-08-01

    The effect of surgically perforating the mandibular condyle to allow synovial fluid to contact the marrow was examined in 5 sheep temporomandibular joints. The surgical defect showed replacement of the marrow with fibro-osseous tissue and subcortical cysts. A vertical, central osteophyte emerged from the perforation, causing attenuation or perforation of the disc and temporal surface proliferation. These changes were radiographically and histologically similar to advanced osteoarthritis. This supports the concept that intraarticular micro or macrofracture may result in osteoarthritis. PMID:1402055

  20. Reevaluation of duodenal endoscopic markers in the diagnosis of celiac disease

    Microsoft Academic Search

    Maria Teresa Bardella; Giorgio Minoli; Franco Radaelli; Maurizio Quatrini; Paolo A. Bianchi; Dario Conte

    2000-01-01

    Background: Loss or reduction of duodenal folds, scalloping of Kerkring folds and a micronodular or mosaic duodenal mucosal pattern have been described in celiac disease (CD), endoscopic findings that are considered reliable in the diagnosis of this disorder. However, most data have been obtained in patients with suspected or certain disease. We assessed the accuracy of the above markers in

  1. Adjuvant antibiotic therapy in duodenal ulcers treated with colloidal bismuth subcitrate

    Microsoft Academic Search

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

    1990-01-01

    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

  2. De-Nol stimulates gastric and duodenal alkaline secretion through prostaglandin dependent mechanism

    Microsoft Academic Search

    S J Konturek; J Bilski; N Kwiecien; W Obtuløwicz; B Kopp; J Oleksy

    1987-01-01

    This study was designed to determine the effects of colloidal bismuth subcitrate De-Nol on gastric HCO3- secretion in 24 healthy subjects and on gastric and duodenal HCO3- secretion in dogs with gastric and duodenal fistulae. Alkaline secretion was measured after pretreatment with ranitidine to abolish the H+ secretion using a constant perfusion aspiration system and back titration of the perfusates

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

    SciTech Connect

    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

    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.

  4. Endoscopic retrograde cholangiopancreatography-related perforation: Management and prevention

    PubMed Central

    Prachayakul, Varayu; Aswakul, Pitulak

    2014-01-01

    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

  5. Treatment of Strip Perforation Using Root MTA: A Case Report

    PubMed Central

    Froughreyhani, Mohammad; Salem Milani, Amin; Barakatein, Behnaz; Shiezadeh, Vahhab

    2013-01-01

    Root perforations are an undesired complication of endodontic treatment which result in loss of integrity of the root, and adversely affect the prognosis of the treatment. Recently, Iranian mineral trioxide aggregate [Root MTA] has been introduced as an ideal material for perforation repair. In this article a successful repair of strip root perforation of mandibular molar using Root MTA is presented with 15-month follow-up. This case suggests that Root MTA may be a substitute material for the treatment of strip perforation; however, more clinical studies with larger sample size and longer follow-ups are needed. PMID:23717336

  6. Spontaneous free perforation of the small intestine in adults

    PubMed Central

    Freeman, Hugh James

    2014-01-01

    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

  7. The inferior turbinate flap for closure of septal perforations.

    PubMed

    Vuyk, H D; Versluis, R J

    1988-02-01

    In 31 patients a symptomatic septal perforation was repaired using an inferior-turbinate flap originally described by Masing. In approximately 50% of the cases the perforation was closed for two-thirds or more. Postoperative scarring causing nasal obstruction or alar asymmetry occurred in 21% of the cases. Some specific symptoms such as epistaxis, whistling and frontal headache appeared to improve even after partial closure. However, the overall degree of satisfaction of the patients and the degree of closure of the perforation were related. Based on the results of this series the inferior-turbinate flap did not prove satisfactory for the closure of septal perforations. PMID:3370854

  8. Gas mediators involved in modulating duodenal HCO3(-) secretion.

    PubMed

    Takeuchi, K; Aihara, E; Kimura, M; Dogishi, K; Hara, T; Hayashi, S

    2012-01-01

    The secretion of HCO3(-) in the duodenum is increased by mucosal acidification, and this process is modulated by gas mediators such as nitric oxide (NO), hydrogen sulfide (H2S), and carbon monoxide (CO), in addition to prostaglandins (PGs). The secretion is increased by NOR3 (NO donor), NaHS (H2S donor), and CORM-2 (CO donor). The HCO3(-) responses to NOR3 and CORM-2 are attenuated by indomethacin, while that to NaHS is mitigated by indomethacin and L-NAME as well as sensory deafferentation. NOR3 and CORM-2 increase mucosal PGE2 production, while H2S increases mucosal PGE2 content and luminal NO release. The HCO3(-) response to mucosal acidification is attenuated by indomethacin, propargylglycine, and SnPP, each inhibiting PG, H2S and CO production, respectively. The acid-induced duodenal damage is worsened when either PG, H2S or CO is lacking. These findings suggest that 1) NO, H2S, and CO, generated endogenously or exogenously, stimulate HCO3(-) secretion in the duodenum; 2) the stimulatory action of NO and CO is mediated, at least partly, by endogenous PGs, while that of H2S is mediated by PGs and NO as well as sensory neurons; 3) these gas mediators are involved in the local regulation of acid-induced HCO3(-) secretion, in addition to endogenous PGs; 4) the acid-induced duodenal damage is worsened by agents inhibiting the endogenous production of NO, H2S or CO. It is assumed that these gas mediators play a role in maintaining the integrity of the duodenal mucosa by modulating the secretion of HCO3(-). PMID:22300075

  9. Adaptive changes of duodenal iron transport proteins in celiac disease.

    PubMed

    Barisani, Donatella; Parafioriti, Antonina; Bardella, Maria Teresa; Zoller, Heinz; Conte, Dario; Armiraglio, Elisabetta; Trovato, Cristina; Koch, Robert O; Weiss, Günter

    2004-05-19

    Iron deficiency is a manifestation of celiac disease (CD) usually attributed to a decreased absorptive surface, although no data on the regulation of iron transport under these conditions are currently available. Our aim was to evaluate divalent metal transporter 1 (DMT1), duodenal cytochrome b (Dcytb), ferroportin 1 (FP1), hephaestin, and transferrin receptor 1 (TfR1) expression, as well as iron regulatory protein (IRP) activity in duodenal biopsies from control, anemic, and CD patients. We studied 10 subjects with dyspepsia, 6 with iron-deficiency anemia, and 25 with CD. mRNA levels were determined by real-time PCR, protein expression by Western blotting or immunohistochemistry, and IRP activity by gel shift assay. Our results showed that DMT1, FP1, hephaestin, and TfR1 mRNA levels were significantly increased in CD patients with reduced body iron stores compared with controls, similar to what was observed in anemic patients. Protein expression paralleled the mRNAs changes. DMT1 protein expression was localized in differentiated enterocytes at the villi tips in controls, whereas with iron deficiency it was observed throughout the villi. FP1 expression was localized on the basolateral membrane of enterocytes and increased with low iron stores. TfR1 was localized in the crypts in controls but also in the villi with iron deficiency. These changes were paralleled by IRP activity, which increased in all iron-deficient subjects. We conclude that duodenal DMT1, FP1, hephaestin, and TfR1 expression and IRP activity, thus the iron absorption capacity, are upregulated in CD patients as a consequence of iron deficiency, whereas the increased enterocyte proliferation observed in CD has no effect on iron uptake regulation. PMID:15054143

  10. Influence of duodenal infusions of EPA and DHA on the lipidic milk secretion of the dairy goat

    E-print Network

    Paris-Sud XI, Université de

    Influence of duodenal infusions of EPA and DHA on the lipidic milk secretion of the dairy goat C and milk lipidic secretion. Seven lactating goats equipped with duodenal cannulae have followed 3 periods, P2, the goats were duodenally perfused, twice a day after milking with an emulsion providing 4 g

  11. Surgical Excision of Duodenal/Pancreatic Metastatic Renal Cell Carcinoma

    PubMed Central

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

    2014-01-01

    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

  12. Intramural duodenal hematoma after submucosal injection of epinephrine for a bleeding ulcer: case report and review

    PubMed Central

    DIBRA, A.; KËLLIÇI, S.; ÇELIKU, E.; DRAÇINI, Xh.; MATURO, A.; ÇELIKU, E.

    2015-01-01

    We present a case of intramural duodenal hematoma as a complication of endoscopic therapy for a bleeding duodenal ulcer in an adult patient with no evidence of other pathologies. A 18-year-old man was admitted in emergency room with gastrointestinal bleeding manifested by melena. Previous medical history revealed that he had endoscopic sclerotherapy for bleeding duodenal ulcer 5 months before. Endoscopy revealed a Forrest 2a ulcer in the duodenal bulb and sclerotherapy was performed by injecting 10 ml of 0.2% epinephrine and 20 ml of NaCl 0.9% solution. Upper occlusion’s signs appeared 36 hours after the procedure. The hematoma, that was identified by endoscopy and confirmed by MRI and CT scan of the abdomen, caused transient duodenal obstruction. Combined conservative management with nasogastric tube and total parenteral nutrition resulted in reduction of obstructive symptoms within 4 weeks. PMID:25827667

  13. Why is the coexistence of gastric cancer and duodenal ulcer rare? Examination of factors related to both gastric cancer and duodenal ulcer

    Microsoft Academic Search

    Hideyuki Ubukata; Hiroyuki Nagata; Teruhiko KasugaTakafumi Tabuchi; Satoru Konishi; Teruhiko Kasuga; Takafumi Tabuchi

    2011-01-01

    The coexistence of gastric cancer with duodenal ulcer has been found empirically to be rare, but why it is rare is difficult\\u000a to explain satisfactorily. To elucidate this question, we carried out a literature review of the subject. The frequency with\\u000a which the two diseases coexist is 0.1–1.7%, and the main factor associated with both gastric cancer and duodenal ulcer

  14. Cyanoacrylate adhesive perforator embolization (CAPE) of incompetent perforating veins of the leg, a feasibility study.

    PubMed

    Toonder, Irwin M; Lam, Yee Lai; Lawson, James; Wittens, Cees Ha

    2014-05-19

    Consideration of treating incompetent perforating veins remains a conundrum based on scientific evidence available till date. While subfascial endoscopic perforator surgery (SEPS) proved to be a worthy alternative for open surgery, other even less invasive techniques were being introduced by the late nineties of the last century. Percutaneous thermo-ablation techniques are still being used today and seem more effective than non-thermal techniques. However, thermal techniques require anaesthesia and potentially may cause inadvertent damage to surrounding tissues such as nerves. Cyanoacrylate adhesive has a proven record, but not for the treatment of chronic venous disease of the leg. Innovation has led to the development of the VenaSeal® Sapheon Closure System which has been designed to use a modified cyanoacrylate glue as a new therapy for truncal vein incompetence. This paper explores the feasibility of ultrasound guided cyanoacrylate adhesive perforator embolization (CAPE). Results show a 76% occlusion rate of incompetent perforating veins without serious complications leading to the conclusion that further investigation with a dedicated delivery device in a larger patient population is warranted. PMID:24843086

  15. Palliation of Malignant Biliary and Duodenal Obstruction with Combined Metallic Stenting

    SciTech Connect

    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

    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.

  16. Preoperative identification of a perforator using computed tomography angiography and metal clip marking in perforator flap reconstruction.

    PubMed

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

    2015-01-01

    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

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

    PubMed Central

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

    2015-01-01

    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

  18. Pressure enhanced penetration with shaped charge perforators

    DOEpatents

    Glenn, Lewis A. (Danville, CA)

    2001-01-01

    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.

  19. Bladder Perforation Secondary to Primary Systemic Amyloidosis

    PubMed Central

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

    2014-01-01

    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

  20. Endoscopic management of a primary duodenal carcinoid tumor.

    PubMed

    Abraham, Albin; Singh, Jaspreet; Siddiqui, Ghulam; Prasad, Apsara; Rashid, Sadat; Vardaros, Magdalene; Garg, Vikas; Rizvon, Kaleem; Subramani, Krishnaiyer; Mustacchia, Paul

    2012-01-01

    Carcinoids are rare, slow-growing tumors originating from a variety of different neuroendocrine cell types. They are identified histologically by their affinity for silver salts and by positive reactions to neuroendocrine markers such as neuron-specific enolase, synaptophysin and chromogranin. They can present with various clinical symptoms and are difficult to diagnose. We present the case of a 43-year-old woman who was referred for evaluation of anemia. Upper endoscopy showed a duodenal bulb mass around 1 cm in size. Histopathological and immunohistochemistry staining were consistent with the diagnosis of a carcinoid tumor. Further imaging and endoscopic studies showed no other synchronous carcinoid lesions. Endoscopic ultrasound (EUS) revealed a 1 cm lesion confined to the mucosa and no local lymphadenopathy. Successful endoscopic mucosal resection of the mass was performed. Follow-up surveillance 6 months later with EUS and Octreoscan revealed no new lesions suggestive of recurrence. No consensus guidelines exist for the endoscopic management of duodenal carcinoid tumors. However, endoscopic resection is safe and preferred for tumors measuring 1 cm or less with no evidence of invasion of the muscularis layer. PMID:22679400

  1. Jejunal perforation caused by abdominal angiostrongyliasis.

    PubMed

    Waisberg, J; Corsi, C E; Rebelo, M V; Vieira, V T; Bromberg, S H; dos Santos, P A; Monteiro, R

    1999-01-01

    The authors describe a case of abdominal angiostrongyliasis in an adult patient presenting acute abdominal pain caused by jejunal perforation. The case was unusual, as this affliction habitually involves the terminal ileum, appendix, cecum or ascending colon. The disease is caused by the nematode Angiostrongylus costaricensis, whose definitive hosts are forest rodents while snails and slugs are its intermediate hosts. Infection in humans is accidental and occurs via the ingestion of snail or slug mucoid secretions found on vegetables, or by direct contact with the mucus. Abdominal angiostrongyliasis is clinically characterized by prolonged fever, anorexia, abdominal pain in the right-lower quadrant, and peripheral blood eosinophilia. Although usually of a benign nature, its course may evolve to more complicated forms such as intestinal obstruction or perforation likely to require a surgical approach. Currently, no efficient medication for the treatment of abdominal angiostrongyliasis is known to be available. In this study, the authors provide a review on the subject, considering its etiopathogeny, clinical picture, diagnosis and treatment. PMID:10602548

  2. Severe metallosis leading to femoral head perforation.

    PubMed

    Sharma, Om Prakash; Lochab, Jasjit; Berkovich, Yaron; Safir, Oleg A; Gross, Allan E

    2013-02-01

    This article describes a case of severe metallosis in a 67-year-old woman who initially underwent primary total hip arthroplasty with a ceramic-on-ceramic articular bearing. This was subsequently revised to a metal-on-polyethylene articulation due to ceramic liner fracture. She presented with severe hip pain and a pelvic mass. Infective workup was negative. Perforation of the cobalt-chrome femoral head was observed intraoperatively. In addition, signs of extensive metallosis, including embedded ceramic debris from the primary procedure, were observed. To the authors' knowledge, this is the first report of a ceramic fracture that led to cobalt-chrome femoral head perforation after subsequent revision total hip arthroplasty. The patient underwent successful revision surgery with a ceramic-on-ceramic coupling. Ceramic materials are increasingly being used in total hip arthroplasty in younger patients. They have excellent tribological properties. However, they also have a lower elasticity and plasticity, which makes them susceptible to sudden material failure. Ceramic fracture is an uncommon yet problematic complication of total hip arthroplasty. Previous authors have reported the importance of performing thorough synovectomy following ceramic liner fracture. Revision surgery using couplings that have a lower hardness, such as metal-on-polyethylene, are best avoided due to their susceptibility to undergo abrasive wear from remaining ceramic particles. The authors advocate revision with ceramic-on-ceramic couplings after ceramic liner fracture. PMID:23383625

  3. Acoustic analysis of elliptical muffler chamber having a perforated pipe

    Microsoft Academic Search

    Nishimura Sohei; Nishimura Tsuyoshi; Yano Takashi

    2006-01-01

    Evidently, a perforated pipe is an essential component in muffler systems. It has the ability to reduce the power levels of noise sources generated by flow. Muffler systems are composed of several elements joined together in series or parallel. In practical approach, each element can have one or more perforated pipe installed. This yields the ability to estimate the acoustic

  4. Modeling and applications of partially perforated intruding tube mufflers

    Microsoft Academic Search

    H. Luo; C. C. Tse; Y. N. Chen

    1995-01-01

    In this study, a new approach is presented for modeling concentric partially perforated intruding tube mufflers. For acoustic impedance in the linear regime, a closed form solution of the partially perforated intruding tube muffler transmission loss was first obtained. With this restriction and in the case of zero mean flow, excellent agreement between predicted and experimental results for various muffler

  5. Acoustic Transmission Loss of Perforated Plates Vincent Phong1

    E-print Network

    Papamoschou, Dimitri

    of perforated facing backed by a porous material. Very early designs of these composite systems focused on the absorption characteristics of the porous material, where the perforated facing was used primarily to hold the porous material in place. The hole diameters of the facings were also very large, contributing very

  6. Laparotomy versus Peritoneal Drainage for Necrotizing Enterocolitis and Perforation

    Microsoft Academic Search

    R. Lawrence Moss; Reed A. Dimmitt; Douglas C. Barnhart; Karl G. Sylvester; Rebeccah L. Brown; David M. Powell; Saleem Islam; Jacob C. Langer; Thomas T. Sato; Mary L. Brandt; Hanmin Lee; Martin L. Blakely; Eric L. Lazar; Ronald B. Hirschl; Brian D. Kenney; David J. Hackam; Daniel Zelterman; Bonnie L. Silverman

    2006-01-01

    BACKGROUND Perforated necrotizing enterocolitis is a major cause of morbidity and mortality in premature infants, and the optimal treatment is uncertain. We designed this multi- center randomized trial to compare outcomes of primary peritoneal drainage with laparotomy and bowel resection in preterm infants with perforated necrotizing enterocolitis. METHODS We randomly assigned 117 preterm infants (delivered before 34 weeks of gestation)

  7. Powder composite materials for plugless facing of perforator shaped charges

    Microsoft Academic Search

    Yu. A. Bykov; T. E. Vorkina

    1994-01-01

    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

  8. Body Force Model for the Aerodynamics of Inclined Perforated Surfaces

    E-print Network

    Papamoschou, Dimitri

    that the effective porosity of the surface is affected by flow separation within the perforations. The flow blockage-bay turbulence [6], and reduction of jet noise [7] as the motivation for this study. Perforated screens are also structural loading, and can attenuate noise. The computational treatment of flows through and around porous

  9. Palatal perforation associated with intranasal prescription narcotic abuse

    Microsoft Academic Search

    Wendi M. Jewers; Yeshwant B. Rawal; Carl M. Allen; John R. Kalmar; Eric Fox; Guillermo E. Chacon; Parish P. Sedghizadeh

    2005-01-01

    BackgroundPalatal perforation resulting from insufflation of cocaine has been well documented. In comparison, reports of destructive orofacial lesions resulting from intranasal abuse of prescription narcotics are rare. We present the clinical and histologic findings in a case of palatal perforation arising in a patient abusing a prescription opioid drug. The patient denied any history of cocaine use but admitted to

  10. Active Control of Liner Impedance by Varying Perforate Orifice Geometry

    NASA Technical Reports Server (NTRS)

    Ahuji, K. K.; Gaeta, R. J., Jr.

    2000-01-01

    The present work explored the feasibility of controlling the acoustic impedance of a resonant type acoustic liner. This was accomplished by translating one perforate over another of the same porosity creating a totally new perforate that had an intermediate porosity. This type of adjustable perforate created a variable orifice perforate whose orifices were non-circular. The key objective of the present study was to quantify, the degree of attenuation control that can be achieved by applying such a concept to the buried septum in a two-degree-of-freedom (2DOF) acoustic liner. An additional objective was to examine the adequacy of the existing impedance models to explain the behavior of the unique orifice shapes that result from the proposed silding perforate concept. Different orifice shapes with equivalent area were also examined to determine if highly non-circular orifices had a significant impact on the impedance.

  11. Optimal conditions for tissue perforation using high intensity focused ultrasound

    NASA Astrophysics Data System (ADS)

    Mochizuki, Takashi; Kihara, Taizo; Ogawa, Kouji; Tanabe, Ryoko; Yosizawa, Shin; Umemura, Shin-ichiro; Kakimoto, Takashi; Yamashita, Hiromasa; Chiba, Toshio

    2012-10-01

    To perforate tissue lying deep part in body, a large size transducer was assembled by combining four spherical-shaped transducers, and the optimal conditions for tissue perforation have studied using ventricle muscle of chicken as a target. The ex vivo experiments showed that ventricle muscle was successfully perforated both when it was exposed to High Intensity Focused Ultrasound (HIFU) directly and when it was exposed to HIFU through atrial muscle layer. Moreover, it was shown that calculated acoustic power distributions are well similar to the perforation patterns, and that the acoustic energy distributes very complexly near the focus. Lastly, perforation on the living rabbit bladder wall was demonstrated as a preliminary in vivo experiment.

  12. Primary Closure without Diversion in Management of Operative Blunt Duodenal Trauma in Children

    PubMed Central

    Smiley, Katherine; Wright, Tiffany; Skinner, Sean; Iocono, Joseph A.; Draus, John M.

    2012-01-01

    Background. Operative blunt duodenal trauma is rare in pediatric patients. Management is controversial with some recommending pyloric exclusion for complex cases. We hypothesized that primary closure without diversion may be safe even in complex (Grade II-III) injuries. Methods. A retrospective review of the American College of Surgeons' Trauma Center database for the years 2003–2011 was performed to identify operative blunt duodenal trauma at our Level 1 Pediatric Trauma Center. Inclusion criteria included ages <14 years and duodenal injury requiring operative intervention. Duodenal hematomas not requiring intervention and other small bowel injuries were excluded. Results. A total of 3,283 hospital records were reviewed. Forty patients with operative hollow viscous injuries and seven with operative duodenal injuries were identified. The mean Injury Severity Score was 10.4, with injuries ranging from Grades I–IV and involving all duodenal segments. All injuries were closed primarily with drain placement and assessed for leakage via fluoroscopy between postoperative days 4 and 6. The average length of stay was 11 days; average time to full feeds was 7 days. No complications were encountered. Conclusion. Blunt abdominal trauma is an uncommon mechanism of pediatric duodenal injuries. Primary repair with drain placement is safe even in more complex injuries. PMID:23213560

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

    SciTech Connect

    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

    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.

  14. Effect of tympanic membrane perforation on middle-ear sound transmission.

    PubMed

    Matsuda, Y; Kurita, T; Ueda, Y; Ito, S; Nakashima, T

    2009-01-01

    Tympanic membrane perforation causes a sound conduction disturbance, and the size of this conduction disturbance is proportional to the perforation area. However, precise evaluation of perforation size is difficult, and there are few detailed reports addressing this issue. Furthermore, such evaluation becomes more difficult for irregularly shaped perforations. This study conducted a quantitative evaluation of tympanic membrane perforations, using image analysis equipment.A significant correlation was found between the degree of sound conduction disturbance and the perforation area; this correlation was greater at low frequencies following a traumatic perforation. The conductive disturbance associated with chronic otitis media was significantly greater at low frequencies. Circular perforations caused only minor conduction disturbance. Perforations in the anteroinferior quadrant were associated with greater conduction disturbance. Traumatic spindle-shaped perforations and malleolar perforations were associated with greater conduction disturbance. PMID:19460211

  15. Iatrogenic Infection of Clostridium welchii Following Intramuscular Injection of Sodium Diclofenac

    PubMed Central

    Sathyanarayana, Hemavathi; Rani, Leela; Rajendran, R; Sarmah, Pooja

    2013-01-01

    Injection site abscess is an iatrogenic infection. Intramuscular (IM) injection is a common route to administer medication. Microorganisms known to cause injection site abscess are Staphylococcus aureus, Pseudomonas, Klebsiella, Escherichia coli commonly, Atypical mycobacteria, Clostridium species rarely. Gas gangrene is a necrotic infection of soft tissue with high mortality, often necessitating amputation in order to control the infection. Here, presenting a case of gas gangrene in a 19-year-old healthy male, who developed a life-threatening infection after IM injection of sodium diclofenac. Prompt clinical diagnosis, laboratory support, and timely surgical intervention saved the patient's life. PMID:24014972

  16. Extensive Iatrogenic Aortic Dissection During Renal Angioplasty: Successful Treatment with a Covered Stent-Graft

    SciTech Connect

    Rasmus, M.; Huegli, R.; Jacob, A.L. [University Hospital of Basel, Interventional Radiology (Switzerland); Aschwanden, M. [University Hospital of Basel, Department of Angiology (Switzerland); Bilecen, D. [University Hospital of Basel, Interventional Radiology (Switzerland)], E-mail: dbilecen@uhbs.ch

    2007-06-15

    An extensive iatrogenic aortic type B dissection during percutaneous transluminal renal angioplasty (PTRA) for bilateral renal artery stenosis was treated with a covered stent placed in the right renal artery. Control angiography confirmed closure of the entry. Postprocedural CT demonstrated a thick intramural hematoma (IMH) up to the left subclavian artery. CT follow-up at 8 months showed an almost complete resorption of the IMH. While medical treatment is the standard therapy for type B dissections, closure of the intimal tear with a covered stent may be an additional option in extensive cases during PTRA.

  17. Iatrogenic Left Main Coronary Artery Stenosis Following Aortic and Mitral Valve Replacement

    PubMed Central

    Alsaddah, Jadan; Alkandari, Saad; Younan, Hany

    2015-01-01

    Iatrogenic coronary artery disease following prosthetic valve implantation is a rare complication. This may result from mechanical injury in the intraoperative period. The use of balloon tip perfusion catheter presumably provides the initial insult with local vessel wall hypoxia. Once the diagnosis of coronary ostial stenosis is established, the procedure of choice is coronary artery bypass surgery. We report a case of a young lady who underwent aortic and mitral valves replacement for infective endocarditis. She was then diagnosed with ostial left main stem coronary stenosis after presenting with atypical symptoms. The patient eventually underwent coronary artery bypass surgery.

  18. Superficial ulnar artery: Clinical recommendations to avoid iatrogenic complications due to variation in arterial system

    PubMed Central

    Salunke, Abhijeet Ashok; Nambi, Gurunathampalayam Ilango; Dhanwate, Anant Dattatray; Siriwardana, Hettige Amila Ruwan Prasad

    2014-01-01

    Superficial ulnar artery is an uncommon variation in which the ulnar artery is having its course superficial to the flexors of the forearm and may arise directly from axillary or brachial arteries. The proper understanding and knowledge of variation of arterial systems is helpful for judicious planning of various reconstructive procedures in oncological, orthopaedic and reconstructive surgeries. We present a case of variant course of ulnar artery which was noted during exploration of a right distal forearm wound. We suggest few clinical recommendations to avoid iatrogenic complications due to variation in arterial system. PMID:25013265

  19. Duodenal epithelial transport in functional dyspepsia: Role of serotonin

    PubMed Central

    Witte, Anne-Barbara; D’Amato, Mauro; Poulsen, Steen Seier; Laurent, Agneta; Knuhtsen, Svend; Bindslev, Niels; Hansen, Mark Berner; Schmidt, Peter Thelin

    2013-01-01

    AIM: To investigate functional duodenal abnormalities in functional dyspepsia (FD) and the role of serotonin (5-hydroxytryptamine, 5-HT) in mucosal ion transport and signalling. METHODS: Duodenal mucosal biopsies were obtained from 15 patients with FD and 18 healthy controls. Immunohistochemistry was used to study the number of 5-HT-containing cells and real-time polymerase chain reaction for expression of 5-HT receptors 1A, 1B, 2A, 2B, 3A, 3B, 3C, 3D, 3E, 4 and 7, as well as expression of the serotonin re-uptake transporter (SERT) gene SLC6A4 and tryptophan hydroxylase 1 (TPH1). Biopsies were mounted in Ussing chambers for evaluation of basal and 5-HT-stimulated short-circuit current (SCC). RESULTS: Conductance was lower in FD [42.4 ± 4.7 mS/cm2 (n = 15) vs 62.5 ± 4.5 mS/cm2 (n = 18), P = 0.005]. 5-HT induced a dose dependent rise in SCC in both FD (n = 8) and controls (n = 9), the rise was lower in FD (P < 0.001). Mean number of 5-HT stained cells per high power field was the same [34.4 ± 8.4 in FD (n = 15) and 30.4 ± 3.7 in controls (n = 18), P = 0.647]. The following genes were highly expressed: 5-HT receptor HTR3E, HTR4, HTR7, SERT gene (SLC6A4) and TPH1. Differences in expression levels were observed for HTR3E (higher expression in FD, P = 0.008), HTR7 (lower expression in FD, P = 0.027), SLC6A4 (higher expression in FD, P = 0.033) and TPH1 (lower expression in FD, P = 0.031). CONCLUSION: Duodenal ion transport in response to exogenous 5-HT is abnormal in FD patients and associated with high expression of the HTR3E receptor and the serotonin transporter. PMID:23755368

  20. Severe diffuse duodenitis successfully treated with intravenous tacrolimus after colectomy for ulcerative colitis.

    PubMed

    Saito, Keiko; Katsuno, Tatsuro; Nakagawa, Tomoo; Minemura, Shoko; Oyamada, Arata; Kanogawa, Naoya; Saito, Masaya; Yoshihama, Sayuri; Maruoka, Daisuke; Matsumura, Tomoaki; Arai, Makoto; Tohma, Takayuki; Miyauchi, Hideaki; Matsubara, Hisahiro; Yokosuka, Osamu

    2014-01-01

    We encountered a rare case of severe diffuse duodenitis associated with ulcerative colitis (UC). A 23-year-old man underwent total proctocolectomy with ileal J-pouch anal anastomosis for UC. He suffered from severe abdominal pain, fever and bloody diarrhea for six months after the surgery. Upper double-balloon enteroscopy disclosed severe diffuse duodenitis, of which the findings were endoscopically and histologically similar to those of colonic lesions of UC. Although the administration of prednisolone was ineffective, treatment with intravenous tacrolimus markedly improved the clinical findings. This is the first report of the successful treatment of severe UC-associated diffuse duodenitis with intravenous tacrolimus. PMID:25366006

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

    PubMed Central

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

    2014-01-01

    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

  2. Experience with 53 portal-duodenal drained solitary pancreas transplants.

    PubMed

    Perosa, Marcelo; Noujaim, Huda; Ianhez, Luiz E; Oliveira, Rodrigo A; Mota, Leonardo T; Branez, Juan R; Paredes, Marcio M; Giacaglia, Luciano; Genzini, Tercio

    2014-02-01

    Systemic-enteric drainage is currently the most common technique for pancreas transplantation (PT). A novel alternative technique, portal-duodenal drainage (PDD), has potential physiological benefits and provides improved monitoring of the pancreatic graft. The current study describes 53 solitary PT procedures (43 pancreas after kidney and 10 pancreas transplant alone) using the PDD technique over the last three yr. This method resulted in one-yr patient survival at 96% and 83% graft survival. There were five cases (9.4%) of thrombosis, in which transplantectomy and two-layer closure of the native duodenum were performed. No fistulas were observed. Here, we demonstrate that the PDD technique in PT was as safe and effective as current techniques in clinical use. PMID:24382212

  3. Somatostatin depletion by cysteamine: mechanism and implication for duodenal ulceration

    SciTech Connect

    Szabo, S.; Reichlin, S.

    1985-06-01

    Cysteamine (CSH) and its close derivatives deplete immunoreactive somatostatin (SS) in rat organs. The effect of CSH is dose and time dependent and reversible. Structural requirements of the analogs are the presence of either -SH or -NH2 on a two- or three-carbon alkyl molecule; both radicals together increase, whereas insertion of carboxyl abolishes potency. The duodenal ulcerogenic potency of CSH derivatives is correlated significantly with their SS-depleting activity in the gastric mucosa. The mechanism of this action of CSH is poorly understood, but it is not caused by increased release, enhanced degradation of the peptide, or selective necrosis of SS cells. It is likely that in the intracellular environment CSH causes a conformational change in the peptide that affects the antigenic and functional properties of SS.

  4. Laser-mediated perforation of plant cells

    NASA Astrophysics Data System (ADS)

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

    2007-07-01

    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.

  5. Treatment of iatrogenic IVC occlusion with implantation of a stent of a new shape dedicated to aortic aneurysms

    PubMed Central

    Siero?, Dominik; Wiggermann, Phillip; Knap, Daniel; Platzek, Ivan; Wawrzynek, Wojciech; Stroszczynski, Christian

    2013-01-01

    Summary Background: Successful treatment of chronic occlusion of inferior vena cava (IVC) and iliocaval confluence with angioplasty and stent implantation is very rare. Case Report: We present a case of a 59-year-old patient with iatrogenic occlusion of IVC following L3/L4 discectomy. The wall of the ventral IVC was ruptured during the operation. Results: The torn wall was treated by patch angioplasty, resulting in a permanent IVC occlusion, as confirmed by angiography. Iatrogenic permanent occlusion of IVC was successfully treated with recanalization and implantation of a non-covered aortic stent. PMID:23493805

  6. Duodenal microbiota composition and mucosal homeostasis in pediatric celiac disease

    PubMed Central

    2013-01-01

    Background Celiac disease (CD) is an autoimmune disorder of the small intestine which is triggered by dietary gluten in genetically predisposed (HLA-DQ2/DQ8 positive) individuals. Only a fraction of HLA-DQ2/DQ8 positive individuals develop CD indicating that other factors have a role in the disorder. Several studies have addressed intestinal microbiota aberrancies in pediatric CD, but the results are inconsistent. Previously, we demonstrated that pediatric CD patients have lower duodenal expression of TLR2 and higher expression of TLR9 as compared to healthy controls (HC) indicating that microbiota may have a role in CD. Methods We used bacterial phylogenetic microarray to comprehensively profile the microbiota in duodenal biopsies of CD (n?=?10) and HC (n?=?9) children. The expression of selected mucosa-associated genes was assessed by qRT-PCR in CD and HC children and in treated CD adults (T-CD, n?=?6) on gluten free diet. Results The overall composition, diversity and the estimated microbe associated molecular pattern (MAMP) content of microbiota were comparable between CD and HC, but a sub-population profile comprising eight genus-like bacterial groups was found to differ significantly between HC and CD. In HC, increased TLR2 expression was positively correlated with the expression of tight junction protein ZO-1. In CD and T-CD, the expression of IL-10, IFN-g and CXCR6 were higher as co5mpared to HC. Conclusions The results suggest that microbiota and altered expression of mucosal receptors have a role in CD. In CD subjects, the increased expression of IL-10 and IFN-g may have partly resulted from the increased TLR9 expression and signaling. PMID:23844808

  7. Duodenal nutrient exclusion improves metabolic syndrome and stimulates villus hyperplasia

    PubMed Central

    Habegger, Kirk M; Al-Massadi, Omar; Heppner, Kristy M; Myronovych, Andriy; Holland, Jenna; Berger, Jose; Yi, Chun-Xia; Gao, Yuanging; Lehti, Maarit; Ottaway, Nickki; Amburgy, Sarah; Raver, Christine; Müller, Timo D; Pfluger, Paul T; Kohli, Rohit; Perez-Tilve, Diego; Seeley, Randy J; Tschöp, Matthias H

    2014-01-01

    Objective Surgical interventions that prevent nutrient exposure to the duodenum are among the most successful treatments for obesity and diabetes. However, these interventions are highly invasive, irreversible and often carry significant risk. The duodenal-endoluminal sleeve (DES) is a flexible tube that acts as a barrier to nutrient-tissue interaction along the duodenum. We implanted this device in Zucker Diabetic Fatty (ZDF) rats to gain greater understanding of duodenal nutrient exclusion on glucose homeostasis. Design ZDF rats were randomised to four groups: Naive, sham ad libitum, sham pair-fed, and DES implanted. Food intake, body weight (BW) and body composition were measured for 28 days postoperatively. Glucose, lipid and bile acid metabolism were evaluated, as well as histological assessment of the upper intestine. Results DES implantation induced a sustained decrease in BW throughout the study that was matched by pair-fed sham animals. Decreased BW resulted from loss of fat, but not lean mass. DES rats were also found to be more glucose tolerant than either ad libitum-fed or pair-fed sham controls, suggesting fat mass independent metabolic benefits. DES also reduced circulating triglyceride and glycerol levels while increasing circulating bile acids. Interestingly, DES stimulated a considerable increase in villus length throughout the upper intestine, which may contribute to metabolic improvements. Conclusions Our preclinical results validate DES as a promising therapeutic approach to diabetes and obesity, which offers reversibility, low risk, low invasiveness and triple benefits including fat mass loss, glucose and lipid metabolism improvement which mechanistically may involve increased villus growth in the upper gut. PMID:24107591

  8. Gastric outlet obstruction due to duodenal bezoar: A case report?

    PubMed Central

    Guner, Ali; Kahraman, Izzettin; Aktas, Adem; Kece, Can; Reis, Erhan

    2012-01-01

    INTRODUCTION Gastric outlet obstruction (GOO) is a clinical syndrome characterized by abdominal pain and postprandial vomiting. Causes of GOO include both benign and malignant disease. Bezoars, concretions of undigested or partially digested material in the gastrointestinal tract, are a rare entity and GOO due to duodenal bezoar is an uncommon presentation. PRESENTATION OF CASE We report the case of a 56-year-old woman who presented to the emergency department acutely with a 3-day history of epigastric pain, weakness and postprandial nonbilious vomiting. Initially, an upper gastrointestinal endoscopy (UGE) was performed to evaluate the cause of the GOO. A solid impacted bezoar was detected in the first portion of the duodenum with complete obstruction of the pyloric canal. In spite of multiple attempts for fragmentation using different devices, the extraction attempts failed. We administered acetylcysteine and cola per os. Abdominal computerized tomography was obtained and showed a solid mass in the duodenum. UGE was performed once more however, the mass was not suitable for fragmentation and removal. Thus, surgical treatment was decided. The bezoar was extracted via gastrotomy. The postoperative period was uneventful. DISCUSSION Even if a duodenal bezoar is small, because of its location it may cause GOO with abruptly clinical features. The diagnostic approach is similar to the other causes of the GOO. However, therapeutic options differ for each patient. CONCLUSION We should remember all the therapeutic and diagnostic options for a patient with upper gastrointestinal bezoars who present at the hospital whether or not there is a predisposing risk factor. PMID:22889707

  9. Duodenal-Mucosal Bacteria Associated with Celiac Disease in Children

    PubMed Central

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

    2013-01-01

    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

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

    PubMed Central

    Jiang, Pengbo; Christakos, Athena; Fam, Mina

    2014-01-01

    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

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

    PubMed

    Ozturk, Hakan; Karaaslan, Serap

    2014-09-01

    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

  12. Endoscopic subfascial dissection of the perforating veins: treatment results.

    PubMed

    Jugenheimer, Michael; Mayer, Wolfgang; Uckele, Matthias

    2003-01-01

    Before introduction of endoscopic subfascial dissection, surgical treatment of the perforating veins was a neglected topic. High error rates in the preoperatively marked perforating veins, wound-healing problems due to the incision in trophically disturbed areas, and leg ulcers prevented correct surgical treatment. Endoscopic subfascial dissection allows the accurate elimination of all clinically relevant, insufficient perforating veins in the lower leg. Therefore, it has become an accepted, improved treatment concept in the surgical therapy of primary varicosis in all three stages of chronic venous insufficiency. This experience is demonstrated based on a prospective study of the patients treated in the year 2000. PMID:12931302

  13. Intraluminal duodenal diverticula: collective review with report of a laparoscopic excision.

    PubMed

    Meinke, Alan Kurt; Meighan, Dennis M; Meinke, Mary E; Mirza, Nadia; Parris, Tchaiko M; Meinke, Richard K

    2013-02-01

    A comprehensive review of intraluminal duodenal diverticulum (IDD) is presented, along with a report of a completely laparoscopic excision of this duodenal abnormality as well as a report of magnetic resonance cholangiopancreatography demonstrating the classic fluoroscopic "wind sock sign" pathognomonic appearance of IDD. IDD may easily be missed unless one specifically considers this entity in patients presenting with symptoms of foregut disease. Patients with IDD typically present in the fourth decade of life with duration of symptoms less than 5 years that typically include pain, nausea and vomiting, pancreatitis, and gastrointestinal bleeding. Diagnosis usually requires imaging studies and upper gastrointestinal endoscopy. Laparoscopic excision is recommended because of superior visualization of significant intestinal anatomic abnormalities, the need for accurate ampullary localization, and the ability to facilitate complete diverticular excision while maintaining biliary and pancreatic ductal integrity. Review of surgical literature suggests that IDD results from congenital duodenal developmental abnormalities matured by long-term duodenal peristalsis. PMID:23256586

  14. Modeling data for pancreatitis in presence of a duodenal diverticula using logistic regression

    NASA Astrophysics Data System (ADS)

    Dineva, S.; Prodanova, K.; Mlachkova, D.

    2013-12-01

    The presence of a periampullary duodenal diverticulum (PDD) is often observed during upper digestive tract barium meal studies and endoscopic retrograde cholangiopancreatography (ERCP). A few papers reported that the diverticulum had something to do with the incidence of pancreatitis. The aim of this study is to investigate if the presence of duodenal diverticula predisposes to the development of a pancreatic disease. A total 3966 patients who had undergone ERCP were studied retrospectively. They were divided into 2 groups-with and without PDD. Patients with a duodenal diverticula had a higher rate of acute pancreatitis. The duodenal diverticula is a risk factor for acute idiopathic pancreatitis. A multiple logistic regression to obtain adjusted estimate of odds and to identify if a PDD is a predictor of acute or chronic pancreatitis was performed. The software package STATISTICA 10.0 was used for analyzing the real data.

  15. Iatrogenic Carotid-Cavernous Fistula Occurring after Embolization of a Cavernous Sinus Meningioma

    Microsoft Academic Search

    John D. Barr; John M. Mathis; Joseph A. Horton

    Summary: A carotid-cavernous fistula developed in a 62-year- old woman during an attempt at embolization of a skull base meningioma. The cause is thought to be perforation by the guide wire during catheterization of the meningohypophyseal trunk at the sharp bend at its origin.

  16. Epidemiology of perforated peptic ulcer: Age- and gender-adjusted analysis of incidence and mortality

    PubMed Central

    Thorsen, Kenneth; Søreide, Jon Arne; Kvaløy, Jan Terje; Glomsaker, Tom; Søreide, Kjetil

    2013-01-01

    AIM: To investigate the epidemiological trends in incidence and mortality of perforated peptic ulcer (PPU) in a well-defined Norwegian population. METHODS: A retrospective, population-based, single-center, consecutive cohort study of all patients diagnosed with benign perforated peptic ulcer. Included were both gastric and duodenal ulcer patients admitted to Stavanger University Hospital between January 2001 and December 2010. Ulcers with a malignant neoplasia diagnosis, verified by histology after biopsy or resection, were excluded. Patients were identified from the hospitals administrative electronic database using pertinent ICD-9 and ICD-10 codes (K25.1, K25.2, K25.5, K25.6, K26.1, K26.2, K26.5, K26.6). Additional searches using appropriate codes for relevant laparoscopic and open surgical procedures (e.g., JDA 60, JDA 61, JDH 70 and JDH 71) were performed to enable a complete identification of all patients. Patient demographics, presentation patterns and clinical data were retrieved from hospital records and surgical notes. Crude and adjusted incidence and mortality rates were estimated by using national population demographics data. RESULTS: In the study period, a total of 172 patients with PPU were identified. The adjusted incidence rate for the overall 10-year period was 6.5 per 100?000 per year (95%CI: 5.6-7.6) and the adjusted mortality rate for the overall 10-year period was 1.1 per 100?000 per year (95%CI: 0.7-1.6). A non-significant decline in adjusted incidence rate from 9.7 to 5.6 occurred during the decade. The standardized mortality ratio for the whole study period was 5.7 (95%CI: 3.9-8.2), while the total 30-d mortality was 16.3%. No difference in incidence or mortality was found between genders. However, for patients ? 60 years, the incidence increased over 10-fold, and mortality more than 50-fold, compared to younger ages. The admission rates outside office hours were high with almost two out of three (63%) admissions seen at evening/night time shifts and/or during weekends. The observed seasonal variations in admissions were not statistically significant. CONCLUSION: The adjusted incidence rate, seasonal distribution and mortality rate was stable. PPU frequently presents outside regular work-hours. Increase in incidence and mortality occurs with older age. PMID:23372356

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

    SciTech Connect

    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

    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.

  18. Geographic differences in the distribution of intestinal metaplasia in duodenal ulcer patients

    Microsoft Academic Search

    Hala M. T. El-Zimaity; Oscar Gutierrez; Jong G. Kim; Taiji Akamatsu; Inanc E. Gurer; Ahmed E. Simjee; David Y. Graham

    2001-01-01

    OBJECTIVE:A strong correlation exists between atrophic gastritis and the intestinal type of gastric carcinoma. Duodenal ulcer disease characteristically has an antral predominant gastritis and a lower risk for gastric cancer. The aim of this study was to investigate the extent and distribution of intestinal metaplasia in duodenal ulcer in countries differing in gastric cancer incidence.METHODS:Topographically mapped gastric biopsy specimens (median

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

    PubMed Central

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

    2014-01-01

    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

  20. Duodenal Wedge Resection for Large Gastrointestinal Stromal Tumour Presenting with Life-Threatening Haemorrhage

    PubMed Central

    Shaw, Alexander; Jeffery, John; Dias, Laura; Nazir, Sarfraz

    2013-01-01

    Background. Duodenal gastrointestinal stromal tumours (GISTs) are an uncommon malignancy of the gastrointestinal (GI) tract. We present a case of life-threatening haemorrhage caused by a large ulcerating duodenal GIST arising from the third part of the duodenum managed by a limited duodenal wedge resection. Case Presentation. A 61-year-old patient presented with acute life-threatening gastrointestinal bleeding. After oesophagogastroduodenoscopy failed to demonstrate the source of bleeding, a 5?cm ulcerating exophytic mass originating from the third part of the duodenum was identified at laparotomy. A successful limited wedge resection of the tumour mass was performed. Histopathology subsequently confirmed a duodenal GIST. The patient remained well at 12-month followup with no evidence of local recurrence or metastatic spread. Conclusion. Duodenal GISTs can present with life-threatening upper GI haemorrhage. In the context of acute haemorrhage, even relatively large duodenal GISTs can be treated by limited wedge resection. This is a preferable alternative to duodenopancreatectomy with lower morbidity and mortality but comparable oncological outcome. PMID:23634309

  1. Effect of tyrosine administration on duodenal ulcer induced by cysteamine in the rat

    SciTech Connect

    Oishi, T.; Szabo, S.

    1987-03-01

    Duodenal ulcers were produced by administering cysteamine to rats. Pretreatment with the catecholamine precursor, L-tyrosine (40 mg/100 g i.p. for 5 days), decreased the intensity of duodenal ulcers induced by cysteamine. Equimolar doses of tyrosine methyl ester (51.2 mg/100 g i.p. or s.c.) were equally effective in reducing ulcer intensity. Other amino acids (i.e., alanine, aspartic acid, glutamic acid, glycine, leucine, lysine, tryptophan and valine) did not prevent experimental duodenal ulcers. Coadministration of other large neutral amino acids (e.g., leucine and valine) that compete with tyrosine for uptake into the brain did not inhibit the effect of tyrosine on duodenal ulcers induced by cysteamine. Gastric, duodenal and brain dopamine concentrations were increased 1 hr after the injection of tyrosine methyl ester (25.6 mg/100 g s.c.). These results suggest that the effect of tyrosine on duodenal ulcer induced by cysteamine may be mediated by changes in gastrointestinal dopamine metabolism.

  2. Management of nasal septal perforation using silicone nasal septal button

    PubMed Central

    Mullace, M; Gorini, E; Sbrocca, M; Artesi, L; Mevio, N

    2006-01-01

    Summary Nasal septal perforation may present with various symptoms: epistaxis, crusting, secondary infection, whistling and nasal obstruction. Perforation may be treated by conservative pharmacological treatment or closed by surgical approach. A useful alternative is mechanical obturation, achieved inserting a prosthesis. The present report refers to a study on 15 patients (10 male, 5 female, mean age 38.5 years) treated by insertion of a one-piece or two-piece silicone septal button (Xomed). In the follow-up period, insertion of the nasal button reduced epistaxis, eliminated whistling during inspiration, and reduced nasal obstruction and crusting around the margin of the perforation. Contraindications are presence of acute infection with osteitis, chronic septal disease (Wegener), neoplasia and extremely large perforations. The latest buttons appear to be superior to the conventional type on account of plasticity and adaptability which offer greater conformity to the septum. This study also reveals that the new septal button is well tolerated by patients. PMID:18236638

  3. Management of nasal septal perforation using silicone nasal septal button.

    PubMed

    Mullace, M; Gorini, E; Sbrocca, M; Artesi, L; Mevio, N

    2006-08-01

    Nasal septal perforation may present with various symptoms: epistaxis, crusting, secondary infection, whistling and nasal obstruction. Perforation may be treated by conservative pharmacological treatment or closed by surgical approach. A useful alternative is mechanical obturation, achieved inserting a prosthesis. The present report refers to a study on 15 patients (10 male, 5 female, mean age 38.5 years) treated by insertion of a one-piece or two-piece silicone septal button (Xomed). In the follow-up period, insertion of the nasal button reduced epistaxis, eliminated whistling during inspiration, and reduced nasal obstruction and crusting around the margin of the perforation. Contraindications are presence of acute infection with osteitis, chronic septal disease (Wegener), neoplasia and extremely large perforations. The latest buttons appear to be superior to the conventional type on account of plasticity and adaptability which offer greater conformity to the septum. This study also reveals that the new septal button is well tolerated by patients. PMID:18236638

  4. CASE REPORT The Perforated Intrauterine Device: Endoscopic Retrieval

    E-print Network

    Eric M. Heinberg

    Background: Uterine perforation is the most serious complication associated with an intrauterine contraceptive device (IUD). Minimally invasive techniques, such as hysteroscopy and advanced laparoscopy, are ideally suited to the diagnosis and surgical management of the perforated IUD. Case Reports: Three cases of uterine perforation caused by an IUD and treated with endoscopic surgery are presented. In all 3 cases, the IUD was located by using x-rays, ultrasonography, or pelvic magnetic resonance imaging. Diagnostic laparoscopy was performed to identify the specific location of the IUD and to remove it. All patients recovered without incident. Conclusion: The gynecologic surgeon should acquire familiarity with the complications of, and proficiency in managing, perforated and ectopic IUDs by using modern surgical techniques that permit the patient’s rapid return to health.

  5. Gastric perforation due to foreign body ingestion mimicking acute cholecystitis.

    PubMed

    Henneman, Daniel; Bosman, Willem-Maarten; Ritchie, Ewan D; van den Bremer, Jephta

    2015-01-01

    An 82-year-old man presented with signs and symptoms that were suggestive of acute cholecystitis. He underwent a laparoscopic cholecystectomy. During the intervention, a wooden foreign body was removed from the infiltrated omentum, probably after it had perforated the gastric antrum. The gastric perforation had led to a secondary infection of the gallbladder. The presumed gastric perforation was treated conservatively, and the patient recovered well and was discharged after 7?days. Secondary inflamed gallbladders are rare; the current case is, to the best of our knowledge, the first case reporting a secondary infection of the gallbladder due to a gastric perforation. Clinicians should be aware of possible ingestion of foreign bodies in elderly patients wearing dental prosthetic devices. PMID:25739796

  6. Treatment of Iatrogenic Internal Carotid Artery Laceration and Carotid Cavernous Fistula with Endovascular Stent-Graft Placement

    Microsoft Academic Search

    Naci Kocer; Osman Kizilkilic; Sait Albayram; Ibrahim Adaletli; Fatih Kantarci; Civan Islak

    Summary: The risk of fatal injury of the internal carotid artery (ICA) and surrounding anatomy during transsphe- noidal surgery for pituitary adenoma is the most severe potential complication associated with this particular ap- proach. We present a case in which iatrogenic injury to a patient's ICA and resultant carotid cavernous fistula and massive hemorrhage was successfully managed with the emergency

  7. Sigmoid Perforation Following Radiation Therapy in Patients with Cervical Cancer

    Microsoft Academic Search

    Pedro T. Ramirez; Charles Levenback; Thomas W. Burke; Patricia Eifel; Judith K. Wolf; David M. Gershenson

    2001-01-01

    Objective. We describe the clinical presentation, evaluation, management, and outcome of patients experiencing sigmoid perforation following radiation therapy for cervical cancer.Methods. A database consisting of over 5000 patients with stage IB–IIIB cervix cancer treated between 1963 and 1992 revealed 35 patients with sigmoid perforation. Twenty-seven were diagnosed and managed at one institution, and they form the study group.Results. The median

  8. 1-D array of perforated diode neutron detectors

    Microsoft Academic Search

    Walter J. McNeil; Steven L. Bellinger; Troy C. Unruh; Chris M. Henderson; Phil Ugorowski; Bryce Morris-Lee; Russell D. Taylor; Douglas S. McGregor

    2009-01-01

    Performance of a 4cm long 64-pixel perforated diode neutron detector array is compared with an identical array of thin-film coated diodes. The perforated neutron detector design has been adapted to a 1-D pixel array capable of 120?m spatial resolution and counting efficiency greater than 12%. Deep vertical trenches filled with 6LiF provide outstanding improvement in efficiency over thin-film coated diode

  9. 1-D array of perforated diode neutron detectors

    Microsoft Academic Search

    Walter J. McNeil; Steven L. Bellinger; Troy C. Unruh; Chris M. Henderson; Phil Ugorowski; Bryce Morris-Lee; Russell D. Taylor; Douglas S. McGregor

    2009-01-01

    Performance of a 4 cm long 64-pixel perforated diode neutron detector array is compared with an identical array of thin-film coated diodes. The perforated neutron detector design has been adapted to a 1-D pixel array capable of 120 mum spatial resolution and counting efficiency greater than 12%. Deep vertical trenches filled with 6LiF provide outstanding improvement in efficiency over thin-film

  10. An unusual presentation of colon perforation following percutaneous nephrolithotomy

    PubMed Central

    Chubak, Barbara; Stern, Joshua M.

    2014-01-01

    Colon perforation is a rare but serious complication of percutaneous nephrolithotomy (PCNL), meriting particular attention to its signs and symptoms for prompt diagnosis and treatment. We report an unusual presentation of colon perforation following tubeless PCNL, characterized by sore throat, pneumomediastinum, and neck and shoulder crepitus. In addition to the details of this case, we review the current literature on bowel injury during PCNL and its management. PMID:25485017

  11. Undetected oesophageal perforation and feeding-tube misplacement.

    PubMed

    Taylor, Stephen J; Ross, Catherine; Hooper, Timothy

    This is a case report of an electromagnetically (EM)-guided Cortrak feeding tube that perforated the lower oesophagus and was not detected by the EM trace or by plain X-ray. Misplacement was diagnosed from computed tomography (CT) following injection of radio-contrast medium down the tube. Recommendations are offered for use of the EM trace in patients at high risk of oesophageal perforation. PMID:25345450

  12. Perforated-Layer Implementation Of Radio-Frequency Lenses

    NASA Technical Reports Server (NTRS)

    Dolgin, Benjamin P.

    1996-01-01

    Luneberg-type radio-frequency dielectric lenses made of stacked perforated circular dielectric sheets, according to proposal. Perforation pattern designed to achieve required spatial variation of permittivity. Consists of round holes distributed across face of each sheet in "Swiss-cheese" pattern, plus straight or curved slots that break up outer parts into petals in "daisy-wheel" pattern. Holes and slots made by numerically controlled machining.

  13. An unusual presentation of colon perforation following percutaneous nephrolithotomy.

    PubMed

    Chubak, Barbara; Stern, Joshua M

    2014-11-01

    Colon perforation is a rare but serious complication of percutaneous nephrolithotomy (PCNL), meriting particular attention to its signs and symptoms for prompt diagnosis and treatment. We report an unusual presentation of colon perforation following tubeless PCNL, characterized by sore throat, pneumomediastinum, and neck and shoulder crepitus. In addition to the details of this case, we review the current literature on bowel injury during PCNL and its management. PMID:25485017

  14. Delayed Diagnosis of Pharyngeal Perforation following Exploding Tyre Blast Barotrauma

    PubMed Central

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

    2014-01-01

    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

  15. Non-Traumatic Ileal Perforation: A Retrospective Study

    PubMed Central

    Singh, Gurjit; Dogra, Bharat Bhushan; Jindal, Neha; Rejintal, Santhosh

    2014-01-01

    Objective: To determine clinical features, operative findings and post-operative complications in patients operated for non-traumatic ileal perforation and to discuss the role of typhoid vaccination. Materials and Methods: A retrospective study was carried out from 2009-2010. Seven patients were admitted through casualty as cases of acute abdomen. Underlying conditions were typhoid ulcers (4 patients) and non-specific etiology (3 patients). Diagnosis was made on clinical grounds, laboratory investigations, radiology and operative findings. Exploratory laporotomy was done. Different variables studied post-operatively were wound infection, residual abscess, recurrence and delayed post-operative complications. Results: Tenderness, distension and rigidity were found in maximum patients. Gases under diaphragm and air fluid levels were common radiological findings. However, widal test and blood culture for S. typhi was positive in four patients. Six patients had single perforation and one patient had two perforations, all being on antimesentric border of ileum. Maximum patients had peritoneal collection of less than 1000 ml. In five patients simple closure of perforation was done and in remaining two resection with end to side ileotransverse anatomosis was required. Wound infection and residual intraabdominal abscess were found in one patient each. Conclusion: Management criteria remain same in typhoid and non-specific perforations. Commonest cause of ileal perforation is typhoid fever in our country, so immunization against typhoid beyond 18 years of age is recommended. PMID:25161970

  16. A hypervelocity projectile launcher for well perforation

    SciTech Connect

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

    1989-01-01

    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.

  17. Iatrogenic fracture of the superomedial orbital rim during frontal trephine irrigation.

    PubMed

    Angel, Douglas; Zener, Rebecca; Rotenberg, Brian W

    2014-12-01

    Frontal sinus trephination (FST) has numerous applications in the treatment of acute and chronic sinus disease. This procedure involves making an incision at the medial aspect of the supraorbital rim and then drilling the sinus's anterior table. Placement of a frontal trephine allows for irrigation of the frontal recess in order to evacuate the frontal sinus in a minimally invasive manner. Orbital injury is a rare complication of FST. We present a case of previously unreported orbital compartment syndrome secondary to iatrogenic fracture of the superomedial orbital rim as a complication of frontal trephine irrigation. We also review the literature on the applications of FST and its associated complications, and we discuss orbital compartment syndrome as a complication of sinus surgery. PMID:25531843

  18. Multimodality imaging and transcatheter coil embolization of an iatrogenic subclavian artery-internal jugular vein fistula.

    PubMed

    Cai, Qiangjun; Sickler, Cory; Christenson, Stuart; Dotani, Imran

    2015-01-01

    A 69-year-old man was found to have a loud continuous bruit in the neck. Duplex carotid ultrasound showed high-velocity turbulent flow in the dilated and pulsatile right internal jugular vein. Computed tomography angiogram demonstrated markedly enlarged right internal jugular vein with a posteriorly located arteriovenous communication. Invasive angiography revealed an arteriovenous fistula originating from the right subclavian artery draining into the dilated and tortuous right internal jugular vein. An endovascular coil was successfully deployed in the fistula tract. Subclavian artery-internal jugular vein fistula is rare. Our case is most likely iatrogenic towing to previous central venous cannulation during coronary bypass grafting. The anatomic challenge of this fistula, being located in the thoracic outlet, makes endovascular repair particularly favourable. PMID:25286164

  19. Foreign body removal with repair of iatrogenic tracheo-bronchial tear repair: An anesthetic challenge

    PubMed Central

    Lahori, Vikram Uday; Aggarwal, Shipra; Simick, Pemala; Dharmavaram, Sudhindra

    2011-01-01

    Foreign body aspiration into the airway is common in the pediatric age group and its anesthetic management is a challenge. Iatrogenic tracheo-bronchial injury further worsens the situation. Flexible pediatric fiberscope is the gold standard for securing the airway in cases of airway injury. We present a case of a 7-year-old girl who presented to the hospital with signs and symptoms of foreign body aspiration and suspected tracheo-bronchial tree injury. The impacted foreign body was removed by rigid bronchoscopy and the presence of a tracheo-bronchial tear was confirmed. To repair the airway tear, thoracotomy was planned necessitating one lung ventilation. A pediatric flexible fiberscope was not available, so left endobronchial intubation for one lung ventilation was done with the help of an airway exchange catheter using a rigid bronchoscope as a conduit. Subsequent intra-operative and post-operative period were uneventful. PMID:22096291

  20. Successful repair of iatrogenic inferior vena cava injury during cardiac surgery.

    PubMed

    Narayan, P; Das, D; Saha, A; Das, M

    2015-03-01

    Iatrogenic injury to the supra-diaphragmatic inferior vena cava (IVC) is uncommon, but can lead to a potentially complicated situation. Injury to the IVC is encountered usually during re-operative and congenital surgery, but can occur during the course of routine cardiac surgery as well. Depending on the mechanism, injury may involve the anterior or posterior wall of the IVC. A short adherent IVC, redo surgery and female sex are incremental risk factors for injury. Control of bleeding, adequate exposure and prevention of extension of the tear are the important considerations at the time of repair. While a number of management techniques have been reported, we describe a very simple maneuver that allows swift control of bleeding, adequate exposure and minimizes the risk of further extension and a satisfactory repair. PMID:24843114

  1. Endovascular treatment of an iatrogenic thoracic aortic injury after spinal instrumentation: case report.

    PubMed

    Minor, Michael E; Morrissey, Nicholas J; Peress, Richard; Carroccio, Alfio; Ellozy, Sharif; Agarwal, Gautam; Teodorescu, Victoria; Hollier, Larry H; Marin, Michael L

    2004-04-01

    Iatrogenic aortic injuries after spinal surgery have been described, but are rare. We describe a case of a 77-year-old woman who underwent surgical correction of a debilitating spinal deformity at an outside institution. Postoperative thoracic spine radiographs and computed tomography scans revealed a misplaced pedicle screw at T5, which was impinging on the descending thoracic aortic wall. The patient was brought to the operating room, where a thoracic stent graft was deployed under fluoroscopic guidance as the malpositioned screw was manually retracted. The patient had an uneventful postoperative course, and was discharged within 24 hours. This case represents a rare but potentially morbid vascular complication of spinal instrumentation surgery that was successfully treated without the need for thoracotomy. PMID:15071460

  2. Septic arthritis in Iceland 1990–2002: increasing incidence due to iatrogenic infections

    PubMed Central

    Geirsson, Á J; Statkevicius, S; Víkingsson, A

    2008-01-01

    Objectives: To assess the impact of increased number of diagnostic and therapeutic joint procedures on the incidence and type of septic arthritis (SA). Methods: All cases of SA in Iceland from 1990–2002 were identified by thorough review of the available medical information. The results of synovial fluid cultures from every microbiology department in Iceland were checked and positive culture results reviewed, as well as patient charts with a discharge diagnosis of septic arthritis (International Statistical Classification of Diseases and Related Health Problems (ICD) code M009). Results: A total of 253 cases of SA (69 children and 184 adults) were diagnosed in Iceland in 1990–2002, giving an average incidence of 7.1 cases/100 000 inhabitants. The incidence of SA increased from 4.2 cases/100 000 in 1990 to 11.0 cases/100 000 in 2002. This rise in SA was primarily observed in adults where the incidence rose by 0.61 cases/100 000 per year (p<0.001). SA was iatrogenic in 41.8% of adults and the number of iatrogenic infections increased from 2.8 cases/year in 1990–1994 to 9.0 cases/year in 1998–2002 (p<0.01). The annual number of arthroscopies increased from 430 in 1990–1994 to 2303 in 1998–2002 (p<0.001) and there was a correlation between the total usage of intra-articular drugs in Iceland and the incidence of SA (p<0.01). The frequency of post-arthroscopy SA was 0.14% and post-arthrocentesis SA 0.037%. Conclusions: The incidence of SA has increased in recent years due to an increased number of arthroscopies and joint injections. Although the frequency of SA per procedure has not changed, these results emphasise the importance of sterile technique and firm indications for joint procedures. PMID:17901088

  3. Juxtapapillary duodenal diverticula risk development and recurrence of biliary stone.

    PubMed

    Ko, Kang Suk; Kim, Seong Hun; Kim, Hyun Chul; Kim, In Hee; Lee, Seung-Ok

    2012-07-01

    We assessed whether the presence of juxtapapillary duodenal diverticula (JPDD) risks biliary stone disease and recurrence. In total, 695 patients who underwent ERCP were divided into two groups: biliary stone disease (group I, n = 523) and non-stone biliary diseases (group II, n = 172). Additionally, for a control group (group III), 80 age-matched healthy subjects underwent side-view duodenoscopy. In group I, rates of post-ERCP pancreatitis, cannulation failure, and disease recurrence in two-year follow up were compared according to the presence of JPDD. In results, the incidence of JPDD in group I (42.4%) was significantly higher than in group II (16.3%) and III (18.8%). The frequencies of JPDD were increased with age in all groups, and reached statistical significance in group I. In group I, rates of post-ERCP pancreatitis were significantly higher in patients with JPDD (18.5%) compared to JPDD negative (12.6%). The cannulation failure rate was also higher in patients with JPDD (9.9%) compared to JPDD negative (5.3%). Recurrence rate was higher in patients with JPDD (25.3%) compared to JPDD negative (9.2%). In conclusion, JPDD develops with aging and risks biliary stone formation. JPDD also seems to be associated with post-ERCP pancreatitis, cannulation failure and biliary stone recurrence. PMID:22787373

  4. Effect of sucralfate on gastric emptying in duodenal ulcer patients

    SciTech Connect

    Petersen, J.M.; Caride, V.J.; Prokop, E.K.; Troncale, F.; McCallum, R.W.

    1985-05-01

    Duodenal ulcer (DU) patients may have accelerated gastric emptying (GE) suggesting that there is an increase in unbuffered gastric acid reaching the duodenum contributing to DU disease. Aluminum-containing antacids were shown to delay GE. The authors' aim was to investigate whether another aluminum-containing compound, Sucralfate, affects GE in normal and DU patients. Nine normal volunteers and 10 patients with documented DU disease were studied. For each test the subject ingested a meal composed of chicken liver Tc-99m-S-C mixed with beef stew and eaten with 4 oz. of water labelled with 100..mu..Ci of III-in-DTPA. On two separate days, subjects received 1 gram of Sucralfate (190 mg of aluminum per gram) or placebo in a randomized double-blind fashion one hour prior to the test meal. GE of liquids and solids in normal subjects was not significantly changed by Sucralfate. Sucralfate in the DU patients significantly slowed liquid emptying in the initial 40 min and solid food throughout the study compared to placebo (p<0.05). This paper summarizes that; GE of solids but not liquids is accelerated in DU patients compared to normal subjects; and sucralfate delays GE of both liquid and solid components of a meal in DU patients but has no effect on GE in normals. The authors conclude that a slowing of gastric emptying possibly mediated by aluminum ions, may be one mechanism by which Sucralfate enhances healing and decreases recurrence of DU.

  5. Comparative duodenal, jejunal and ileal responses to luminal saline load.

    PubMed

    Chikh-Issa, A R; Charpin, G; Dumas, C; Nicol, P; Pansu, D; Descroix-Vagne, M

    1993-01-01

    Intestinal ionic exchanges were studied in rat duodenal, jejunal and ileal ligated loops in response to different luminal saline loads: NaCl concentration varied from 150-0 mM, solutions being made isoosmotic with mannitol. The contact delay was 60 min. An exponential relationship was found between water, Na and Cl movements and the initial saline concentration. Maximal absorption was obtained with 150 mM NaCl, and was significantly higher in the duodenum than in the jejunum and ileum. The NaCl concentration for which water, Na, and Cl movements were null was approximately 70 mM NaCl in the duodenum and jejunum, 41 mM for Na and 18 mM for Cl in the ileum. The water efflux induced by the 0-mM NaCl test solution was maximal in the duodenum (1.5 +/- 0.2 ml/h) and decreased in the jejunum (0.8 +/- 0.1 ml/h) and ileum (0.3 +/- 0.1 ml/h) as did sodium, chloride and non-chloride anion efflux. These data support the functional heterogeneity of the small intestine regulating the water and ion exchange in response to luminal saline load, the main difference being connected with the efflux capacity of the mucosa, decreasing from the duodenum to the jejunum and ileum. PMID:8363739

  6. Milk feeding and xylazine treatment induce increased antroduodenal motility in young cattle with opposite effects on duodenal digesta flow rate.

    PubMed

    Merritt, A M; Ruckebusch, Y

    1988-01-01

    Antroduodenal myoelectrical activity and duodenal digesta flow rate in young cattle were assessed by implanted nichrome wire electrodes and reentrant duodenal cannulation with interposed flow-meter. In addition, a small glass electrode was inserted through a duodenal cannula to continuously measure the pH of duodenal contents. When eating only hay ad libitum, the duodenal myoelectrical activity showed the usual migrating myoelectrical complex (MMC) pattern. Duodenal contents pH rose sharply at the end of a period of repetitive spike activity (RSA), or phase III, from pH less than 2 to greater than 5 and remained high through most of the subsequent period of no spike activity (NSA), or phase I, during which there was no antral spiking and no flow of duodenal contents. Feeding milk (pH 6.5) caused a marked increase in antroduodenal spike activity and intraduodenal flow rate, with a concomitant rapid rise in duodenal contents pH from 1.8 +/- 0.3 (SEM) to 5.0 +/- 0.2 which then slowly declined over the next few hours. Within 5 min after the administration of the alpha 2-adrenergic agonist xylazine (25 and 50 micrograms/kg intramuscular), there was a significant increase (P less than 0.05) in antroduodenal spike frequency and a concomitant marked drop in intraduodenal flow rate with a sustained low pH of intraduodenal contents. The results suggest that: (1) continuous measurement of proximal duodenal pH adds a useful dimension to documenting relationships between antroduodenal myoelectrical activity and duodenal digesta flow rate; and (2) increased spike activity in the antroduodenal region does not necessarily indicate an increased duodenal flow rate is occurring. PMID:3338358

  7. De-Nol stimulates gastric and duodenal alkaline secretion through prostaglandin dependent mechanism.

    PubMed Central

    Konturek, S J; Bilski, J; Kwiecien, N; Obtuløwicz, W; Kopp, B; Oleksy, J

    1987-01-01

    This study was designed to determine the effects of colloidal bismuth subcitrate De-Nol on gastric HCO3- secretion in 24 healthy subjects and on gastric and duodenal HCO3- secretion in dogs with gastric and duodenal fistulae. Alkaline secretion was measured after pretreatment with ranitidine to abolish the H+ secretion using a constant perfusion aspiration system and back titration of the perfusates to the original pH 6.0. Luminal release of PGE2 was also measured in the gastric and duodenal perfusates. Addition of De-Nol in gradually increasing concentrations resulted in step wise increments in gastric HCO3- secretion in man and in dogs reaching, respectively, about 80% and 55% of the maximal HCO3- response to 16, 16dimethyl-PGE2 (dmPGE2). The duodenal HCO3- response to De-Nol in dogs reached 72% of the dmPGE2 maximum. These effects were accompanied by a significant increase in luminal release of PGE2. Pretreatment with atropine reduced basal and in part De-Nol induced alkaline secretion, whereas pirenzepine did not affect this secretion in man and dogs. Aspirin (in man) and indomethacin (in dogs) reduced the release of PGE2 by about 80% and suppressed almost completely the gastric and duodenal HCO3- response to De-Nol in these species. This study provides evidence that De-Nol stimulates gastroduodenal alkaline secretion through a prostaglandin dependent mechanism. PMID:3480844

  8. Pyloric exclusion in the treatment of severe duodenal injuries: results from the National Trauma Data Bank.

    PubMed

    DuBose, Joseph J; Inaba, Kenji; Teixeira, Pedro G R; Shiflett, Anthony; Putty, Bradley; Green, D J; Plurad, David; Demetriades, Demetrios

    2008-10-01

    Pyloric exclusion (PEX) has traditionally been used in the management of complicated duodenal injuries to temporarily protect the duodenal repair and prevent septic abdominal complications. We used the American College of Surgeons National Trauma Data Bank (v 5.0) to evaluate adult patients with severe duodenal injuries [American Association for the Surgery of Trauma (AAST) Grade > or = 3] undergoing primary repair only or repair with PEX within 24 hours of admission. Propensity scoring was used to adjust for relevant confounding factors during outcomes comparison. Among 147 patients with severe duodenal injuries, 28 (19.0%) underwent PEX [15.9% (11/69) Grade III vs 34.0% (17/50) Grade IV-V]. Despite similar demographics, PEX was associated with a longer mean hospital stay (32.2 vs 22.2 days, P = 0.003) and was not associated with a mortality benefit. There was a trend toward increased development of septic abdominal complications (intra-abdominal abscess, wound infection, or dehiscence) with PEX that was not statistically significant. After multivariable analysis using propensity score, no statistically significant differences in mortality or occurrence of septic abdominal complications was noted between those patients undergoing primary repair only or PEX. The use of PEX in patients with severe duodenal injuries may contribute to longer hospital stay and confers no survival or outcome benefit. PMID:18942615

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

    PubMed Central

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

    2009-01-01

    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

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

    SciTech Connect

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

    2009-09-15

    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.

  11. Perforated diverticulitis of the sigmoid colon causing a subcutaneous emphysema

    PubMed Central

    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

    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

  12. [Aesthetic gluteal region reconstruction with a perforator artery flap].

    PubMed

    Ho Quoc, C; Boucher, F; Meeus, P; Boespflug, A; Neidhart, E M; Delay, E

    2013-08-01

    The gluteal region is an important pressure zone in every day life. Defects associated with bone exposure in the sacral region are more frequent among pressure sores. The gold standard treatment consists in a musculocutaneous gluteal flap; it can have as side effects functional deficits for walking and an important scar. In order to diminish the donor site morbidity muscle sparing flaps, as perforator flaps, have been described. The purpose of this article is to report the case of a 29-year-old patient with a median sacral defect with bone exposure after oncological resection, covered by a perforator gluteal flap. A superior gluteal artery perforator was researched using a Doppler flowmetry. The role of the perforator was to make the flap more reliable and to obtain a higher degree of mobilization of the flap devoid of tension or flap morbidity, without interfering with the gluteus maximus muscle integrity. Also, the aesthetic units of the gluteal region have been considered in order to obtain a better scar quality. At the 4 months follow-up, the result was stable with a discrete scar and no walking difficulties. In conclusion, the median defects associating bone exposure in the sacral region are difficult to treat, especially in young patients. The treatment should consist in a stable soft tissue coverage with minimal functional and aesthetic sequela. The perforator gluteal flap respects the aesthetic units and can be considered as an elegant and efficient solution to treat this type of defects. PMID:23182675

  13. Cascaded Perforates as One-Dimensional, Bulk Absorbers

    NASA Technical Reports Server (NTRS)

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

    2006-01-01

    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.

  14. Complex heel reconstruction with a sural fasciomyocutaneous perforator flap.

    PubMed

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

    2014-02-01

    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

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

    Microsoft Academic Search

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

    2000-01-01

    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

  16. Long-term recording and computer analysis of simultaneous gastric and duodenal pH under normal conditions in man

    Microsoft Academic Search

    R F McCloy; J H Baron; J C Vickery

    1980-01-01

    A technique has been developed to make simultaneous digital recordings of gastric and duodenal pH. An intraluminal miniature glass electrode assembly has been maintained in a stable position in the duodenal bulb and stomach in 34 out of 41 studies. The pH data can be logged by a transportable system at up to one second intervals for periods of 24

  17. A Case of Acute Ischemic Duodenal Ulcer Associated with Superior Mesenteric Artery Dissection After Transarterial Chemoembolization for Hepatocellular Carcinoma

    SciTech Connect

    Jang, Eun Sun; Jeong, Sook-Hyang, E-mail: jsh@snubh.org; Kim, Jin Wook; Lee, Sang Hyub [Seoul National University Bundang Hospital, Department of Internal Medicine, College of Medicine (Korea, Republic of); Yoon, Chang Jin; Kang, Sung Gwon [Seoul National University Bundang Hospital, Department of Radiology (Korea, Republic of)

    2009-03-15

    We report a case of transarterial chemoembolization (TACE)-related acute ischemic duodenal ulcer that developed in association with dissection of the superior mesenteric artery. We conclude that the acute duodenal ulcer was developed by ischemia related to superior mesenteric artery dissection during TACE. TACE should be conducted carefully with continuous observation of abdominal arteries.

  18. Comparison of the healing mechanisms of human dry and endogenous wet traumatic eardrum perforations.

    PubMed

    Lou, Zhengcai; Wang, Yubizhuo; Su, Kaiming

    2014-08-01

    This prospective study aimed to assess the spontaneous healing mechanisms of human dry and endogenous wet traumatic tympanic membrane perforations (TMPs). A total of 106 patients with traumatic TMPs were included. Based on the presence or absence of endogenous bloody or watery exudates on the residual eardrum and/or at perforation margins, 73 perforations were classified as dry perforations and the remaining 33 as endogenous wet perforations. In 65 of the 73 dry perforations, centripetal migration of an epithelial layer was the first event seen during the spontaneous healing process, which was followed by growth and migration of the other two layers (i.e., the fibrous layer and the inner mucous layer). In the remaining eight dry perforation cases, outward epithelial migration was observed on the side of the perforation edge. In the 33 endogenous wet perforations, closure seemed to start with growth of the fibrous layers which were then covered by the migrating epithelium. Within the first week after injury, only 16.3 ± 6.7 % of the perforation area healed in the dry perforation cases, whereas 82.2 ± 13.9 % of the perforation area healed in the wet perforation cases; the difference was significant (P < 0.01). These observations suggest that different mechanisms may be involved in spontaneous healing of dry and wet traumatic TMPs in humans, thereby resulting in differences in healing time and healing outcome. PMID:24057097

  19. Successful endoscopic therapy of postoperative duodenal fistula by lipiodol injection: a new therapeutic approach.

    PubMed

    Ozdil, Burhan; Yamak, Yusuf Ziya; Kece, Can; Cebi, Kibar

    2011-05-01

    Postoperative upper gastrointestinal fistulas or anastomotic leaks with peritonitis are rare but serious clinical conditions. Due to severe fluid and electrolyte imbalance and risk of development of sepsis implementation of efficient and timely management is crucial. Various endoscopic interventions have been performed to date for postoperative upper gastrointestinal fistulas. We herein describe a new therapeutical approach involving lipiodol injection, which we performed to treat a patient who had unsuccessfully undergone surgery for a posttraumatic duodenal fistula. The fistula was then successfully managed by endoscopic lipiodol injection. We present this case due to its interesting nature of a postsurgical duodenal fistula without evident fistula tract, and a successful therapy by a new approach, lipiodol injection. We conclude that this new method offers an option for patients with high operation risk or for those with failed surgery, and this new method may decrease morbidity, mortality and the time required for the closure of duodenal fistulas. PMID:20929423

  20. The use of pyloric exclusion in the management of severe duodenal injuries.

    PubMed

    Vaughan, G D; Frazier, O H; Graham, D Y; Mattox, K L; Petmecky, F F; Jordan, G L

    1977-12-01

    Repair of severe duodenal injuries often constitutes a technical challenge, and a variety of special technics have been described. For the past seven years we have utilized temporary pyloric exclusion and gastrojejunostomy to produce "diverticulization" of the duodenum. This procedure was utilized in seventy-five patients selected from 175 consecutive patients presenting with duodenal trauma. The mortality was 19 per cent and the rate of fistula formation was 5 per cent in this series and 14 per cent and 2 per cent, respectively, in the overall series. Follow-up studies of gastric physiology and functional anatomy show no evidence of alteration of these parameters. We thus believe that patients presenting with severe duodenal trauma and often multiple devastating associated organ injuries can be adequately treated with this procedure with a significant decrease in mortality and with marked improvement of postoperative morbidity. PMID:596547

  1. Relative importance of pancreatic, hepatic, and mucosal bicarbonate in duodenal neutralization of acid in anaesthetized pigs.

    PubMed

    Ainsworth, M A; Svendsen, P; Ladegaard, L; Cantor, P; Olsen, O; Schaffalitzky de Muckadell, O B

    1992-05-01

    Pancreatic and hepatic bicarbonate secretion and the disappearance rate of acid during duodenal acidification were measured simultaneously in anaesthetized pigs. Perfusion of the duodenum with HCl resulted in an increase in both hepatic and pancreatic bicarbonate secretion. During all acid loads hepatic bicarbonate secretion was significantly greater than pancreatic secretion. Furthermore, the disappearance rate of acid in the duodenum during diversion of both bile and pancreatic juice was significantly greater than the amount of acid which could be neutralized by the concomitant pancreatic bicarbonate secretion. Diversion of pancreatic juice from the duodenum did not affect the disappearance rate of acid at any acid load, whereas diversion of bile caused a significant decrease. Thus, in the anaesthetized pig the liver and the duodenal mucosa are of greater importance than the pancreas for the neutralization of acid in the duodenum. It is suggested that the importance of the pancreatic contribution to duodenal neutralization should be reevaluated in other species, including man. PMID:1529266

  2. Predicting Chemically Induced Duodenal Ulcer and Adrenal Necrosis with Classification Trees

    NASA Astrophysics Data System (ADS)

    Giampaolo, Casimiro; Gray, Andrew T.; Olshen, Richard A.; Szabo, Sandor

    1991-07-01

    Binary tree-structured statistical classification algorithms and properties of 56 model alkyl nucleophiles were brought to bear on two problems of experimental pharmacology and toxicology. Each rat of a learning sample of 745 was administered one compound and autopsied to determine the presence of duodenal ulcer or adrenal hemorrhagic necrosis. The cited statistical classification schemes were then applied to these outcomes and 67 features of the compounds to ascertain those characteristics that are associated with biologic activity. For predicting duodenal ulceration, dipole moment, melting point, and solubility in octanol are particularly important, while for predicting adrenal necrosis, important features include the number of sulfhydryl groups and double bonds. These methods may constitute inexpensive but powerful ways to screen untested compounds for possible organ-specific toxicity. Mechanisms for the etiology and pathogenesis of the duodenal and adrenal lesions are suggested, as are additional avenues for drug design.

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

    SciTech Connect

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

    1983-07-01

    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.

  4. Unduly extensive uncinate process of pancreas in conjunction with pancreatico-duodenal fold

    PubMed Central

    Sharma, Mona; Pakhiddey, Rohini; Thakur, Avinash; Mehta, Vandana; Suri, Rajesh K.; Rath, Gayatri

    2015-01-01

    Anatomical variations of pancreatic head and uncinate process are rarely encountered in clinical practice. These variations are primarily attributed to the complex development of the pancreas. An unduly enlarged uncinate process of the pancreas overlapping the third part of duodenum was discovered during dissection. This malformation of the pancreatic uncinate process was considered to be due to excessive fusion between the ventral and dorsal buds during embryonic development. On further dissection, an avascular pancreatico-duodenal fold guarding the pancreatico-duodenal recess was observed. The enlarged uncinate process can cause compression of neurovascular structures and also cause compression of adjoining viscera. The pancreatico-duodenal recess becomes a potential site for internal herniation. This case is of particular interest to the gastroenterologists and surgeons performing surgical resections. Precise knowledge of embryogenesis of such pancreatic anomalies is necessary for understanding and thus treating many diseases of the pancreas. PMID:25806126

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

    SciTech Connect

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

    1983-07-01

    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.

  6. Andreas Vecsei, Thomas Fuhrmann, Michael Liedlgruber, Leonhard Brunauer, Hannes Payer and Andreas Uhl, "Automated classification of duodenal imagery in celiac disease using evolved

    E-print Network

    Uhl, Andreas

    Uhl, "Automated classification of duodenal imagery in celiac disease using evolved Fourier feature.cmpb.2009.02.017 #12;Automated classification of duodenal imagery in Celiac disease using evolved Fourier. These are applied to duodenal imagery for diagnosis of celiac disease. Features are extracted from the Fourier

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

    E-print Network

    Paris-Sud XI, Université de

    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

  8. Position paper: management of perforated sigmoid diverticulitis

    PubMed Central

    2013-01-01

    Over the last three decades, emergency surgery for perforated sigmoid diverticulitis has evolved dramatically but remains controversial. Diverticulitis is categorized as uncomplicated (amenable to outpatient treatment) versus complicated (requiring hospitalization). Patients with complicated diverticulitis undergo computerized tomography (CT) scanning and the CT findings are used categorize the severity of disease. Treatment of stage I (phlegmon with or without small abscess) and stage II (phlegmon with large abscess) diverticulitis (which includes bowel rest, intravenous antibiotics and percutaneous drainage (PCD) of the larger abscesses) has not changed much over last two decades. On the other hand, treatment of stage III (purulent peritonitis) and stage IV (feculent peritonitis) diverticulitis has evolved dramatically and remains morbid. In the 1980s a two stage procedure (1st - segmental sigmoid resection with end colostomy and 2nd - colostomy closure after three to six months) was standard of care for most general surgeons. However, it was recognized that half of these patients never had their colostomy reversed and that colostomy closure was a morbid procedure. As a result starting in the 1990s colorectal surgical specialists increasing performed a one stage primary resection anastomosis (PRA) and demonstrated similar outcomes to the two stage procedure. In the mid 2000s, the colorectal surgeons promoted this as standard of care. But unfortunately despite advances in perioperative care and their excellent surgical skills, PRA for stage III/IV diverticulitis continued to have a high mortality (10-15%). The survivors require prolonged hospital stays and often do not fully recover. Recent case series indicate that a substantial portion of the patients who previously were subjected to emergency sigmoid colectomy can be successfully treated with less invasive nonoperative management with salvage PCD and/or laparoscopic lavage and drainage. These patients experience a surprisingly lower mortality and more rapid recovery. They are also spared the need for a colostomy and do not appear to benefit from a delayed elective sigmoid colectomy. While we await the final results ongoing prospective randomized clinical trials testing these less invasive alternatives, we have proposed (based primarily on case series and our expert opinions) what we believe safe and rationale management strategy. PMID:24369826

  9. Rectal Perforation Caused by Anal Stricture After Hemorrhoid Treatment

    PubMed Central

    Suh, Yong Joon; Ha, Heon-Kyun; Oh, Heung-Kwon; Shin, Rumi; Jeong, Seung-Yong

    2013-01-01

    Inappropriate therapies for hemorrhoids can lead to various complications including anorectal stricture. We report a patient presenting with catastrophic rectal perforation due to severe anal stricture after inappropriate hemorrhoid treatment. A 67-years old man with perianal pain visited the emergency room. The hemorrhoids accompanied by constipation, had tortured him since his youth. Thus he had undergone injection sclerotherapy several times by an unlicensed therapist and hemorrhoidectomy twice at the clinics of private practitioners. His body temperature was as high as 38.5?. The computed tomographic scan showed a focal perforation of posterior rectal wall. The emergency operation was performed. The fibrotic tissues of the anal canal were excised. And then a sigmoid loop colostomy was constructed. The patient was discharged four days following the operation. This report calls attention to the enormous risk of unlicensed injection sclerotherapy and overzealous hemorrhoidectomy resulting in scarring, progressive stricture, and eventual rectal perforation. PMID:23586012

  10. Spontaneous, idiopathic urinary bladder perforation--case report.

    PubMed

    Wieloch, Maria; Bazyli?ska, Kamila; Ziemniak, Piotr

    2013-12-01

    Spontaneous, idiopathic urinary bladder rupture is a very rare disease entity, which may face the problem of proper preoperative diagnosis. In many cases the medical history, physical examination, and additional tests raise false suspicion of gastrointestinal perforation. The study presented a case of a female patient with spontaneous urinary bladder perforation, paying particular attention to the diagnostic difficulties associated with the above-mentioned pathology. The aim of the study was to analyse the presence of symptoms and imaging and laboratory results observed in case of spontaneous urinary bladder rupture, as well as differentiate the above-mentioned pathology with gastrointestinal perforation. Whenever diagnosing a patient with acute peritonitis symptoms, in whom the predominating symptoms include sudden abdominal pain, peritoneal cavity fluid presence, hematuria, oliguria, and coexisting increased urea, creatinine, and potassium levels, one should consider the possibility of urinary bladder rupture. PMID:24468594

  11. Distally based perforator sural flaps for foot and ankle reconstruction

    PubMed Central

    Chang, Shi-Min; Li, Xiao-Hua; Gu, Yu-Dong

    2015-01-01

    Distally based perforator sural flaps from the posterolateral or posteromedial lower leg aspect are initially a neurofasciocutaneous flap that can be transferred reversely to the foot and ankle region with no need to harvest and sacrifice the deep major artery. These flaps are supplied by a perforating artery issued from the deep peroneal artery or the posterior tibial artery, and the chain-linked adipofascial neurovascular axis around the sural/saphenous nerve. It is a versatile and reliable technique for soft-tissue reconstruction of the heel and ankle region with 180-degrees rotation. In this paper, we present its developing history, vascular basis, surgical techniques including flap design and elevation, flap variations in pedicle and component, surgical indications, and illustrative case reports with different perforating vessels as pivot points for foot and ankle coverage.

  12. One-trip perforate and gravel pack system

    SciTech Connect

    Hailey, T.T.; Donovan, J.F.; Van Sickle, E.W.

    1985-03-01

    A downhole tool system has been developed that makes it possible to perforate a well casing with all the advantages of a Tubing Conveyed Perforating gun and to gravel pack that well using proven techniques, all on the same trip to the hole. The system has been operated successfully and has been in development for about two years in the Texas and Louisiana Gulf Coast area under varying well conditions. In this paper the main components of the system are described and its operation discussed. The chief limitation of the system is the amount of rathole available in the well. The area below the producing zone must be long enough to accept the spent Tubing Conveyed Perforating gun assembly.

  13. Cytomegalovirus Enteritis Causing Ileal Perforation in an Elderly Immunocompetent Individual

    PubMed Central

    Lee, Joung Il; Choe, Jae Won; Joo, Kwang Ro; Jung, Sung Won; Shin, Hyun Phil; Choi, Sung Il

    2010-01-01

    Cytomegalovirus (CMV) infection is usually subclinical in immunocompetent individuals, however it can be life threatening in an elderly immunocompetent individual. We report a case of CMV enteritis causing ileal perforation in a physically active elderly man. An 88-year-old healthy man presented with abdominal pain and diarrhea. After initial conservative treatment, emergency laparotomy was performed for ileal perforation. The diagnosis of CMV enteritis was based on histological findings revealing many large cells with CMV inclusion bodies in the surgical specimen. In elderly individuals, even though they are immunocompetent, CMV enteritis may result in major complications such as bowel perforation, and it should be included in the differential diagnosis of diarrhea if it is resistant to conventional treatment. PMID:20191024

  14. Distally based perforator sural flaps for foot and ankle reconstruction.

    PubMed

    Chang, Shi-Min; Li, Xiao-Hua; Gu, Yu-Dong

    2015-04-18

    Distally based perforator sural flaps from the posterolateral or posteromedial lower leg aspect are initially a neurofasciocutaneous flap that can be transferred reversely to the foot and ankle region with no need to harvest and sacrifice the deep major artery. These flaps are supplied by a perforating artery issued from the deep peroneal artery or the posterior tibial artery, and the chain-linked adipofascial neurovascular axis around the sural/saphenous nerve. It is a versatile and reliable technique for soft-tissue reconstruction of the heel and ankle region with 180-degrees rotation. In this paper, we present its developing history, vascular basis, surgical techniques including flap design and elevation, flap variations in pedicle and component, surgical indications, and illustrative case reports with different perforating vessels as pivot points for foot and ankle coverage. PMID:25893175

  15. Prolonged duodenal acid perfusion and dyspeptic symptom occurrence in healthy volunteers.

    PubMed

    di Stefano, M; Vos, R; Vanuytsel, T; Janssens, J; Tack, J

    2009-07-01

    The pathophysiology of functional dyspepsia (FD) is unknown and several mechanisms associated with specific symptom patterns have been recently proposed. Increased duodenal acid exposure has been supposed to be associated with nausea, but recently an increase of severity of several dyspeptic symptoms was noted in a subset of dyspeptic patients. As its pathogenetic role is still unclear, we evaluated an involvement of duodenal acid exposure in symptom generation by inducing a hyperacidity status of the duodenum. Twelve young adult healthy volunteers in a randomized, double-blind protocol, underwent duodenal acid (0.2 N, 5 mL min(-1)) or saline perfusion, antropyloroduodenal manometry and duodenal pH monitoring both during fasting and postprandially. Every 15 min, severity of discomfort, fullness, bloating, belching, nausea, heartburn, epigastric burning, satiety and pain were evaluated by visual analogue scale. During acid perfusion, symptom scores for discomfort, bloating, nausea, epigastric burning were significantly higher (P < 0.01) compared to saline. Postprandial antral motility index was lower (2.96 +/- 1.8 vs 3.62 +/- 1.8, P = 0.01) and jejunal motility index higher (4.87 +/- 1.0 vs 4.37 +/- 1.4, P = 0.01) during acid perfusion. Occurrence and duration of phases III of the migrating motor complex showed no difference. Duodenal acid perfusion causes a sensitization to dyspeptic symptoms and induces antral hypomotility and jejunal hypercontractility. Through these mechanisms, increased duodenal acid exposure may play a role in the pathophysiology of FD symptoms. PMID:19236580

  16. An unusual cause of small bowel perforation: apricot pit.

    PubMed

    Atila, Koray; Güler, Sanem; Bora, Seymen; Gülay, Hüseyin

    2011-05-01

    Ingestion of foreign bodies can be a common problem, especially among children, alcoholics, and psychiatric and senile patients. Foreign bodies with smooth edges usually do not pose significant problems, but a sharp foreign object that is not retrieved immediately may penetrate the wall and cause complications. Ingested foreign bodies usually pass the intestinal tract uneventfully, and perforation occurs in less than 1%. In this study, we report a case of small bowel obstruction with perforation in a 73-year-old female due to the accidental swallowing of an apricot pit. PMID:21935813

  17. Isolated Perforation of Left Coronary Cusp after Blunt Chest Trauma

    PubMed Central

    Maini, Rohit; Dadu, Razvan T.; Addison, Daniel; Cunningham, Luke; Hamzeh, Ihab; Wall, Matthew; Lakkis, Nasser; Tabbaa, Rashed

    2015-01-01

    Left coronary cusp perforation is an extremely rare consequence of blunt chest trauma. A 22-year-old male presented after a motor vehicle accident with dyspnea. Transthoracic echocardiogram (TTE) and transesophageal echocardiogram (TEE) showed moderate to severe aortic regurgitation with prolapsing right coronary cusp. In the operating room he was found to have a left coronary cusp tear near the annulus and an enlarged right cusp. The patient recovered well after successful aortic valve replacement with a mechanical valve. Traumatic aortic regurgitation with left cusp perforation is serious and surgical intervention may be lifesaving if performed timely.

  18. The effect of perforation patterns upon well productivity

    E-print Network

    Neale, John William

    1955-01-01

    LIBRARY A 4N COLLEGE OF TEXAS THE EFFECT OF PERFORATION PATTERNS UPON WELL PRODUCTIVITT A Thesis By John N, Neale ~ ~ Submitted to the Graduate Sohool of the Agrioultural and Meohanioal College of Texas in partial fulfillment... of the requirements for the degree of EASTER OF SCIENCE August 1966 Na)or Subgeotg PETROLBUM ENGINEERING THE EFFEC1 OF PERFORATION IN. TTERNS UPON WELL PRODUCTIVITX 4, Thesis JOHN W, NEI, LE Approved as to style and oontent lg s 7. Chai man of ommi ttee H...

  19. A Rare Complication of an Ingested Foreign Body: Gallbladder Perforation

    PubMed Central

    Karacay, Safak; Topçu, Koray; Sözübir, Selami

    2013-01-01

    We present a 13-year-old child who admitted with a dull right upper quadrant pain that started 3 weeks before her referral. Several medications were given but they did not change the intensity and the frequency of the pain. Her physical examination was nonspecific except for slight right upper quadrant tenderness. The imaging studies revealed a sewing pin perforating the stomach and gallbladder. The patient was treated with a successful operation, and no postoperative complications were observed. To our knowledge, this is the first case of a sharp foreign body gallbladder perforation in a child. PMID:23984118

  20. Amyand's hernia with perforated appendix in a neonate.

    PubMed

    Ngom, Gabriel; Amadou, Issa; Ibrahima, K A; Mubake, André; Ndour, Oumar; Ndoye, Mamadou

    2010-01-01

    Inguinal hernia with acute appendicitis known as Amyand's hernia is uncommon. It occurs mostly in adults, older children and infants. The appendix inside the hernial sac is rarely perforated. The authors describe in a neonate aged 14 days an unusual case of inguinal hernia containing a perforated appendix that was clinically considered as a strangulated inguinal hernia. Surgery performed with an inguinal approach permitted us to remove the appendix and close the hernial sac. The postoperative course was uneventful after a follow-up of 1 year. PMID:22791723

  1. Optimal Control of the Obstacle Problem in a Perforated Domain

    SciTech Connect

    Stroemqvist, Martin H., E-mail: stromqv@kth.se [Royal Institute of Technology, Department of Mathematics (Sweden)

    2012-10-15

    We study the problem of optimally controlling the solution of the obstacle problem in a domain perforated by small periodically distributed holes. The solution is controlled by the choice of a perforated obstacle which is to be chosen in such a fashion that the solution is close to a given profile and the obstacle is not too irregular. We prove existence, uniqueness and stability of an optimal obstacle and derive necessary and sufficient conditions for optimality. When the number of holes increase indefinitely we determine the limit of the sequence of optimal obstacles and solutions. This limit depends strongly on the rate at which the size of the holes shrink.

  2. Spontaneous esophageal perforation (Boerhaave syndrome): Diagnosis with CT-esophagography

    PubMed Central

    Tonolini, Massimo; Bianco, Roberto

    2013-01-01

    Spontaneous esophageal perforation (Boerhaave syndrome) is a very uncommon, life-threatening surgical emergency that should be suspected in all patients presenting with lower thoracic-epigastric pain and a combination of gastrointestinal and respiratory symptoms. Variable clinical manifestations and subtle or unspecific radiographic findings often result in critical diagnostic delays. Multidetector computed tomography complemented with CT-esophagography represents the ideal “one-stop shop” investigation technique to allow a rapid, comprehensive diagnosis of BS, including identification of suggestive periesophageal abnormalities, direct visualization of esophageal perforation and quantification of mediastinitis. PMID:23493470

  3. Iatrogenic Aorto-Cisterna Chyli Fistula During Percutaneous Balloon Aortoplasty in a Patient with Takayasu's Arteritis: A Case Report

    SciTech Connect

    Hwang, Hye Sun; Shin, Sung Wook, E-mail: swshin@smc.samsung.co.kr; Kim, Eun Hui; Do, Young Soo; Choo, Sung Wook; Cho, Sung Ki; Park, Kwang Bo [Sungkyunkwan University School of Medicine, Department of Radiology and Center for Imaging Sciences, Samsung Medical Center (Korea, Republic of)

    2007-04-15

    We present a case of iatrogenic aorto-cisterna chyli fistula that developed during percutaneous transluminal aortoplasty in a 16-year old girl with Takayasu's arteritis. The aorto-cisterna chyli fistula was angiographically confirmed and treated using a stent-graft, which successfully occluded the fistula. Her claudication then improved, although follow-up CT angiography at 10 months revealed mild recurrent aortic stenosis.

  4. [The treatment of chronic duodenal ulcer with accompanying Helicobacter pylori infection].

    PubMed

    Petsch, B; Kabala, A; Paw?owski, W

    1998-08-01

    Three hundred seventy four patients with duodenal ulcers and Helicobacter pylori infections were given a four-week treatment of bismuth or ranitidin. In all patients two-week antibiotic therapy were given. Endoscopies with urease tests and histologic examinations were performed before initiation and four weeks after cessation of therapy. Four-week therapy with ranitidini and two-week therapy with amoxicillin and metronidasole is highly effective (89.6%) in duodenal ulcer healing and symptom improvement comparison to bismuth and antibiotic therapy. PMID:10101457

  5. Diagnosis of obstructive jaundice in infants: Tc-99m DISIDA in duodenal juice

    SciTech Connect

    Jaw, T.S.; Wu, C.C.; Ho, Y.H.; Huang, B.L.; Lu, C.C.

    1984-03-01

    Technetium-99m di-isopropylphenylcarbamoylmethylimidodiacetic acid cholescintigraphy, together with measurements of radioactivity in duodenal juice, was used to evaluate 23 infants with prolonged obstructive jaundice. Four patients proved to have biliary atresia. The remainder had neonatal hepatitis. There was distinct differentiation of biliary atresia from neonatal hepatitis when the time-activity curves were analyzed. In neonatal hepatitis the radioactivity in duodenal juice is obviously higher, peaking above 1500 cpm/100 ..mu..l per mCi dose. In biliary atresia the pattern is flattened, with maximal activity below 500 cpm/100 ..mu..l per mCi dose.

  6. A prospective analysis of glove perforation in primary and revision total hip and total knee arthroplasty.

    PubMed

    Carter, Aaron H; Casper, David S; Parvizi, Javad; Austin, Matthew S

    2012-08-01

    Literature in regard to glove perforation rates in revision total joint arthroplasty (TJA) is scarce. Our purpose was to determine the incidence of perforation in revision TJA. Gloves from all scrubbed personnel were tested based on the American Society for Testing and Materials. A total of 3863 gloves were collected from 58 primary and 36 revision arthroplasty cases. Surgeons had a 3.7% outer-glove perforation rate in primary TJA compared with 8.9% in revision TJA. When both gloves were perforated, the outer-glove perforation was recognized intraoperatively 100% of the time, and the inner-glove perforation was noted only 19% of the time. The surgeon has the highest rate of glove perforation. Outer-glove perforations should prompt careful inspection of the inner glove. PMID:22425303

  7. Characterization of cardiac lead perforation risk via a dynamic simulated environment

    E-print Network

    Rosario, Matthew J

    2012-01-01

    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 ...

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

    PubMed

    Gibbons, Christopher H; Freeman, Roy

    2015-01-01

    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

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

    SciTech Connect

    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

    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.

  10. Microstructure based model for sound absorption predictions of perforated closed-cell metallic foams

    E-print Network

    Paris-Sud XI, Université de

    Microstructure based model for sound absorption predictions of perforated closed-cell metallic to enhance their sound absorption is to perforate them. This method has shown good preliminary results-cell foam behaves similarly to a perforated solid; however, its sound absorption is modulated by the foam

  11. Incidence, predictors, in-hospital, and late outcomes of coronary artery perforations

    Microsoft Academic Search

    Goran Stankovic; Dejan Orlic; Nicola Corvaja; Flavio Airoldi; Alaide Chieffo; Vassilis Spanos; Matteo Montorfano; Mauro Carlino; Leo Finci; Giuseppe Sangiorgi; Antonio Colombo

    2004-01-01

    We sought to determine the incidence of coronary perforations, predisposing factors, and in-hospital and late outcome of patients with coronary perforations. Perforations occurred in 0.84% of treated lesions and more frequently in patients with complex lesions after atheroablative procedures and who underwent intravascular ultrasound guided lumen optimization. The incidence of adverse events, emergency coronary artery bypass grafting and death significantly

  12. Study of outcome of tympanoplasties in relation to size and site of tympanic membrane perforation.

    PubMed

    Vaidya, Sudhakar; Sharma, J K; Singh, Gurchand

    2014-09-01

    There are not many studies on the effect of the site and size of the perforation on the hearing loss. This study is set to investigate the relationship between the size and site of perforation and hearing loss. This study was carried out between September 2011 to September 2013, at a tertiary care centre during which 100 cases of chronic otitis media tubotympanic type having central perforation were selected. All patients underwent, tympanoplasty using temporalis fascia/cartilage graft, underlay technique with or without simple mastoidectomy/modified radical mastoidectomy and followed up for 3 months and evaluated for graft uptake and hearing improvement with respect to size and site of TM perforation. To measure the size of perforation intra-operatively, thin transparency sheet was used, on which a graph paper of 1 × 1 mm(2) size was printed. Significant relationship was observed between size and site of tympanic membrane perforation with hearing loss. Perforations which were involving all four quadrants (AS + AI + PS + PI) are having maximum residual perforations after the surgery. In relation with size, subtotal perforation were having more residual perforations postoperatively, followed by medium sized perforations. An inherent relationship noted between ossicular involvement and hearing loss, maximum average hearing loss was observed in those cases, where all three ossicles (malleus, incus & stapes) were involved, also more hearing loss was noted in posterior perforations. PMID:25032126

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

    PubMed Central

    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

    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

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

    PubMed Central

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

    2014-01-01

    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

  15. Corneal biomechanics in iatrogenic ectasia and keratoconus: A review of the literature

    PubMed Central

    Moshirfar, Majid; Edmonds, Jason N.; Behunin, Nicholas L.; Christiansen, Steven M.

    2013-01-01

    The Ocular Response Analyzer (ORA) (Reichert Ophthalmic Instruments, Buffalo, NY) allows direct measurement of corneal biomechanical properties. Since its introduction, many studies have sought to elucidate the clinical applications of corneal hysteresis (CH) and corneal resistance factor (CRF). More recently, detailed corneal deformation signal waveform analysis (WA) has potentially expanded the diagnostic capabilities of the ORA. In this review, the role of CH, CRF, and WA are examined in keratoconus (KC) and iatrogenic ectasia (IE). The PubMed database was searched electronically for peer-reviewed literature in July 2012 and August 2012 without date restrictions. The search strategy included medical subject heading (MeSH) and natural language terms to retrieve references on corneal biomechanics, CH, CRF, corneal deformation signal WA, IE, and KC. The evidence suggests that while CH and CRF are poor screening tools when used alone, increased sensitivity and specificity of KC and IE screening result when these parameters are combined with tomography and topography. Recent advances in WA are promising, but little is currently understood about its biomechanical and clinical relevance. Future studies should seek to refine the screening protocols for KC and IE as well as define the clinical applicability of WA parameters. PMID:23772119

  16. Glycemic goals in diabetes: trade-off between glycemic control and iatrogenic hypoglycemia.

    PubMed

    Cryer, Philip E

    2014-07-01

    The selection of a glycemic goal in a person with diabetes is a compromise between the documented upside of glycemic control-the partial prevention or delay of microvascular complications-and the documented downside of glycemic control-the recurrent morbidity and potential mortality of iatrogenic hypoglycemia. The latter is not an issue if glycemic control is accomplished with drugs that do not cause hypoglycemia or with substantial weight loss. However, hypoglycemia becomes an issue if glycemic control is accomplished with a sulfonylurea, a glinide, or insulin, particularly in the setting of absolute endogenous insulin deficiency with loss of the normal decrease in circulating insulin and increase in glucagon secretion and attenuation of the sympathoadrenal response as plasma glucose concentrations fall. Then the selection of a glycemic goal should be linked to the risk of hypoglycemia. A reasonable individualized glycemic goal is the lowest A1C that does not cause severe hypoglycemia and preserves awareness of hypoglycemia, preferably with little or no symptomatic or even asymptomatic hypoglycemia, at a given stage in the evolution of the individual's diabetes. PMID:24962915

  17. May-Thurner syndrome: High output cardiac failure as a result of iatrogenic iliac fistula.

    PubMed

    Singh, Shantanu; Singh, Shivank; Jyothimallika, Juthika; Lynch, Teresa J

    2015-03-16

    May-Thurner syndrome (MTS) also termed iliocaval compression or Cockett-Thomas syndrome is a common, although rarely diagnosed, condition in which the patient has an anatomical variant wherein the right common iliac artery overlies and compresses the left common iliac vein against the fifth lumbar spine resulting in increased risk of iliofemoral deep venous thrombosis. This variant has been shown to be present in over 23% of the population but most go undetected. We present a patient with MTS who developed high output cardiac failure due to an iatrogenic iliac fistula. The patient underwent an extensive workup for a left to right shunt including MRI and arterial duplex in the vascular lab. He was ultimately found to have a 2.1 cm left common iliac artery aneurysm and history of common iliac stent. We took the patient to the operating room for aortogram with placement of an endovascular plug of the left internal iliac artery and aorto-bi-iliac stent graft placement with CO2 and IV contrast. Subsequently the patient underwent successful stent placement in the area that was compressed followed by 6 mo of anticoagulation with warfarin. The flow from the fistula decreased significantly. PMID:25789305

  18. May-Thurner syndrome: High output cardiac failure as a result of iatrogenic iliac fistula

    PubMed Central

    Singh, Shantanu; Singh, Shivank; Jyothimallika, Juthika; Lynch, Teresa J

    2015-01-01

    May-Thurner syndrome (MTS) also termed iliocaval compression or Cockett-Thomas syndrome is a common, although rarely diagnosed, condition in which the patient has an anatomical variant wherein the right common iliac artery overlies and compresses the left common iliac vein against the fifth lumbar spine resulting in increased risk of iliofemoral deep venous thrombosis. This variant has been shown to be present in over 23% of the population but most go undetected. We present a patient with MTS who developed high output cardiac failure due to an iatrogenic iliac fistula. The patient underwent an extensive workup for a left to right shunt including MRI and arterial duplex in the vascular lab. He was ultimately found to have a 2.1 cm left common iliac artery aneurysm and history of common iliac stent. We took the patient to the operating room for aortogram with placement of an endovascular plug of the left internal iliac artery and aorto-bi-iliac stent graft placement with CO2 and IV contrast. Subsequently the patient underwent successful stent placement in the area that was compressed followed by 6 mo of anticoagulation with warfarin. The flow from the fistula decreased significantly. PMID:25789305

  19. Limitation of Imaging in Identifying Iatrogenic Aortic Coarctation following Thoracic Endovascular Aortic Repair.

    PubMed

    Thakkar, Rajiv N; Thomaier, Lauren; Qazi, Umair; Verde, Franco; Malas, Mahmoud B

    2015-04-01

    A 21-year-old male suffered blunt trauma from a motor vehicle accident causing thoracic aorta tear. The smallest available stent graft was deployed. Definitive repair was later performed using a 22 × 22 × 116 mm Talent Thoracic Stent Graft. The postoperative course was uneventful. Seventeen months later, he presented with dizziness, chest pain, acute renal failure, malignant hypertension, and troponin elevation. Computed tomography (CT) angiogram and transesophageal echocardiogram did not reveal any dissection, stent stenosis or collapse. Cardiac catheterization showed normal coronary arteries but a 117 mm Hg gradient across the stent graft. Iatrogenic coarctation of the aorta was confirmed with a second measurement during arch angiogram. A Palmaz stent was deployed over the distal end of the previous stent graft with complete resolution of symptoms and gradual normalization of kidney function. This case report demonstrates a need for wider availability and selecting appropriate stent graft in treating traumatic aortic injuries in young patients. It is the first case report of the inability of current imaging modalities in confirming stent collapse. Pressure gradient is a useful tool in confirming stent collapse when clinical scenario does not match CT findings. PMID:25637574

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

    PubMed Central

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

    2015-01-01

    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

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

    PubMed

    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

    2014-08-01

    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 (PrP(Sc)) 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 PrP(Sc) between iCJD and sCJD. However, using PMCA, we find that convertibility and amplification efficiency of PrP(Sc) 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

  2. Iatrogenic salt water drowning and the hazards of a high central venous pressure

    PubMed Central

    2014-01-01

    Current teaching and guidelines suggest that aggressive fluid resuscitation is the best initial approach to the patient with hemodynamic instability. The source of this wisdom is difficult to discern, however, Early Goal Directed therapy (EGDT) as championed by Rivers et al. and the Surviving Sepsis Campaign Guidelines appears to have established this as the irrefutable truth. However, over the last decade it has become clear that aggressive fluid resuscitation leading to fluid overload is associated with increased morbidity and mortality across a diverse group of patients, including patients with severe sepsis as well as elective surgical and trauma patients and those with pancreatitis. Excessive fluid administration results in increased interstitial fluid in vital organs leading to impaired renal, hepatic and cardiac function. Increased extra-vascular lung water (EVLW) is particularly lethal, leading to iatrogenic salt water drowning. EGDT and the Surviving Sepsis Campaign Guidelines recommend targeting a central venous pressure (CVP)?>?8 mmHg. A CVP?>?8 mmHg has been demonstrated to decrease microcirculatory flow, as well as renal blood flow and is associated with an increased risk of renal failure and death. Normal saline (0.9% salt solution) as compared to balanced electrolyte solutions is associated with a greater risk of acute kidney injury and death. This paper reviews the adverse effects of large volume resuscitation, a high CVP and the excessive use of normal saline. PMID:25110606

  3. EXPERIMENTAL INVESTIGATION OF ACOUSTIC PROPERTIES OF MUFFLERS WITH PERFORATED PIPES

    Microsoft Academic Search

    Ying Guo; Sabry Allam

    Transmission loss of exhaust mufflers with perforated pipes is experimentally investigated. The main work of this paper is focused on the one dimensional plane wave propagation; additionally, higher order mode effects are discussed. Two types of cross flow mufflers, a plug flow muffler and an eccentric muffler, are investigated with and without the presence of mean flow, using the two

  4. A Rare Cause of Acute Abdomen: Jejunal Diverticulosis with Perforation

    PubMed Central

    Aydin, Ibrahim; Pergel, Ahmet; Yucel, Ahmet Fikret; Sahin, Dursun Ali

    2013-01-01

    Jejunal diverticulosis is generally asymptomatic and is associated with high morbidity and mortality secondary to complications, especially in elderly patients. We present a case report of a 74-year-old female patient with jejunal diverticulosis and perforation due to diverticulitis. PMID:24083068

  5. Removal of completely perforating IUDs by explorative laparotomy.

    PubMed

    Abramovici, H; Bornstein, J; Faktor, J H; Atad, J; Pascal, B

    1987-01-01

    Nine patients with completely perforating intrauterine contraceptive devices are presented. In all cases, the device was removed by explorative laparotomy. In eight out of the nine women, the device was found to be embedded in the omentum or vesical peritoneal plica. The advantages of explorative laparotomy over laparoscopy or colpotomy are emphasized. PMID:2887524

  6. CHARACTERIZATION OF CLEAN AND FOULED PERFORATED MEMBRANE DIFFUSERS

    EPA Science Inventory

    Laboratory analyses were conducted on plasticized PVC perforated membrane tube diffusers after varying periods in service at two different municipal wastewater treatment facilities. ne set of diffusers from Cedar Creek, NY, was in service for 26 months. he other set from the Gree...

  7. CHARACTERIZATION OF CLEAN AND FOULED PERFORATED MEMBRANE DIFFUSERS

    EPA Science Inventory

    Laboratory analyses were conducted on plasticized PVC perforated membrane tube diffusers after varying periods in service at two different municipal wastewater treatment facilities. One set of diffusers from Cedar Creek, NY, was in service for 26 months. The other set from the ...

  8. Vibroacoustic properties of thin micro-perforated panel absorbers.

    PubMed

    Bravo, Teresa; Maury, Cédric; Pinhède, Cédric

    2012-08-01

    This paper presents theoretical and experimental results on the influence of panel vibrations on the sound absorption properties of thin micro-perforated panel absorbers (MPPA). Measurements show that the absorption performance of thin MPPAs generates extra absorption peaks or dips that cannot be understood assuming a rigid MPPA. A theoretical model is established that accounts for structural-acoustic interaction between the micro-perforated panel and the backing cavity, assuming uniform conservative boundary conditions for the panel and separable coordinates for the cavity cross-section. This model is verified experimentally against impedance tube measurements and laser vibrometric scans of the cavity-backed panel response. It is shown analytically and experimentally that the air-frame relative velocity is a key factor that alters the input acoustic impedance of thin MPPAs. Coupled mode analysis reveals that the two first resonances of an elastic MPPA are either panel-cavity, hole-cavity, or panel-controlled resonances, depending on whether the effective air mass of the perforations is greater or lower than the first panel modal mass. A critical value of the perforation ratio is found through which the MPPA resonances experience a frequency "jump" and that determines two absorption mechanisms operating out of the transitional region. PMID:22894201

  9. Vibroacoustics of thin micro-perforated sound absorbers , T. Bravob

    E-print Network

    Boyer, Edmond

    Vibroacoustics of thin micro-perforated sound absorbers C. Maurya , T. Bravob and C. Pinhedea constitute compact sound absorbing resonators, mostly efficient in the mid-frequency range, and that may the sound absorbing model initially proposed by Maa for a rigid MPP [1]. The aim of this work

  10. Performance evaluation of perforated micro-cantilevers for MEMS applications

    NASA Astrophysics Data System (ADS)

    Swamy, Kenkere Balashanthamurthy Mruthyunjaya; Mukherjee, Banibrata; Ali Syed Mohammed, Zishan; Chakraborty, Suman; Sen, Siddhartha

    2014-04-01

    Miniaturized cantilevers are one of the elementary structures that are widely used in many micro-devices and systems. The dynamic performance of micro-cantilevers having process dictated through perforations is investigated. High-aspect ratio, long silicon cantilevers, intended for improved performance through lowered stiffness are designed with a series of through holes and simulated along with similar nonperforated/solid cantilevers for comparison. A few perforated structures are also fabricated using silicon-on-insulator-based multiproject MEMS processes from MEMSCAP Inc. (Durham, North Carolina) by reduced mask level and eliminating complex substrate trenching step. The dynamic behavior of these fabricated structures is experimentally studied for both in-plane and out-of-plane directions. It is shown that, due to the presence of perforations, stiffness in planar direction is lightly affected, whereas in out-of-plane direction it is significantly reduced by >35%. Similarly, the variation of damping in both perforated and nonperforated beams, too, is thoroughly analyzed for the first few modes of vibration. Nevertheless, their frequency response variation of <10% for modal frequencies in both planar and out-of-plane directions as compared to the nonperforated counterparts, points to potential applications in several micro-systems including those based on comb drives.

  11. Incidence of inadvertent globe perforation during strabismus surgery

    Microsoft Academic Search

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

    1990-01-01

    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

  12. ROOT GROWTH: HOMOGENIZATION IN DOMAINS WITH TIME DEPENDENT PARTIAL PERFORATIONS

    E-print Network

    Rheinisch-Westfälische Technische Hochschule Aachen (RWTH)

    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

  13. Hepatic abscess resulting from gastric perforation of a foreign object.

    PubMed

    Dugger, K; Lebby, T; Brus, M; Sahgal, S; Leikin, J B

    1990-07-01

    A case of a patient with a hepatic abscess secondary to a fish or chicken bone is presented. Of interest is the fact that the abscess resulted from gastrointestinal perforation of the foreign object. A review of the literature of this unusual occurrence along with clues to making the diagnosis are discussed. PMID:2194468

  14. Sound radiation from a line forced perforated elastic sandwich panel

    E-print Network

    Abrahams, I. David

    Sound radiation from a line forced perforated elastic sandwich panel I. David Abrahams Department INTRODUCTION Sound transmission through panels has long been a sub- ject of importance in a variety- plates separated by stiffeners or ribs in between.2 The trans- mission and reflection of sound waves

  15. A Case of Liposarcoma With Peritonitis Due to Jejunal Perforation

    PubMed Central

    Matsui, Miwa; Yamamoto, Tatsuo; Mochizuki, Ryosuke; Uematsu, Takeshi; Fujiwara, Masachika; Ohse, Hirotaka

    2003-01-01

    A 21-year-old man, who had been treated for congenital dilatation of the bile duct 13 years previously, presented with an acute abdomen. The physical examination suggested peritonitis, and an emergent laparotomy was performed. A perforation was foundin the jejunum approximately 100 cm distal to the ligament of Treitz, followed by resection of a 60-cm jejunal segment. No tumorous lesions were found during the operation, and the resected jejunal segment showed only focal myxomatous thickening of the serosa. Despite intensive therapy, he died of uncontrollable septic shock 2 days after the operation. Unexpectedly, however, histological examination revealed a liposarcoma, showing an unclassifiable histology. From the distribution of the lesion and the histological findings, it is thought that a primary lesion was somewhere else, covered by severe adhesions due to the previous operation, and that the tumor cells spreading from it could have caused the jejunal perforation through vascular involvement. Although extremely rare, liposarcomas in the abdomen can cause intestinal perforation. It is important for both clinicians andpathologists to carefully investigate the cause of an unusual clinical presentation such as intestinal perforation. PMID:18521366

  16. Stercoral Perforation of the Sigmoid Colon in a Schizophrenic Patient

    PubMed Central

    Singh, Amit; Singh, Rohit Pratap

    2015-01-01

    Stercoral perforation of the colon is a life threatening condition, due to pressure necrosis by hard fecaloma which, are commonly found in chronic constipated patients. We report the case of a 45-year-old schizophrenic woman, under psychiatric treatment for two years, presenting with a 10-day history of absolute obstipation and distension. On physical examination the patient had signs of generalized peritonitis. Preoperative diagnostic workup gave no clear-cut clues about diagnosis. Emergency laparotomy revealed a single perforation over the antimesentric border of the sigmoid colon with hard fecal matter protruding through perforation margin. A segmental resection of the sigmoid colon with colonic lavage and end to end anastomosis was performed. The patient made an uneventful recovery. We have discussed the diagnostic work-up, and the management of this rare entity. Patient was on antipsychotic, anticholenergic and NSAID’S drugs for long time with longstanding immobilisation and poor oral intake. Association of these etiological factors with chronic constipation which ultimately leads to stercoral perforation have been corroborated. PMID:25738027

  17. Migrated biliary plastic stent causing double sigmoid colon perforation

    PubMed Central

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

    2014-01-01

    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

  18. [Diagnosis of esophageal wall perforation and its sequelae].

    PubMed

    Minnigerode, B

    1985-05-01

    Based on the symptoms of oesophageal wall perforation and its sequelae the significance of immediate examination and clinical observation are emphasised. This disease is difficult to diagnose by modern technology in the early stages. Advice is given on the main diagnostic symptoms and the appropriate sequence of examination. PMID:4008283

  19. 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

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

    1987-03-01

    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.

  20. Atypical presentation of gastrointestinal stromal tumor masquerading as a large duodenal cyst: A case report

    PubMed Central

    Kumar, Ameet; Jakhmola, C.K.; Chauhan, Shivraj Singh; Singh, Apoorv

    2015-01-01

    Introduction Gastrointestinal stromal tumors (GIST) are solid tumors. A duodenal GIST masquerading as a cystic lesion has never been reported. We report a large duodenal cyst that finally turned out to be a GIST and was managed without a pancreaticoduodenectomy (PD). Presentation of case A 55 year old lady presented with painful lump in epigastrium. A CT scan revealed a large exophytic cystic lesion from the duodenum with a small solid component. An endoscopy showed a polypoid lesion in the second part of the duodenum adjacent to what looked like a diverticulum. A sleeve duodenal resection, duodeno-duodenostomy and pyloric exclusion was done. The histopathology was duodenal GIST. Discussion This case posed diagnostic difficulty as it was thought to be either a duplication cyst or a diverticulum of duodenum. The odd point was the small solid component in it. We considered the possibility of a malignancy arising in these settings, which is has been occasionally reported. To our surprise, it turned out to be a GIST. An extensive literature search yielded only four reports that have reported cystic GISTS, all arising from the stomach or pancreas where they have been mistaken for pseudocysts or even a mucinous cystadenocarcinoma of the pancreas. This is the first report of a cystic GIST arising from the duodenum. Conclusion GISTS can present as a predominantly cystic lesion and needs to be considered in the differential diagnosis of cystic lesions of the duodenum. Local resection is an attractive option in select cases and avoids a PD. PMID:25768277

  1. Malignant Gastric and Duodenal Stenosis: Palliation by Peroral Implantation of a Self-Expanding Metallic Stent

    SciTech Connect

    Pinto, Isabel T. [Department of Radiology, Hospital Universitario de Getafe, Ctra. de Toledo, Km. 12.5, E-28905 Getafe, Madrid (Spain)

    1997-11-15

    Purpose: To assess the use of self-expanding metallic stents in patients with inoperable malignant antrum-pylorus-duodenal obstruction. Methods: Six patients underwent implantation of a Wallstent self-expanding metallic endoprosthesis (20 mm in five patients and 16 mm in one). In five patients a catheter (Berenstein) was introduced perorally into the stomach. A guidewire (Terumo) was introduced through the catheter and advanced through the antrum-pylorus-duodenal stenosis. The guidewire was removed and a 260-cm-long, 0.035'' superstiff guide (Amplatz) was introduced. After the catheter was removed the stent assembly was introduced. In the last patient the stent was implanted through a percutaneous gastrostomy. Results: Treatment of inoperable gastric outlet obstruction caused by tumor compression is difficult and unsatisfactory. Peroral implantation of self-expanding metallic stents resulted in successful palliative therapy of antrum-pylorus-duodenal stenosis in six patients in whom surgery was not possible because of advanced disease and poor general condition. On average, patients were able to eat during 41 days. One patient is tolerating oral intake at 3 months. Conclusion: Implantation of stents resulted in palliative relief of malignant antrum-pylorus-duodenal obstructions.

  2. Pyloric exclusion in the management of complicated duodenal and pancreatic disease.

    PubMed

    Cogbill, T H; Moore, E E; Newman, M M; Halgrimson, C G

    1984-05-01

    Pyloric exclusion with gastrojejunostomy has been shown to be an effective adjuvant in the treatment of severe duodenal and pancreatic trauma. The authors have successfully applied this technique to the treatment of two patients with complicated pancreatic pseudocysts drained by cyst duodenostomy. A third patient with malignant duodenocolic fistula was palliated with this modality but eventually succumbed to his advanced disease. PMID:6721288

  3. [Periodontal status in children with various morphological forms of chronic gastritis and duodenitis].

    PubMed

    Romanenko, E G

    2014-01-01

    The purpose of the study was to determine the condition of the periodontal tissues in 80 children with various morphological forms of gastritis and duodenitis. The examination included determination of oral hygiene and periodontal status by the simplified Green-Vermillion index, Silness-Low index, papillary-marginal-alveolar index, gingival Muhlemann-Cowell bleeding index, Schiller-Pisarev iodine index. In children with chronic gastritis and duodenitis high incidence of chronic catarrhal gingivitis (85.0%) was revealed. At the same time it was pointed out that inflammation in the periodontal tissues correlated with changes in the gastroduodenal mucosa. In 65.4% of children with superficial gastritis and duodenitis, chronic catarrhal gingivitis (localized in 38.5% of cases, generalized in 26.9%) was observed. In 94.4% of all children with diffuse and erosive gastritis and duodenitis, chronic generalized catarrhal gingivitis was observed, and low oral hygiene level was revealed. The severity and duration of the underlying disease aggravated clinical manifestations of chronic catarrhal gingivitis in children with lesions of the upper gastrointestinal tract. PMID:24576968

  4. The incidence of duodenal and gastric ulcers in a large health maintenance organization.

    PubMed Central

    Kurata, J H; Honda, G D; Frankl, H

    1985-01-01

    We report the incidence of peptic ulcers (duodenal, pyloric canal, gastric, and combined) verified by radiologic, endoscopic, or surgical evidence in a large Health Maintenance Organization (HMO) in Los Angeles, California. For members age 15 and above, the peptic ulcer incidence rate was 0.86 per 1,000 person-years (p-y) (males 1.10, females 0.63). The male to female sex ratio was 1.7. Two hundred twenty-two duodenal, 17 pyloric canal, 89 gastric, and 21 combined first-time diagnosed ulcer cases were located. For duodenal and pyloric canal ulcer, the incidence rate for members age 15 and above was 0.58 per 1,000 p-y (males 0.76, females 0.40). For gastric ulcer, the incidence rate for members age 15 and above was 0.21 per 1,000 p-y (males 0.23, females 0.18). The combined ulcer rate was 0.05 per 1,000 p-y (males 0.07, females 0.02). Gastric ulcer rates were two times higher in 1980 than in 1977. Peptic ulcer age-specific incidence rates increased with age. Incidence rates were much lower than those reported in previous studies, but the gastric to duodenal ulcer ratio and the age and sex relation to ulcer incidence were similar to those previously reported. PMID:4003625

  5. Clinical Study Duodenal Bulb Mucosa with Hypertrophic Gastric Oxyntic Heterotopia in Patients with Zollinger Ellison Syndrome

    E-print Network

    Emil Kohan; David Oh; Hank Wang; Salar Hazany; Gordon Ohning; Joseph R. Pisegna

    2009-01-01

    Objectives. Zollinger-Ellison Syndrome (ZES) results in hypersecretion of gastric acid (via gastrinoma) leading to peptic ulcers, diarrhea, and abdominal pain. We describe the novel discovery of hypertrophic, heterotopic gastric mucosa in the proximal duodenal bulb in patients with ZES, which we

  6. Foveolar gastric metaplasia of the duodenum: a frequent, so far neglected type of duodenal polyp.

    PubMed

    Sarbia, M; Sauer, G; Karimi, D; Berndt, R

    2014-04-01

    Foveolar gastric metaplasia of the duodenum (FGM) is considered as imperfect mucosal healing in the context of H. pylori gastritis and intake of NSAIDs or ASS.? Typical endoscopic findings are redness of the mucosa, erosion/ulcer and loss of mucosal folds. During diagnostic histological examinations we observed a frequent so far not described association of FGM with endoscopically observed duodenal polyps. The archives of two institutes of pathology with high gastroenterological workload (approximately 100?000 patients per year) were investigated for an association between "duodenal polyp" and "foveolar gastric metaplasia". In Institute 1, of 481 duodenal polyps 41?% were classified as FGM, 9?% as adenoma and 2?% as heterotopic gastric mucosa. In 48?% no histological correlate was present. In Institute 2, 217 cases of FGM were diagnosed. Of these, in 69 cases the endoscopic finding was "polyp" (32?%). In the other cases, the endoscopic findings were mucosal defect (18?%), redness/inflammation (16?%), suspicion for gastric heterotopia (5?%) and scar (3?%). In 26?% of cases no pathologic endoscopic finding was reported. Both groups of patients with FGM showed a similar distribution of age ranges (24?-?83 years and 16?-?88 years), median age (62 years and 61 years, respectively) and a dominance of male sex (both 1.5:1). In conclusion, foveolar gastric metaplasia is a frequent, so far neglected correlate of endoscopically detected duodenal polyps. PMID:24718939

  7. Helicobacter pylori infection and abnormalities of acid secretion in patients with duodenal ulcer disease

    Microsoft Academic Search

    Emad M. El-Omar; Ian D. Penman; Joy E. S. Ardill; Ravi S. Chittajallu; Catherine Howie; Kenneth E. L. McColl

    1995-01-01

    Background & Aims: The mechanism by which Helicobacter pylori predisposes to duodenal ulcers (DUs) remains unclear. The aim of this study was to investigate the effect of the infection on acid secretion. Methods: Acid output was examined basally and in response to gastrin-releasing peptide (GRP) and gastrin in healthy volunteers with and without H. pylori infection and in patients with

  8. Curing Helicobacter pylori infection in patients with duodenal ulcer may provoke reflux esophagitis

    Microsoft Academic Search

    J Labenz; AL Blum; E Bayerdorffer; A Meining; M Stolte; G Borsch

    1997-01-01

    BACKGROUND & AIMS: We have shown previously that cure of Helicobacter pylori infection leads to the disappearance of acid-neutralizing substances. Also, patients with ulcer after cure may gain weight. The aim of this study was to investigate whether cure of the infection increases the risk of reflux esophagitis. METHODS: Patients with duodenal ulcer without reflux esophagitis at the time of

  9. Optical Markers in Duodenal Mucosa Predict the Presence of Pancreatic Cancer

    E-print Network

    Ottino, Julio M.

    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

  10. Automated classification of duodenal imagery in celiac disease using evolved Fourier feature vectors

    Microsoft Academic Search

    Andreas Vécsei; Thomas Fuhrmann; Michael Liedlgruber; Leonhard Brunauer; Hannes Payer; Andreas Uhl

    2009-01-01

    Feature extraction techniques based on selection of highly discriminant Fourier filters have been developed for an automated classification of magnifying endoscope images with respect to pit patterns of colon lesions. These are applied to duodenal imagery for diagnosis of celiac disease. Features are extracted from the Fourier domain by selecting the most discriminant features using an evolutionary algorithm. Subsequent classification

  11. Incidence of perforation with Goode T-tube.

    PubMed

    Matt, B H; Miller, R P; Meyers, R M; Campbell, J M; Cotton, R T

    1991-02-01

    Two groups of patients from the same era were retrospectively studied in Cincinnati and Chicago. In Cincinnati two subgroups were studied. The first group received myringotomy with insertion of a 'T'-shaped ventilating tube (75 patients, 140 ears, 147 insertions). Fifty-eight ears still had the tube in place, 31 had healed after spontaneous extrusion, 17 had healed after removal of the tube, 20 had persistent perforation after the tube was gone, 2 had a cholesteatoma, and 4 patients (7 ears) were lost to follow-up. The second set received myringotomy and insertion of a small grommet (Donaldson tube, 71 patients, 140 ears, 164 insertions) tympanostomy tube. None could be documented to still have the tube in place, 156 ears healed after spontaneous extrusion, none required removal, 3 ears had a persistent perforation after the tube was gone, none had cholesteatoma, and 5 patients (5 ears) were lost to follow-up. The perforation rate for the T-tube is 13.6% and for the grommet is 1.8% (P = 0.0005). In Chicago, 93 patients who received the Goode T style tube (175 ears, 175 insertions) prior to March, 1986 were evaluated. The degree of retraction of the tympanic membrane preoperatively was recorded. No ears still had the tube in place, 145 had healed after spontaneous extrusion or removal of the tube, 30 had persistent perforation 12 months after the tube was gone, 4 had a cholesteatoma, and 8 patients (15 ears) were lost to follow-up. The rate of perforation is 18.8% which is not statistically different from the Cincinnati rate.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:2037413

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

    PubMed Central

    Graham, David Y

    2014-01-01

    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

  13. Diagnosis and treatment strategies of tuberculous intestinal perforations: a case series.

    PubMed

    Lee, Ming J; Cresswell, Fiona V; John, Laurence; Davidson, Robert N

    2012-05-01

    Gastrointestinal tuberculosis (TB) may result in intestinal obstruction and perforation, even after antituberculous therapy has been initiated. Despite surgical intervention tuberculous perforation has a high complication and mortality rate, and it is difficult to predict the subgroup of patients with abdominal TB who progress to perforation. In this study, we retrospectively investigated the clinical features that may predict disease progression in patients in our institution who presented abdominal TB over a 5-year period between January 2006 and August 2011, as well as describe an unreported method of managing tuberculous intestinal perforations when resection with end-to-end anastomosis is unfeasible. Six out of 91 patients (6.6%) with abdominal TB developed perforations. Factors linked with increased complications and mortality were age, comorbidities, multiple perforations and length of time between onset of abdominal symptoms and perforation. Four patients (66.7%) had long histories of abdominal symptoms before perforation. Three patients were receiving or had completed antituberculous therapy before developing perforation. Five patients were managed surgically, two underwent laparostomy as both primary closure and end-to-end anastomosis were deemed too risky. Mortality following perforation was 17%. Patients with prolonged abdominal symptoms, even after antituberculous therapy, should raise suspicion for subacute intestinal obstruction. This should be recognized early and surgical intervention considered in order to prevent mortality secondary to perforation. Laparostomy may be an alternative when resection and end-to-end anastomosis is not possible. PMID:22293329

  14. The rate of glove perforations in orthopaedic procedures: single versus double gloving. A prospective study.

    PubMed

    Chan, K Y; Singh, V A; Oun, B H; To, B H Se

    2006-12-01

    Glove perforation during surgery has always been a matter of concern as it increases the infection rate and the risk of transmission of blood borne diseases. To determine the common causes, the site and the awareness of glove perforations in orthopaedic surgery, a prospective study was conducted to assess the rate of glove perforation during 130 consecutive orthopaedic operations. All gloves worn by the surgical team were assessed after the surgery using the water-loading test. A total of 1452 gloves were tested, and the rate of perforation was 3.58%. Most of these perforations (61.5%) were unnoticed. The main surgeons had the most perforations (76.9%), followed by first assistants (13.5%) and second assistants (9.6%). Most perforations occurred at the non-dominant hand. The commonest site of perforation was the index finger followed by the thumb. Shearing force with instruments accounted for 45% of the noticed perforations. Majority of these occurred during nailing procedures (33%) and internal fixation without the use of wires (19%). Our rate of glove perforation is similar to other series. Most of them went unnoticed and were mainly due to shearing injuries rather than perforation by sharps. Therefore, there is an increased risk of contamination and break in asepsis during surgery. PMID:17605178

  15. Lumbar nerve rootlet entrapment by an iatrogenically spliced percutaneous intra-thecal lumbar cerebrospinal fluid catheter

    PubMed Central

    Yue, James J.; Castro, Carlos A.; Scott, David

    2015-01-01

    Background Complications associated with the use of percutaneous intra-thecal lumbar indwelling spinal catheters include infection, hematoma, neurologic dysfunction, and persistent undesired retention among others. A case of iatrogenic splicing associated with neurologic dysfunction with the use of a percutaneous intra-thecal indwelling spinal catheter is presented in this study. Method Single case study review. Results Review of case materials indicate Y pattern splicing/fragmentation of an indwelling intra-thecal catheter causing neurologic dysfunction and resistance to removal during attempted removal. Pain and weakness were evident soon after insertion of the catheter and were amplified with attempted catheter removal. Computed tomography revealed a double dot sign on axial view and a Y appearance on sagittal view. Surgical findings revealed entrapment of nerve rootlets in the axilla of the spliced catheter. Conclusions Splicing/fragmentation causing neurologic dysfunction as well as catheter retention is described as a potential complication of intra-thecal indwelling cerebrospinal fluid catheters. A symptom of fragmentation of a catheter may include neurologic dysfunction including pain and weakness of a lumbar nerve root. If resistance is experienced upon attempted catheter removal, with or without associated neurologic dysfunction, further attempts at removal should not be attempted. In those cases in which pain and/or lumbar weakness are evident post catheter placement and/or following attempted removal, computed tomography should be performed. If fragmentation of a catheter is evident on CT scan, spinal surgical consultation should be obtained. Recommended spinal surgical intervention includes an open durotomy and visualization of catheter fragments and nerve rootlets and removal of catheter fragments. PMID:25600724

  16. A case report of an ampullary tumor presenting with spontaneous perforation of an aberrant bile duct and treated with total laparoscopic pancreaticoduodenectomy

    PubMed Central

    2012-01-01

    Background This case report discusses a patient who presented with bile peritonitis due to spontaneous perforation of an aberrant bile duct that originated in the triangular ligament of the liver. It was associated with an ampullary tumor and treated with total laparoscopic pancreaticoduodenectomy (TLPD). Case report A 58-year-old male patient was admitted to the emergency department of Medical Park Gaziantep Hospital in September 2009 with acute abdominal findings. He underwent an urgent laparoscopy, and, interestingly, bile peritonitis due to the rupture of an aberrant bile duct in the triangular ligament was noted. After laparoscopic treatment of the acute conditions, the follow-up examinations of the patient showed the finding of obstructive jaundice. Endoscopic retrograde cholangio-pancreatography revealed a 1-cm polypoid mass located at the ampulla of Vater (duodenal papilla) with possible extension to the ampullary sphincter. A stent was inserted for temporary biliary drainage, and subsequent endoscopic biopsy showed the pathological finding of adenocarcinoma. After waiting for a 1-month period for the peritonitis to heal, the patient underwent pylorus-preserving TLPD and was discharged without any major complications on postoperative day 7. Conclusion In patients with bile peritonitis, it should be considered that the localization of the perforation may be in an aberrant bile duct localized at the triangular ligament and the etiology may be associated with an obstructing periampullary tumor. Laparoscopic pancreaticoduodenectomy is a feasible operative procedure in carefully selected patients. This technique can achieve adequate margins and follows oncological principles. Randomized comparative studies are needed to establish the superiority of minimally invasive surgery over traditional open surgery. PMID:22788965

  17. Value of MRCP using oral Gd-DTPA as negative contrast materials in diagnosis of atypical juxtapapillary duodenal diverticulum

    Microsoft Academic Search

    Jingshan Gong; Hong Zhao; Te Liu; Rennan Ling; Jianmin Xu

    2009-01-01

    ObjectiveTo investigate value of magnetic resonance cholangiopancreatography (MRCP) using oral diluted gadolinium (Gd)-diethylenetriamine penta-acetic acid (DTPA) as negative contrast materials in diagnosis of juxtapapillary duodenal diverticulum with atypical imaging features.

  18. A salvage procedure for an accidentally twisted small bowel in orthotopic duodenal reconstruction after pylorus-preserving partial pancreatoduodenectomy.

    PubMed

    Käser, S A; Glauser, P M; Dätwiler, S; Maurer, C A

    2011-10-01

    A case of pylorus-preserving Whipple procedure with an accidentally clockwise 360° rotated small bowel limb in orthotopic duodenal reconstruction is presented. A simple salvage procedure is proposed. PMID:21544872

  19. Scleral perforation complicating titanium mesh plaque in orbital blowout fracture.

    PubMed

    Koktekir, Bengu Ekinci; Bakbak, Berker; Karamese, Mehtap; Gedik, Sansal; Tosun, Zekeriya

    2012-07-01

    A 27-year-old man who underwent a previous reconstruction surgery for left orbital blowout fracture and recent revision surgery for left cicatricial ectropion was admitted to the ophthalmology outpatient clinic with a 20-mm irregular conjunctival and scleral incision in the left eye at the 6-o'clock position. The scleral and conjunctival incisions were repaired, and during the operation, the anterior end of the titanium mesh plate was visible at the inferior orbital rim. The plastic surgery team removed the irritating end of the plate. Obvious adherence of periocular tissues onto the titanium implant and fibrovascular ingrowth through the implant were seen during this operation. The possible mechanism for the misdirection of the anterior end of the implant might be explained by iatrogenic rotation during the revision of the cicatricial ectropion. To the best of our knowledge, this is the first reported case demonstrating scleral incision caused by an orbital titanium implant. PMID:22777447

  20. Ventricular perforation by pacemaker lead repaired with two hemostatic devices

    PubMed Central

    Prestipino, Filippo; Nenna, Antonio; Casacalenda, Adele; Chello, Massimo

    2014-01-01

    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

  1. Acoustic analysis of elliptical muffler chamber having a perforated pipe

    NASA Astrophysics Data System (ADS)

    Sohei, Nishimura; Tsuyoshi, Nishimura; Takashi, Yano

    2006-11-01

    Evidently, a perforated pipe is an essential component in muffler systems. It has the ability to reduce the power levels of noise sources generated by flow. Muffler systems are composed of several elements joined together in series or parallel. In practical approach, each element can have one or more perforated pipe installed. This yields the ability to estimate the acoustic characteristic by the product of the individual element four-pole parameters. In this work, a method to derive the four-pole parameters of such element with consideration of higher-order mode is presented. Based on the results obtained, the parameter C was investigated systematically. Some comparisons between the experimental measurements and the predicted results are discussed. The mean flow velocity is not considered in this paper.

  2. Directional bending wave propagation in periodically perforated plates

    NASA Astrophysics Data System (ADS)

    Andreassen, Erik; Manktelow, Kevin; Ruzzene, Massimo

    2015-01-01

    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.

  3. An acoustic beam shifter with enhanced transmission using perforated metamaterials

    NASA Astrophysics Data System (ADS)

    Wei, Pengjiang; Liu, Fu; Liang, Zixian; Xu, Yan; Tak Chu, Sai; Li, Jensen

    2015-01-01

    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.

  4. Anomalous sound absorption in lattices of cylindrical perforated shells

    NASA Astrophysics Data System (ADS)

    García-Chocano, Victor M.; Sánchez-Dehesa, José

    2015-03-01

    This work reports the enhancement of sound absorption by sonic crystals slabs made of cylindrical perforated shells. These building units, with perforations of millimeter size, show small losses and cannot explain the strong absorption observed at some specific frequencies when the slabs consist of just a few number of rows. It is found that this phenomenon is due to a resonant Wood anomaly which occurs when the incident wave couples with a leaky guided mode supported by the slab. This effect results in an enhancement of the absorption, since the energy transferred to the guided mode travels within the slab, along a direction perpendicular to the incident one. Multiple scattering and finite element simulations give support to the proposed behavior, the transmittance results being in good agreement with experimental data previously reported.

  5. Apparatus and method for sealing perforated well casing

    DOEpatents

    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

    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.

  6. Apparatus and method for sealing perforated well casing

    DOEpatents

    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

    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.

  7. Features of radiation beam formation in resonators with perforated mirrors

    SciTech Connect

    Boreysho, A S; Leonov, A F; Strakhov, S Yu; Trilis, A V [Institute of Laser Instruments and Technologies, D F Ustinov 'VOENMEKh' Baltic State Technical University, St Petersburg (Russian Federation)

    2003-02-28

    The possibility of using perforated output mirrors in stable resonators of cw CO{sub 2} lasers is discussed. The main factors responsible for the intracavity losses, including those connected with the diffraction of beams at the edges of holes in the mirrors are considered. The results of the experimental investigation of a 100-kW combustion product gas-dynamic CO{sub 2} laser with stable and unstable resonators and output mirrors of various types are compared with the results of numerical simulation. The theoretical and experimental studies performed over a wide range of parameters explain some peculiarities of the beam formation process in resonators with perforated mirrors. Practical recommendations are offered for choosing the parameters of such mirrors. (resonators)

  8. Perforation of a domain wall by a point mass

    NASA Astrophysics Data System (ADS)

    Gal'tsov, D. V.; Melkumova, E. Yu.; Spirin, P.

    2014-04-01

    We investigate the collision of a point particle and an infinitely thin planar domain wall interacting gravitationally within linearized gravity in a Minkowski space-time of arbitrary dimension. In this setting we are able to describe analytically the perforation of the wall by an impinging particle, showing that it is accompanied by an excitation of the spherical branon shock wave propagating outwards with the speed of light. Formally, the shock wave is a free solution of the branon wave equation which has to be added to ensure the validity of the retarded solution at the perforation point. Physically, the domain wall gets excited due to the shake caused by an instantaneous change of sign of the repulsive gravitational force. This effect is shown to hold, in particular, in four space-time dimensions, which is applicable to the problem of cosmological domain walls.

  9. Cecal perforation and adrenocortical adenoma in a dog.

    PubMed

    Moore, M P; Robinette, J D

    1987-07-01

    Cecal perforation was diagnosed in a dog with a history of acute vomiting. The dog also had an adrenocortical adenoma. Intestinal perforation can be a serious complication of cortico-steroid treatment in the dog, but has not been attributable to hyperadrenocorticism. Fever and an inflammatory CBC were not observed, which could have been secondary to adrenal-dependent hyperadrenocorticism. The acute abdominal crisis associated with peritonitis required quick resolution in an attempt to save the dog, but also precluded any further diagnostic procedures for possible hyperadrenocorticism. The signs that suggested hyper-adrenocorticism in this dog included alopecia, lymphopenia, eosinopenia, high liver enzyme activities, hypercholesterolemia, and one large and one small adrenal gland. This latter finding presumably indicated negative feedback suppression and atrophy attributable to a functional adrenocortical adenoma. PMID:3610787

  10. Enhancement of extracellular molecule uptake in plasmonic laser perforation.

    PubMed

    Kalies, Stefan; Birr, Tobias; Heinemann, Dag; Schomaker, Markus; Ripken, Tammo; Heisterkamp, Alexander; Meyer, Heiko

    2014-07-01

    The use of laser induced surface plasmons on metal nanoparticles has proven to be an excellent tool for the delivery of molecules like siRNA and DNA into cells. However, a detailed understanding of the basic mechanisms of molecular uptake and the influence of parameters like biological environment is missing. In this study we analyzed the uptake of fluorescent dextrans with sizes from 10 to 2000 kDa, which resembles a wide range of biologically relevant molecules in size using a 532 nm picosecond laser system and 200 nm gold nanoparticles. Our results show a strong uptake-dependence on cell medium or buffer, but no dominant dependence on osmotic conditions. The relation between pulse energy and number of pulses for a given perforation efficiency revealed that multiphoton ionization of water might contribute to perforation. Moreover, a seven-fold uptake-enhancement could be reached with optimized parameters, providing a very promising basis for further studies and applications. PMID:23341255

  11. Reconstruction of Thermographic Signals to Map Perforator Vessels in Humans

    PubMed Central

    Liu, Wei-Min; Maivelett, Jordan; Kato, Gregory J.; Taylor, James G.; Yang, Wen-Chin; Liu, Yun-Chung; Yang, You-Gang; Gorbach, Alexander M.

    2013-01-01

    Thermal representations on the surface of a human forearm of underlying perforator vessels have previously been mapped via recovery-enhanced infrared imaging, which is performed as skin blood flow recovers to baseline levels following cooling of the forearm. We noted that the same vessels could also be observed during reactive hyperaemia tests after complete 5-min occlusion of the forearm by an inflatable cuff. However, not all subjects showed vessels with acceptable contrast. Therefore, we applied a thermographic signal reconstruction algorithm to reactive hyperaemia testing, which substantially enhanced signal-to-noise ratios between perforator vessels and their surroundings, thereby enabling their mapping with higher accuracy and a shorter occlusion period. PMID:23667389

  12. Iatrogenic implantation of giant cell tumor at bone graft donor site and clinical recommendations to prevent "a rare avoidable complication".

    PubMed

    Gulia, Ashish; Puri, Ajay; Salunke, Abhijeet; Desai, Subhash; Jambhekar, N A

    2013-08-01

    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

  13. Central retinal artery occlusion as an iatrogenic complication of treatment of central giant cell granuloma of the mandible.

    PubMed

    Bhushan, Gauri; Gupta, Swati; Bhushan, Urvashi; Raina, Usha Kaul

    2015-05-01

    Although intralesional steroid injection as a management option for central giant cell granuloma (CGCG) of the mandible is considered safe, central retinal artery occlusion (CRAO) is a dreaded and previously unreported complication of this treatment modality. The present report discusses an iatrogenic case of CRAO that occurred during treatment of CGCG of the mandible. This complication occurred because of high injection pressure, which led to the opening of an anastomosis between the external and internal carotid arteries, leading to retrograde migration of steroid particles. This report also highlights the importance of being aware of such communications. PMID:25883007

  14. Percutaneous Closure of an Iatrogenic Ventricular Septal Defect Following Concomitant Septal Myectomy at the Time of Aortic Valve Replacement

    PubMed Central

    Ryu, Il Hwan; Kim, Won Ho; Ryu, Ah Jeong; Kim, Min Gyu; Jeon, Jae Woong; Kim, Joo Seok; Lee, Jae Joon

    2014-01-01

    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

  15. Quasi-static and ballistic perforation of carbon fiber laminates

    Microsoft Academic Search

    Werner Goldsmith; C. K. H. Dharan; Hui Chang

    1995-01-01

    The partial and complete perforation of woven carbon fiber\\/epoxy laminates with thicknesses ranging from 1.3 to 6.6 mm by 60° cylindro-conical hard steel strikers at normal incidence has been examined under both quasi-static and dynamic conditions. Quasi-static experiments were conducted in a standard experiments were conducted in a standard testing machine at rates ranging from 0.012 to 6.5s?1, where the

  16. [Intestinal perforation by Angiostrongylus costaricensis. A report of 2 cases].

    PubMed

    Sánchez, G A

    1992-05-01

    Two cases of abdominal angiostronylosis with terminal ileum perforation are reported. The first two cases diagnosed in Panama of a well established eosinophilic granulomatous process which affects mostly children in Costa Rica. The parasite Angiostrongylus costaricensis has been demonstrated in cases with a geographic range, from Mexico down to Brazil. The parasite has been found in rodents in Panama (Sigmodon hispidus and Rattus rattus) with an still pending further epidemiological and serological studies in order to determine the true disease morbidity. PMID:1620898

  17. Olmesartan Associated Sprue-Like Enteropathy and Colon Perforation

    PubMed Central

    Abdelghany, Mahmoud; Gonzalez, Luis; Slater, John; Begley, Christopher

    2014-01-01

    We are reporting a unique case of olmesartan associated severe sprue-like enteropathy in a 52-year-old woman who presented to our hospital complaining of severe abdominal pain and nausea. At the emergency department she suffered from a cardiac arrest and was found to have a colon perforation. The patient was treated conservatively without surgical intervention and olmesartan was discontinued. After one month, she had complete resolution of her symptoms. PMID:24711933

  18. Clinical value of ultrasound in diagnosing pediatric choledochal cyst perforation.

    PubMed

    Chen, Jingyu; Tang, Yi; Wang, Zhigang; Wang, Qiao; Wang, Dong

    2015-03-01

    OBJECTIVE. The objective of our study was to evaluate ultrasound images of pediatric patients with choledochal cyst perforation and establish imaging findings that can be used as the basis for timely surgical intervention. MATERIALS AND METHODS. Our study group was composed of 23 pediatric patients who presented with various symptoms of acute abdomen and were admitted to our institution between 1996 and 2013. All had undergone preoperative ultrasound examination and had a final diagnosis of choledochal cyst perforation that was confirmed at exploratory laparotomy. The imaging and surgical data were reviewed and analyzed retrospectively. RESULTS. The 23 patients included nine males and 14 females with a mean age of 2.55 years and mean disease duration of 12.48 days. The most common initial diagnoses were intestinal obstruction and peritonitis. Real-time ultrasound imaging with multislice views revealed characteristics of choledochal cyst perforation, including changes in the shape of the bile duct, loss of local gallbladder tension, thickened gallbladder wall, changes in the morphology of the gallbladder, and peritoneal effusion. The inability to visualize the gallbladder, gallbladder enlargement, the presence of gallbladder sludge and of pebblelike stones, and dilatation of the intrahepatic ducts were also noted on ultrasound. Choledochectasia was present in a majority of the patients (17/23), and ascites was seen in all 23 patients. The ultrasound signs corresponded to the surgical findings, thus showing the high clinical diagnostic value of ultrasound in this setting. CONCLUSION. Real-time ultrasound imaging-with its multislice views and good reproducibility-allows definitive preoperative diagnosis of pediatric choledochal cyst perforation. PMID:25714296

  19. Cardiac Perforation and Tamponade During Transjugular Intrahepatic Portosystemic Shunt Placement

    SciTech Connect

    McCowan, Timothy C. [Department of Radiology, University of Arkansas for Medical Sciences, 4301 West Markham, Little Rock, AR 72205 (United States); Hummel, Michael M. [Radiologists of North Iowa, Mason City, IA 50401 (United States); Schmucker, Tracey [Department of Ophthalmology, University of Arkansas for Medical Sciences, 4301 West Markham, Little Rock, AR 72215 (United States); Goertzen, Timothy C.; Culp, William C.; Habbe, Thomas G. [Department of Radiology, University of Nebraska Medical Center, 981045 Nebraska Medical Center, Omaha, NE 68198-1045 (United States)

    2000-07-15

    A patient developed acute severe hemodynamic compromise during a transjugular intrahepatic portosystemic shunt (TIPS) procedure for intractable ascites. Rapid clinical and radiographic evaluation of the patient disclosed pericardial blood and cardiac tamponade as the cause, probably due to right heart perforation from guidewire and catheter manipulation. The tamponade was successfully treated percutaneously, and the patient survived. Cardiac tamponade should be considered in the differential diagnosis of patients who develop hypotension during TIPS placement.

  20. Temperature Driven Annealing of Perforations in Bicellar Model Membranes

    SciTech Connect

    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

    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.

  1. Laparoscopic pyloric exclusion after endoscopic retrograde cholangiopancreatography perforation.

    PubMed

    Himpens, J; Rogge, F; Leman, G; Sonneville, T; Nelis, P

    2002-05-01

    We describe a laparoscopic technique of pyloric exclusion with gastroenterostomy and common bile duct T tube insertion for obvious perforation at endoscopic retrograde cholangiopancreatography with papillotomy. The patient was operated on immediately after diagnosis of the lesion. The postoperative sequellae were very comparable to those of elective laparoscopic common bile duct exploration. We believe this approach is interesting, especially in the current era of frequent litigation. PMID:11997841

  2. Depositing graphene films on solid and perforated substrates.

    PubMed

    Banerjee, A; Grebel, H

    2008-09-10

    Graphene-a monolayer of graphite-has attracted vast interest recently owing to its perfect two-dimensional crystallographic nature and its potential use in a new generation of microelectronic devices. Yet, a deposition method, which results in a large coverage of monolayer thick graphite, is still lacking. By using a chemical mechanical polishing (CMP) method we were able to deposit stress-free graphene on solid and perforated substrates alike, achieving area coverage of hundreds of microns squared. PMID:21828868

  3. Evaluation of Perforated Carbonate Cores Under Acid Stimulation

    E-print Network

    Diaz, Nerwing Jose

    2011-10-21

    to evaluate the impact of reactive charges on acid wormholing in representative carbonate cores. A set of oil-saturated Indiana limestone and cream chalk cores have been perforated under simulated downhole conditions using either a conventional or a... thankful to Mohamed Mahmoud for running the chemical analysis of the core effluent fluids and Yanbin Zhang for teaching me everything needed to perform the acidizing experiments. I am also very thankful to John Maldonado for all his time and help...

  4. Colonic perforation during percutaneous nephrolithotomy: An 18-year experience

    PubMed Central

    AslZare, Mohammad; Darabi, Mohammad Reza; Shakiba, Behnam; Gholami-Mahtaj, Leila

    2014-01-01

    Introduction: Percutaneous nephrolithotomy (PCNL) is the treatment of choice for large, extracorporeal lithotripsy failure stones and those in the inferior calyx. Despite the development of new techniques and the increasing experience in recent decades, complications may still occur. Colonic perforation is one of the most dangerous and rare complications of PCNL, which may lead to peritonitis and sepsis. We present our 18-year experience on the diagnosis and management of colonic perforation during PCNL Methods: We retrospectively reviewed the data of 5260 PCNL procedures performed between May1995 and August 2013. Preoperative and operative factors, such as age, sex, history of previous ipsilateral stone intervention, stone side, stone location, site of skin puncture and punctured calyx, were reviewed in patients with colonic injury. Results: Colonic perforation was found in 11 patients (5 males and 6 females) and the mean age was 40.4 ± 22.2 years (range: 4 to 71). All injuries were retroperitoneal. The left side was affected in 5 patients and the right side was injured in 6 cases. Conservative management was the treatment planned for all patients. It included withdrawal of the nephrostomy tube outside the kidney to the colon as a percutaneous colostomy, insertion of a double-J ureteral stent, intravenous broad-spectrum antibiotics, bowel rest and total parenteral nutrition. Under this conservative management, complete healing of the colon was achieved in all patients. Conclusion: Early diagnosis and conservative management of colonic perforation can minimize patient morbidity and mortality and result in excellent healing of the fistulous tract without any serious complications. PMID:24940458

  5. A controlled trial of glycopyrronium and l-hyoscyamine in the long-term treatment of duodenal ulcer

    Microsoft Academic Search

    Michael D. Kaye; J. Rhodes; Peter Beck; Peter M. Sweetnam; G. T. Davies; K. T. Evans

    1970-01-01

    A controlled single-blind trial has been carried out to determine the value of long-term anticholinergic therapy in duodenal ulcer. Of 106 male patients with symptomatic and radiologically proven duodenal ulcer admitted to the trial, 91 completed the study. Patients were divided randomly into three groups. They received either glycopyrronium, or 1-hyoscyamine in a sustained-release form, or inert tablets for one

  6. A Novel Duodenal Iron-Regulated Transporter, IREG1, Implicated in the Basolateral Transfer of Iron to the Circulation

    Microsoft Academic Search

    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

    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

  7. Computed tomography attenuation values of ascites are helpful to predict perforation site

    PubMed Central

    Seishima, Ryo; Okabayashi, Koji; Hasegawa, Hirotoshi; Tsuruta, Masashi; Hoshino, Hiroki; Yamada, Toru; Kitagawa, Yuko

    2015-01-01

    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

  8. Plasminogen initiates and potentiates the healing of acute and chronic tympanic membrane perforations in mice

    PubMed Central

    2014-01-01

    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

  9. Micro-mechanical modeling of perforating shock damage

    SciTech Connect

    Swift, R.P.; Krogh, K.E. [Los Alamos National Lab., NM (United States); Behrmann, L.A. [Schlumberger Perforating and Testing (United States); Halleck, P.M. [Pennsylvania State Univ., University Park, PA (United States)

    1997-11-17

    Shaped charge jet induced formation damage from perforation treatments hinders productivity. Manifestation of this damage is in the form of grain fragmentation resulting in fines that plug up pore throats along with the breakdown of inter-grain cementation. The authors use the Smooth Particle Hydrodynamic (SPH) computational method as a way to explicitly model, on a grain pore scale, the dynamic interactions of grains and grain/pores to calculate the damage resulting from perforation type stress wave loading. The SPH method is a continuum Lagrangian, meshless approach that features particles. Clusters of particles are used for each grain to provide representation of a grain pore structure that is similar to x-ray synchrotron microtomography images. Numerous damage models are available to portray fracture and fragmentation. In this paper the authors present the results of well defined impact loading on a grain pore structure that illustrate how the heterogeneity affects stress wave behavior and damage evolution. The SPH approach easily accommodates the coupling of multi-materials. Calculations for multi-material conditions with the pore space treated as a void, fluid filled, and/or clay filled show diverse effects on the stress wave propagation behavior and damage. SPH comparisons made with observed damage from recovered impacted sandstone samples in gas gun experiments show qualitatively the influence of stress intensity. The modeling approach presented here offers a unique way in concert with experiments to define a better understanding of formation damage resulting from perforation completion treatments.

  10. Perforated plates for cryogenic regenerators and method of fabrication

    DOEpatents

    Hendricks, John B. (Huntsville, AL)

    1994-01-01

    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.

  11. Perforated plates for cryogenic regenerators and method of fabrication

    DOEpatents

    Hendricks, J.B.

    1994-03-29

    Perforated plates having very small holes with a uniform diameter throughout the plate thickness are prepared by a [open quotes]wire drawing[close quotes] 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 containing erbium and nickel metals in a stacked array 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, one of which is small enough for storage of helium, are also disclosed. 10 figures.

  12. On the level-dependent attenuation of a perforated device.

    PubMed

    Chen, Lan; Sang, Jinqiu; Li, Xiaodong

    2009-05-01

    To investigate the physical principle governing the level-dependent attenuation of a perforated earplug, a mathematical model is first established with the transfer-matrix method to calculate the noise reduction through a simplified device, one perforated panel with back cavity, mounted in an impedance tube. The model prediction is compared with the measured noise reduction through two series of large-scale devices and one device with the dimensions of the ear canal under continuous noise and sinusoidal excitations. The model helps to improve significantly the level-dependent attenuation of the large-scale device. It also illustrates that the attenuation is not solely determined by the resistance of the orifice, which has been a well accepted design concept, but resulted from an incorporated effect of the acoustic filter comprised of the acoustic impedance of the orifice and other elements in the earplug-ear-canal system. This mechanism can interpret a resonance at low incident levels on improper design and reveal approaches to eliminate it. Finally, the model's potential contributions to the design of a perforated earplug are discussed, along with the threshold of level-dependent attenuation supported with experimental evidence. PMID:19425643

  13. Hydraulic Fracture Initiation and Propagation from Wellbore with Oriented Perforation

    NASA Astrophysics Data System (ADS)

    Zhu, Haiyan; Deng, Jingen; Jin, Xiaochun; Hu, Lianbo; Luo, Bo

    2015-03-01

    Considering the influence of casing, analytical solutions for stress distribution around a cased wellbore are derived, based on which a prediction model for hydraulic fracture initiation with the oriented perforation technique (OPT) is established. Taking well J2 of Z5 oilfield for an example, the predicted initiation pressure with the OPT of our model is about 4.2 MPa higher than the existing model, which neglects the influence of casing. In comparison with the results of laboratory fracturing experiments with OPT on a 400 × 400 × 400 mm3 rock sample for a cased well with the deviation of 45°, the fracture initiation pressure of our model has an error of 3.2 %, while the error of the existing model is 6.6 %; when the well azimuth angle is 0° and the perforation angle is 45°, the prediction error of the fracture initiation pressure of the existing model and our model are 3.4 and 7.7 %, respectively. The study verifies that our model is more applicable for hydraulic fracturing prediction of wells with OPT completion; while the existing model is more suitable for hydraulic fracturing with conventional perforation completion.

  14. Endoscope-assisted laparoscopic repair of perforated peptic ulcers.

    PubMed

    Lee, Kun-Hua; Chang, Hung-Chi; Lo, Chong-Jeh

    2004-04-01

    Laparoscopic repairs for perforated peptic ulcer (PPU) are likely to fail in patients with shock, gastric outlet obstruction, or large perforations. This prospective study was performed to evaluate a revised approach of laparoscopic repair with endoscopic assistance to treat these patients. Between April 2001 and February 2002, 30 consecutive patients with PPU were enrolled in this study. The mean age was 43.1 +/- 12.2 years. Male to female ratio was 27:2. One patient was excluded from laparoscopic repair due to a gastric outlet obstruction. The other 29 patients were managed according to a protocol of preoperative upper endoscopy and laparoscopic intracorporeal suture repair with an omental patch. The average operative time was 58.1 +/- 13.5 minutes (range, 36-96 min). The average diameter of perforation was 4.2 +/- 2.0 mm (range, 1-12 mm). The average time to resume oral fluids was 3.2 +/- 0.8 days (range, 2-8 days). The average hospital stay was 4.7 +/- 1.1 days (range, 3-10 days). There was no leakage or mortality. Most patients did not receive parenteral analgesics postoperatively. We conclude that endoscope-assisted laparoscopic repair for PPU is safe and effective. This revised technique allows surgeons to exclude patients who are likely to fail the laparoscopic repair. PMID:15098791

  15. Hybrid silencers with micro-perforated panels and internal partitions.

    PubMed

    Yu, Xiang; Cheng, Li; You, Xiangyu

    2015-02-01

    A sub-structuring approach, along with a unit cell treatment, is proposed to model expansion chamber silencers with internal partitions and micro-perforated panels (MPPs) in the absence of internal flow. The side-branch of the silencer is treated as a combination of unit cells connected in series. It is shown that, by connecting multiple unit cells with varying parameters, the noise attenuation bandwidth can be enlarged. With MPPs, the hybrid noise attenuation mechanism of the silencer is revealed. Depending on the size of the perforation hole, noise attenuation can be dominated by dissipative, reactive, or combined effects together. For a broadband sound absorption, the hole size, together with the perforation ratio and other parameters, can be optimized to strike a balance between the dissipative and reactive effect, for ultimately achieving the desired noise attenuation performance within a prescribed frequency region. The modular nature of the proposed formulation allows doing this in a flexible, accurate, and cost effective manner. The accuracy of the proposed approach is validated through comparisons with finite element method and experiments. PMID:25698027

  16. [The emergency plastic reconstruction of the tympanic membrane defects of post-traumatic and iatrogenic etiology with the application of the nanostructured bioplastic material].

    PubMed

    Zabirov, R A; Kar'kaeva, S M; Shchetinin, V N; Akimov, A V

    2014-01-01

    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

  17. Endoscopic treatment of intraluminal duodenal ("windsock") diverticulum: varying techniques from five cases.

    PubMed

    Law, R; Topazian, M; Baron, T H

    2012-12-01

    The optimal endoscopic approach to intraluminal duodenal diverticulum (IDD) has not been established. We report on our experience of endoscopic resection of symptomatic IDD in five patients (three men, two women; mean age 37 years) who were treated between August 2004 and April 2012.?Four patients underwent endoscopic diverticulectomy using a standard polypectomy snare. Following diverticulectomy, the remaining duodenal septum was incised using a needle-knife in two patients. The fifth patient underwent endoscopic diverticulotomy using a needle-knife. In four cases the IDD was resected and reviewed histologically and demonstrated substantial vascularity. All patients developed clinically significant, post-procedural bleeding, which was managed endoscopically. Endoscopic management of symptomatic IDD can be achieved using various approaches. Post-procedural bleeding appears to be a common adverse event, but this complication can be managed endoscopically. PMID:23188665

  18. Neurofibromatosis 1 presenting with multiple duodenal GISTS associated with a somatostatin-producing D cell neoplasm.

    PubMed

    Serio, Giovanni; Zampatti, Clementina; Ballabio, Andrea; Ricci, Riccardo; Martini, Maurizio; Zurleni, Francesco

    2013-06-01

    The co-existence of a duodenal somatostatin-producing D cell neoplasm and multiple duodenal gastrointestinal stromal tumours (GISTs) in a 61-year-old woman with neurofibromatosis type 1 is reported. Histologically, the D cell neoplasm showed a glandular pattern with psammoma bodies and was metastatic to regional lymph nodes and liver at the time of surgery. Tumour cells were monomorph and showed intense and diffuse immunoreactivity for somatostatin, focal positivity for calcitonin, while were negative for other gastroenteropancreatic hormones including insulin, glucagon, pancreatic polypeptide, serotonin and gastrin. Four submucosal and subserosal GISTs, ranging from 5 to 15 mm in diameter, were composed of uniform spindle-shaped cells lacking mitoses and contained numerous skeinoid fibres. The tumours were positive for CD117, DOG1, vimentin and CD34 and did not have KIT or PDGFRA mutations. The clinical and pathological importance of this unusual association is discussed. PMID:23564025

  19. Down syndrome: Molecular mapping of the congenital heart disease and duodenal stenosis

    SciTech Connect

    Korenburg, J.R. (University of California, Los Angeles (United States)); Bradley, C.; Disteche, C.M. (University of Washington, Seattle (United States))

    1992-02-01

    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.

  20. Structure-activity relations between alkyl nucleophilic chemicals causing duodenal ulcer and adrenocortical necrosis

    SciTech Connect

    Szabo, S.; Reynolds, E.S.; Unger, S.H.

    1982-10-01

    Structure-activity relationships were qualitatively and quantitatively examined for 56 chemicals (e.g., derivatives of propionitrile, acrylonitrile and cysteamine) which caused duodenal ulcer and/or adrenocortical necrosis in rats. For the first time the duodenal ulcerogenic property of numerous chemicals has been studied in a rational and predictive manner. Ulcerogenic activity was most intense in the carbonitriles attached to two or three carbon backbones and diminished by shortening, lengthening, branching, unsaturating, halogenating or hydroxylating the carbon chains. Different modes of action are implied. Adrenocorticolytic potency was associated with unsaturation of the carbon chain and substitution of the nitrile by thiol or amine radicals. An action of these chemicals on the central nervous system has been suggested.

  1. Delayed duodenal obstruction after intramural hematoma in a patient with paroxysmal nocturnal hemoglobinuria: A case report

    PubMed Central

    Tezcaner, Tugan; Ekici, Yahya; K?rnap, Mahir; Kural, Feride; Moray, Gökhan

    2014-01-01

    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

  2. An enucleated duodenal gastrinoma with multiple type 1 endocrine neoplasia located by selective arterial calcium injection.

    PubMed

    Shoji, Hirokazu; Kuroki, Michio; Nakano, Eriko; Hiramoto, Keiichiro; Matsumura, Yoshifumi; Miura, Atsushi; Kikuchi, Yoshifumi; Hirakawa, Hidetoshi; Matsuda, Mikio

    2011-01-01

    We report a duodenal gastrinoma in a 50-year-old man who was admitted to our hospital with tarry stools. Esophagogastroduodenoscopy revealed multiple ulcers in the duodenal bulb and a submucosal tumor in the descending duodenum. His serum gastrin level was 1400pg/ml. We suspected Zollinger-Ellison syndrome and performed selective arterial calcium injection to locate the gastrinoma. Increase in the hepatic venous gastrin level was seen only in the gastroduodenal artery area. We diagnosed a gastrinoma located in the pancreaticoduodenal area. Genetic examination showed a single-base deletion in the MEN-1 gene. At operation, the tumor was found in the submucosal layer of the descending duodenum and was extirpated. He is alive without recurrence 3 years after surgery. PMID:21212598

  3. [Surgical treatment of chronic duodenal ulcer complicated by extravasal compression of the celiac trunk].

    PubMed

    Gervaziev, V B; Lubianski?, V G

    1993-07-01

    The work analyses the results of examination and operative treatment of 69 patients with chronic duodenal ulcer and concurrent extravasal compression of the celiac trunk. The clinical signs characteristic of this combination are distinguished and it is shown that these patients have low indices of maximal acid production with a high frequency of duodenal reflux. Decrease of the hepatic and gastric blood flow was also found. It is suggested that such patients should be treated by combination of selective proximal vagotomy and decompression of the celiac trunk which is accomplished by exposure of the aorta over the celiac trunk and retrograde division of the median diaphragmatic ligament. The late-term results of the operation were analysed for follow-up periods of up to 10 years. Poor results were recorded in 6.2% of cases. PMID:8271737

  4. Gastric emptying of combined liquid-solid meals in healed duodenal ulcer

    SciTech Connect

    Moore, J.G.; McIntyre, B.; Alazraki, N.

    1985-12-01

    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.

  5. [Microneural reconstruction after iatrogenic lesions of the lingual nerve and the inferior alveolar nerve. Critical evaluation].

    PubMed

    Cornelius, C P; Roser, M; Ehrenfeld, M

    1997-07-01

    As microneural repair techniques of the sensory mandibular branches enter the third decade of their clinical use, there are but a few long-term investigations into the value of these procedures in the treatment of iatrogenic injury to the lingual (LN), inferior alveolar (IAN) or mental (MN) nerve. To establish the efficacy of microneural repair in lesions of the LN, IAN or MN with loss of continuity, the outcome of sensory recovery was evaluated in a series of 92 patients (LN: direct coaptation n = 39, coaptation + sural nerve grafting n = 23; IAN: direct coaptation n = 11 coaptation + sural nerve grafting n = 10; MN: direct coaptation n = 11). The minimum duration of follow-up was 14 months postoperatively. The persistent sensory deficit was assessed using standardized neurosensory testing and gustometric stimuli. In addition the patients answered a multiple-choice questionnaire containing a list of complaints. To obtain a numeric estimate for interindividual and intergroup comparison the information from clinical measurements and patient reports was condensed into a 'neurological score' and a 'complaint score', respectively. Furthermore, adequate items from both scores were combined to affirm or deny the return of sensory function in terms of protective and discriminative sensation. The overall results show a broad range of variation in the scores, sometimes reflecting severe degrees of persistent sensory impairment. The lowest scores, corresponding to the best regeneration, were found after direct coaptation of the LN, IAN and NM, but even the best results did not provide sensory recovery to a preinjury level. After direct coaptation of LN 69% of the patients exhibited protective sensation and 41% regained discriminative function. In contrast, LN grafting was ensued from restoration of protective function in 39% and discriminative function in 17% of the patients. More striking differences were found between coaptation and grafting of the IAN (IAN coaptation: 91% protective function; 18% discriminative function; IAN grafting: 60% protective function, 0% discriminative function). In the LN coaptation group low scores and improved taste perception were convincingly associated with short periods since injury (i.e. timing of repair). In conclusion, we feel there is sufficient justification to optimize the potential results of microneural repair by immediate (LN/MN) or early (IAN) reexposure of the injured site in order to clarify the precise nature of the underlying nerve damage and prevent delay, if patients present with complete loss of sensory function subsequent to dentoalveolar or oral surgery. However, clinical and electrophysiologic findings suggesting impairment or partial loss of sensory function are considered a contraindication to microneural intervention, in view of the limited prospects of sensory recovery after surgical repair. PMID:9410631

  6. Recurrent pancreatitis due to an intraluminal duodenal diverticulum: report of a case.

    PubMed

    Pumberger, Wolfgang; Maier-Hiebl, Beate; Kargl, Simon

    2012-06-01

    We report the investigation and treatment of a 14-year-old girl in whom a detailed assessment of recurrent episodes of pancreatitis revealed a large intraluminal 'windsock'-like duodenal diverticulum. As the diverticulum was closely attached to the papilla of Vater, it was resected by a transduodenal approach. This report focuses on the significance of rare congenital anomalies of the duodenum (e.g., duplication cyst, intraluminal diverticulum) during the diagnostic workup of recurrent pancreatitis in children. PMID:22270334

  7. Duodenal Microflora in Very-Low-Birth-Weight Neonates and Relation to Necrotizing Enterocolitis

    PubMed Central

    Hoy, Christine M.; Wood, Christopher M.; Hawkey, Peter M.; Puntis, John W. L.

    2000-01-01

    Necrotizing enterocolitis (NEC) is the most common gastrointestinal emergency in the neonatal period. Small-bowel overgrowth with aerobic gram-negative bacteria has previously been implicated in the development of NEC. This prospective study performed quantitative bacteriology on 422 duodenal aspirates collected from 122 very-low-birth-weight (<1,500-g) newborns, at the time of routine changing of nasogastric tubes. Isolates of Enterobacteriaceae were typed by repetitive extragenic, palindromic PCR and pulsed-field gel electrophoresis. One or more samples from 50% of these infants yielded gram-negative bacteria, predominantly Escherichia coli, Klebsiella spp., and Enterobacter spp., with counts up to 108 CFU/g. The proportion of samples with gram-negative bacteria increased with postnatal age, while the percentage of sterile samples declined. Molecular typing revealed marked temporal clustering of indistinguishable strains. All infants had been fed prior to isolation of gram-negative organisms. Antibiotic use had no obvious effect on colonization with Enterobacteriaceae. There were 15 episodes of suspected NEC (stage I) and 8 confirmed cases of NEC (2 stage II and 6 stage III) during the study period. Duodenal aspirates were collected prior to clinical onset in 13 episodes of NEC. Seven of these yielded Enterobacteriaceae, of which five strains were also isolated from infants without NEC. Very-low-birth-weight infants have high levels of duodenal colonization with Enterobacteriaceae, with evidence of considerable cross-colonization with indistinguishable strains. There was no association between duodenal colonization with particular strains of Enterobacteriaceae and development of NEC. PMID:11101593

  8. Duodenal pH in cystic fibrosis and its relationship to fat malabsorption

    Microsoft Academic Search

    P. J. Robinson; A. L. Smith; P. D. Sly

    1990-01-01

    To investigate the relationship between duodenal pH levels and supplemental pancreatic enzyme function in cystic fibrosis, 18 children with this condition had pH recordings performed from the second and fourth part of the duodenum. Compared to age-matched controls, patients with cystic fibrosis had significantly longer periods below a pH of 4.0 in the postprandial period and significantly less time above

  9. Pancreatic-polypeptide cell hyperplasia associated with pancreatic or duodenal gastrinomas

    Microsoft Academic Search

    Eugenia Marta Martella; Gabriella Ferraro; Cinzia Azzoni; Massimo Marignani; Cesare Bordi

    1997-01-01

    An immunohistochemical investigation of pancreatic-polypeptide (PP) cells in the PP-rich region of the pancreas, of ventral embryological origin, was performed in three female patients affected by or previously operated on for functioning duodenal or pancreatic gastrinomas not associated with multiple endocrine neoplasia syndrome. A pronounced PP-cell hyperplasia showing histological patterns of endocrine cell dysplasia and focal adenomatosis as defined by

  10. The Absence of Thyroid Hormones in a Growth Factor of Duodenal Powder

    Microsoft Academic Search

    C. J. ACKERMAN

    Three fractions prepared from the acid-insoluble residue after acid hydrolysis of duodenal powder were effective in reinstating growth of growth-arrested, sulfaguanidine-fed rats. One fraction was studied more extensively than the others to determine whether the growth response to this fraction was due to thyroxine or tri- iodothyronine. The stability of this fraction to acid hydrolysis, its insolubility in acid, its

  11. Induction of oesophageal and forestomach carcinomas in rats by reflux of duodenal contents.

    PubMed Central

    Miwa, K.; Segawa, M.; Takano, Y.; Matsumoto, H.; Sahara, H.; Yagi, M.; Miyazaki, I.; Hattori, T.

    1994-01-01

    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

  12. Early Results of Laparoscopic Biliopancreatic Diversion with Duodenal Switch: A Case Series of 40 Consecutive Patients

    Microsoft Academic Search

    Christine J. Ren; Emma Patterson; Michel Gagner

    2000-01-01

    Background: Biliopancreatic diversion with duodenal switch (BPD-DS) is an operation which provides one of the greatest maintained\\u000a weight losses of any bariatric procedure.We looked at the safety and efficacy of laparoscopic BPD-DS for morbid obesity. Methods:\\u000a A 150-200 ml sleeve gastrectomy was created and anastomosed to the distal 250 cm of divided ileum. The median length of the\\u000a common channel

  13. Emergency transcatheter arterial embolization for patients with acute massive duodenal ulcer hemorrhage

    PubMed Central

    Wang, Yong-Li; Cheng, Ying-Sheng; Liu, Li-Zhen; He, Zhong-Hui; Ding, Kun-Hong

    2012-01-01

    AIM: To evaluate the efficacy and safety of emergency transcatheter arterial embolization (ETAE) for patients with acute massive duodenal ulcer hemorrhage. METHODS: Twenty-nine consecutive patients with acute massive bleeding of duodenal ulcer were admitted to our hospital from 2006 to 2011. Superselective angiography of the celiac and gastroduodenal arteries was performed to find out the bleeding sites before ETAE, then, embolotherapy was done with gelatin sponge particles or microstrips via a 5 French angiographic catheter or 3 French microcatheter. After ETAE, further superior mesenteric arteriography was undertaken in case collateral circulation supplied areas of the duodenal ulcer. Technical and clinical success rates were analyzed. Changes in the mucous membrane were observed using endoscopy following ETAE. RESULTS: Angiography showed active bleeding with extravasation of contrast medium in seven cases with a 24% positive rate of celiac artery bleeding, and in 19 cases with a 65.5% rate of gastroduodenal artery bleeding. There were no angiographic signs of bleeding in three patients who underwent endoscopy prior to ETAE. Twenty-six patients achieved immediate hemostasis and technical success rate reached 90%. No hemostasis was observed in 27 patients within 30 d after ETAE and clinical success rate was 93%. Recurrent hemorrhage occurred in two patients who drank a lot of wine who were treated by a second embolotherapy in the same way. Five patients underwent transient ischem with light abdominal pain under xiphoid, spontaneous restoration without special treatment. No mucous necrosis happened to 29 cases for ischem of gastroduodenal arteries embolized. CONCLUSION: ETAE is an effective and safe measure to control acute massive bleeding of duodenal ulcer. PMID:23002347

  14. Tissue MicroArray Analyses of Pancreatic Duodenal Homeobox-1 in Human Cancers

    Microsoft Academic Search

    Xiao-Ping Wang; Zhi-Jun Li; Jonas Magnusson; F. Charles Brunicardi

    2005-01-01

    In previous studies, we demonstrated that rat insulin promoter (RIP)-driven gene therapy successfully targeted human pancreatic tumor PANC-1 cells and mouse insulinoma NIT-1 cells, which are both pancreatic duodenal homeobox-1 (PDX-1)-positive. The purpose of this study was to perform a human tissue array analysis to determine potential targets for RIP-driven gene therapy. A custom-designed tissue MicroArray analysis of various human

  15. Effect of vitamin D3 on duodenal absorptive cell plasma membranes: freeze fracture replication study.

    PubMed

    Jande, S S

    1976-01-01

    Vitamin D3 induced changes in the number of 5.8 nm sized randomly scattered particles on the EF faces of plasma membranes of chick duodenal absorptive cells. Their number increased as compared to those in rachitic animals. Also vitamin D3 seemed to alter the nature of the zonula occludens. These changes appear to be related to increased active absorption and passive diffusion of calcium respectively under vitamin D3 influence. PMID:201433

  16. Gastric acid secretion in patients with duodenal ulcer treated for one year with anticholinergic drugs

    Microsoft Academic Search

    Michael D. Kaye; Peter Beck; John Rhodes; Peter M. Sweetnam

    1969-01-01

    Ninety patients with duodenal ulcer, divided randomly into three groups, were treated continuously for one year with either glycopyrronium, 1-hyoscyamine (as a sustained-release preparation) or inert tablets. Dosage with active tablets was so adjusted that the patient experienced definite but tolerable side-effects. Basal and maximal gastric acid secretion were measured immediately before and one week after cessation of treatment. There

  17. Effect of omeprazole on duodenal ulcer-associated antral gastritis and Helicobacter pylori

    Microsoft Academic Search

    W. M. Hui; S. K. Lam; J. Ho; C. L. Lai; A. S. F. Lok; M. M. T. Ng; W. Y. Lau; F. J. Branicki

    1991-01-01

    This study set out to investigate the effects of omeprazole or ranitidine on the progression of antral gastritis andHelicobacter pylori in patients with active duodenal ulcer. A double-blind, double-dummy trial was performed in 270 patients, 241 of whom were studied histologically for the presence ofH. pylori. Patients were randomized to receive omeprazole, 10 mg every morning, omeprazole, 20 mg every

  18. Duodenal control of gastric emptying in the milk-fed calf.

    PubMed

    Bell, F R; Mostaghni, K

    1975-02-01

    1. It has been ascertained experimentally that an open duodenal cannula does not cause any marked variation in emptying of the abomasum when compared to the rate of emptying of the normal viscus or when the cannulae are closed. 2. Duodenal re-entrant cannulae provide a preparation whereby it is possible to infuse the duodenum via the distal cannula and to collect simultaneously the effluent fluid of the abomasum from the proximal arm of the cannula (Fig. 1). 3. With this preparation the duodenal infusate is not contaminated by the gastric effluent and thus the duodenal stimulus can be restricted to the single non-varying effect of the infusate. 4. In the milk-fed calf using this preparation the following facts have been established. (a) On infusion into the duodenum, hypotonic and isotonic solutions of sodium chloride and sodium bicarbonate increase abomasal emptying; bicarbonate being the more effective stimulus. (b) Potassium chloride, calcium chloride, glucose and hydrochloric acid inhibit gastric emptying when infused into the duodenum. (c) Ammonium chloride, urea, lactose and acetic acid have little effect. (d) Hypertonic solutions of all substances tested were inhibitory to gastric emptying when infused into the duodenum. 5. It has been demonstrated unequivocally that it is the effect of the infusate in the duodenum which controls gastric emptying for when the stomach is isolated from the duodenum, gastric emptying can be manipulated from the duodenum whatever the stomach contents may be. 6. Our results bring firm experimental confirmation of the views discussed by Hunt & Knox (1968) that gastric outflow is regulated by mechanisms initiated from receptors situated in the duodenum. PMID:1142171

  19. Dehiscence following successful endoscopic closure of gastric perforation during endoscopic submucosal dissection

    PubMed Central

    Sekiguchi, Masau; Suzuki, Haruhisa; Oda, Ichiro; Yoshinaga, Shigetaka; Nonaka, Satoru; Saka, Makoto; Katai, Hitoshi; Taniguchi, Hirokazu; Kushima, Ryoji; Saito, Yutaka

    2012-01-01

    Gastric perforation is one of the most serious complications that can occur during endoscopic submucosal dissection (ESD). In terms of the treatment of such perforations, we previously reported that perforations immediately observed and successfully closed with endoclips during endoscopic resection could be managed conservatively. We now report the first case in our medical facility of a gastric perforation during ESD that was ineffectively treated conservatively even after successful endoscopic closure. In December 2006, we performed ESD on a recurrent early gastric cancer in an 81-year-old man with a medical history of laparotomy for cholelithiasis. A perforation occurred during ESD that was immediately observed and successfully closed with endoclips so that ESD could be continued resulting in an en-bloc resection. Intensive conservative management was conducted following ESD, however, an endoscopic examination five days after ESD revealed dehiscence of the perforation requiring an emergency laparotomy. PMID:22919258

  20. Squamous cell carcinoma of the small bowel manifesting as a jejunal perforation: a case report

    PubMed Central

    Sun, Der Sheng; Shin, Ok Ran; Ku, Young Mi; Kim, Young-Seok; Seo, Kyung-Jin

    2014-01-01

    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

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

    PubMed Central

    Ozturk, Hakan; Karaaslan, Serap

    2014-01-01

    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

  2. Placement of a subdural evacuating port system for management of iatrogenic hyperacute subdural hemorrhage following intracranial monitor placement.

    PubMed

    Ivan, Michael E; Nathan, Jay K; Manley, Geoffery T; Huang, Michael C

    2013-12-01

    A 22-year-old man was admitted with a severe traumatic brain injury developed a hyperacute subdural hematoma (SDH) following attempted brain tissue oxygen monitor placement. This patient was successfully treated by placement of a subdural evacuation portal system (SEPS). The patient presented to a Level I trauma center after a severe bike versus auto accident. On admission, he was found to have a Glasgow Coma Scale (GCS) score of 3. The patient had small areas of intraparechymal hemorrhage as well as suspicion for diffuse axonal injury in the midbrain. Based on the patient's GCS score, neurological monitoring was indicated as a part of his intensive care unit treatment, however a SDH occurred during an attempted placement of a brain tissue oxygen monitor. This iatrogenic hyperacute SDH after burr hole monitoring device placement was treated with a SEPS drain. The SEPS drain has been shown to provide complete and/or temporary decompression of liquefied SDH. To our knowledge, this is the first report of using the SEPS to treat iatrogenic SDH associated with an intracranial monitoring device. This technique should be added to the armament of treatment options for a neurosurgeon to treat or temporize a hyperacute SDH with increased intracranial pressure in specific patients. PMID:24090520

  3. Efficacy of ilaprazole in the treatment of duodenal ulcers: A meta-analysis

    PubMed Central

    Ji, Xi-Qing; Du, Jun-Feng; Chen, Gang; Chen, Guang; Yu, Bo

    2014-01-01

    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

  4. Role of duodenal iron transporters and hepcidin in patients with alcoholic liver disease

    PubMed Central

    Dostalikova-Cimburova, Marketa; Balusikova, Kamila; Kratka, Karolina; Chmelikova, Jitka; Hejda, Vaclav; Hnanicek, Jan; Neubauerova, Jitka; Vranova, Jana; Kovar, Jan; Horak, Jiri

    2014-01-01

    Patients with alcoholic liver disease (ALD) often display disturbed iron indices. Hepcidin, a key regulator of iron metabolism, has been shown to be down-regulated by alcohol in cell lines and animal models. This down-regulation led to increased duodenal iron transport and absorption in animals. In this study, we investigated gene expression of duodenal iron transport molecules and hepcidin in three groups of patients with ALD (with anaemia, with iron overload and without iron overload) and controls. Expression of DMT1, FPN1, DCYTB, HEPH, HFE and TFR1 was measured in duodenal biopsies by using real-time PCR and Western blot. Serum hepcidin levels were measured by using ELISA. Serum hepcidin was decreased in patients with ALD. At the mRNA level, expressions of DMT1, FPN1 and TFR1 genes were significantly increased in ALD. This pattern was even more pronounced in the subgroups of patients without iron overload and with anaemia. Protein expression of FPN1 paralleled the increase at the mRNA level in the group of patients with ALD. Serum ferritin was negatively correlated with DMT1 mRNA. The down-regulation of hepcidin expression leading to up-regulation of iron transporters expression in the duodenum seems to explain iron metabolism disturbances in ALD. Alcohol consumption very probably causes suppression of hepcidin expression in patients with ALD. PMID:24894955

  5. Non-healing gastro-duodenal ulcer: A rare presentation of primary abdominal tuberculosis

    PubMed Central

    Merali, Nabeel; Chandak, Pankaj; Doddi, Sudeendra; Sinha, Prakash

    2014-01-01

    INTRODUCTION We present a case of primary gastrointestinal tuberculosis that has culminated in ulcer formation, in the absence of pulmonary involvement in an immunocompetent patient. PRESENTATION OF CASE A 28-year-old Asian male presented to casualty with a 1-week history of epigastric cramping abdominal pain and several episodes of non-bilious vomiting. The patient deteriorated clinically, becoming more cachectic and given his unexplained weight loss, an oesophageal-gastro-duodenal endoscopic imaging confirmed a duodenal ulcer. The biopsy of the non-healing ulcer was the hallmark of the disease, revealing evidence of granulomatous inflammation consistent with tuberculosis bacilli. DISCUSSION Gastrointestinal tuberculosis with ulceration is rare with respect to the oesophagus, stomach and duodenum. This case proves to be unique, as our patient had experienced primary isolated gastric tuberculosis in the absence of pulmonary tuberculosis in a healthy individual. Immunohistochemical staining, histopathology and radiological investigations have demonstrated their importance in confirming abdominal tuberculosis and the extent of bowel involvement. CONCLUSION This case has illustrated the difficulties associated with a prompt diagnosis of an unusual case of primary duodenal tuberculosis from chronic peptic ulcer disease in an immunocompetent patient. PMID:25506841

  6. Duodenal ulcer penetration into the liver at the previous left hemihepatectomy site?

    PubMed Central

    Hayashi, Hironori; Kitagawa, Hirohisa; Shoji, Masatoshi; Nakanuma, Shin-ichi; Makino, Isamu; Oyama, Katsunobu; Inokuchi, Masafumi; Nakagawara, Hisatoshi; Miyashita, Tomoharu; Tajima, Hidehiro; Takamura, Hiroyuki; Ninomiya, Itasu; Fushida, Sachio; Fujimura, Takashi; Tani, Takashi; Ohta, Tetsuo

    2013-01-01

    INTRODUCTION Duodenal ulcer penetration into the liver is a rare, but serious complication. Its frequency was thought to have decreased owing to advances in therapies for peptic ulcers. However, we encountered a case in which the duodenal ulcer had penetrated into a previous hemihepatectomy site. PRESENTATION OF CASE A 69-year-old man with a history of left hemihepatectomy 20 months previously presented to the emergency room with sudden-onset abdominal pain and nausea. An upper gastrointestinal examination with a fiberscope revealed a giant ulcer in the duodenal bulb. In addition, a foreign body was detected at the ulcer floor and was strongly suspected of being a ligature from previous hemihepatectomy. DISCUSSION The presence of a gas-filled liver mass and bowel wall thickening with inflammatory changes are important imaging findings for prompt diagnosis of such a condition, but in this case, none of these were reported. Further, no definite abscess was found. Thus, the patient was treated conservatively with a proton pump inhibitor. CONCLUSION This case demonstrates the importance of using absorbable suture materials, adequate lavage in the postoperative peritoneal space and gastroduodenal mucosal protection postoperatively. PMID:24240081

  7. Surgical management of pancreatico-duodenal tumors in multiple endocrine neoplasia syndrome type 1.

    PubMed

    Akerström, Göran; Stålberg, Peter; Hellman, Per

    2012-01-01

    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

  8. Nerve-mediated contractile and electrical activity of the guinea-pig choledocho-duodenal junction.

    PubMed

    Vongalis, F; Bywater, R A; Taylor, G S

    1989-12-30

    The intrinsic motor innervation of the guinea-pig choledocho-duodenal junction was investigated by recording the contractile and intracellular electrical activity of smooth muscle from different regions of this tissue. Electrical transmural nerve stimulation evoked phasic contractions in rings of muscle from the ampulla (0.45 s-1) and tonic contractions in rings of muscle from the choledochal sphincter. Intracellular microelectrode recordings from muscle strips from these two regions revealed that excitatory junction potentials (peak amplitude 7 mV) evoked by transmural nerve stimulation were more conspicuous in muscle strips from the choledochal sphincter, but inhibitory junction potentials (peak amplitude 13 mV) were of larger amplitude in muscle strips from the ampulla. Contractions and membrane depolarization evoked by transmural nerve stimulation were sensitive to 1.4 microM atropine and abolished by 3.1 microM tetrodotoxin. Histological studies on the choledocho-duodenal junction also revealed that the distribution of smooth muscle was non-uniform along the tissue. These results suggest that the two regions may have different functions in the motility of the choledocho-duodenal junction. PMID:2632634

  9. Marked decrease in serum pepsinogen II levels resulting from endoscopic resection of a large duodenal tumor.

    PubMed

    Yada, Tomoyuki; Ito, Koichi; Suzuki, Keigo; Okubo, Koki; Aoki, Yoichiro; Akazawa, Naoki; Koizuka, Hitohiko; Ishida, Tsuyoshi; Uemura, Naomi

    2014-12-01

    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

  10. Adenocarcinoma of the third duodenal portion: Case report and review of literature.

    PubMed

    Sista, Federico; Santis, Giuseppe De; Giuliani, Antonio; Cecilia, Emanuela Marina; Piccione, Federica; Lancione, Laura; Leardi, Sergio; Amicucci, Gianfranco

    2012-01-27

    We focus on the diagnostic and therapeutic problems of duodenal adenocarcinoma, reporting a case and reviewing the literature. A 65-year old man with adenocarcinoma in the third duodenal portion was successfully treated with a segmental resection of the third part of the duodenum, avoiding a duodeno-cephalo-pancreatectomy. This tumor is very rare and frequently affects the III and IV duodenal portion. A precocious diagnosis and the exact localization of this neoplasia are crucial factors in order to decide the surgical strategy. Given a non-specificity of symptoms, endoscopy with biopsy is the diagnostic gold standard. Duodeno-cephalo-pancreatectomy (DCP) and segmental resection of the duodenum (SRD) are the two surgical options, with overlapping morbidity (27% vs 18%) and post operative mortality (3% vs 1%). The average incidence of postoperative long-term survival is 100%, 73.3% and 31.6% of cases after 1, 3 and 5 years from surgery, respectively. Long-term survival is made worse by two factors: the presence of metastatic lymph nodes and tumor localization in the proximal duodenum. The two surgical options are radical: DCP should be used only for proximal localizations while SRD should be chosen for distal localizations. PMID:22347539

  11. Perforated Peptic Ulcer Treated by Simple Closure and Helicobacter Pylori Eradication

    Microsoft Academic Search

    Juan C. Rodríguez-Sanjuán; Roberto Fernández-Santiago; Rosa A. García; Soledad Trugeda; Isabel Seco; Fernando la de Torre; Angel Naranjo; Manuel Gómez-Fleitas

    2005-01-01

    Simple closure followed by Helicobacter pylori (Hp) eradication has become the most used procedure in perforated ulcer treatment. However, its efficacy and safety are still\\u000a to be determined. To assess recurrence and re-perforation rates, and as a secondary objective, to analyze Hp infection rates\\u000a in perforated ulcer patients and controls, we conducted a prospective study. Ninety-two consecutive patients (ages: 19–96

  12. Fish bone perforation of the terminal ileum presenting as acute appendicitis.

    PubMed

    Saunders, David; Jones, Michael; Kaushik, Monika; Thomas, William Michael

    2014-01-01

    We report a case of a bowel perforation due to a fish bone that presented as an acute abdomen. This patient's gastrointestinal perforation was treated with laparoscopic and open technique. Diagnosis can be difficult as foreign body bowel perforation can mimic other causes of acute abdomen. Diagnosis is still most commonly made intraoperatively. Laparoscopy proved useful in this case as it allowed the most appropriate surgical approach to be made. PMID:24639331

  13. Spontaneous perforation of jejunal gastrintestinal stromal tumour (gist). Case report and review of literature

    PubMed Central

    2012-01-01

    GIST is the commonest mesenchymal tumour of the gastrointestinal tract. Jejunal GIST is rare and spontaneous perforation of asymptomatic jejunal GIST is unique. A review of the English literature reveals only fifteen cases of perforated GIST till date. Pre-operative diagnosis is difficult. Diagnosis is confirmed on histopathology and immuno-histochemistry. Complete removal with postoperative imatinib therapy entails optimal treatment. Perforated GIST is associated with high recurrence. PMID:23194007

  14. PVC Salt-Film Perforation On-Line Inspecting System Based on CCD Imaging

    Microsoft Academic Search

    Gong Chenglong; Liu Yongqiang; Yang Rui; Feng Yuan; Zhang Ming

    2009-01-01

    This paper introduces an imaging inspecting system used in salt-film pulling machine to avoid film perforation malfunction. Imaging measuring circuit with linear CCD TCP1206 as inspecting camera is constructed. Perforation inspection precision, inspection rate and image borderline check were probed into. App effect shows, the system can achieve diameter 0.954 mm PVC salt-film perforation failure inspection precision and 0.4416 m\\/s

  15. Endoscopic closure of gastric tube perforations with titanium clips: a four-case report.

    PubMed

    Zhan, Xianghong; Wang, Bin; Di, Dongmei; Zhuang, Yun; Zhang, Xiaoying; Chen, Jianping

    2015-12-01

    Perforation of a gastric tube is a rare yet lethal complication after esophagectomy for esophageal cancer treatment. Currently, over-the-scope clip (OTSC) is an effective way to treat gastric tube perforation. Due to the lack of OTSCs, we invented an alternative method composed of a titanium clip and gastroscope. The aim of this study was to describe this novel endoscopic device in the treatment of gastric tube perforation. We used a titanium clip system to treat 4 male patients (range, 53 to 77 years with gastric tube perforation. After the location of the perforation was identified by gastroscope, a titanium endoscopic clip was used to close the perforation. Successful closure of the gastric tube perforation was achieved in three patients while in one patient this failed due to his refusal to undergo reoperation. No postoperative complication was found in the three patients whose perforations were closed and the patient who refused reoperation died due to the reoccurrence of his esophago-cardiac carcinoma. The endoscopic system composed of titanium clip and gastroscope proved to be an efficient and effective device in the treatment of the patients with gastric tube perforations. PMID:25778014

  16. ERCP-related perforations in the new millennium: A large tertiary referral center 10-year experience

    PubMed Central

    Kodali, Sudha; Kim, Hwasoon; Ramesh, Jayapal; Trevino, Jessica; Varadarajulu, Shyam; Wilcox, C Mel

    2015-01-01

    Introduction Endoscopic retrograde cholangiopancreatography (ERCP) is an important diagnostic and therapeutic modality for pancreatic and biliary disorders. Perforation is one of the most dreaded complications of ERCP. Since it is uncommon, there has been little study of incidence, risk factors, and outcomes of management. Objectives We aim to assess the incidence of ERCP-related perforations and outcomes at a large tertiary referral center. Methods We undertook a review of an ERCP database for all perforations from 2002 to December 2012. Results The cumulative incidence of ERCP-related perforations was 0.14% (12 out of 8264), and sphincterotomy-related perforations constituted the most common cause. The mean age of these 12 patients was 58.6 years and majority were female (83.3%). The most common indications for ERCP were: suspected sphincter of Oddi dysfunction (SOD) 41%, and common bile duct stones (CBD stones) 41%. Nine of the 12 patients (75%) had a leak and were managed medically, and four who had a perforation had surgical repair (25%). Conclusions In our study, leaks were much more common than perforations and the majority of patients were successfully managed with conservative therapy alone. We report a very low perforation rate and most perforations can be managed conservatively with a good outcome. PMID:25653856

  17. The effect of topical estrogen on healing of chronic tympanic membrane perforations and hearing threshold

    PubMed Central

    Barati, Behrouz; Abtahi, Seyyed Hamid Reza; Hashemi, Seyyed Mostafa; Okhovat, Seyyed Ahmad Reza; Poorqasemian, Mehdi; Tabrizi, Ali Goljanian

    2013-01-01

    Background: Considering the presence of squamous epithelial cells and fibroblasts in the tympanic membrane (TM), topical estrogen application may influence the repair of TM perforations. Therefore, this study was designed to investigate the healing effect of topical estrogen on chronic TM perforations and improvement in hearing threshold. Materials and Methods: Sixty patients were enrolled in a randomized clinical trial. Thirty patients were treated with paper patch and 30 with estrogen-impinged paper patch. Complete closure of the TM perforation and hearing threshold were evaluated in both groups. Chronic unilateral perforations of the TM involving less than 40% of the total area of the TM without active disease in the middle ear were selected. The margin of the perforation was chemically trimmed using 15% trichloroacetic acid and patching performed under an operating microscope. Microscopic examination was performed after 14 days and repeated after 30 days. Complete closure of the TM perforation was considered as successful repair. Hearing threshold was determined before the start of the trial and 30 days after treatment. Results: No significant difference was found between the two groups after 14 days in complete closure of the perforation (P = 0.310). After 30 days, patients treated with estrogen-impinged paper patch showed a significantly higher rate of closure of the perforation (63.4%) and improvement in hearing threshold (P = 0.017). Conclusion: Topical estrogen may have a healing effect on chronic TM perforations and improvement in hearing threshold. PMID:23914209

  18. Postoperative Delayed Duodenum Perforation following Elective Laparoscopic Cholecystectomy.

    PubMed

    Jing, Kong; Shuo-Dong, Wu

    2014-01-01

    Background. Duodenum injury is extremely rare complication of laparoscopic cholecystectomy with potentially fatal consequences. Methods. Over the past 13-year period, 3000 laparoscopic cholecystectomies were performed in our institution. Duodenum injury only occurred in one patient recently who had undergone gastrectomy owing to duodenal diverticulum. The diagnosis and management of this rare complication of laparoscopic cholecystectomy are described, and the literature is reviewed. Results. We present this case of duodenum injury on the fourth postoperative day after selective laparoscopic cholecystectomy was treated successfully by percutaneous needle aspiration and catheter drainage. The hospital stay was 26 days. No abscess recurred during the follow-up period. Conclusion. Duodenum injuries are extremely rare complications of laparoscopic cholecystectomy with potentially fatal consequences if not promptly recognized and treated. Sonographically guided percutaneous needle aspiration and catheter drainage can be used to treat the intraperitoneal abscess. Billroth II subtotal gastrectomy and gastrojejunostomy were beneficial for the treatment. PMID:24790609

  19. A Dosimetric Model of Duodenal Toxicity After Stereotactic Body Radiotherapy for Pancreatic Cancer

    SciTech Connect

    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

    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.

  20. Glenoid perforation with pegged components during total shoulder arthroplasty.

    PubMed

    Hsu, Jason E; Namdari, Surena; Baron, Matthew; Kuntz, Andrew F; Abboud, Joseph A; Huffman, G Russell; Williams, Gerald R; Glaser, David L

    2014-06-01

    A subset of patients undergoing primary total shoulder arthroplasty (TSA) have a medialized joint line secondary to glenoid wear. In some cases, the central pegs or peripheral pegs of a peg design glenoid component may violate the medial cortex of the glenoid vault. It is unknown whether this leads to early failure. The objectives of this study were to determine (1) whether glenoid components with uncontained pegs would be associated with a high rate of failure and (2) whether peg perforation would be associated with inferior clinical outcomes. The authors performed a case-control retrospective review comparing 25 TSAs in which one or multiple pegs perforated the medial glenoid vault (uncontained group) with 25 TSAs without peg perforation (contained group). Implant survival was calculated with revision for glenoid component loosening as the primary outcome variable. Clinical outcomes were determined using American Shoulder and Elbow Surgeons (ASES) and Penn Shoulder Scores. Average follow-up was more than 5 years. No patient in either group had symptomatic glenoid loosening. Two (8%) patients in the uncontained group required revision for rotator cuff tears. Penn and ASES scores were significantly lower in the uncontained group (Penn, P=.002; ASES, P=.004). Pain and satisfaction subscores were similar between the groups, but function subscores were significantly lower in the uncontained group (Penn, P=.002; ASES, P=.005). Uncontained pegs of an anchor peg glenoid component are not associated with early glenoid loosening. Similar pain relief is obtained when compared with contained glenoid components, but shoulder function is significantly lower in patients with uncontained pegs. PMID:24972442