Sample records for iatrogenic duodenal perforation

  1. Duodenal Perforation Precipitated by Scrub Typhus

    PubMed Central

    Rajat, Raghunath; Deepu, David; Jonathan, Arul Jeevan; Prabhakar, Abhilash Kundavaram Paul

    2015-01-01

    Scrub typhus is an acute febrile illness usually presenting with fever, myalgia, headache, and a pathognomonic eschar. Severe infection may lead to multiple organ failure and death. Gastrointestinal tract involvement in the form of gastric mucosal erosions and ulcerations owing to vasculitis resulting in gastrointestinal bleeding is common. This process may worsen a pre-existent asymptomatic peptic ulcer, causing duodenal perforation, and present as an acute abdomen requiring surgical exploration. We report the case of a patient with no previous symptoms or risk factors for a duodenal ulcer, who presented with an acute duodenal perforation, probably precipitated by scrub typhus infection.

  2. Case report: Portal and systemic venous gas in a patient with perforated duodenal ulcer: CT findings

    PubMed Central

    Fam, Maged Nassef Abdalla; Attia, Khaled Mostafa Elgharib; Khalil, Safaa Maged Fathelbab

    2014-01-01

    Gas within the portal circulation has been known to be associated with a number of conditions most commonly mesenteric ischemia and necrosis. Systemic venous gas is described with few conditions and is mostly iatrogenic in nature. We describe a case of combined portal and systemic venous gas detected by computed tomography in a patient with perforated duodenal ulcer. PMID:25426236

  3. Management of iatrogenic colorectal perforation: From surgery to endoscopy

    PubMed Central

    Cai, Shi-Lun; Chen, Tao; Yao, Li-Qing; Zhong, Yun-Shi

    2015-01-01

    Iatrogenic colon perforation is one the most pernicious complications for patients undergoing endoscopic screening or therapy. It is a serious but rare complication of colonoscopy. However, with the expansion of the indications for endoscopic therapies for gastrointestinal diseases, the frequency of colorectal perforation has increased. The management of iatrogenic colorectal perforation is still a challenge for many endoscopists. The methods for treating this complication vary, including conservative treatment, surgical treatment, laparoscopy and endoscopy. In this review, we highlight the etiology, recognition and treatment of colorectal iatrogenic perforation. Specifically, we shed light on the endoscopic management of this rare complication.

  4. Duodenal perforation: an unusual complication of sickle cell anemia

    PubMed Central

    Ac?payam, Can; Ald?ç, Güliz; Akçora, Bülent; Çelikkaya, Mehmet Emin; A?kar, Hasan; Dorum, Bayram Ali

    2014-01-01

    Duodenal perforation in childhood is a rare condition with a high mortality rate if not treated surgically. Primary gastroduodenal perforation is frequently associated with peptic ulcer and exhibits a positive family history. Helicobacter pylorus is the most significant agent. Secondary gastroduodenal perforation may be a finding of specific diseases, such as Crohn disease, or more rarely may be associated with diseases such as cystic fibrosis or sickle cell anemia. A 14-year-old boy presented with abdominal and back pain. The patient was operated on for acute abdomen and diagnosed with duodenal perforation. Helicobacter pylorus was negative. There was no risk factor to account for duodenal perforation other than sickle cell anemia. Surgical intervention was successful and without significant sequelae. Duodenal perforation is a rare entity described in patients with sickle cell anemia. To our knowledge, this is the first report of duodenal perforation in a patient sickle cell anemia. PMID:25422692

  5. 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. PMID:25838951

  6. Medical management of iatrogenic esophageal perforations

    Microsoft Academic Search

    Ryan D. Madanick

    2008-01-01

    Opinion statement  Esophageal perforation is an uncommon, potentially disastrous occurrence with high mortality rates even when managed with\\u000a surgery. Over the past few decades, several case series have shown that nonoperative management is a feasible option in some\\u000a patients, although the criteria for selecting such patients are neither firmly established nor accepted by all those who manage\\u000a these critical patients. The

  7. [Treatment of perforated duodenal ulcer: the celioscopic approach].

    PubMed

    Mutter, D; Evrard, S; Keller, P; Vix, M; Vartolomei, S; Marescaux, J

    1994-01-01

    Ten patients underwent laparoscopic surgery for typical perforated peptic ulcer symptomatology. Two conversions to open surgery were due to technical problems related to delayed hospital admission. Nine patients underwent duodenal suture reinforced with fibrin glue, and one perforation was only glued. The postoperative course was uneventful without abdominal septic or abdominal wall complications in the eight patients treated by laparoscopy. Laparoscopic surgery may become the method of choice for the treatment of perforated peptic ulcer. PMID:8085758

  8. 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. PMID:25883825

  9. Duodenal Perforation in a Neonate: An Unusual Presentation and Analysis of the Cause

    PubMed Central

    Al Omran, Yasser; Omer Anwar, Mohammed; Al-Hindi, Saeed

    2015-01-01

    Duodenal perforation in neonates is a rare surgical emergency. In the cases reported, most perforations are localised to the anterior duodenum and a few at posterior aspect. We present a case of duodenal perforation in the second part of the duodenum in a 26-day-old healthy male neonate.

  10. Surgical management of iatrogenic perforation in maxillary central incisor using mineral trioxide aggregate

    PubMed Central

    Nagpal, Rajni; Manuja, Naveen; Pandit, I K; Rallan, Mandeep

    2013-01-01

    Root perforations are undesired complications of endodontic treatment. The repair of root perforation can be accomplished using different materials and techniques. Mineral trioxide aggregate (MTA) is widely used to seal perforations because of its biocompatibility and sealability. This article describes a case report where an iatrogenic root perforation was repaired successfully with MTA in maxillary right central incisor of a 13-year-old boy. PMID:23845686

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

    PubMed Central

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

    2013-01-01

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

  12. Surgeons' attitudes to the operative management of duodenal ulcer perforation and haemorrhage.

    PubMed Central

    Stringer, M. D.; Cameron, A. E.

    1988-01-01

    The currently preferred operative management of duodenal ulcer haemorrhage and perforation was assessed by means of a questionnaire sent to 274 consultant general surgeons in England. A 70% response rate was achieved. Simple closure, with or without H2 antagonist treatment, was the most popular management of a perforated acute duodenal ulcer. For perforation of a chronic duodenal ulcer occurring during H2 antagonist therapy, truncal vagotomy and drainage was the definitive procedure of choice. There was no consensus about the operative management of perforation complicating non-steroidal anti-inflammatory drug treatment in the elderly patient. Proximal gastric vagotomy appears to have few advocates in the definitive management of either duodenal ulcer perforation or haemorrhage. Of our sample 70% selected truncal vagotomy and drainage with underrunning of the ulcer as the operative treatment of choice for bleeding. Endoscopic coagulation appears to be used only rarely. PMID:2901246

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

    PubMed

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

    2014-08-28

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

  14. Acute perforated duodenal ulcer is not associated with Helicobacter pylori infection

    Microsoft Academic Search

    D H Reinbach; G Cruickshank; K E McColl

    1993-01-01

    Most patients with chronic duodenal ulcer disease have Helicobacter pylori infection and eradicating it considerably reduces the relapse rate. The prevalence of H pylori in 80 patients (mean age = 52 years, range 17-85) presenting with acute perforated duodenal ulcer was examined and compared with age and sex matched hospital control patients. H pylori state was assessed by serum anti-H

  15. Iatrogenic Colonic Perforation due to Computed Tomographic Colonography

    PubMed Central

    Kato, Takashi; Muroya, Tsukasa; Goda, Takayuki; Takabayashi, Ken; Sasaki, Kiyotaka; Takahashi, Toshiyuki; Horita, Shoichi

    2015-01-01

    Although the complications of computed tomographic colonography (CTC) are very rare, CTC is associated with potential risk of colonic perforation. In the present report we describe two cases of colonic perforation secondary to CTC. In the first case with ascending colonic carcinoma, insertion of a rigid double-balloon catheter caused direct rectal wall perforation. In the second case with obstructive colonic carcinoma, pneumoperitoneum developed due to automated carbon dioxide insufflation. Both patients were asymptomatic after examination and recovered without any complications. Based on the findings of the current cases, we recommend that a soft-tip catheter be used for CTC, and suggest that colonic perforation can occur even with automatic insufflation, depending on patient characteristics. PMID:26120298

  16. An Unusual Case of Duodenal Perforation Caused by a Lollipop Stick: A Case Report

    PubMed Central

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

    2014-01-01

    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

  17. Asymptomatic Duodenal Perforation from an Inferior Vena Cava Filter

    PubMed Central

    Park, Jean R.; Oza, Veeral M.

    2014-01-01

    Recent exponential increase in inferior vena cava (IVC) filter placements has led to a higher rate of filter complications. A 46-year-old man with a past history of IVC filter placement for bilateral deep vein thrombosis presented with lower abdominal pain. Imaging studies demonstrated IVC filter strut penetrations into multiple structures. Upper endoscopy confirmed an uncomplicated single IVC filter strut penetration into the duodenal wall. The abdominal pain was determined to be unrelated to IVC filter strut penetration, and the patient was managed conservatively. Although IVC filter strut penetrations can cause significant complications, current guidelines remain unclear for management of asymptomatic enteric IVC filter strut penetrations.

  18. Successful open abdomen treatment for multiple ischemic duodenal perforated ulcers in dermatomyositis

    PubMed Central

    2014-01-01

    Introduction Dermatomyositis is an autoimmune disease characterized by proximal myopathy, cutaneous Gottron papules and heliotrope rash; intestinal involvement associated to acute vasculitis is less common but could be a life-threatening condition. Methods A 21-year-old woman, affected by dermatomyositis, presented to our attention with a three-day story of severe abdominal pain, no bowel movement and biliary vomit. She was diagnosed with acute abdomen. A CT scan with bowel contrast demonstrated the presence of a leakage from the retroperitoneal aspect of duodenum. The surgical and clinical management in the light of literature review is presented. Results Our first approach consisted in primary repair of the duodenal perforation with omentopexy. Post-operative course was complicated by hemorrhage. A reintervention showed a new perforation associated with multiple ischemic intestinal areas. We performed a gastroenteric anastomosis with functional exclusion of the damaged duodenum and positioning of drainages to create a biliary fistula. A nutritional enteric tube and an open abdomen vacuum-assisted closure system to monitor the fistula creation and to prevent abdominal contamination and collections were positioned. To reduce the amount of biliary leakage, a percutaneous transhepatic biliary drainage was placed, with progressive fistula flow disappearance in four months. Conclusions In patients with dermatomyositis, when clinical findings and symptoms suggest abdominal vasculitis, it is very important to be aware of the risk of bowel and particularly duodenal perforations. Open abdomen treatment favors control of contamination by gastrointestinal contents, offers temporary abdominal closure, helps ICU care and delays definitive surgery.

  19. Migratory surgical gossypiboma-cause of iatrogenic perforation: case report with review of literature.

    PubMed

    Malhotra, Mohinder Kumar

    2012-01-01

    Forgotten foreign bodies, such as cotton sponges, gauze, or instruments, after any surgical procedure is considered a misadventure but avoidable complication. "Gossypiboma" denotes a mass of cotton that is accidentally retained in the body postoperatively. This study's goal was to systematically review the literature on retained sponges to identify incidence, site of occurrence, time of discovery, methods for detection, pathogenesis for intraluminal migration and risk factors. Author is reporting this case in which a 45-year old woman presented with features of chronic pain abdomen following abdominal hysterectomy (first surgery) which lead to open cholecystectomy (second surgery) after two and half year of first surgery. As patients continued to have persistent abdominal pain in spite of second surgery patient went to medical gastroenterologist who advised her series of tests including colonoscopy examination. The whole colon was normal on examination but on examination of terminal portion of small bowel some intraluminal mass was visualized. Attempt to retrieve this mass lead to iatrogenic ileal perforation. PMID:24027390

  20. Migratory Surgical Gossypiboma—Cause of Iatrogenic Perforation: Case Report with Review of Literature

    PubMed Central

    Malhotra, Mohinder Kumar

    2012-01-01

    Forgotten foreign bodies, such as cotton sponges, gauze, or instruments, after any surgical procedure is considered a misadventure but avoidable complication. “Gossypiboma” denotes a mass of cotton that is accidentally retained in the body postoperatively. This study’s goal was to systematically review the literature on retained sponges to identify incidence, site of occurrence, time of discovery, methods for detection, pathogenesis for intraluminal migration and risk factors. Author is reporting this case in which a 45-year old woman presented with features of chronic pain abdomen following abdominal hysterectomy (first surgery) which lead to open cholecystectomy (second surgery) after two and half year of first surgery. As patients continued to have persistent abdominal pain in spite of second surgery patient went to medical gastroenterologist who advised her series of tests including colonoscopy examination. The whole colon was normal on examination but on examination of terminal portion of small bowel some intraluminal mass was visualized. Attempt to retrieve this mass lead to iatrogenic ileal perforation. PMID:24027390

  1. Endoscopic tissue shielding with polyglycolic acid sheets, fibrin glue and clips to prevent delayed perforation after duodenal endoscopic resection.

    PubMed

    Doyama, Hisashi; Tominaga, Kei; Yoshida, Naohiro; Takemura, Kenichi; Yamada, Shinya

    2014-04-01

    The incidence of delayed perforation after endoscopic resection for superficial non-ampullary duodenal epithelial tumors is extremely high. Endoscopic tissue shielding with polyglycolic acid (PGA) sheets and fibrin glue is a promising method to prevent delayed perforation after endoscopic resection in the duodenum. However, we often encounter difficulty when covering an artificial ulcer with PGA sheets after endoscopic resection. We report three cases of postoperative ulcers covered by PGA sheets, fibrin glue, and clips. PMID:24750147

  2. Management of necrotising appendicitis associated with widespread necrotising enterocolitis of the small and large bowel and perforated duodenal ulcer.

    PubMed

    Gupta, Vaibhav; Zani, Augusto; Jackson, Paul; Singh, Shailinder

    2015-01-01

    A 7-year-old boy presented in septic shock secondary to appendicitis with generalised peritonitis. Following crystalloid resuscitation, he underwent surgery. Faecopurulent contamination and free air were found. This was secondary to a perforated and gangrenous appendix, multiple large and small bowel segments with perforations, patches of necrosis, interspersed with healthy bowel and segments of questionable viability. There was also a perforated duodenal ulcer. Necrotic segments were resected using a 'clip-and-drop' technique to shorten operative duration and guide resection to preserve bowel length. After six laparotomies and multiple bowel resections, the child was discharged home with an ileostomy that was subsequently reversed. He is currently on a normal diet and pursuing all activities appropriate for his age. Perforated appendicitis can be associated with widespread bowel necrosis and multiple perforations. A conservative damage limitation approach using the 'clip-and-drop' technique and relook laparotomies is useful in the management of extensive bowel necrosis in children. PMID:26055603

  3. Endoscopic tissue shielding method with polyglycolic acid sheets and fibrin glue to prevent delayed perforation after duodenal endoscopic submucosal dissection.

    PubMed

    Takimoto, Kengo; Imai, Yoshihito; Matsuyama, Kiichi

    2014-04-01

    Delayed perforation after duodenal endoscopic submucosal dissection (ESD) occurs at a high rate because the duodenal wall is very thin and the artificial ulcer after resection is exposed to bile and pancreatic juice. We investigated the application of the combination of a polyglycolic acid (PGA) sheet and fibrin glue. PGA sheets comprise materials widely used in surgery for absorbable thread. Fibrin glue is a heated blood product and is used for hemostasis during operations. We developed a combined method using both materials. We have used this method in two cases. One case involved an elevated lesion located in the lower duodenal angle of the duodenum. The other involved an elevated lesion in the second portion of the duodenum. About 1 week after ESD, the PGA sheets remained covering the ulcer and delayed perforation did not occur. We were able to easily carry out this method for several parts of the duodenum. This method may be helpful for the prevention of delayed perforation after duodenal ESD. PMID:24750148

  4. Endoscopic management of iatrogenic perforations during endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) for colorectal polyps: a case series

    PubMed Central

    Pissas, Dimitrios; Ypsilantis, Efthymios; Papagrigoriadis, Savvas; Hayee, Bu’Hussain

    2015-01-01

    Background: Iatrogenic perforation during therapeutic colonoscopy, reported in up to 1% of endoscopic mucosal resections (EMRs) and up to 14% of endoscopic submucosal dissections (ESDs), has conventionally been an indication for surgery. Aims: We present a case series of successful endoscopic management of iatrogenic colorectal perforation during EMR and ESD, demonstrating the feasibility and safety of the method. Methods: Retrospective analysis of a database of patients undergoing EMR and ESD for colorectal polyps in a tertiary referral centre in the United Kingdom. Results: Four cases of perforation were identified (two EMRs and two ESDs) in a series of 218 procedures (1.8%), all detected at the time of endoscopy and managed with endoscopic clips. Patients were observed in hospital and treated with antibiotics. Their median length of stay was 3 days (range 2–6 days), with no mortality or need for surgery. Conclusion: Surgery is no longer the first choice in the management of iatrogenic perforations during EMR and ESD for colorectal polyps; in selected patients with small perforations and minimal extraluminal contamination, conservative management with application of endoscopic clips, antibiotics and close patient monitoring constitute a safe and effective treatment option, avoiding the morbidity of major surgery. PMID:26136835

  5. Iatrogenic uterine perforation with abdominal extrusion of fetal parts: A rare radiological diagnosis

    PubMed Central

    Chauhan, Narvir Singh; Gupta, Amit; Soni, Pawan Kumar; Surya, Mukesh; Mahajan, Som Raj

    2013-01-01

    Background Failure to detect uterine perforation during surgical abortion may result in adverse patient outcome besides having medicolegal implications. This rare case of uterine perforation was diagnosed seven days after abortion and underscores the importance of remaining vigilant for this complication during and after the procedure. Case A female underwent surgical abortion at sixteen weeks gestation and was discharged after the procedure, assuming no complication. She presented with abdominal pain seven days after the event. Ultrasound and CT revealed uterine perforation with abdominal expulsion of fetal parts. Conclusion A patient complaining of abdominal pain following recent abortion related instrumentation should alert the clinician regarding possibility of perforation. Secondary signs on ultrasound may reveal the diagnosis even if rent is not identified. CT is valuable in emergent situations. PMID:23372874

  6. Chronic subclinical perforation of a duodenal ulcer presenting with an abdominal abscess in a patient with seronegative rheumatoid arthritis.

    PubMed

    Ashfaq, Awais; Chapital, Alyssa B

    2015-01-01

    Peptic ulcer disease has been a major problem since the turn of this century with high morbidity and mortality. Perforation is less common, with an estimated incidence of 7-10 per 100?000. We present a young woman with rheumatoid arthritis presenting with anaemia. On work up, she was found to have a chronic abdominal abscess secondary to subclinical perforation of a duodenal ulcer. After undergoing percutaneous drainage, she became haemodynamically unstable and was taken for surgical washout and jejunostomy tube placement. A week later she had a decrease in the size of the abscess and was discharged home with drain and tube feeds. At her follow-up a few weeks later, she was tolerating goal tube feeds. PMID:26150649

  7. Duodenal perforation following esophagogastroduodenoscopy (EGD) with cautery and epinephrine injection for peptic ulcer disease: An interesting case of nonoperative management in the medical intensive care unit (MICU)

    PubMed Central

    Chertoff, Jason; Khullar, Vikas; Burke, Lucas

    2015-01-01

    Introduction The utilization of esophagogastroduodenoscopy (EGD) and related procedures continues to rise. Due to this increase in utilization is an inevitable rise in serious complications such as hemorrhage and perforation. One understudied and dreaded complication of EGD causing significant morbidity and mortality is duodenal perforation. Presentation of case We present the case of a 63-year-old male who presented to our institution’s emergency room with dyspepsia, melanic stools, tachycardia, and hypotension. Initial laboratory evaluation was significant for severe anemia, lactic acidosis, and acute kidney injury, while CT scan of the abdomen pelvis did not suggest retroperitoneal hematoma or bowel perforation. An emergent EGD was performed which showed multiple bleeding duodenal ulcers that were cauterized and injected with epinephrine. Post-procedure the patient developed worsening abdominal pain, distension, diaphoresis, and tachypnea, requiring emergent intubation. A CT scan of the abdomen and pelvis with oral contrast confirmed pneumoperitoneum and duodenal perforation. Discussion Due to the patient’s hemodynamic instability and multiple comorbidities, he was treated non-operatively with strict bowel rest and intravenous antibiotics. The patient ultimately had a 19-day hospital course complicated by renal failure requiring hemodialysis and an ischemic limb necessitating above knee amputation. Conclusion This case describes an unsuccessful attempt at nonoperative management of duodenal perforation following EGD. PMID:25837967

  8. Diagnosis and Management of Perforated Duodenal Ulcers following Roux-En-Y Gastric Bypass: A Report of Two Cases and a Review of the Literature

    PubMed Central

    Iskandar, Mazen E.; Chory, Fiona M.; Goodman, Elliot R.; Surick, Burton G.

    2015-01-01

    Perforated duodenal ulcers are rare complications seen after roux-en-Y gastric bypass (RYGP). They often present as a diagnostic dilemma as they rarely present with pneumoperitoneum on radiologic evaluation. There is no consensus as to the pathophysiology of these ulcers; however expeditious treatment is necessary. We present two patients with perforated duodenal ulcers and a distant history of RYGP who were successfully treated. Their individual surgical management is discussed as well as a literature review. We conclude that, in patients who present with acute abdominal pain and a history of RYGB, perforated ulcer needs to be very high in the differential diagnosis even in the absence of pneumoperitoneum. In these patients an early surgical exploration is paramount to help diagnose and treat these patients. PMID:25949843

  9. Experimental Model for Production of Perforating Duodenal Ulcers by Cysteamine in the Rat

    Microsoft Academic Search

    Hans Selye; Sandor Szabo

    1973-01-01

    IT has long been known that exposure to stress, in itself1 or in combination with various sensitizing agents, particularly glucocorticoids2,3, can produce acute haemorrhagic erosions of the gastric mucosa which have been used as experimental models of ``stress ulcers''. However, these erosions have little, if any, tendency to perforate and usually disappear after a few days unless the eliciting Stressor

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

    PubMed

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

    2015-01-01

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

  11. Iatrogenic hepatopancreaticobiliary injuries: a review.

    PubMed

    Vachhani, Prasanti G; Copelan, Alexander; Remer, Erick M; Kapoor, Baljendra

    2015-06-01

    Iatrogenic hepatopancreaticobiliary injuries occur after various types of surgical and nonsurgical procedures. Symptomatically, these injuries may lead to a variety of clinical presentations, including tachycardia and hypotension from hemobilia or hemorrhage. Iatrogenic injuries may be identified during the intervention, immediately afterwards, or have a delayed presentation. These injuries are categorized into nonvascular and vascular injuries. Nonvascular injuries include biliary injuries such as biliary leak or stricture, pancreatic injury, and the development of fluid collections such as abscesses. Vascular injuries include pseudoaneurysms, arteriovenous fistulas, dissection, and perforation. Imaging studies such as ultrasound, computed tomography, magnetic resonance imaging, and digital subtraction angiography are critical for proper diagnosis of these conditions. In this article, we describe the clinical and imaging presentations of these iatrogenic injuries and the armamentarium of minimally invasive procedures (percutaneous drainage catheter placement, balloon dilatation, stenting, and coil embolization) that are useful in their management. PMID:26038625

  12. 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.

  13. Intrathoracic esophageal perforation: The merit of primary repair

    Microsoft Academic Search

    Richard I. Whyte; Mark D. Iannettoni; Mark B. Orringer

    1995-01-01

    Between 1976 and 1993, 22 patients with intrathoracic esophageal perforations, none associated with carcinoma, underwent primary repair regardless of the interval between perforation and the time of repair. Eighteen perforations were iatrogenic and four were spontaneous. The interval from perforation to operation was less than 12 hours in 10 patients, 12 to 24 hours in 3, and more than 24

  14. Perforation of a duodenal ulcer into a non-parasitic liver cyst: a rare case of a penetrate hole blockaded with conservative medical management.

    PubMed

    Ono, Koichi; Takeda, Masaharu; Makihata, Eiichi; Okazaki, Junji; Nagai, Akira

    2014-01-01

    An 88-year-old Japanese woman was admitted to our hospital for abdominal pain with a raised inflammatory reaction. Esophagogastroduodenoscopy (EGD) and computed tomography (CT) showed a duodenal ulcer punching a liver cyst. Since neither ascites nor free air were detected on CT and her family did not wish for aggressive medical treatment, the patient received clinical observation and conservative management. Antibiotic and proton-pump inhibitor therapy was effective, and she exhibited an uneventful recovery. A reexamination of EGD and CT confirmed that the fistulous tract between the liver cyst and duodenum was blockaded. PMID:24827482

  15. 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. PMID:25901218

  16. Future directions of duodenal endoscopic submucosal dissection.

    PubMed

    Matsumoto, Satohiro; Miyatani, Hiroyuki; Yoshida, Yukio

    2015-04-16

    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. PMID:25901218

  17. Iatrogenic Main Renal Artery Injury: Treatment by Endovascular Stent-Graft Placement

    SciTech Connect

    Heye, Sam, E-mail: sam.heye@uz.kuleuven.ac.be; Vanbeckevoort, Dirk [University Hospitals Gasthuisberg, Department of Radiology (Belgium); Blockmans, Daniel [University Hospitals Gasthuisberg, Department of Internal Medicine (Belgium); Nevelsteen, Andre [University Hospitals Gasthuisberg, Department of Vascular Surgery (Belgium); Maleux, Geert [University Hospitals Gasthuisberg, Department of Radiology (Belgium)

    2005-01-15

    We report on a patient who presented with perforation of the left main renal artery as a complication of a percutaneous retroperitoneal drainage procedure. Only a small number of cases of iatrogenic main renal artery perforations have been reported, none of them due to a percutaneous drainage attempt. Endovascular treatment by means of a coronary stent-graft was successful.

  18. Iatrogenic nerve injuries.

    PubMed

    Kretschmer, Thomas; Heinen, Christian W; Antoniadis, Gregor; Richter, Hans-Peter; König, Ralph W

    2009-01-01

    As long as humans have been medically treated, unfortunate cases of inadvertent injury to nerves afflicted by the therapist have occurred. Most microsurgically treated iatrogenic nerve injuries occur directly during an operation. Certain nerves are at a higher risk than others, and certain procedures and regions of the body are more prone to sustaining nerve injury. A high degree of insecurity regarding the proper measures to take can be observed among medical practitioners. A major limiting factor in successful treatment is delayed referral for evaluation and reconstructive surgery. This article on iatrogenic nerve injuries intends to focus on relevant aspects of management from a nerve surgeon's perspective. PMID:19064181

  19. 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

  20. Iatrogenic tumor implantation

    Microsoft Academic Search

    Ying Ma; Ping Bai

    2008-01-01

    Iatrogenic tumor implantation is a condition that results from various medical procedures used during diagnosis or treatment\\u000a of a malignancy. It involves desquamation and dissemination of tumor cells that develop into a local recurrence or distant\\u000a metastasis from the tumor under treatment. The main clinical feature of the condition is nodules at the operation’s porous\\u000a channel or incision, which is

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

    Microsoft Academic Search

    Y. Ishihara; S. Okabe

    1983-01-01

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

  2. Enhancement of duodenal and jejunal ulceration by histamine-induced gastric hypersecretion in dogs with diversion of duodenal contents.

    PubMed

    Clémençon, G H; Lawson, H H

    1984-01-01

    In a previous investigation deviation of duodenal contents protected rats significantly from the development of peptic ulceration under maximal acid secretion. We have now assessed the effect of diversion of duodenal contents in dogs submitted to the same operative procedure under histamine-induced hypersecretion. Six mongrel dogs underwent the following procedure: A two cm duodenal segment was left adjacent to the intact pylorus, proximal jejunum anastomosed to this segment and a Roux-en-Y duodeno-jejunostomy performed. The dogs were given 30 mg histamine in beeswax daily i.m. Unexpectedly their physical condition deteriorated rapidly by the second day and they were sacrificed on the 4th day. Necropsy revealed multiple and severe peptic ulceration. There was a total of 9 duodenal ulcers with no perforations. 5 anastomotic and 24 jejunal ulcers with 1 and 3 perforations respectively. It was concluded that the diversion of duodenal contents enhanced ulcer formation in dogs and that the model mimicked a Zollinger-Ellison Syndrome. Ulceration occurred in transitional or jejunal type of duodenal mucosa. No gastric lesions were found and this suggests that the diversionary procedure was an effective means of preventing bile from reaching the gastric mucosa. PMID:6588497

  3. Duodenal stump tumor.

    PubMed

    Golden, R L; Sokol, E M

    1978-10-01

    A rare case of duodenal stump tumor is described. The patient was an 84-year-old woman who had undergone a subtotal gastrectomy nine years previously. The polypoid tumor of the duodenal stump may have been a factor in the production of extrahepatic biliary obstruction, for which surgical treatment was required. The aged patient withstood the operation well. PMID:701696

  4. 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

  5. Management Strategies, Early Results, Benefits, and Risk Factors of Laparoscopic Repair of Perforated Peptic Ulcer

    Microsoft Academic Search

    Raimundas Lunevicius; Matas Morkevicius

    2005-01-01

    The primary goal of this study was to describe epidemiology and management strategies of the perforated duodenal ulcer, as\\u000a well as the most common methods of laparoscopic perforated duodenal ulcer repair. The secondary goal was to demonstrate the\\u000a value of prospective and retrospective studies regarding the early results of surgery and the risk factors. The tertiary goal\\u000a was to emphasize

  6. [Iatrogenic depression (author's transl)].

    PubMed

    Chevalier, J F; Ginestet, D

    1979-01-01

    A number of drugs are traditionally blamed for causing depression: in general medicine, the antihypertensives, the oral contraceptives and the appetite suppressants; in psychiatry, the neuroleptics. The identification of iatrogenic depression is difficult methodologically, for two reasons: 1. Detection of the depression. 2. Linking convincingly that state of depression with the administration of a particular drug, given the presence of many non-pharmacological factors. The literature and the experience of clinicians provide fairly contradictory evidence, but an analysis of published work calls for the following observations: --the type and severity of depression are rarely specified;--a history of psychiatric disorder is commonly stressed;--the specific role of the disability caused by physical or mental illness and the need to use palliative rather than curative measures are usually underestimated;--biochemically, it is surprising that the effects which some of these drugs are known to have upon the cerebral amines do not cause more depression of mood. In fact, if we consider how widely the drugs incriminated are used, it is clear that real drug-caused depression is rather uncommon. PMID:44864

  7. [Iatrogenic electrolyte disorders].

    PubMed

    Kettritz, R; Luft, F C

    2015-07-01

    The maintenance of water and electrolyte homeostasis is of enormous importance for the functioning of cells and tissues. A number of therapeutic procedures intentionally or unintentionally influence important regulatory mechanisms of these interdependent balanced systems. Excessive salt intake doesn't only expand the extracellular volume; it can also cause a considerable increase in tonicity. Owing to its insulin-dependent duality of action, glucose can represent an effective or an ineffective osmolyte. This fact has to be considered in patients with diabetic ketoacidosis. Diuretics reduce the volume expansion via renal excretion of sodium (and water); however, in addition to hypokalemia, diuretics can also cause severe alkalosis. Nowadays, hemodialysis is a routine procedure-but even routine procedures can deliver undesirable surprises. Can dialysis cause an increase in calcium levels, or does the procedure remove therapeutically administered radioactive iodine? The current article presents a series of cases we have come across in recent years. These case reports illustrate common, but also rare iatrogenic situations. The discussion of these cases is aimed at raising awareness of the issues involved in a pathophysiological approach to clinical problems. PMID:26036655

  8. Prevalence of duodenal diverticulum in South indians: a cadaveric study.

    PubMed

    Sakthivel, Sulochana; Kannaiyan, Kavitha; Thiagarajan, Sivakami

    2013-01-01

    Background. Duodenum is the second most common site of diverticula after the colon. Diagnosis of duodenal diverticula is incidental and found during other therapeutic procedures. In 90% of cases, they are asymptomatic, and less than 10% develop clinical symptoms. The difficulty to ascertain the true incidence of duodenal diverticula demanded for the present study to elucidate the prevalence of the duodenal diverticulum in South Indians. Materials and Methods. One hundred and twenty specimens of duodenum were utilized for the study. The prevalence, anatomical location, and dimension of duodenal diverticulum were studied. Results. Among the 120 specimens of duodenum, five specimens had solitary, extraluminal, and globular-shaped diverticula in the medial wall of the duodenum. In three (60%) cases, it was found in the second part of duodenum and in two (40%) cases in the third part. The mean size of the diverticula was 1.4?cm. Conclusion. In the present study in South Indian people, the prevalence (4.2%) of duodenal diverticula is low comparable to other studies in the literature. Even though most of the duodenal diverticula are asymptomatic, the knowledge about its frequency and location is of great importance to prevent complications like diverticulitis, hemorrhage, obstructive jaundice, and perforation. PMID:25938103

  9. Successful Endoscopic Decompression for Intramural Duodenal Hematoma with Gastric Outlet Obstruction Complicating Acute Pancreatitis

    PubMed Central

    Lee, Jun Young; Chung, Jin Soo

    2012-01-01

    Non-traumatic intramural duodenal hematoma (IDH) with duodenal obstruction caused by acute pancreatitis is rare. Most patients with non-extensive hematoma show improvement with non-operative treatments. Percutaneous drainage or surgery may be necessary in cases with suspected malignancy, perforation, or intestinal tract obstruction. We present a case of IDH caused by acute pancreatitis that led to obstruction of the duodenum and an experience of successful endoscopic decompression of the hematoma. PMID:22977802

  10. Safety and Efficacy of Endoscopic Submucosal Dissection for Non-Ampullary Duodenal Neoplasms: A Case Series

    PubMed Central

    Akiyama, Hitoshi; Suzuki, Koyu; Fujita, Yoshiyuki

    2015-01-01

    Sixteen non-ampullary duodenal neoplasms in 16 patients were treated with endoscopic submucosal dissection (ESD) performed by an endoscopist and an instrument assistant between February 2011 and November 2014. En bloc resection was performed in 15 cases (94%); lateral and vertical margins were pathologically free in 13 cases. Perforation occurred during submucosal dissection using a flex knife, but no perforations occurred in 15 cases using the hook knife only. No postoperative bleeding nor recurrence has been reported in any patient during the median 17-month follow-up period. Use of the hook knife as the main instrument and targeted training of the endoscopist and instrument assistant contributed to safe and effective duodenal ESD for non-ampullary duodenal neoplasms.

  11. Colonoscopic Perforation Management by Laparoendoscopy: An Algorithm

    PubMed Central

    Damadi, Amir; Mittal, Vijay K.; Itawi, Ed; Rana, Gurteshwar

    2014-01-01

    Background and Objectives: The role of laparoscopy in the management of iatrogenic colonoscopic injuries has increased with surgeons becoming facile with minimally invasive methods. However, with a limited number of reported cases of successful laparoscopic repair, the exact role of this modality is still being defined. Drawing from previous literature and our own experiences, we have formulated a simple algorithm that has helped us treat colonoscopic perforations. Methods: A retrospective review was undertaken of patients treated for colonoscopic perforations since the algorithm's introduction. For each patient, initial clinical assessment, management, and postoperative recovery were carefully documented. A Medline search was performed, incorporating the following search words: colonoscopy, perforation, and laparoscopy. Twenty-three articles involving 106 patients were identified and reviewed. Results: Between May 2009 and August 2012, 7 consecutive patients with colonoscopic perforations were managed by 2 surgeons using the algorithm. There were no complications and no deaths, with a mean length of stay of 4.43 days (range, 2–7 days). Of the 7 patients, 6 required surgery. A single patient was managed conservatively and later underwent an elective colon resection. Conclusions: Traditionally, laparotomy was the preferred method for treating colonoscopic perforations. Our initial experience reinforces previous views that laparoendoscopic surgery is a safe and effective alternative to traditional surgery for managing this complication. We have formulated a simple algorithm that we have found helpful for surgeons considering a laparoscopic approach to managing this condition. PMID:24680138

  12. 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.

  13. Iatrogenic nondiabetic hyperosmolar states1

    PubMed Central

    Webb, A K; Phillips, M J; Hanson, Gillian C

    1979-01-01

    Four cases of the iatrogenic nondiabetic hyperosmolar state are presented. The clinical presentation, biochemical findings and management are discussed. No hypertonic solution should be infused at a rate above the level of patient tolerance; irrigation of a hollow viscus with a hypertonic solution should be avoided, and salt should not be used as an emetic. Patients under stress are particularly prone to this condition, largely because of the high circulating cortisol levels. The use of corticosteroids, salt-containing solutions in excess of patient requirements, water depletion and intravenous nutrition in the absence of careful biochemical monitoring, are all factors which may precipitate the hyperosmolar state in the critically ill. PMID:233253

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

    PubMed

    Asouhidou, I; Katsaridis, V

    2014-12-01

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

  15. Situs inversus totalis with perforated duodenal ulcer: a case report

    Microsoft Academic Search

    Mohammad Tayeb; Faiz Mohammad Khan; Fozia Rauf

    2011-01-01

    Introduction  Situs inversus is an uncommon anomaly. Situs inversus viscerum can be either total or partial. Total situs inversus, also\\u000a termed as mirror image dextrocardia, is characterized by a heart on the right side of the midline while the liver and the\\u000a gall bladder are on the left side. Patients are usually asymptomatic and have a normal lifespan. The exact etiology

  16. 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.

  17. [Retroperitoneal perforation of duodenum - surgical approach].

    PubMed

    Kowalewski, Piotr; Najdecki, Marek E; Trojanowski, Piotr; Pa?nik, Krzysztof

    2015-04-01

    Retroperitoneal perforation of the duodenum, caused by abdominal trauma, endoscopic examination or diverticulitis, is a serious clinical problem, because of it's lack of specific symptoms. Surgical treatment is often performed in sepsis. That is why the knowledge of adequate techniques is crucial for surgeons. We would like to present our model of surgical approach, based on several trauma center's cases. Among the methods and techniques presented we emphasize the duodenal by-pass with bile duct drainage. Post-op cases of gastrojejunal anastomosis' bleeding prompt to implement a selective vagotomy, which however requires further studies. PMID:25938390

  18. Highly overbalanced perforating

    SciTech Connect

    Dees, J.M. [Dees Well Completions, Richardson, TX (United States)

    1995-05-01

    This article briefly describes a new perforating technique that will result in clean, open perforations. The well is normally stimulated when highly overbalanced perforation techniques are used. This perforation process improves formation evaluation because the well flows better and is easier to test.

  19. [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

  20. [Iatrogenic damage of the main vessels].

    PubMed

    Shor, N A; Burilov, M V

    2012-02-01

    The results of treatment of 55 patients, suffering iatrogenic damage of the main vessels, which constitute 22.4% of all damages of vessels occurred during last ten years, were analyzed. The causes of the vessels iatrogenic damage were analyzed in detail. A favorable result achievement, a vessel integrity restoration with maintenance of the vascular tube passability have become possible in 50 (90.9%) patients due to early and technically adequate operation conduction. The extremity amputation was performed in 2 (3.6%) patients, 3 (5.5%) patients died. PMID:22629806

  1. Trends in the incidence of intestinal perforation in US dialysis patients (1992–2005)

    PubMed Central

    Yang, Ju-Yeh; Lee, Tsung-Chun; Montez-Rath, Maria E.; Desai, Manisha; Winkelmayer, Wolfgang C.

    2014-01-01

    Background Little is known about the incidence of intestinal perforation in patients undergoing dialysis. Concerns exist that sevelamer hydrochloride may increase the risk of intestinal perforation. We examined long-term trends for the incidence of intestinal perforation among US dialysis patients. Methods We studied all dialysis patients (1992–2005) who had Medicare as primary payer. We used ICD-9 diagnosis code 569.83 to ascertain events of intestinal perforation. We studied (a) all perforations and (b) perforations that did not appear to be associated with specific causative conditions (specific diseases or iatrogenic procedures within 7 days of perforation). We used Poisson regression to model the annual number of intestinal perforations and tested for any changes in levels and temporal trends of incidence rates before versus after January 1, 1999. Results Overall, 1,060,132 patients contributed 2.7 million patient-years. We observed 12,355 events of intestinal perforation and 7,814 spontaneous perforations. The corresponding incidence rates were 4.6 (total) and 2.9 (spontaneous perforation) episodes per 1,000 person-years, respectively. For both outcome definitions, 30-day mortality was 42%. Unadjusted and adjusted incidence rates were not materially different over time. Formal tests for any changes in the level or slope of incidence comparing time periods before and after January 1, 1999, indicated no evidence for any changes in the incidence of intestinal perforation over time. Conclusions In US dialysis patients, incidence of intestinal perforation was low, but associated with high short-term mortality. We did not detect any significant changes in the incidence of intestinal perforation before versus after approval of sevelamer hydrochloride in late 1998. PMID:22419235

  2. 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

  3. An approach to duodenal biopsies

    PubMed Central

    Serra, S; Jani, P A

    2006-01-01

    The introduction of endoscopy of the upper digestive tract as a routine diagnostic procedure has increased the number of duodenal biopsy specimens. Consequently, the pathologist is often asked to evaluate them. In this review, a practical approach to the evaluation of a duodenal biopsy specimen is discussed. An overview of the handling of specimens is given and the normal histology and commonly encountered diseases are discussed. Finally, a description of commonly seen infections is provided, together with an algorithmic approach for diagnosis. PMID:16679353

  4. Iatrogenic’ Wernicke’s Encephalopathy in Japan

    Microsoft Academic Search

    Elisa Shikata; Tomohiko Mizutani; Yuji Kokubun; Toshiaki Takasu

    2000-01-01

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

  5. Iatrogenic ruptures of the tracheobronchial tree

    Microsoft Academic Search

    H. S. Hofmann; G. Rettig; J. Radke; H. Neef; R. E Silber

    2002-01-01

    Objective: Iatrogenic tracheobronchial ruptures are seldom but severe complications after intubation or bronchoscopy. Therefore, we evaluated the reasons, the subsequent therapy and the outcome of patients with tracheal rupture, who were admitted to our hospital. Methods: In a retrospective study we examined 19 patients (15 women, four men; 43–87 years) treated for acute tracheobronchial lesions. Eleven (58%) patients had a

  6. Iatrogenic vascular injury during peripheral revascularization.

    PubMed

    Bunt, T J; Manship, L; Moore, W

    1985-05-01

    Iatrogenic vascular injury may occur during peripheral revascularization procedures secondary to the application of vascular occlusive devices. This review summarizes the known mechanical causes of such injury, relates this to clamp design, and suggests methods to minimize such injury by appropriate selection and handling of vascular occlusive clamps. PMID:3889383

  7. Water soluble perforation pack

    SciTech Connect

    Mondshine, T.C.

    1986-11-11

    This patent describes a well completion and workover method wherein a subterranean formation in a well is perforated to provide channels for fluids within the formation to flow to the well bore, the steps comprising: (a) pumping a first treating fluid into the well and contacting the perforation channels with the first treating fluid. The first treating fluid comprises a saturated aqueous saline solution with at least one water soluble particulate sized salt which is substantially insoluble in the saturated aqueous saline solution; (b) filling the perforation channels with the water soluble particulate sized salt which is substantially insoluble in the first treating fluid. The water soluble particulate sized salt has a particle size range such that the perforation channels filled with the water soluble salt have a permeability sufficiently high to affect the easy removal of the water soluble particulate sized salt from the perforation channels when desired; (c) forming a bridge and seal on the surface of the filled perforation channels to bridge and seal off the filled perforation channels by contacting the filled perforation channels with a second treating fluid. The second treating fluid comprises a saturated aqueous saline solution in which the water soluble particulate sized salt filled within the perforation channels is substantially insoluble having suspended therein at least one particulate bridging material having a particle size range such that a low permeability seal of the filled perforation channels is obtained; and thereafter when desired.

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

    PubMed Central

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

    2014-01-01

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

  9. Extrinsic duodenal obstruction and halitosis.

    PubMed Central

    Stephenson, B. M.; Rees, B. I.

    1990-01-01

    Two siblings with extrinsic duodenal obstruction caused by congenital peritoneal bands are reported. Attention is drawn to the unusual physical sign of halitosis as a presenting feature. It is suggested that this physical sign may be an indication for barium studies. Images Figure 1 Figure 2 Figure 3 PMID:2217018

  10. Perforation apparatus and method

    SciTech Connect

    Brieger, E.F.

    1988-07-12

    A perforating apparatus is described for perforating earth formations traversed by a casing which is cemented in a well bore comprising: (a) an elongated tubular housing having a closed interior bore which is open at one end and adapted for coupling and for fluid communication with a string of tubing when disposed in a casing adjacent to earth formations, (b) a set of first and second shaped charge perforating devices disposed in the closed interior bore and aligned relative to one another so as to produce, when detonated, first and second perforation openings in the tubular housing.

  11. Esophageal perforation during laparoscopic adjustable gastric band: conversion to open sleeve gastrectomy and endoscopic stent placement

    PubMed Central

    PAPADIMITRIOU, G.; VARDAS, K.; KYRIAKOPOULOS, G.; ALFARAS, K.; ALFARAS, P.

    2015-01-01

    Laparoscopic adjustable gastric band (LAGB) is one of the most popular bariatric surgical procedures both in Europe and United States, because it is considered to be a safe and effective way of treating morbid obesity. This minimally invasive frequently employed bariatric procedure has many reported complications, but only a few cases of esophageal perforation have been reported. We present a case of iatrogenic esophageal perforation in an 18-year-old patient occurring during attempt to place an adjustable gastric band laparoscopically, which was diagnosed intraoperatively. Conversion to open sleeve gastrectomy with primary suturing of the perforation and drainage were performed. On the early postoperative period leak from the intra-abdominal part of the esophagus was diagnosed and treated with endoscopic placement of a self-expandable metal stent. After 2-years of follow-up the patient continues to have no sequelae from the perforation or symptoms of dysphagia, while Excess Weight Loss is 74%. PMID:26017105

  12. An Unusual Complication of the Ventricular Septal Defect Closure by Device: Late Right Aortic Cusp Perforation.

    PubMed

    Topcuoglu, M Sah; Atalay, Atakan; Gocen, Ugur; Guzel, Yasin; Basturk, Yuksel; Demir, Fadli

    2015-07-01

    Aortic regurgitation (AR) is a rare complication of transcatheter closure of perimembranous ventricular septal defects (pmVSD). It results from iatrogenic pinching of the aortic valve by the VSD occluder or perforation by the catheter. It is usually detected during control echocardiography (ECHO). The current study reports the first case of a late AR, which resulted from late right coronary cusp perforation by the VSD occluder. The current manuscript discusses the possible causes of late cusp erosion due to occluder, advantages of early operation in such cases, and an alternative treatment method where the occluder removal is not possible at the operation. PMID:25937396

  13. Safe sinus lift: use of acrylic stone trimmer to avoid sinus lining perforation.

    PubMed

    Haribabu, Prashanth Konatham; Raja, Krishna Kumar; Iyer, Shankar

    2014-06-01

    Iatrogenic injury to the maxillary sinus membrane is a common complication during direct sinus lift procedures. The most common cause is perforation of the Schneiderian membrane using a tungsten-carbide round bur no.6. We propose a safe technique in which an acrylic stone trimmer is used to create a window in the maxillary antrum thereby minimizing the risk of injury to the delicate sinus membrane. PMID:24914914

  14. Integrating geology and perforating

    SciTech Connect

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

    1997-02-01

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

  15. Spontaneous asymptomatic gallbladder perforation.

    PubMed

    Ba?ara, I??l; Seçil, Mustafa

    2014-06-01

    Gallstone disease is common. However, a proportion of patients are asymptomatic and remain undiagnosed until the occurrence of complications. Common complications include acute cholecystitis, biliary obstruction, acute pancreatitis and cholangitis. Severe complications include gallbladder perforation, Mirizzi syndrome and fistula formation are usually associated with significant morbidity and mortality. We report a case of asymptomatic spotaneous gallbladder perforation due to acute cholecystitis. PMID:24914424

  16. Spontaneous asymptomatic gallbladder perforation

    PubMed Central

    Seçil, Mustafa

    2014-01-01

    Gallstone disease is common. However, a proportion of patients are asymptomatic and remain undiagnosed until the occurrence of complications. Common complications include acute cholecystitis, biliary obstruction, acute pancreatitis and cholangitis. Severe complications include gallbladder perforation, Mirizzi syndrome and fistula formation are usually associated with significant morbidity and mortality. We report a case of asymptomatic spotaneous gallbladder perforation due to acute cholecystitis. PMID:24914424

  17. 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.

  18. Refractory duodenal ulcers (nonhealing duodenal ulcers with standard doses of antisecretory medication)

    Microsoft Academic Search

    Martin J. Collen; Valerie J. Stanczak; Cecelia A. Ciarleglio

    1989-01-01

    To evaluate possible differences between patients with refractory duodenal ulcers and those with duodenal ulcers that respond to standard doses of antisecretory medications, we determined basal acid outputs by nasogastric suction and daily smoking histories in 75 patients with endoscopically documented active duodenal ulcers. Patients were treated for at least eight weeks with standard doses of antisecretory medications and endoscopic

  19. Immediate detection of endoscopic retrograde cholangiopancreatography-related periampullary perforation: Fluoroscopy or endoscopy?

    PubMed Central

    Motomura, Yasuaki; Akahoshi, Kazuya; Gibo, Junya; Kanayama, Kenji; Fukuda, Shinichiro; Hamada, Shouhei; Otsuka, Yoshihiro; Kubokawa, Masaru; Kajiyama, Kiyoshi; Nakamura, Kazuhiko

    2014-01-01

    AIM: To investigate the causes and intraoperative detection of endoscopic retrograde cholangiopancreatography (ERCP)-related perforations to support immediate or early diagnosis. METHODS: Consecutive patients who underwent ERCP procedures at our hospital between January 2008 and June 2013 were retrospectively enrolled in the study (n = 2674). All procedures had been carried out using digital fluoroscopic assistance with the patient under conscious sedation. For patients showing alterations in the gastrointestinal anatomy, a short-type double balloon enteroscope had been applied. Cases of perforation had been identified by the presence of air in or leakage of contrast medium into the retroperitoneal space, or upon endoscopic detection of an abdominal cavity related to the perforated lumen. For patients with ERCP-related perforations, the data on medical history, endoscopic findings, radiologic findings, diagnostic methods, management, and clinical outcomes were used for descriptive analysis. RESULTS: Of the 2674 ERCP procedures performed during the 71-mo study period, only six (0.22%) resulted in perforations (male/female, 2/4; median age: 84 years; age range: 57-97 years). The cases included an endoscope-related duodenal perforation, two periampullary perforations related to endoscopic sphincterotomy, two periampullary perforations related to endoscopic papillary balloon dilation, and a periampullary or bile duct perforation secondary to endoscopic instrument trauma. No cases of guidewire-related perforation occurred. The video endoscope system employed in all procedures was only able to immediately detect the endoscope-related perforation; the other five perforation cases were all detected by subsequent digital fluoroscope applied intraoperatively (at a median post-ERCP intervention time of 15 min). Three out of the six total perforation cases, including the single case of endoscope-related duodenal injury, were surgically treated; the remaining three cases were treated with conservative management, including trans-arterial embolization to control the bleeding in one of the cases. All patients recovered without further incident. CONCLUSION: ERCP-related perforations may be difficult to diagnose by video endoscope and digital fluoroscope detection of retroperitoneal free air or contrast medium leakage can facilitate diagnosis. PMID:25400465

  20. Prepacking perforations improves gravel packs

    SciTech Connect

    Hall, B.E.; Pace, J.R. (Western Co., The Woodlands, TX (US))

    1990-05-21

    Productivity can be increased by prepacking perforations with gravel before a major gravel pack is pumped. The main gravel-pack treatment follows immediately after the prepack. This procedure can increase perforation permeability due to a more complete gravel fill of the perforation. The gravel pack prevents perforations from collapsing or filling with formation sand.

  1. Narrowing of giant gastric perforation by purse-string suture before omental plugging

    PubMed Central

    Usta, Sertac; Kayaalp, Cuneyt; Gozeneli, Orhan

    2015-01-01

    Introduction Timely diagnosis of the gastroduodenal perforation usually allows primary repair or resection. Treatment of a large gastric perforation is more difficult than the common duodenal ulcer perforation by plugging and usually requires agastric resection. On the other hand, gastric resection fora hemodynamically compromised patient in sepsis hasa high rate of anastomotic failure and mortality. Here, we described a practical surgical technique that can avoid emergency gastric resection in such situations. Presentation of case A 83 year-old female admitted with peritonitis, severe sepsis and hemodynamic instability. After the diagnosis of hollow organ perforation and supportive therapy, laparotomy revealed a delayed and large (7 cm) gastric perforation. Instead of gastrectomy, we downsized the large defect by means of a purse-string suture around the perforation and made it suitable for the application of omental plugging. Discussion The patients with poor performance status who are not suitable for the gastric resection, a free omental plug fixation to the narrowed perforation area by a purse-string suture can overcome the problem. Conclusion This method can be keep in mind as a damage control surgery technique in the non-traumatic abdominal emergencies due to large gastric perforations. PMID:25984301

  2. Duodenal ulcerogens cysteamine and propionitrile decrease duodenal neutralization of acid in the rat

    SciTech Connect

    Adler, R.S.; Gallagher, G.T.; Szabo, S.

    1983-08-01

    Neutralization of acid was evaluated in rat proximal duodenal segments isolated from biliary and pancreatic secretions. Duodenal ulcerogenic doses of cysteamine produced a significant decrease in acid disposal 0.5-2 hr after treatment. Oral or subcutaneous administration of the duodenal ulcerogen was effective. The potent ulcerogen cysteamine produced a more pronounced decrease than propionitrile (a weak duodenal ulcerogen). The failure of ethanolamine, a nonulcerogenic structural analog of cysteamine to significantly alter acid disposal suggests that the effect is not due to the toxic properties of the duodenal ulcerogen. The results reinforce the concept that the duodenum is able to dispose of significant quantities of acid. The decrease in acid-handling may contribute to duodenal susceptibility to acid after treatment with ulcerogens and possibly reflects pathophysiologic changes early in duodenal ulceration.

  3. 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

  4. [Duodenal diaphragm in children (two cases)].

    PubMed

    Wandaogo, A; Sano, D; Tapsoba, T L; Cisse, R; Sanou, A

    1998-01-01

    Duodenal diaphragm is a rare cause of intestinal obstruction. Two pediatric cases are reported in which vomiting of bile-stained material and distension of the epigastrium were the main clinical signs. Roentgenograms and sonograms were highly suggestive. Duodenal bypass was easy to perform and effective. Nevertheless, it must be kept in mind that associated anomalies are frequent and may be severe. PMID:10797969

  5. 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

  6. Update on strategies limiting iatrogenic hypoglycemia

    PubMed Central

    Bonaventura, Aldo; Montecucco, Fabrizio; Dallegri, Franco

    2015-01-01

    The prevalence of type 2 diabetes mellitus (T2DM) is increasing all over the world. Targeting good glycemic control is fundamental to avoid the complications of diabetes linked to hyperglycemia. This narrative review is based on material searched for and obtained via PubMed up to April 2015. The search terms we used were: ‘hypoglycemia, diabetes, complications’ in combination with ‘iatrogenic, treatment, symptoms.’ Serious complications might occur from an inappropriate treatment of hyperglycemia. The most frequent complication is iatrogenic hypoglycemia that is often associated with autonomic and neuroglycopenic symptoms. Furthermore, hypoglycemia causes acute cardiovascular effects, which may explain some of the typical symptoms: ischemia, QT prolongation, and arrhythmia. With regards to the latter, the night represents a dangerous period because of the major increase in arrhythmias and the prolonged period of hypoglycemia; indeed, sleep has been shown to blunt the sympatho-adrenal response to hypoglycemia. Two main strategies have been implemented to reduce these effects: monitoring blood glucose values and individualized HbA1c goals. Several drugs for the treatment of T2DM are currently available and different combinations have been recommended to achieve individualized glycemic targets, considering age, comorbidities, disease duration, and life expectancy. In conclusion, according to international guidelines, hypoglycemia-avoiding therapy must reach an individualized glycemic goal, which is the lowest HbA1c not causing severe hypoglycemia and preserving awareness of hypoglycemia. PMID:26099256

  7. Update on strategies limiting iatrogenic hypoglycemia.

    PubMed

    Bonaventura, Aldo; Montecucco, Fabrizio; Dallegri, Franco

    2015-09-01

    The prevalence of type 2 diabetes mellitus (T2DM) is increasing all over the world. Targeting good glycemic control is fundamental to avoid the complications of diabetes linked to hyperglycemia. This narrative review is based on material searched for and obtained via PubMed up to April 2015. The search terms we used were: 'hypoglycemia, diabetes, complications' in combination with 'iatrogenic, treatment, symptoms.' Serious complications might occur from an inappropriate treatment of hyperglycemia. The most frequent complication is iatrogenic hypoglycemia that is often associated with autonomic and neuroglycopenic symptoms. Furthermore, hypoglycemia causes acute cardiovascular effects, which may explain some of the typical symptoms: ischemia, QT prolongation, and arrhythmia. With regards to the latter, the night represents a dangerous period because of the major increase in arrhythmias and the prolonged period of hypoglycemia; indeed, sleep has been shown to blunt the sympatho-adrenal response to hypoglycemia. Two main strategies have been implemented to reduce these effects: monitoring blood glucose values and individualized HbA1c goals. Several drugs for the treatment of T2DM are currently available and different combinations have been recommended to achieve individualized glycemic targets, considering age, comorbidities, disease duration, and life expectancy. In conclusion, according to international guidelines, hypoglycemia-avoiding therapy must reach an individualized glycemic goal, which is the lowest HbA1c not causing severe hypoglycemia and preserving awareness of hypoglycemia. PMID:26099256

  8. 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

  9. Duodenal carcinoid tumor - a case report.

    PubMed

    Debnath, C R; Debnath, M R; Haque, M A; Das, S N; Moshwan, M M; Karim, R; Uddoula, M S

    2014-01-01

    Carcinoid tumors are well differentiated neuroendochrine tumors which most frequently involve the gastrointestinal tract; however duodenal carcinoid tumors are rare. They can present with various clinical symptoms and are difficult to diagnose. A 52 years old lady presented with the symptoms of recurrent upper abdominal pain, burning sensation of whole body and passage of loose stool. On endoscopy of upper GIT, there was a duodenal polyp. Polyp was removed by endoscopic resection and tissue was taken for biopsy. Histological findings of biopsy specimen shows carcinoid tumor. As duodenal carcinoid tumor is a rare presentation so we are going to present this case in this article. PMID:24584389

  10. Transarterial glue embolization in iatrogenic renovascular injuries.

    PubMed

    Cimsit, Nuri Cagatay; Baltacioglu, Feyyaz; Cengic, Ismet; Akpinar, Ihsan Nuri; Ilker, Yalçin; Turkeri, Levent

    2008-01-01

    Iatrogenic injuries of the intrarenal arterial system include pseudoaneurysms and fistulas. They can cause hematuria and life-threatening hemodynamic instability, and therefore should be treated promptly. Endovascular treatment is recommended for these cases due to its effectiveness. Among the different agents used for embolization, n-butyl-2-cyanoacrylate (glue) has rarely been used. We present 15 patients with pseudoaneurysms and/or arteriovenous or caliceal fistulas who were treated by glue embolization. In our patient group, five had a history of percutaneous nephrolithotomy, six had renal biopsies, three had nephron-sparing surgery, and one had percutaneous nephrostomy. Glue embolizations were performed with the microcatheter technique. All patients were successfully treated, and all but one had excellent follow-ups. One patient suffered from disseminated intravascular coagulation secondary to transfusion and died after the procedure. We think glue embolization is a safe and effective treatment for this group of patients and present our experience along with the technical approach. PMID:18437524

  11. Laparoscopic duodenoduodenostomy for duodenal atresia.

    PubMed

    Bax, N M; Ure, B M; van der Zee, D C; van Tuijl, I

    2001-02-01

    A 3,220-g newborn baby with trisomy 21 presented with duodenal atresia. No other congenital malformations were diagnosed. Informed consent for a laparoscopic approach was obtained. The child was placed in a supine, head-up position slightly rotated to the left at the end of a shortened operating table. The surgeon stood at the bottom end with the cameraperson to his left and the scrub nurse to his right. The screen was at the right upper end. Open insertion of a cannula for a 5-mm 30 degrees telescope through the inferior umbilical fold was performed. A carbon dioxide (CO2) pneumoperitoneum with a pressure of 8 mmHg and a flow of 2l/min was established. Two 3.3-mm working cannulas were inserted; one in the left hypogastrium and one pararectally on the right at the umbilical level. Two more such cannulas were inserted; one under the xyphoid for a liver elevator and one in the right hypogastrium for a sucker. Mobilization of the dilated upper and collapsed lower duodenum was easy. After transverse enterotomy of the upper duodenum and longitudinal enterotomy of the distal duodenum, a diamond-shaped anastomosis with interrupted 5 zero Vicryl sutures were performed. The absence of air in the bowel beyond the atresia increased the working space and greatly facilitated the procedure. The technique proved to be easy, and the child did very well. Laparoscopic bowel anastomosis in newborn babies had not been described previously. Recently, a diamond-shaped duodenoduodenostomy for duodenal atresia was performed. The technique proved to be simple and is described in detail. The child did very well. PMID:12200660

  12. Fingertip and palmar patterns in duodenal ulcer.

    PubMed

    Habibullah, C M; Mujahid Ali, M; Shivaprakash, M; Iqbal, M A; Ishaq, M

    1982-01-01

    Dermatoglyphic studies were carried out on 90 adult males suffering from duodenal ulcer. Fingertip and palmar patterns were analysed to see if there was an association between duodenal ulcer and any of the dermatoglyphic traits. The patterns which were significantly different are: (1) increased frequency of whorls; (2) reduced frequency of loops on fingertips, and (3) increased frequency of patterns in the thenar I and IV interdigital area. PMID:7152533

  13. 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.

  14. Well perforation inspection

    SciTech Connect

    Katahara, K.W.

    1993-06-08

    A method of determining the location of a perforation into an earth formation from a wellbore is described comprising the steps of: placing means in said wellbore including means for transmitting an acoustic signal and receiving means for receiving an acoustic signal resulting from the transmitted signal; moving said means through said wellbore while transmitting acoustic signals of a predetermined range of selected frequencies into said wellbore and receiving reflected acoustic signals from said wellbore resulting from said transmitted acoustic signals; and comparing the intensities of the received acoustic signals at said receiving means with the frequencies of said received acoustic signals to determine when a received acoustic signal of a resonant frequency of one said transmitted acoustic signals has been detected by said receiving means as an indication of the location of said perforation with respect to at least one of said means for transmitting and said receiving means.

  15. Shaped charge well perforator

    SciTech Connect

    Mcphee, W.A.

    1983-06-14

    A shaped charge unit is claimed for well perforating having a outer shell with an internal cavity formed therein. An explosive charge material conforms in exterior shape with the inside surface of the cavity and is retained in place by a conical liner of nonexplosive material. The interior shape of the cavity is such that an increased amount of explosive material is provided in a circumferential channel located proximate to the periphery of the base of the conical liner.

  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. IVC Filter Perforation through the Duodenum Found after Years of Abdominal Pain

    PubMed Central

    Jehangir, Asad; Rettew, Andrew; Shaikh, Bilal; Bennett, Kyle; Jehangir, Qasim; Qureshi, Anam; Arshad, Sharjeel; Spiegel, Adam

    2015-01-01

    Patient: Female, 67 Final Diagnosis: IVC filter perforation through duodenum Symptoms: Abdominal pain Medication: — Clinical Procedure: Esophagogastroduodenoscopy Specialty: Gastroenterology and Hepatology Objective: Challenging differential diagnosis Background: The number of IVC filter-related complications has increased with their growing utilization; however, IVC filter perforation of the duodenum is rare. It can manifest with nonspecific abdominal pain, gastrointestinal bleeding, cava-duodenal fistula, or small bowel obstruction. Case Report: A 67-year-old female presented with several years of right upper quadrant abdominal pain which was exacerbated by movement and food intake. She had a history of hepatic steatosis, cholecystectomy, and multiple DVTs with inferior vena cava filter placement. Physical exam was unremarkable. Laboratory tests demonstrated elevated alkaline phosphatase and transaminases. Esophagogastroduodenoscopy revealed a thin metallic foreign body embedded in the duodenal wall and protruding into the duodenal lumen with surrounding erythema and edema, but no active hemorrhage. Further evaluation with non-contrast CT scan revealed that one of the prongs of her IVC filter had perforated through the vena cava wall into the adjacent duodenum. Exploratory laparotomy was required for removal of the IVC filter and repair of the vena cava and duodenum. Her post-operative course was uneventful. Conclusions: In patients with history of IVC filter placement with non-specific abdominal pain, a high clinical suspicion of IVC filter perforation of the duodenum should be raised, as diagnosis may be challenging. CT scan and EGD are valuable in the diagnosis. Excellent outcomes have been reported with open surgical filter removal. Low retrieval rates of IVC filters have led to increased complications; hence, early removal should be undertaken as clinically indicated. PMID:25979859

  18. Percutaneous BioOrganic Sealing of Duodenal Fistulas: Case Report and Review of Biological Sealants with Potential Use in Interventional Radiology.

    PubMed

    Wadhwa, Vibhor; Leeper, William R; Tamrazi, Anobel

    2015-08-01

    Biological sealants are being increasingly used in a variety of surgical specialties for their hemostatic and sealing capabilities. However, their use in interventional radiology has not been widely reported. The authors describe a case of duodenal perforation occurring after 15 years of gastric bypass surgery, in whom surgical diversion was unsuccessfully attempted and the leakage was successfully controlled using percutaneous administration of a combination of biological and organic sealants. PMID:25613669

  19. 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

  20. Mini-loop ligation of a bleeding duodenal Dieulafoy's lesion

    PubMed Central

    Gomer?i? Pal?i?, Marija; Ljubi?i?, Neven

    2013-01-01

    Two percent of gastrointestinal hemorrhages are caused by Dieulafoy’s lesions, which are located in duodenum in only 15% of cases. There are no recommendations regarding the prime endoscopic treatment technique for this condition. A 61-year-old woman presented with melena without signs of hemodynamic instability. During an urgent upper endoscopy, blood oozing from the normal mucosa of the duodenum was seen and this was classified as a Dieulafoy’s lesion. A mini-loop was opened at the rim of a transparent ligation chamber, at the end of the endoscope, and after aspiration of the lesion, closed and detached. Complete hemostasis was achieved without early or postponed complications. In every day clinical practice, mini-loop ligation is rarely used because of possible complications, such as site ulceration, organ perforation, re-bleeding and possible inexperience of the operator. To the best of our knowledge this is the first case of successful treatment of bleeding duodenal Dieulafoy’s lesion by mini-loop ligation. PMID:23801846

  1. Feasibility and safety of endoscopic cryoablation at the duodenal papilla: Porcine model

    PubMed Central

    Yang, Dennis; Reinhard, Mary K; Wagh, Mihir S

    2015-01-01

    AIM: To assess the feasibility and safety of liquid nitrogen spray cryoablation at the duodenal papilla in a porcine model. METHODS: This prospective study protocol was approved by the University of Florida Institutional Animal Care and Use Committee. Six pigs underwent liquid nitrogen spray cryotherapy at the duodenal papilla. Freeze time of 20-s was applied per cycle (4 cycles/session). Survival animals (n = 4) were monitored for adverse events. Hemoglobin, white blood count, liver tests, and lipase were obtained at baseline and post-treatment. EGD was performed on day#7 to evaluate the papilla and for histology. All animals were euthanized and necropsy was performed at the end of the one-week survival period. Feasibility was defined as successful placement of the decompression tube in the duodenum, followed by delivery of spray cryotherapy to the duodenal papilla. Safety was determined by monitoring post-treatment blood tests and clinical course. Treatment effect was defined as endoscopic and histologic changes after cryotherapy. This was established by comparing endoscopic and histologic findings from mucosal biopsies prior to cryotherapy and on post-operative day (POD)#7. Full-thickness specimen was obtained post-mortem to assess depth of injury. RESULTS: Spray cryotherapy was feasible and successfully performed in all 6/6 (100%) animals. Cryospray with liquid nitrogen (four 20-s freeze-thaw cycles) at the duodenal papilla resulted in white frost formation at and around the target region. The mean procedural time was 54.5 min (range 50-58 min). All six animals studied had stable blood pressure, heart rate, and pulse oximetry measurements during the procedure. There were no significant intra-procedural adverse events. There were no significant differences in hemoglobin, white cell count, liver tests or lipase from baseline to post-cryotherapy. Survival animals were monitored daily post-operatively without any clinical ill effects from the cryotherapy. There was no bleeding, infection, or perforation on necropsy. Endoscopic on POD#7 showed edema and ulceration at the duodenal papilla. On histology, there was loss of crypt architecture with moderate to severe necrosis and acute mixed inflammatory infiltration in each specimen following cryotherapy. The extent of cryogen-induced tissue necrosis (depth of injury) was limited to the mucosa on full-thickness specimen evaluation. CONCLUSION: Endoscopic liquid nitrogen spray cryotherapy is feasible and safe for ablation at the duodenal papilla in a porcine model.

  2. Continuous tables. Perforation of high productivity wells

    SciTech Connect

    Not Available

    1984-07-01

    Perforating correctly is an important step in completing a quality producer, particularly if the well is to be gravel packed. The figures presented contain useful information pertaining to the perforation and perforation cleanup of high productivity wells. They illustrate well productivity vs. pack to formation permeability ratio, pressure drop vs. flow rate for 3 perforation sizes, and perforating gun configurations.

  3. Laparoscopic appendectomy for perforated appendicitis

    Microsoft Academic Search

    Jimmy B. Y. So; Ee-Cherk Chiong; Edmond Chiong; Wei-Keat Cheah; David Lomanto; Peter Goh; Cheng-Kiong Kum

    2002-01-01

    Although laparoscopic appendectomy for uncomplicated appendicitis is feasible and safe, its application to perforated appendicitis\\u000a is uncertain. A retrospective study of all patients with perforated appendicitis from 1992 to 1999 in a university hospital\\u000a was performed. A series of 231 patients were diagnosed as having perforated appendicitis. Of these patients, 85 underwent\\u000a laparoscopy (LA), among whom 40 (47%) required conversion

  4. [Bronchial asthma and duodenal ulcer and erosive bulbo-duodenitis in children: report of 6 cases].

    PubMed

    Kawakami, E; Maranhão, H de S; Tahan, S

    1992-01-01

    The coexistence of moderate and severe asthma and duodenal ulcer is not very well established as yet. We started a protocol trying to establish the presence of reflux esophagitis in children with moderate or severe asthma. Thirty two patients underwent upper digestive endoscopy and, surprisingly, we found six children (18.7%) with the following digestive aspects: four children had duodenal ulcer, and two had erosive duodenitis. We report these cases and discuss some etiopathogenic aspects about these possible association, and beware the clinician to pay attention to abdominal pain in children with bronchial asthma. PMID:1340752

  5. [Perforating necrobiosis lipoidica].

    PubMed

    Peteiro, C; Zulaica, A; Toribio, J

    1986-01-01

    This is the case history of a woman with a 6 year history of insulin-dependent diabetes mellitus and a 5 year history of tuberous lesions on the dorsal aspect of the metacarpophalangeal joints. Histological examination revealed multiple necrobiotic foci throughout the dermis and subcutaneous tissue, with varying degrees of degeneration, alternating with fibrotic areas. This picture is compatible with lipoid necrobiosis. The existence of various foci of epithelial perforation, manifested clinically by a point hyperkeratosis similar in appearance to blackheads, suggests transfollicular elimination. This would explain the total absence of a pilosebaceous follicles in the lesion. PMID:3550319

  6. Gravel placement through perforations and perforation cleaning for gravel packing

    SciTech Connect

    Penberthy, W.L. Jr.

    1988-02-01

    In large-scale model testing, the effectiveness of gravel prepacking under four different conditions was studied: when there had been no previous sand production, after sand production had occurred, after perforation washing, and after perforation surging. In the case of no previous sand production, pressure parting occurred in the unconsolidated formation when a critical injection pressure level was exceeded. The orientation was normal to the least principal stress. In those cases where earlier fluid production caused the removal of formation sand, prepacking produced multiple pressure parts in the low-stress-state sand in the vicinity of the perforation because stable cavities had not formed. The orientation of these pressure parts was also normal to the least principal stress. Gravel prepacking after perforation washing and surging resulted in grave-placement geometries that were controlled by the stress state and geometry of the formation sand around the perforation after these operations. Prepacking after perforation washing generally resulted in placement that resembled the geometry of the washed region, which was usually a void. Prepacking after surging resulted in pressure parting and considerable mixing of the prepack gravel with the formation sand because stable cavities had not formed. Perforation washing results demonstrated that washing should be conducted at the maximum practical pump rate with water used as the wash fluid. Perforation surging tests indicated that the amount of formation sand removed was proportional to the surge pressure.

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

    PubMed

    Goldner, Bryan; Stabile, Bruce E

    2014-10-01

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

  8. Well perforating apparatus and method

    Microsoft Academic Search

    1980-01-01

    A method and apparatus for perforating a well casing and surrounding formation are disclosed. The perforating apparatus includes a laser source for projecting a high intensity laser beam transversely through the well bore and surrounding formation and a nozzle assembly for injecting exothermically reactive gas along the path of the laser beam. The gas stream shields the output lens of

  9. 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...

  10. Shaped charge perforating device

    SciTech Connect

    Ayers, D.B.

    1986-04-22

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

  11. Perforation cleaning tool

    SciTech Connect

    Facteau, D.M.; Cobb, T.A.; Hyman, M.D.

    1992-08-04

    This patent describes a well tool for use in cleaning a perforation that extends from a well bore into a formation, the well tool having an elongated tubular body with upper and lower chambers therein, fluidic oscillator means in the upper chamber having first and second outlets, the oscillator means being responsive to the flow of fluids in the running string for creating alternating pressure pulses at the first and second outlets; means communicating the first outlet with the lower chamber; means communicating the second outlet with the annular well bore region externally of the body and the lower chamber. This patent describes improvement in cylindrical filter means mounted adjacent the respective upper and lower ends of the body for concentrating the pressure variations in the annular region and for substantially isolating the well bore above and below the filter means from the pressure pulses.

  12. Perforation cleaning tools

    SciTech Connect

    Facteau, D.M.; Cobb, T.A.; Hyman, M.D.

    1993-07-20

    A well tool is described for use in cleaning a perforation that communicates a well bore with a formation, said well tool having an elongated tubular body that is adapted to be lowered into a well on a running-in string, comprising: fluidic oscillator means in said body having first and second outlets, said oscillator means being responsive to the flow of fluids in said running-in string for creating alternating pressure pulses at said first and second outlets; first and second cavity means in said body in communication respectively with said first and second outlets; passage means for communicating each of said cavity means with the annular well bore region externally of said body and said cavity means; and filter means mounted adjacent the respective upper and lower ends of said body for substantially confining said pressure variations to said annular region and for substantially isolating the well bore above and below said filter means from said pressure pulses.

  13. Endovascular management of iatrogenic renal arterial lesions and clinical outcomes

    PubMed Central

    Güneyli, Serkan; Gök, Mustafa; Bozkaya, Halil; Ç?nar, Celal; Tizro, Arastu; Korkmaz, Mehmet; Ak?n, Yi?it; Par?ldar, Mustafa; Oran, ?smail

    2015-01-01

    PURPOSE We aimed to evaluate iatrogenic renal arterial lesions, including pseudoaneurysm, arteriovenous fistula, and arteriocaliceal fistula, their management by endovascular embolization, and the clinical results. METHODS Fifty-five patients (forty males, fifteen females) with a median age of 40 years (range, 8–85 years), who underwent endovascular embolization of iatrogenic renal arterial lesions between March 2003 and December 2013 were included in this retrospective study. Types of iatrogenic lesions and details of embolization procedures were reported. Estimated glomerular filtration rate (eGFR), renal function tests, hemoglobin, and hematocrit levels before and after embolization were recorded and compared. RESULTS Median follow-up was 24 months. We identified 53 pseudoaneurysms, 30 arteriovenous fistulas, and 11 arteriocaliceal fistulas in 55 patients, after percutaneous nephrolithotomy (n=26), renal biopsy (n=21), nephrostomy (n=3), renal surgery (n=3), and extracorporeal shock wave lithotripsy (n=2). Median number of pseudoaneurysms was 1 (range, 1–4) with a median size of 7 mm (range, 1.5–35 mm). Fifty-one patients underwent coil embolization. Median number of coils was 5 (range, 2–21) and median renal parenchymal loss was 5% (range, 1%–50%). There were no significant differences between pre- and postoperative eGFR and serum parameters. CONCLUSION Iatrogenic renal arterial lesion can be a life threatening condition. Superselective coil embolization is a safe, minimally invasive treatment option with minimal renal parenchymal loss and without significant change in renal function. PMID:25835080

  14. Iatrogenic pneumomediastinum and facial emphysema after endodontic treatment

    Microsoft Academic Search

    Y. Smatt; H. Browaeys; A. Genay; G. Raoul; J. Ferri

    2004-01-01

    Subcutaneous emphysema is well known, but diffusion of gas into the mediastinum is not so common, particularly if it is caused by treatment of a root canal without apparent osseous fenestration or mucoperiostal lesions. We report a case of iatrogenic pneumomediastinum and facial emphysema after endodontic treatment. The diagnosis was confirmed by computed tomography, and the patient recovered after treatment

  15. Lower Eyelid Reconstruction for Iatrogenic Eyelid-to-Globe Malposition.

    PubMed

    Takahashi, Yasuhiro; Miyazaki, Hidetaka; Chan, WengOnn; Kakizaki, Hirohiko

    2015-05-01

    An 86-year-old man with iatrogenic eyelid-to-globe malposition had a combination of medial tarsal strip, lateral periosteal sling, and inferior tarsal support with the ear cartilage. An appropriate apposition between the globe and lower eyelid was established postoperatively with good tear meniscus and acceptable cosmetic results. PMID:25915665

  16. Iatrogenic complications in the neonatal intensive care unit

    Microsoft Academic Search

    K C Sekar

    2010-01-01

    With the introduction of novel technologies and approaches in neonatal care and the lack of appropriately designed and well-executed randomized clinical trials to investigate the impact of these interventions, iatrogenic complications have been increasingly seen in the neonatal intensive care unit. In addition, increased awareness and the introduction of more appropriate quality control measures have resulted in higher levels of

  17. Iatrogenic Creutzfeldt-Jakob disease via surgical instruments.

    PubMed

    Thomas, Jonathan G; Chenoweth, Carol E; Sullivan, Stephen E

    2013-09-01

    Creutzfeldt-Jakob disease (CJD) is a neurodegenerative prion disease that can spread via contaminated neurosurgical instruments previously used on an infected patient. We examine current guidelines on how to recognize, handle, and prevent instrument-related iatrogenic CJD. Despite only four reported patients worldwide implicating contaminated neurosurgical instruments, and none in the past 30 years, the public health consequences of potential instrument-related iatrogenic CJD can be far-reaching. Conventional sterilization and disinfection methods are inadequate in reducing prion infectivity of contaminated instruments, and World Health Organization recommendations for disinfection using bleach or sodium hydroxide are often impractical for routine decontamination. Recently, possible CJD exposure via infected surgical instruments was suspected at a large teaching hospital. Although CJD was later disproven, the intervening investigation exposed the difficulty in tracking infected surgical instruments and in protecting subsequent surgical patients from prion infection. To identify patients at risk for iatrogenic CJD, infectivity of instruments after this index patient is estimated using simple scenario modeling, assuming a certain log reduction of infectivity for each cleansing cycle. Scenario modeling predicts that after six cycles of instrument use with conventional cleansing following an index patient, other patients are highly unlikely to be at risk for iatrogenic CJD. Despite its rarity, the threat of iatrogenic CJD transmission via contaminated instruments poses tremendous challenges to neurosurgeons. Basic prevention strategies should be employed for patients with suspected CJD, including use of disposable instruments where possible and quarantining non-disposable instruments until the diagnosis is ascertained, or using special instrument reprocessing methods if CJD is suspected. PMID:23896549

  18. Method and apparatus for borehole perforating

    SciTech Connect

    Bullard, G.D.

    1980-01-29

    Method and apparatus are described for perforating an earth formation from a well bore wherein each perforator unit of a perforator gun utilizes the combination of a shaped charge and a bullet and the perforator unit is adapted to fire the shaped charge responsive to detonation of detonating cord and the bullet is fired responsive to the firing of the shaped charge.

  19. Glove perforation during oral surgical procedures

    Microsoft Academic Search

    Ruth Lopes; Belmiro Cavalcanti; Egito Vasconcelos; Luiz Carlos Ferreira da Silva; Gabriela Granja Porto; B. Vasconcelos

    Objective: The aim of this study was to determine the incidence of glove perforation among undergraduates and residents performing maxillofacial surgery and identify procedures associated with the perforations. Study Design: For this purpose, 200 pairs of surgical gloves were used. For inspecting the perforations, the gloves were filled with water, at least 500 ml. Results: Sixteen gloves (8%) were perforated,

  20. Nasal septum perforation of welders.

    PubMed

    Lee, Choong Ryeol; Yoo, Cheol In; Lee, Ji ho; Kang, Seong Kyu

    2002-07-01

    During the periodic physical checkups in 1997-2000, the authors have found eleven cases of nasal septum perforation among 2,869 welders in Ulsan, Korea. They have not suffered from diseases and conditions that could cause septum perforation such as tuberculosis, syphilis, and long-term use of topical corticosteroids. And also they did not have trauma history and surgical experiences on their nasal septum. To investigate the cause of septum perforation we reviewed the past history of pre-employment, the results of annual working environment survey and the material safety data sheets of welding rods and steels with which they have dealt. We also analyzed the concentration of several metals of welding fume and the concentration of blood and urinary chromium. In the result, we assumed that the nasal septum perforation of welders was due to chronic exposure to low-level hexavalent chromium. PMID:12141379

  1. Biliopancreatic Diversion with a Duodenal Switch

    Microsoft Academic Search

    Douglas S. Hess; Douglas W. Hess

    1998-01-01

    Background: This paper evaluates biliopancreatic diversion combined with the duodenal switch, forming a hybrid procedure which\\u000a is a combination of restriction and malabsorption. Methods: The evaluation is of the first 440 patients undergoing this procedure\\u000a who had had no previous bariatric surgery. The mean starting weight was 183 kg, with 41% of our patients considered super\\u000a morbidly obese (BMI >

  2. Endoscopic mucosal resection and endoscopic submucosal dissection in the treatment of sporadic nonampullary duodenal adenomatous polyps

    PubMed Central

    Marques, Joana; Baldaque-Silva, Francisco; Pereira, Pedro; Arnelo, Urban; Yahagi, Naohisa; Macedo, Guilherme

    2015-01-01

    Although uncommon, sporadic nonampullary duodenal adenomas have a growing detection due to the widespread of endoscopy. Endoscopic therapy is being increasingly used for these lesions, since surgery, considered the standard treatment, carries significant morbidity and mortality. However, the knowledge about its risks and benefits is limited, which contributes to the current absence of standardized recommendations. This review aims to discuss the efficacy and safety of endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) in the treatment of these lesions. A literature review was performed, using the Pubmed database with the query: “(duodenum or duodenal) (endoscopy or endoscopic) adenoma resection”, in the human species and in English. Of the 189 retrieved articles, and after reading their abstracts, 19 were selected due to their scientific interest. The analysis of their references, led to the inclusion of 23 more articles for their relevance in this subject. The increased use of EMR in the duodenum has shown good results with complete resection rates exceeding 80% and low complication risk (delayed bleeding in less than 12% of the procedures). Although rarely used in the duodenum, ESD achieves close to 100% complete resection rates, but is associated with perforation and bleeding risk in up to one third of the cases. Even though literature is insufficient to draw definitive conclusions, studies suggest that EMR and ESD are valid options for the treatment of nonampullary adenomas. Thus, strategies to improve these techniques, and consequently increase the effectiveness and safety of the resection of these lesions, should be developed.

  3. Unexpected endoscopic full-thickness resection of a duodenal neuroendocrine tumor

    PubMed Central

    Hatogai, Ken; Oono, Yasuhiro; Fu, Kuang-I; Odagaki, Tomoyuki; Ikematsu, Hiroaki; Kojima, Takashi; Yano, Tomonori; Kaneko, Kazuhiro

    2013-01-01

    A 57-year-old man underwent endoscopy for investigation of a duodenal polyp. Endoscopy revealed a hemispheric submucosal tumor, about 5 mm in diameter, in the anterior wall of the duodenal bulb. Endoscopic biopsy disclosed a neuroendocrine tumor histologically, therefore endoscopic mucosal resection was conducted. The tumor was effectively and evenly elevated after injection of a mixture of 0.2% hyaluronic acid and glycerol at a ratio of 1:1 into the submucosal layer. A small amount of indigo-carmine dye was also added for coloration of injection fluid. The lesion was completely resected en bloc with a snare after submucosal fluid injection. Immediately, muscle-fiber-like tissues were identified in the marginal area of the resected defect above the blue-colored layer, which suggested perforation. The defect was completely closed with a total of 9 endoclips, and no symptoms associated with peritonitis appeared thereafter. Histologically, the horizontal and vertical margins of the resected specimen were free of tumor and muscularis propria was also seen in the resected specimen. Generally, endoscopic mucosal resection is considered to be theoretically successful if the mucosal defect is colored blue. The blue layer in this case, however, had been created by unplanned injection into the subserosal rather than the submucosal layer. PMID:23864794

  4. Study of Slanted Perforated Jets

    NASA Astrophysics Data System (ADS)

    Ahmed, R. Asad; Thanigaiarasu, S.; Santhosh, J.; Elangovan, S.; Rathakrishnan, E.

    2013-12-01

    This paper presents the numerical simulation of the subsonic jets controlled by slanted perforated tabs and its performance of mixing efficiency is compared with the jet controlled by solid tab and free jet. The objective of this paper is to study the performance of slanted perforation geometry tabs in controlling high speed jets to enhance the mixing of jet with the ambient air, to suppress the noise level and to minimize the thrust loss. In this paper the simulations have been carried out using the commercial meshing and analysis software. Due to the effect of tabs the potential core decay occurs and velocity reduces drastically because of enhanced mixing produced by the tabs. From the results it is found that in slanted perforated tab the main jet interacts with the slanted perforated jet which causes in effective mixing, instability in jets and lower thrust loss when compared with the free jet. The decay of the potential core and velocity reduction is computed by simulation for 0.4 Mach number. Velocity plots are obtained at both near field and far field downstream locations to study the jet distortion with slanted perforated tabs and solid tabs. The results obtained for perforated tabs for 0.4 Mach number are also compared with various other Mach numbers. They have also been validated with experimental results which show good agreement with the computational results.

  5. Spontaneous Intestinal Perforation in Neonates

    PubMed Central

    Tiwari, Charu; Sandlas, Gursev; Jayaswal, Shalika; Shah, Hemanshi

    2015-01-01

    Background: The term Spontaneous Intestinal Perforation (SIP) suggests a perforation in the gastrointestinal tract of a newborn with no demonstrable cause. Methods: Four neonates presenting with spontaneous bowel perforation were analyzed with respect to clinical presentation, management and outcome. Results: The mean age at presentation was 11.4 days. There were three males and one female. One of the neonates was preterm, very low birth weight and the other three were full term. Two neonates underwent emergency exploratory laparotomy and two were initially managed by peritoneal drainage in view of poor general condition; one of them improved and did not require further operative intervention. The preterm very low birth weight neonate was stabilized and explored after 48 hours. Intra-operatively, two of them had two ileal perforations each which required ileostomy; one had single perforation in the transverse colon which was primarily repaired. All four had an uneventful recovery. Conclusion: SIP is a distinct clinical entity and has better outcome than neonates with intestinal perforation secondary to Necrotizing Enterocolitis (NEC).

  6. Duodenal string test in typhoid fever.

    PubMed

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

    1993-05-01

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

  7. Well-Differentiated Duodenal Tumor\\/Carcinoma (Excluding Gastrinomas)

    Microsoft Academic Search

    Robert T. Jensen; Guido Rindi; Rudolf Arnold; José M. Lopes; Maria Luisa Brandi; Wolf O. Bechstein; Emanuel Christ; Babs G. Taal; Ulrich Knigge; Hakan Ahlman; Dik J. Kwekkeboom; Dermot O’Toole

    2006-01-01

    Duodenal neuroendocrine tumors (NETs) are located in the duodenum and may or may not be associated with a functional clinical syndrome. The term duodenal NET includes all duodenal tumors with neuroendocrine (NE) features as determined by histological\\/immunohistochemical methods including positivity for NET cytosolic markers [neuron-specific enolase (NSE), PGP 9.5] or secretory vesicle proteins [chromogranin A (CgA), synaptophysin] and also frequently

  8. 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

  9. 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

  10. Semianalytical productivity models for perforated completions

    SciTech Connect

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

    1991-02-01

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

  11. Bladder outlet obstruction in women: iatrogenic, anatomic, and neurogenic

    Microsoft Academic Search

    Rebecca J. McCrery; Rodney A. Appell

    2006-01-01

    This paper outlines the presentation, evaluation, and management of bladder outlet obstruction (BOO) in women as it relates\\u000a to iatrogenic, anatomic, and neurogenic causes. Attention is given to the different diagnostic criteria used by various authors\\u000a in their case series and studies. The lack of standardization with regard to the diagnosis of BOO in women emphasizes the\\u000a fact that BOO

  12. Human Thrombin Injection for the Percutaneous Treatment of Iatrogenic Pseudoaneurysms

    SciTech Connect

    Elford, Julian [Department of Radiology, DerrifordHospital, Plymouth PL6 8DH (United Kingdom); Burrell, Christopher [Department of Cardiology, DerrifordHospital, Plymouth PL6 8DH (United Kingdom); Freeman, Simon; Roobottom, Carl [Department of Radiology, DerrifordHospital, Plymouth PL6 8DH (United Kingdom)

    2002-03-15

    Purpose: Thrombin injection is becoming well established for the percutaneous management of iatrogenic pseudoaneurysms. All the published series to date use bovine thrombin,and there have been reports of adverse immunologic effects following its use. Our study aimed to assess the efficacy of human thrombin injection for pseudoaneurysm occlusion. Methods:Fourteen patients with iatrogenic pseudoaneurysms underwent a color Doppler ultrasound examination to assess their suitability for percutaneous human thrombin injection. Human thrombin 1000 IU was then injected into the pseudoaneurysm sac under sterile conditions and with ultrasound guidance. A further color Doppler ultrasound examination was performed 24 hr later to confirm occlusion. Results: All 14 pseudoaneurysms were successfully occluded by human thrombin injection. In two cases a second injection of thrombin was required,but there were no other complications, and all pseudoaneurysms remained occluded at 24 hr. Conclusion: Ultrasound-guided human thrombin injection is simple to perform, effective and safe. We recommend that human thrombin becomes the agent of choice for percutaneous injection into iatrogenic pseudoaneurysms.

  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. 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

  15. 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

  16. Duodenal diverticula occurring in a family--chance or inheritance?

    PubMed Central

    Sternberg, A.; Deutsch, A. A.; Kott, I.; Reiss, R.

    1984-01-01

    The incidence, aetiology and possible inheritance of duodenal diverticula remain controversial. These aspects are discussed through the presentation of a family, in which duodenal diverticula occurred in a man and his two sons. To the best of our knowledge, this is the first such family documented in the medical literature. This familial occurrence may be attributed solely to the high incidence of duodenal diverticula in the general population (set by various authors at up to 14.2%), and, therefore, of no hereditary significance at all. We believe a screening study of the families of individuals with proven duodenal diverticula is most desirable, for it could shed light upon the controversial questions of incidence, aetiology, and inheritance patterns of duodenal diverticula. PMID:6431400

  17. Venting of pressure through perforated plates

    Microsoft Academic Search

    C. Kingery; G. Coulter; R. Pearson

    1978-01-01

    Results are presented for a series of experiments designed to determine the pressure venting characteristics of perforated plates. Pressure decay from a chamber as a function of the vented area is presented for a series of perforated plates.

  18. Diversion of bile and pancreatic secretion in the rat and its effect on cysteamine-induced duodenal and peptic ulcer development under maximal acid secretion.

    PubMed

    Clémençon, G H; Fehr, H F; Finger, J

    1984-01-01

    In this investigation we assess whether diversion of bile and pancreatic secretion protects rats from ulceration under maximal acid secretion as it does in cysteamine-induced ulcers. The rats were divided into a cysteamine-group (Cy) comprising 16 rats and a secretagogue group (PC) with 18 white male rats. Half of the animals of each group were submitted to the diversion-operation (division of the duodenum distally from the pylorus, jejuno-duodenostomy and entero-y-anastomosis), Cy2 and PC2 respectively. The other animals were not operated (Cy1 and PC1). In the cysteamine group the rats were given twice cysteamine-HC1 injections subcutaneously and the PC group were given a 24 h infusion with pentagastrin and carbachol. All animals of the Cy1 group had duodenal ulcers, 3 perforated. However, only 2 rats had one ulcer each in the Cy2 group (p less than 0.01). The PC1 group totalled 30 duodenal ulcers in the 9 animals with 10 perforations, 13 ulcers in 6 animals with 3 perforations in PC2. Furthermore in PC1 group 34 gastric ulcers were found in 7 rats and only 4 ulcers in the PC2 group. It is therefore concluded, that the diversion operation provided protection against cysteamine-induced duodenal ulcers (p less than 0.01) and ulcer formation under maximal acid stimulation in the duodenum (p less than 0.02) as well as in the rat stomachs (p less than 0.05). In the PC group the restraint haltering of the animals promoted presumably a stress situation with bile reflux in the non-operated whereas in the operated animals (PC2) reflux did not occur. PMID:6588494

  19. High pressure well perforation cleaning

    SciTech Connect

    Buell, R.S.

    1991-10-29

    This patent describes an apparatus for jet washing perforation tunnels in a well casing or liner positioned in a well and perforation tunnels in an adjacent geologic formation. It comprises a tubing means forming a well flow path from the earth's surface to a location adjacent to the well liner positioned in the well; conduit means connecting a source of high pressure liquid to the tubing means, jet tool means having at least one hole in the wall thereof for jetting the high pressure liquid at the perforation tunnels in the well casing or liner, the jet tool means comprising a tubular member connected to the lower end of the tubing means; a jet seat member fixedly connected to the tubular member, the jet seat member having a central opening aligned with the hole and a jet body having a central opening at least 3/23 inch in diameter formed therein hydraulically sealed in the jet seat member, whereby the jet body may be rotated to provide axial movement of the jet body with respect to the jet seat member; and a source of high pressure liquid able to provide a hydraulic horsepower for supplying liquid at a flow rate of at least 0.77 barrels per minute per jet body used at pressures in excess of 5,000 psi, to wash the perforated tunnel to a standoff distance of at least 12 times the diameter of the central opening of the jet body.

  20. Fishbone-induced perforated appendicitis.

    PubMed

    Bababekov, Yanik J; Stanelle, Eric J; Abujudeh, Hani H; Kaafarani, Haytham M A

    2015-01-01

    We review the literature and describe a case of fishbone-induced appendicitis. A 63-year-old man presented with abdominal pain. Work up including a focused history and imaging revealed fishbone-induced perforated appendicitis. The patient was managed safely and successfully with laparoscopic removal of the foreign body and appendectomy. PMID:25994432

  1. [Perforating eye injuries in children].

    PubMed

    Prado Júnior, J; Alves, M R; Kara José, N; Usuba, F S; Onclix, T M; Marantes, C R

    1996-01-01

    The author studied 140 cases of perforating eye injury in children up to 15 years old admitted at the Clinic Hospital of the Medical College of the University of São Paulo (Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo) from January 1989 to December 1993. These cases represent 24.71% of the total of the perforating eye injuries seen during this period, showing a ratio of 76.42% of males, a ratio of 2/1 in the group from 0 to 6 years old, 7/1 in the group from 7 to 11 years old and a ratio of 3/1 in the group from 12 to 15 years old. The most common perforating eye injuries were due to sharp objects (54.71%), contusion (20%), explosions (7.85%) and flying objects (5.71%). The relation between the severity of the injury and the prognosis is emphasized. Safety precautions should be effective in order to reduce frequence and morbidity of these perforating ocular injuries. PMID:9008931

  2. 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

  3. Prion diseases and iatrogenic infections I. A review.

    PubMed

    Panà, Augusto; Jung, Mirko

    2005-01-01

    Iatrogenic diseases are disorders caused by the treatment of physician or surgeon (iatros from Greek "healer"). The disease develops by transmission of prion-infected material from the (clinically inapparent) donor to the recipient. First case significantly confirmed by animal bioassay was described in a corneal transplant 1974 and another following a neurosurgical procedure in 1977. Over one hundred of cases were detected in recipients of cadaveric, prion infected pituitary hormones (mostly growth hormone or, significantly less, gonadotrophins); the majority in France, UK and USA. Over one hundred of cases were detected following transplantation of prion-infected dura mater (mostly lyophilized commercial preparations) mostly in Japan. Some hormonal as well dura mater cases still occur because of an enormously prolonged incubation period. There are no fresh cases because cadaveric hormones were replaced by synthetic preparations and cadaveric dura mater by autologous tissue (fascia lata, fascia temporalis). Actual problems of iatrogenic prion infections are confined to surgery/neurosurgery, ophthalmology, otorhinolaryngology and dental surgery. Prions have also been detected outside the central nervous system, posterior eye, peripheral nerves, muscles, spleen, lymphoreticular system as tonsils and appendix, intestine, urine (?), olfactory cilia and central olfactory pathway representing a route of infection (nasal secretions). General anaesthesia may also be involved. Medical devices in contact with infected tissues became contaminated within minutes. Iatrogenic infections may occur thereafter incubating for years or decades. They are difficult to register because the hospital documentation has been actually kept for ten years only. It is evident that prion diseases have frequently a surgical history, according to some authors in one third of patients. Another problem of greatest importance is the prion decontamination of infected medical devices that is really difficult at present and rarely, if ever, properly performed in greatest majority of world hospitals. The decontamination methods will be presented in the second part of this article. PMID:17242714

  4. Iatrogenic arteriovenous fistula of the superficial temporal artery

    Microsoft Academic Search

    Grzegorz Miekisiak; Maciej Mis; Adam Sandler; Adam Druszcz

    2008-01-01

    Introduction  The temporal artery courses superficially over the temporal bone and thus can be vulnerable to trauma. Although traumatic\\u000a lacerations of this vessel are indeed common, trauma-induced arteriovenous fistulae involving the temporal artery are relatively\\u000a rare. Arteriovenous fistulae caused by iatrogenic injury to the temporal artery are rarer still.\\u000a \\u000a \\u000a \\u000a Discussion and conclusion  We report a case of an ateriovenous fistula involving the

  5. Bladder outlet obstruction in women: iatrogenic, anatomic, and neurogenic.

    PubMed

    McCrery, Rebecca J; Appell, Rodney A

    2006-09-01

    This paper outlines the presentation, evaluation, and management of bladder outlet obstruction (BOO) in women as it relates to iatrogenic, anatomic, and neurogenic causes. Attention is given to the different diagnostic criteria used by various authors in their case series and studies. The lack of standardization with regard to the diagnosis of BOO in women emphasizes the fact that BOO is often a clinical diagnosis that is made by taking into account the history, physical examination, imaging of the lower urinary tract, and urodynamic pressure-flow parameters. Individual obstructive conditions including urethral stricture, postsurgical obstruction, primary bladder neck obstruction, pelvic organ prolapse, and neurogenic causes are addressed briefly. PMID:16959175

  6. Iatrogenic Trichuris suis infection in a patient with Crohn disease.

    PubMed

    Kradin, Richard L; Badizadegan, Kamran; Auluck, Pavan; Korzenik, Joshua; Lauwers, Gregory Y

    2006-05-01

    We report a case of biopsy-proven iatrogenic infection by the pig whipworm Trichuris suis in a patient with Crohn disease. The deliberate therapeutic ingestion of T suis ova has been adopted as an experimental approach to the treatment of Crohn disease in an effort to promote a switch from the T helper subtype 1 to T helper subtype 2 inflammatory phenotype in vivo. This report examines the morphology of the immature and adult T suis, the effects of this intervention on the immunophenotype of the bowel mucosa, and it also raises the possibility of persistent active infection in man. PMID:16683891

  7. Maxillary sinus perforation by orthodontic anchor screws.

    PubMed

    Motoyoshi, Mitsuru; Sanuki-Suzuki, Rina; Uchida, Yasuki; Saiki, Akari; Shimizu, Noriyoshi

    2015-01-01

    To facilitate safe placement of orthodontic anchor screws (miniscrews), we investigated the frequency of maxillary sinus perforation after screw placement and the effect of sinus perforation on screw stability. Maxillary sinus perforations involving 82 miniscrews (diameter, 1.6 mm; length, 8 mm) were evaluated using cone-beam computed tomography. All miniscrews were placed in maxillary alveolar bone between the second premolar and first molar for anchorage for anterior retraction in patients undergoing first premolar extraction. The placement torque and screw mobility of each implant were determined using a torque tester and a Periotest device, and variability in these values in relation to sinus perforation was evaluated. Eight of the 82 miniscrews perforated the maxillary sinus. There was no case of sinusitis in patients with miniscrew perforation and no significant difference in screw mobility or placement torque between perforating and non-perforating miniscrews. The sinus floor was significantly thinner in perforated cases than in non-perforated cases. A sinus floor thickness of 6.0 mm or more is recommended in order to avoid miniscrew perforation of the maxillary sinus. (J Oral Sci 57, 95-100, 2015). PMID:26062857

  8. Duodenal obstruction due to a preduodenal portal vein.

    PubMed

    Vilakazi, Mnc; Ismail, F; Swanepoel, H M; Muller, E W; Lockhat, Z I

    2014-01-01

    An infant presented with clinical signs and symptoms suggestive of a pyloric stenosis. On abdominal ultrasound, pyloric stenosis was excluded, and other causes for proximal duodenal obstruction, such as a duodenal web or annular pancreas, were suspected. At surgery, the cause was found to be due to an anterior portal vein or preduodenal portal vein, compressing the duodenum. There were no associated findings such as midgut malrotation, duodenal web and congenital anomalies. The treatment was a diamond-shaped duodeno-duodenostomy anterior to the portal vein. The patient improved after surgery. PMID:25323190

  9. Aetiology of perforating eye injury.

    PubMed Central

    Luff, A J; Hodgkins, P R; Baxter, R J; Morrell, A J; Calder, I

    1993-01-01

    This study addresses the aetiology of perforating ocular injury in childhood and possible preventive measures. Data have been collected from the case notes of 143 patients presenting over a 10 year period to a single ophthalmic unit. Injuries occurred most often in a domestic setting (34%) or with a child at play (19%) and showed an overall four to one ratio of boys to girls. Sports injuries accounted for 15% and assault for 8% of all injuries. A changing pattern of ocular injury is evident: road traffic accidents constituted 6% of injuries, compared with 31% in a similar study published in 1976. The role of litigation is discussed, particularly with regard to firearms, which accounted for 8% of injuries. It is concluded that the most important factor in the prevention of perforating ocular trauma is parental awareness, 53% of injuries occurring with the child in a domestic setting or at play. PMID:8323341

  10. Tests reveal perforating charge performance

    SciTech Connect

    Jimenez, M. Jr.; McCready, K.E.; Ott, R.E.; White, C.W. (Mobil Exploration and Production U.S. Inc., Midland, TX (US))

    1992-01-06

    A series of independent tests, conducted by Mobil Exploration and Production U.S. Inc., has revealed that quality control by manufacturers of perforating gun charges can be relied upon during this interim period when API testing standards are undergoing changes. This paper reports that the performance of the charges is difficult to compare among manufacturers because of the lack of standardized testing procedures. API currently provides neither standards nor guidelines in the QC area. To alleviate this problem for the Mobil Midland division, an extensive perforating charge evaluation program was initiated. The 4-in. guns/charges most commonly used in our completions were randomly selected from the field magazines. These were tested in a common, controlled Berea target as well as in the manufacturer's QC target.

  11. Morphometric Evaluation of Duodenal Biopsies in Celiac Disease

    Microsoft Academic Search

    Adrian G Cummins; Basile G Alexander; Adrian Chung; Edward Teo; Josh A Woenig; John B J Field; Fiona M Thompson; Ian C Roberts-Thomson

    2011-01-01

    OBJECTIVES:The Marsh classification is a semiquantitative method for the diagnosis and monitoring of changes in duodenal biopsies in celiac disease. We have explored the possibility that quantitative changes in villous area and crypt length (morphometry) may provide better information on changes in duodenal morphology, particularly after the introduction of a gluten-free diet.METHODS:We measured villous height, apical and basal villous widths,

  12. 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.

  13. 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.

  14. Incidence of glove perforation during episiotomy repair

    Microsoft Academic Search

    B. Arena; N. Maffulli; I. Vocaturo; G. Scognamiglio

    1992-01-01

    Summary  A total of 416 gloves were tested for punctures after 200 episiotomy repairs. Evidence of perforation was found in 34 (8%)\\u000a of the gloves used and in only half the cases did the surgeon actually realise that a perforation had occurred. The left index\\u000a finger and thumb were more often perforated than other parts of the gloves. The implications of

  15. 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

  16. Endoscopic mucosal resection of duodenal bulb adenocarcinoma with neuroendocrine features: An extremely rare case report

    PubMed Central

    Wen, Ming-Yao; Wang, Yu; Meng, Xiao-Yan; Xie, Hua-Ping

    2015-01-01

    Duodenal adenocarcinoma, especially duodenal bulb with neuroendocrine features (NEF), is extremely rare. Here, we report one such case of duodenal bulb adenocarcinoma with neuroendocrine features. A 63-year-old Han Chinese woman was admitted to our department with the diagnosis of a duodenal bulb polyp and underwent an endoscopic mucosal resection. The pathological findings confirmed it as duodenal bulb adenocarcinoma with NEF. The patient remains curative after one and half a years of follow-up. Duodenal adenocarcinoma with NEF might be a low malignant neuroendocrine tumor rather than a conventional adenocarcinoma. Endoscopic treatment, including endoscopic mucosal resection, might be an ideal option for the adenocarcinomas with NEF.

  17. Bladder repair following iatrogenic cystotomy in irradiated small capacity bladders

    PubMed Central

    Chee, Jia Yi; Durai, Pradeep; Wu, Mei Wen Fiona; Tiong, Ho Yee

    2015-01-01

    During laparotomy in a previously irradiated and operated pelvis, incidental cystotomies can occur and a tension-free, watertight, two- or three-layer closure of the bladder may be impossible. We herein report two cases of iatrogenic defects of the bladders in post-irradiated pelvises and compare the two different methods of bladder repair employed – an ileal augmentation segment used in the first case and bovine pericardial graft used in the second. Successful closures of the bladder defects were achieved in both cases. Native irradiated bowel and bovine pericardium can be useful substitutes in situations involving bladder defects in a previously irradiated pelvis. The advantages and disadvantages of the two approaches are also herein discussed. PMID:25820861

  18. Surgical hardware-related iatrogenic venous compression syndrome.

    PubMed

    Mathur, Moses; Shafi, Irfan; Alkhouli, Mohamad; Bashir, Riyaz

    2015-04-01

    Deep vein thrombosis related to immobilization is a common and extensively studied disorder, particularly in hospitalized patients. However, the phenomenon of iatrogenic venous compression (IAVC) and related deep venous thrombosis (DVT) is under-recognized and under-reported. In the absence of relieving the compressive pathology, the recanalization rates are expected to be very low - thereby putting patients at a significant risk for the development of post-thrombotic syndrome (PTS). In this report, we describe two cases of DVT related to IAVC, and review similar cases that have been previously reported in the literature. With advancements in catheter-based technology, patients with IAVC (with or without DVT) may now be offered advanced endovascular treatment options such as catheter-directed pharmacomechanical thrombolysis (PMT) and percutaneous venoplasty and/or stenting. Hence, timely recognition and treatment is essential in the prevention of disabling PTS or life-threatening pulmonary embolism. PMID:25425626

  19. 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

  20. Malignant gastric lymphoma with spontaneous perforation

    PubMed Central

    Shimada, Satoko; Gen, Tokichi; Okamoto, Hiroyuki

    2013-01-01

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

  1. Perforating damage and shot density analyzed

    SciTech Connect

    Aaron Cheng, M.C.

    1985-03-04

    Although turbulence can account for 90% of the pressure drop for gas flowing through casing perforations, recent studies indicate that flow through the damaged compacted zone around each perforation is especially important. This article presents the results of a computer model study which outposts the effect of damaged compacted-zone permeability on gas productivity, and selection of perforation shot density for a high-flowrate well. The analysis may be useful to the completion engineer in determining the most appropriate perforation technique and shot density.

  2. 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

  3. Calmodulin independence of human duodenal adenylate cyclase.

    PubMed Central

    Smith, J A; Griffin, M; Mireylees, S E; Long, R G

    1991-01-01

    The calmodulin and calcium dependence of human adenylate cyclase from the second part of the duodenum was assessed in washed particulate preparations of biopsy specimens by investigating (a) the concentration dependent effects of free [Ca2+] on enzyme activity, (b) the effects of exogenous calmodulin on enzyme activity in ethylene glycol bis (b-aminoethyl ether)N,N'-tetra-acetic acid (EGTA) washed particulate preparations, and (c) the effects of calmodulin antagonists on enzyme activity. Both basal (IC50 = 193.75 (57.5) nmol/l (mean (SEM)) and NaF stimulated (IC50 = 188.0 (44.0) nmol/l) adenylate cyclase activity was strongly inhibited by free [Ca2+] greater than 90 nmol/l. Free [Ca2+] less than 90 nmol/l had no effect on adenylate cyclase activity. NaF stimulated adenylate cyclase activity was inhibited by 50% at 2.5 mmol/l EGTA. This inhibition could not be reversed by free Ca2+. The addition of exogenous calmodulin to EGTA (5 mmol/l) washed particulate preparations failed to stimulate adenylate cyclase activity. Trifluoperazine and N-(8-aminohexyl)-5-IODO-1-naphthalene-sulphonamide (IODO 8) did not significantly inhibit basal and NaF stimulated adenylate cyclase activity when measured at concentrations of up to 100 mumol/l. These results suggest that human duodenal adenylate cyclase activity is calmodulin independent but is affected by changes in free [Ca2+]. PMID:1752461

  4. Duodenal luminal chemosensing; acid, ATP, and nutrients.

    PubMed

    Akiba, Yasutada; Kaunitz, Jonathan D

    2014-01-01

    Intestinal chemosensing of endogenous and exogenous luminal compounds, including acid, CO2, bile acids and nutrients is an emerging area of gastrointestinal research, since gut hormones, particularly including incretins and glucagon-like peptide-2 (GLP-2) are released in response to luminal nutrients. Identification of luminal chemosensors such as nutrient-ligand G-protein coupled receptors (GPCRs) in enteroendocrine cells has linked luminal compounds to the corresponding gut hormone release. Mucosal chemical sensors are necessary to exert physiological responses such as secretion, digestion, absorption, and motility. We have been studying the mechanisms by which luminal compounds are sensed via mucosal acid sensors and GPCRs, which trigger mucosal defense mechanisms. In addition to luminal acid/CO2 sensing in the duodenum, recent studies also show that compounds present post-prandially such as amino acids, bile acids and fatty acids, enhance duodenal mucosal defenses, with digestion following the initial gastric processing. These studies may form the basis for therapies in which luminal nutrients release gut hormones that affect the mucosal protection, appetite, satiety, and systemic metabolisms. PMID:23886391

  5. EFFECTIVE MACROSCOPIC DYNAMICS OF STOCHASTIC PARTIAL DIFFERENTIAL EQUATIONS IN PERFORATED

    E-print Network

    Heller, Barbara

    EFFECTIVE MACROSCOPIC DYNAMICS OF STOCHASTIC PARTIAL DIFFERENTIAL EQUATIONS IN PERFORATED DOMAINS equation defined on a domain perforated with small holes or heterogeneities. The homogenized effective, effective macroscopic model, stochastic homogenization, white noise, probability distribution, perforated

  6. Effects of perforation flow geometry on evaluation of perforation flow efficiency

    SciTech Connect

    Liu, Z. (Petroleum Administration Bureau (CN)); Peden, J. (Heriot-Watt Univ., Edinburgh (UK))

    1988-01-01

    This paper presents a study on effects of perforation flow geometry on the evaluation of the flow performance of perforations. From data obtained in the laboratory serious deficiency and poor accuracy were identified in exploring the linear perforation targets recommended by API RP 43 Section II for the evaluation of the flow performance of perforations. This discredits the validity of the procedure and poses doubt to the correctness of applying API RP 43 results to the downhole conditions. The work suggested that perforations with radial flow configuration should be utilized in such an evaluation.

  7. Diagnosis and treatment of gallbladder perforation

    Microsoft Academic Search

    Hayrullah Derici; Cemal Kara; Ali Dogan Bozdag; Okay Nazli; Tugrul Tansug; Esra Akca

    AIM: To present our clinical experience with gallbladder perforation cases. METHODS: Records of 332 patients who received medical and\\/or surgical treatment with the diagnosis of acute cholecystitis in our clinic between 1997 and 2006 were reviewed retrospectively. Sixteen (4.8%) of those patients had gallbladder perforation. The parameters including age, gender, time from the onset of symptoms to the time of

  8. [Retroperitoneal perforation of the gallbladder (author's transl)].

    PubMed

    Alawneh, I

    1978-12-01

    Perforation of the gallbladder into the retroperitoneum is a very rare event. A case report is given of a 71 year old patient suffering from acute cholecystitis. A perforation occurred and a retroperitoneal abscess developed. Cholecystectomy, appendectomy and retroperitoneal drainage were performed, and the patient recovered. A review from the literature is given covering 6 other cases. PMID:739816

  9. Intestinal trichobezoar with perforation in a child.

    PubMed

    Sharma, V; Sharma, I D

    1992-04-01

    A 4-year-old girl presented with a history and examination results suggestive of peritonitis. Exploration of abdomen was done with suspicion of enteric perforation, which showed long ileal trichobezoar with perforation of .5-cm diameter. The stomach was devoid to any fragment of bezoar. There was no history of hair eating and nervous habits. PMID:1522470

  10. Barrett's ulcer: cause of spontaneous oesophageal perforation.

    PubMed Central

    Limburg, A J; Hesselink, E J; Kleibeuker, J H

    1989-01-01

    We report two patients, who presented within six months with the classic clinical picture of 'spontaneous' oesophageal perforation, which was caused by a perforated Barrett's ulcer. These two cases underline the importance of postoperative endoscopy in ruling out intrinsic oesophageal disease as the cause of the rupture in every patient, who survives this life threatening condition. PMID:2707641

  11. Iatrogenic Ureteric Injuries: Incidence, Aetiological Factors and the Effect of Early Management on Subsequent Outcome

    Microsoft Academic Search

    Khaleel Al-Awadi; Elijah O. Kehinde; Adel Al-Hunayan; Ahmed Al-Khayat

    2005-01-01

    Objective: To investigate the changing pattern in incidence, aetiological factors and the effect of early diagnosis and surgical treatment on the outcome of iatrogenic ureteric injuries in our Urology Unit over a 5 year period. Patients\\/Methods: All patients with ureteric injuries caused as a result of any surgical procedures (iatrogenic ureteric injuries) were studied during a 5 year period (1998–2002). Data collected

  12. 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. PMID:25810715

  13. Frequency dependence of hearing loss with perforations.

    PubMed

    Bhusal, C L; Guragain, R Ps; Shrivastav, R P

    2007-01-01

    This cross-sectional study was conducted in different sizes of pars tensa perforation in patients with chronic suppurative otitis media (CSOM) tubo-tympanic type undergoing myringoplasty. A total of 50 patients were recruited from the outpatient Department of Otorhinolaryngology - Head and Neck Surgery in TU Teaching Hospital from June 2003 to May 2004. Cases of CSOM tubo-tympanic type with dry central perforation, conductive type of hearing loss were subjected to myringoplasty. Preoperative audiometric evaluations were done. While operating under microscope diameter of perforations were measured and perforations were grouped according to the size. This study showed that the hearing loss was found to be more at lower frequencies and less as the frequencies increased. Hearing loss is more marked at lower frequencies as compared to higher frequencies, irrespective any size or location of perforation of pars tensa. PMID:18340370

  14. Oriented perforations -- A rock mechanics view

    SciTech Connect

    Abass, H.H.; Meadows, D.L.; Brumley, J.L.; Hedayati, S.; Venditto, J.J.

    1995-11-01

    Hydraulic fracture initiation dictates the communication path between the wellbore and fracture plane. Nonplanar fracture geometries such as multiple, T-Shaped, and reoriented fractures are not advantageous and they adversely affect the potential to achieve a desired stimulation treatment. Oriented perforations can be the solution to initiate a single wide fracture in vertical and deviated wells. Also oriented perforations may be used to create stable tunnels in poorly consolidated formations thus avoiding sand failure and consequently preventing sand production. This paper presents laboratory experimental results related to oriented perforations for hydraulic fracturing. It also discusses the use of oriented perforation for sand control. Experiments were designed to investigate the effect of perforation orientation in vertical and horizontal wells on hydraulic fracturing treatment.

  15. Duodenal Transection without Pancreatic Injury following Blunt Abdominal Trauma

    PubMed Central

    Bankar, Sanket Subhash; Gosavi, Vikas S.; Hamid, Mohd.

    2014-01-01

    With the inventions of faster cars and even more faster motorbikes there is a worldwide increase in road traffic accidents, which has increased the incidence of blunt abdominal trauma but still duodenal injury following a blunt abdominal trauma is uncommon and can pose a formidable challenge to the surgeon and failure to manage it properly can result in devastating results. It may typically occur in isolation or with pancreatic injury. Here, we report a case of an isolated transection of the third part of the duodenum with normal pancreas following a blunt abdominal trauma. The initial clinical changes in isolated duodenal injury may be extremely subtle before life-threatening, peritonitis develops. Hence, a high index of suspicion, on the basis of mechanism of injury and physical examination is the key in early detection of duodenal injury especially in a rural hospital like ours where the facilities for computed tomography scan are not available. PMID:25598947

  16. Duodenal Transection without Pancreatic Injury following Blunt Abdominal Trauma.

    PubMed

    Bankar, Sanket Subhash; Gosavi, Vikas S; Hamid, Mohd

    2014-01-01

    With the inventions of faster cars and even more faster motorbikes there is a worldwide increase in road traffic accidents, which has increased the incidence of blunt abdominal trauma but still duodenal injury following a blunt abdominal trauma is uncommon and can pose a formidable challenge to the surgeon and failure to manage it properly can result in devastating results. It may typically occur in isolation or with pancreatic injury. Here, we report a case of an isolated transection of the third part of the duodenum with normal pancreas following a blunt abdominal trauma. The initial clinical changes in isolated duodenal injury may be extremely subtle before life-threatening, peritonitis develops. Hence, a high index of suspicion, on the basis of mechanism of injury and physical examination is the key in early detection of duodenal injury especially in a rural hospital like ours where the facilities for computed tomography scan are not available. PMID:25598947

  17. 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

  18. Assessment of duodenal amino acid profile in dairy cows by the in situ method

    Microsoft Academic Search

    H. Tagari; A. Arieli; S. Mabjeesh; I. Bruckental; S. Zamwell; Y. Aharoni

    1995-01-01

    In situ evaluation of the duodenal amino acid (AA) profile was attempted in a 4 × 4 Latin square study using four lactating Holstein cows fitted with ruminal and duodenal cannulas. Dietary supplemental crude protein (CP) sources, making up 40% of the dietary CP, were: soybean meal, cottonseed meal, corn gluten meal or urea. Duodenal flow of organic matter (OM)

  19. Campylobacter pyloridis and acid induced gastric metaplasia in the pathogenesis of duodenitis

    Microsoft Academic Search

    J I Wyatt; B J Rathbone; M F Dixon; R V Heatley

    1987-01-01

    Biopsy specimens of gastric and duodenal mucosa from 290 patients were examined histologically for metaplasia and Campylobacter pyloridis. Estimates of pH on samples of fasting gastric juice from 55 of the patients were performed, and mucosal biopsy specimens from 33 patients were also cultured for C pyloridis. Active duodenitis was seen in 34 duodenal biopsy specimens. Thirty (88%) of the

  20. Helicobacter pylori augments the pH-increasing effect of omeprazole in patients with duodenal ulcer

    Microsoft Academic Search

    J Labenz; B Tillenburg; U Peitz; JP Idstrom; EF Verdu; M Stolte; G Borsch; AL Blum

    1996-01-01

    BACKGROUND & AIMS: Omeprazole is less effective in healthy subjects than in patients with duodenal ulcers. The aim of this study was to determine whether Helicobacter pylori augments the pH-increasing effect of omeprazole in patients with duodenal ulcers. METHODS: In 16 patients with duodenal ulcers, baseline intragastric acidity was measured before and 4-6 weeks after the cure of H. pylori

  1. Left atrio-esophageal fistula of a possibly iatrogenic aetiology.

    PubMed

    Arkuszewski, Piotr; Barzdo, Maciej; Ostrowski, Stanis?aw; Szram, Stefan; Berent, Jaros?aw

    2015-07-01

    The study presents an exceptionally rare case of an esophago-left atrial fistula, which was diagnosed during a forensic post-mortem examination. Due to complex nature of the disease and many attempts to cure the patient, the authors did not manage to identify the aetiology of the fistula. It was only implied that the fistula might have been a distant complication of intraoperative endocardial ablation or it might have appeared as a consequence of perforation of the esophageal wall or left atrial wall of the enlarged heart with the end of an intubation tube or nasogastric tube. PMID:25952079

  2. 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

  3. Perforating gun charge carrier improvements

    SciTech Connect

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

    1986-07-08

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

  4. Wash tool for well having perforated casing

    SciTech Connect

    Burroughs, T.C.

    1989-03-28

    A tool is described for washing a perforation zone in an earth formation adjacent a perforated casing in a bore hole of a well comprising: a tubular mandrel having an axial flow passage therethrough and adapted to be connected at its upper end to a drill string for receiving pressurized fluid therefrom; an elastomeric tubular packer on each mandrel end section in face to face contact with the outer peripheral surface of the mandrel and defining upper and lower packers; means on the mandrel for securing the upper and lower ends on each of the elastomeric packers in fixed position on the mandrel; a fluid passage through the mandrel wall from the axial flow passage to each of the packers to provide fluid from the mandrel bore to the area between the outer surface of the mandrel and the inner surface of the packers; a second fluid passage in the intermediate section extending through the mandrel wall form the axial flow passage at location between the packers of supplying fluid to the perforation zone adjacent the casing; and means for blocking fluid flow through the second fluid passage at the predetermined fluid pressure, the means being actuated at a second higher predetermined fluid pressure in the mandrel bore to permit fluid flow through the second fluid passage means and the perforated casing to the perforation zone outside the casing. Also described is a method of circulating fluid in a well having a perforated casing at a predetermined depth in the perforation zone.

  5. Perforator Flaps in Head and Neck Reconstruction

    PubMed Central

    Chana, Jagdeep S.; Odili, Joy

    2010-01-01

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

  6. [Iatrogenic injuries of the facial nerve in the mastoid region].

    PubMed

    Príhodová, J; Zelený, M; Kozák, J

    1990-09-01

    During the past ten years nine patients were referred to our hospital with lesions of the VIIth nerve. These lesions were inflicted during operation on account of chronic otitis media. One patient recovered after conservative treatment. Based on the EMG examination and clinical picture, eight patients were operated. In one who had an extensive lesion it did not prove possible to find the proximal stump and the patient improved after Normann-Dott's operation. In the remaining seven subjects also severe damage was involved: five times complete severing of the nerve occurred, twice partial severing and contusion, always in the mastoid portion of the VIIth nerve. The authors achieved as a rule a 50-75% restoration of function of the VIIth nerve Ballance-Duel's operation, using a graft of the n. suralis with microsuture of the epineurium and gluing of the nerve by plasma. Evaluation of late functional results was made 1-8 years after Ballance-Duel's operation. The authors recommend to reduce the risk of iatrogenic lesions of the VIIth nerve in beginners by assistance of experienced surgeons at several operations. PMID:2225170

  7. Acupuncture-induced haemothorax: a rare iatrogenic complication of acupuncture

    PubMed Central

    Karavis, Miltiades Y; Argyra, Erifili; Segredos, Venieris; Yiallouroy, Aneza; Giokas, Georgios; Theodosopoulos, Thedosios

    2015-01-01

    This paper reports a rare iatrogenic complication of acupuncture-induced haemothorax and comments on the importance and need for special education of physicians and physiotherapists in order to apply safe and effective acupuncture treatment. A 37-year-old healthy woman had a session of acupuncture treatments for neck and right upper thoracic non-specific musculoskeletal pain, after which she gradually developed dyspnoea and chest discomfort. After some delay while trying other treatment, she was eventually transferred to the emergency department where a chest X-ray revealed a right pneumothorax and fluid collection. She was admitted to hospital and a chest tube inserted into the right hemithorax (under ultrasound guidance) drained 800?mL of bloody fluid (haematocrit (Hct) 17.8%) in 24?h and 1200?mL over the following 3?days. Her blood Hct fell from 39.0% to 30.8% and haemoglobin from 12.7 to 10.3?g/dL. The patient recovered completely and was discharged after 9?days of hospitalisation. When dyspnoea, chest pain and discomfort occur during or after an acupuncture treatment, the possibility of secondary (traumatic) pneumo- or haemopneumothorax should be considered and the patient should remain under careful observation (watchful waiting) for at least 48?h. To maximise the safety of acupuncture, specific training should be given for the safe use of acupuncture points of the anterior and posterior thoracic wall using dry needling, trigger point acupuncture or other advanced acupuncture techniques. PMID:25791844

  8. Acupuncture-induced haemothorax: a rare iatrogenic complication of acupuncture.

    PubMed

    Karavis, Miltiades Y; Argyra, Erifili; Segredos, Venieris; Yiallouroy, Aneza; Giokas, Georgios; Theodosopoulos, Thedosios

    2015-06-01

    This paper reports a rare iatrogenic complication of acupuncture-induced haemothorax and comments on the importance and need for special education of physicians and physiotherapists in order to apply safe and effective acupuncture treatment. A 37-year-old healthy woman had a session of acupuncture treatments for neck and right upper thoracic non-specific musculoskeletal pain, after which she gradually developed dyspnoea and chest discomfort. After some delay while trying other treatment, she was eventually transferred to the emergency department where a chest X-ray revealed a right pneumothorax and fluid collection. She was admitted to hospital and a chest tube inserted into the right hemithorax (under ultrasound guidance) drained 800?mL of bloody fluid (haematocrit (Hct) 17.8%) in 24?h and 1200?mL over the following 3?days. Her blood Hct fell from 39.0% to 30.8% and haemoglobin from 12.7 to 10.3?g/dL. The patient recovered completely and was discharged after 9?days of hospitalisation. When dyspnoea, chest pain and discomfort occur during or after an acupuncture treatment, the possibility of secondary (traumatic) pneumo- or haemopneumothorax should be considered and the patient should remain under careful observation (watchful waiting) for at least 48?h. To maximise the safety of acupuncture, specific training should be given for the safe use of acupuncture points of the anterior and posterior thoracic wall using dry needling, trigger point acupuncture or other advanced acupuncture techniques. PMID:25791844

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

    PubMed Central

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

    1989-01-01

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

  10. Histiocytic sarcoma with fatal duodenal ulcers.

    PubMed

    Akishima, Yuri; Akasaka, Yoshikiyo; Yih-Chang, Ger; Ito, Kinji; Ishikawa, Yukio; Lijun, Zhang; Kiguchi, Hideko; Lipscomb, Gary; Strong, Jack P; Ishii, Toshiharu

    2004-01-01

    Histiocytic sarcoma is an uncommon neoplasm of mature histiocytes with very poor outcome. We report an autopsy case of a true histiocytic sarcoma with characteristic symptoms of so-called "malignant histiocytosis of the intestine". The liver and spleen were enlarged, with remarkable tumor cell infiltration in the hepatic sinusoids and splenic sinuses. Tumor cells aggregated to form sporadic nodular lesions in the liver, which often showed coagulative necrosis. Infarcted lesions also occurred at the splenic subcapsular area. In addition, tumor cell infiltration was noted in the sinuses of bone marrow and lymph node. Tumor cells often demonstrated moderate pleomorphism with multinucleated giant cells. They were positive for CD68 and negative for T- and B-cell lineage markers, megakaryocytic markers, and CD30. Various examinations were done to rule out infection-associated hemophagocytic syndrome, and the absence of infectious diseases was revealed. Thus, the diagnosis of histiocytic sarcoma was made. Apart from these lesions, multiple ulcerations, some with fatal perforation, were found in the esophagus and duodenum. They showed only non-specific inflammatory changes without tumor cell involvement. The ulcers probably derived from ischemic condition through an embolic process caused by tumor cell infiltration elsewhere in the blood vessels at the periphery of the ulcers. PMID:15310151

  11. Numerical simulations of steel plate perforation

    SciTech Connect

    Chen, E.P.

    1992-08-01

    Numerical simulations of perforation in steel plates involve the treatment of material failure during the perforation process. One way to model physical material separation is to delete failed elements from the analysis based on an appropriate failure criterion. Different algorithms were used in different transient finite element codes to delete failed elements. This investigation compares the results of PRONTO 2D and LS-DYNA2D codes for a specific steel plate perforation problem. Influences of the deletion algorithms on material parameters are discussed.

  12. Numerical simulations of steel plate perforation

    SciTech Connect

    Chen, E.P.

    1992-01-01

    Numerical simulations of perforation in steel plates involve the treatment of material failure during the perforation process. One way to model physical material separation is to delete failed elements from the analysis based on an appropriate failure criterion. Different algorithms were used in different transient finite element codes to delete failed elements. This investigation compares the results of PRONTO 2D and LS-DYNA2D codes for a specific steel plate perforation problem. Influences of the deletion algorithms on material parameters are discussed.

  13. Lifesaving Embolization of Coronary Artery Perforation

    SciTech Connect

    Katsanos, Konstantinos, E-mail: katsanos@med.upatras.g [Guy's and St. Thomas' Hospitals, NHS Foundation Trust, Department of Interventional Radiology (United Kingdom); Patel, Sundip [Guy's and St. Thomas' Hospitals, NHS Foundation Trust, Department of Interventional Cardiology (United Kingdom); Dourado, Renato; Sabharwal, Tarun [Guy's and St. Thomas' Hospitals, NHS Foundation Trust, Department of Interventional Radiology (United Kingdom)

    2009-09-15

    Coronary artery perforation remains one of the most fearsome complications during cardiac catheterization procedures. Although emergent bypass surgery is the preferred treatment for cases with uncontrollable perforation, endovascular vessel sealing and arrest of bleeding with a combination of balloons, covered stents, or embolic materials have also been proposed. The authors describe a case of emergent lifesaving microcoil embolization of the distal right coronary artery in a patient with uncontrollable grade III guidewire perforation resulting in cardiac tamponade. The relevant literature is reviewed and the merits and limitations of the endovascular approach are highlighted.

  14. The effect of perforating conditions on well performance

    SciTech Connect

    McLeod, H.O. Jr.

    1983-01-01

    The productivity of a perforated gas well is affected strongly by non-Darcy or turbulent flow through the compacted zone around each perforation. The turbulence coefficient depends on the permeability of this compacted zone. This permeability, a function of perforation condition, can be used with perforation dimensions to predict gas well performance.

  15. The instrumented dynamic perforation test applied to a composite shell

    E-print Network

    Paris-Sud XI, Université de

    The instrumented dynamic perforation test applied to a composite shell S. Pattofatto, H. Tsitsiris Wilson, F-94230 Cachan, France Abstract. Perforation tests are commonly used on composites but give velocity (45 m/s) by means of an instrumented perforation test. First, an inversed dynamic perforation

  16. SUBSHIFTS AND PERFORATION JULIEN GIOL AND DAVID KERR

    E-print Network

    Kerr, David

    SUBSHIFTS AND PERFORATION JULIEN GIOL AND DAVID KERR Abstract. We demonstrate that the perforative work [29] showed that the perforation that can be observed in the ordered K0 group of certain manifolds. As a consequence of the perforation in K0, Villadsen's C-algebra fails to Date: September 8, 2008. 2000 Mathematics

  17. “Mini-perforation” of the colon—Not all postpolypectomy perforations require laparotomy

    Microsoft Academic Search

    John P. Christie; Joseph Marrazzo

    1991-01-01

    In a 10-year experience with 4,784 consecutive colonoscopic polypectomies, the need for operative intervention in just two of seven perforations indicates that patients with specially defined, limited perforations can usually be treated nonoperatively. This specific complication, which has been termed “mini-perforation,” is generally detected within 6–24 hours of polypectomy, and is characterized by local pain and tenderness, without signs of

  18. Surgical and nutritional management of postoperative duodenal fistulas

    Microsoft Academic Search

    O. James Garden; Evelyn H. Dykes; David C. Carter

    1988-01-01

    Twenty-four patients with postoperative external duodenal fistulas were managed in general surgical units over a six-year period. Management included aggressive nutritional support, localization and drainage of intraabdominal sepsis, and definitive surgical closure for those fistulas which did not close spontaneously. Spontaneous closure occurred in 92% of cases. All but one patient survived admission to hospital, and one patient died following

  19. Altered gastric and duodenal motility in intestinal obstruction

    Microsoft Academic Search

    Tim B. Hunter; Laurie L. Fajardo; J. Luther Jarvis; Hugo V. Villar

    1990-01-01

    There are no strict clinical or radiographic criteria that consistently indicate imminent strangulation in cases of small bowel obstruction. An intestinal obstruction with vascular compromise produces a marked retention of food, fluid, or contrast material in the stomach and duodenum, while an obstruction without vascular problems may show no change or somewhat delayed gastric emptying with some duodenal hypotonia. The

  20. 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...

  1. Antacid maintenance therapy in the prevention of duodenal ulcer relapse

    Microsoft Academic Search

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

    1988-01-01

    The effectiveness of antacid maintenance therapy in preventing duodenal ulcer (DU) relapse was investigated. Two hundred and fifty one asymptomatic patients with healed DU were stratified into smokers and non-smokers and randomised to receive for one year either placebo, or Maalox TC three tablets (81 mmol) at bedtime (hs), or Maalox TC three tablets in the morning plus three tablets

  2. Visceral leshmaniasis diagnosed on duodenal biopsy in a child.

    PubMed

    Boukthir, S; Mejri, A; M'rad, S; Barsaoui, S

    2003-01-01

    Visceral leishmaniasis is usually easy to recognize when clinical presentation is complete: splenomegaly, fever and palor associated to pancytopenia, hypoalbuminaemia and hypergamma globulinemia. Bone marrow smears, culture and serology confirm the diagnosis. We report the case of an infant in whom clinical and biological findings are suggestive of leishmaniasis and the diagnosis confirmed only by duodenal biopsy. PMID:14618961

  3. 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.

  4. 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.

  5. Effects of underbalance on perforation flow

    SciTech Connect

    Halleck, P.M.; Deo, M.

    1989-05-01

    In a study of perforation flow in standard API test targets, underbalance between 500 and 1,000 psi (3.4 and 6.9 MPa) was needed to obtain optimum flow efficiency. Perforation cleanup due to transient pressure gradients was separated from that caused by postshot, steady-state flow. Perforations with low initial flow efficiencies could be improved by steady-state washing, but not to optimum levels. The amount of rock debris washed from the perforation during the washing phase correlated directly with the shooting underbalance applied. Tests performed in kerosene-saturated, brine-free targets resulted in generally lower flow efficiencies and required higher underbalances to obtain optimum levels.

  6. Breast Reconstruction: Deep Inferior Epigastric Perforator

    MedlinePLUS Videos and Cool Tools

    ... tough decisions these and other women made after learning they had breast cancer. You will also see the breast reconstruction surgery each of them chose to undergo. The deep inferior epigastric perforator flap technique allows surgeons to ...

  7. Attenuation of weak shock waves along pseudo-perforated walls

    Microsoft Academic Search

    A. Sasoh; K. Matsuoka; K. Nakashio; E. Timofeev; K. Takayama; P. Voinovich; T. Saito; S. Hirano; S. Ono; Y. Makino

    1998-01-01

    .   In order to attenuate weak shock waves in ducts, effects of pseudo-perforated walls were investigated. Pseudo-perforated\\u000a walls are defined as wall perforations having a closed cavity behind it. Shock wave diffraction and reflection created by\\u000a these perforations were visualized in a shock tube by using holographic interferometer, and also by numerical simulation.\\u000a Along the pseudo-perforated wall, an incident shock

  8. Sigmoid diverticulitis with perforation and generalized peritonitis

    Microsoft Academic Search

    David M. Nagorney; Martin A. Adson; John H. Pemberton

    1985-01-01

    Sigmoid diverticulitis with perforation and generalized peritonitis is a grave complication of diverticular disease. To compare\\u000a accurately the results of two operative approaches—proximal colostomy with drainage and proximal colostomy with resection\\u000a or exteriorization—the authors assessed the clinical and pathologic features of 121 consecutive patients with perforating\\u000a sigmoid diverticulitis. There were no differences between treatment groups in age, sex, mean duration

  9. Novel therapeutic approaches to gastric and duodenal ulcers: an update.

    PubMed

    Dajani, E Z; Klamut, M J

    2000-07-01

    Over the last 25 years, a remarkable revolution in the pathophysiology and treatment of gastric and duodenal ulcers has occurred. Effective therapies were developed not only to heal ulcers, but also to cure most patients. The two principal causes for gastric and duodenal ulcers are either infection with Helicobacter pylori or the use of non-steroidal anti-inflammatory drugs (NSAIDs). With H. pylori eradication, gastric and duodenal ulcers are rapidly becoming historical diseases. This communication reviews the salient pharmacology of the novel anti-ulcer drugs currently in development, with particular emphasis on the treatment of gastric and duodenal ulcers. Intense research is currently focused on the development of proton pump inhibitors primarily for the treatment and prevention of gastroesophageal reflux disease. The older proton pump inhibitors, omeprazole and lansoprazole, are effective in healing gastric and duodenal ulcers. Furthermore, both drugs are effective in eradicating H. pylori when given with various antibiotics. Pantoprazole, rabeprazole and esomeprazole are new proton pump inhibitors, which appear to have comparable therapeutic profiles with omeprazole and lansoprazole. Rebamipide is a new mucosal protective drug, which is effective in healing gastric ulcers. Polaprezinc and nocloprost are also mucosal protective drugs, which are in clinical development. However, none of these three cytoprotective drugs have been evaluated for their efficacy in eradicating H. pylori when given in combination with antibiotics. Likewise, no published literature exists on the use of these drugs for preventing NSAID-induced ulcers. With the rapid eradication of H. pylori currently happening in the developed world, the therapeutic challenge is now directed toward preventing NSAID-associated ulcer. Significant reduction of NSAID-induced ulcers is achieved by using continuous prophylactic anti-ulcer therapy (misoprostol or omeprazole) or by using NSAIDs possessing selective COX-2 inhibitory activity. However, outcome clinical studies are needed to compare the adjuvant anti-ulcer therapies given with COX-1 inhibitors versus the selective COX-2 inhibitors given alone. PMID:11060758

  10. Ventriculoperitoneal shunt perforations of the gastrointestinal tract.

    PubMed

    Thiong'o, Grace Muthoni; Luzzio, Christopher; Albright, A Leland

    2015-07-01

    OBJECT The purposes of this study were to evaluate the frequency with which children presented with ventriculoperitoneal (VP) shunt perforations of the gastrointestinal (GI) tract, to determine the type of shunts that caused the perforations, and to compare the stiffness of perforating catheters with the stiffness of catheters from other manufacturers. METHODS Medical records were reviewed of 197 children who were admitted with VP shunt malfunction. Catheter stiffness was evaluated by measuring relative resistance to cross-sectional compression, resistance to column buckling, and elasticity in longitudinal bending. Catheter frictional force was measured per unit length. RESULTS Six children were identified whose VP shunts had perforated the GI tract; 2 shunts subsequently protruded through the anal orifice, 1 protruded through the oral cavity, and 3 presented with subcutaneous abscesses that tracked upward from the intestine to the chest. All perforating shunts were Chhabra shunts. Catheter stiffness and resistance to bending were greatest with a Medtronic shunt catheter, intermediate with a Codman catheter, and least with a Chhabra catheter. Frictional force was greatest with a Chhabra catheter and least with a Medtronic catheter. CONCLUSIONS The frequency of perforations by Chhabra shunts appears to be higher than the frequency associated with other shunts. The increased frequency does not correlate with their stiffness but may reflect their greater frictional forces. PMID:25837887

  11. A hypervelocity projectile launcher for well perforation

    SciTech Connect

    Fugelso, L.E.; Albright, J.N.; Langner, 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 launcher for a hypervelocity projectile to be used in well perforation applications has been designed. This launcher will provide an alternative technique to be used when the conventional devices do not yield the maximum well perforation. 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. Perforation tests of both device configurations (with and without the pellet) into steel-jacketed sandstone cylinders were made. Static radiographs of the cavities in the sandstone showed similar cavities, however, the perforation of the steel can was larger in response to the pellet. DYNA2D calculations were made to assist in the interpretation of the experimental records. The preliminary results show promise that a useful perforating tool can be developed. Plans for an extended experimental program are outlined. 23 refs., 14 figs.

  12. Computer codes for oilwell perforator design

    SciTech Connect

    Regalbuto, J.A.; Gill, B.C.

    1995-12-31

    The interaction of the shaped charge jet with fluid-filled porous media is a phenomenon of basic importance to the completion of oil wells. Unfortunately, a method to predetermine perforator performance in this interaction has not been readily available. This paper will describe the use of three computer codes to analyze and direct design efforts toward oilwell perforators that are specifically tailored to hydrocarbon-bearing formations. The codes are: (1) A Lagrangian, finite-element code, (2) An Eulerian, finite-difference code, and (3) A coupled Lagrangian-analytic code. Applications of the codes are presented involving: (1) Charge-to-charge interference effects, (2) Estimation of penetration and hole size, (3) Explanation of charge/gun system behavior, and (4) Perforator design optimization. Analysis of an existing six-shot-per-foot system, which showed charge-to-charge interference, is presented. The solution, which eliminated the interference and increased overall performance, involved charge-case modification. The mechanism of producing buff-free holes in casing is explained by modeling the perforation system. An example of perforator performance improvement by determination of discrete jet properties is presented. Finally, expanding the application of the codes by enlarging the equation-of-state database to include fluid-filled porous media is discussed. Use of these codes has solved charge-to-charge interference problems and has made significant contribution to the refinement of perforator design.

  13. [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

  14. Iatrogenic comorbidity in childhood and adolescence: new insights from the use of antidepressant drugs.

    PubMed

    Offidani, Emanuela; Fava, Giovanni A; Sonino, Nicoletta

    2014-09-01

    The term "iatrogenic comorbidity" refers to unfavorable modifications in the course of an illness, with regard to its characteristics and responsiveness, which may be related to previous treatments. Some iatrogenic adverse events arising from either pharmacotherapy or psychotherapy cannot be subsumed under the traditional rubric of adverse effects and require careful evaluation. Children and adolescents are generally more likely to experience adverse health consequences after drug treatment. The use of antidepressant drugs in this age group may cause potential long-term detrimental effects, such as mood elevation that does not subside when drugs are discontinued and may predispose to the development of a bipolar disorder. The concept of iatrogenic comorbidity in children and adolescents has heuristic value in weighing potential benefits and risks associated particularly with psychotropic treatments. PMID:24980773

  15. 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.

  16. 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

  17. Coronary Perforation and Covered Stents: An Update and Review

    PubMed Central

    Al-Mukhaini, Mohammed; Panduranga, Prashanth; Sulaiman, Kadhim; Riyami, Abdulla Amour; Deeb, Mohammed; Riyami, Mohamed Barkat

    2011-01-01

    Coronary perforation is a rare complication of percutaneous coronary intervention. We present two different types of coronary intervention, but both ending with coronary perforation. However, these perforations were tackled successfully by covered stents. This article reviews the incidence, causes, presentation, and management of coronary perforation in the present era of aggressive interventional cardiology. Coronary perforations are classified as type I (extraluminal crater), II (myocardial or pericardial blushing), and III (contrast streaming or cavity spilling). Types I and II coronary perforations are caused by stiff or hydrophilic guidewires. Type I has a benign prognosis, whereas type II coronary perforations have the potential to progress to tamponade. Type III coronary perforations are caused by balloons, stents, or other intracoronary devices and commonly lead to cardiac tamponade necessitating pericardial drainage. However, type III perforations can be managed with covered stents without need for surgical intervention. PMID:22121463

  18. Through-tubing perforating apparatus

    SciTech Connect

    Clark, D.A.

    1989-07-04

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

  19. Early Rupture of an Ultralow Duodenal Stump after Extended Surgery for Gastric Cancer with Duodenal Invasion Managed by Tube Duodenostomy and Cholangiostomy

    PubMed Central

    Blouhos, Konstantinos; Boulas, Konstantinos A.; Konstantinidou, Anna; Salpigktidis, Ilias I.; Katsaouni, Stavroula P.; Ioannidis, Konstantinos; Hatzigeorgiadis, Anestis

    2013-01-01

    When dealing with gastric cancer with duodenal invasion, gastrectomy with distal resection of the duodenum is necessary to achieve negative distal margin. However, rupture of an ultralow duodenal stump necessitates advanced surgical skills and close postoperative observation. The present study reports a case of an early duodenal stump rupture after subtotal gastrectomy with resection of the whole first part of the duodenum, complete omentectomy, bursectomy, and D2+ lymphadenectomy performed for a pT3pN2pM1 (+ number 13 lymph nodes) adenocarcinoma of the antrum. Duodenal stump rupture was managed successfully by end tube duodenostomy, without omental patching, and tube cholangiostomy. Close assessment of clinical, physical, and radiological signs, output volume, and enzyme concentration of the tube duodenostomy, T-tube, and closed suction drain, which was placed near the tube duodenostomy site to drain the leak around the catheter, dictated postoperative management of the external duodenal fistula. PMID:24159410

  20. Early rupture of an ultralow duodenal stump after extended surgery for gastric cancer with duodenal invasion managed by tube duodenostomy and cholangiostomy.

    PubMed

    Blouhos, Konstantinos; Boulas, Konstantinos A; Konstantinidou, Anna; Salpigktidis, Ilias I; Katsaouni, Stavroula P; Ioannidis, Konstantinos; Hatzigeorgiadis, Anestis

    2013-01-01

    When dealing with gastric cancer with duodenal invasion, gastrectomy with distal resection of the duodenum is necessary to achieve negative distal margin. However, rupture of an ultralow duodenal stump necessitates advanced surgical skills and close postoperative observation. The present study reports a case of an early duodenal stump rupture after subtotal gastrectomy with resection of the whole first part of the duodenum, complete omentectomy, bursectomy, and D2+ lymphadenectomy performed for a pT3pN2pM1 (+ number 13 lymph nodes) adenocarcinoma of the antrum. Duodenal stump rupture was managed successfully by end tube duodenostomy, without omental patching, and tube cholangiostomy. Close assessment of clinical, physical, and radiological signs, output volume, and enzyme concentration of the tube duodenostomy, T-tube, and closed suction drain, which was placed near the tube duodenostomy site to drain the leak around the catheter, dictated postoperative management of the external duodenal fistula. PMID:24159410

  1. Simulation of sandstone acidizing of a damaged perforation

    SciTech Connect

    Lea, C.M.; Hill, A.D.; Sepehrnoori, K. (Univ. of Texas (US))

    1992-05-01

    A mathematical model was developed to study the effect of acidizing on the productivity of a single perforation penetrating a sandstone reservoir as a function of the distribution of damage around the perforation. Assuming the perforation to be ellipsoidal, the authors derived a 2D model that describes the single-phase flow of an acid through a perforated sandstone that contains two pseudochemical minerals dissolving at different rates. This paper presents cases that show the effectiveness of acidizing in removing both drilling-fluid damage and perforation damage. The most effective stimulation occurs when the perforation damage is removed by the acid.

  2. Apparatus for perforating a well and its method of assembly

    SciTech Connect

    Rommer, T.J.

    1981-06-16

    A method and apparatus are described for attaching shaped charge units into a well perforating gun. The shaped charge unit has an ear-shaped extension having a cavity for receiving a wire in the perforating assembly. A second extension is positioned on the perforating charge unit having a threaded hole for containing a screw which may be advanced into tight engagement with the wire in the cavity of the first extension. This arrangement allows perforating units to be added quickly or taken out of a perforating gun assembly by adjustment of the screws through the threaded assemblies of the perforating charges. 9 claims.

  3. Studies reveal fractured reservoir perforating damage

    SciTech Connect

    Halleck, P. [Pennsylvania State Univ., University Park, PA (United States)

    1996-04-01

    Shock stresses resulting from detonation of the shaped explosive charges used in jet perforating cause deformation of the reservoir rock surrounding each perforation tunnel. Gas Research Institute (GRI) researchers have observed how this process seals a fracture where it intersects a perforation. Even an underbalance of 750 psi may not be sufficient to clear a performation of this debris or open the perforation fracture interface where deformation has closed the connection. Developing techniques to reduce skin in fractured gas reservoirs requires understanding the performation/fracture interface. Conventional engineering wisdom recognizes two causes for high skin values in fractured reservoirs; natural fractures may become plugged with cement or cement filtrate, or the performations may fail to intersect existing fractures. Fluid loss additives in the drilling and completion fluids and proper performation design can help alleviate these problems. However, a third possibility is that the connection between fracture and perforation may be plugged as a result of the performation process itself. Testing the hypothetical mechanism for such fracture plugging is the goal of this research effort.

  4. Liver Parenchyma Perforation following Endoscopic Retrograde Cholangiopancreatography

    PubMed Central

    Kayashima, Hiroto; Ikegami, Toru; Kasagi, Yuta; Hidaka, Gen; Yamazaki, Koji; Sadanaga, Noriaki; Itoh, Hiroyuki; Emi, Yasunori; Matsuura, Hiroshi; Okadome, Kenichiro

    2011-01-01

    Although endoscopic retrograde cholangiopancreatography (ERCP) is an effective modality for the diagnosis and treatment of biliary and pancreatic diseases, it is still related with several severe complications. We report on the case of a female patient who developed liver parenchyma perforation following ERCP. She underwent ERCP with sphincterotomy and extraction of a common bile duct stone. Shortly after ERCP, abdominal distension was identified. Abdominal computed tomography revealed intraabdominal air leakage and leakage of contrast dye penetrating the liver parenchyma into the space around the spleen. Since periampullary perforation related to sphincterotomy could not be denied, she was referred for immediate surgery. Obvious perforation could not be found at surgery. Cholecystectomy, insertion of a T tube into the common bile duct, placement of a duodenostomy tube and drainage of the retroperitoneum were performed. She did well postoperatively and was discharged home on postoperative day 28. In conclusion, as it is well recognized that perforation is one of the most serious complication related to ERCP, liver parenchyma perforation should be suspected as a cause. PMID:21960953

  5. [Endoscopic piecemeal removal of large adenomatous duodenal polyp].

    PubMed

    Zasada, Jakub; Rembiasz, Kazimierz; Budzy?ski, Andrzej; Gwó?d?, Anna; Mat?ok, Maciej; Budzy?ski, Piotr; Dyduch, Grzegorz

    2009-01-01

    Duodenal polyps are rare pathologies. They can be single or multiple, like in familial adenomatous polyposis or Gardner syndrome. Histologically they are usually bening: adenomas, myomas, lipomas, carcinoids, Brunner adenomas or hamartomas. Malignant lesions are mainly adenocarcinomas localized in the ampulla of the Vater area. Small polyps localized in the superior or descending segment of duodenum can be usually removed endoscopically. Larger or more distally localized polyps must be excised surgically. The largest polyps, up to several centimeters, are adenomas. Ileus or anemia are the main symptoms. Here we report the case of a 52 year old woman with a large polyp (7 cm diameter) localized in the duodenal bulb presenting with anemia. The polyp was removed endoscopically with a piecemeal method using diathermic loop. Histopthologic examination revealed that it was a ademona with grade II dysplasia. PMID:19739585

  6. 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

  7. Offshore sandstone reservoir perforating practices used in Saudi Arabia

    SciTech Connect

    Benedyczak, C.

    1984-09-01

    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 hydrocarbon-bearing zones to control oil, gas, water, and solid particle entry into the wellbores. Reservoir fluid flow into wellbores is obtained through perforation tunnels made in casings, cement sheaths, and reservoir rock. Perforation technology and methods of evaluating perforation efficiencies have advanced greatly during the past 50 years. The resulting selection of well perforating devices and perforating methods is vast. However, few studies have been published that address field assessment of well perforating efficiencies. The inability of many oil-producing wells to flow naturally to surface hampers evaluation of their perforation effectiveness. Saudi Arabian offshore oil production is obtained from naturally flowing wells. This situation readily lends itself to analysis of well production profiles and perforation flow efficiencies. This paper examines perforation efficiencies of jet guns in high-production flowing wells. Perforation interval flow profiles, wellbore pressure buildups and productivity index (PI) tests were evaluated for comparison of well perforation efficiencies. Effects of drilling operations and the quality of primary cementation on the well perforation efficiencies were evaluated also.

  8. Report of a case of precancerous primary duodenal polyp and a review of the related literature

    Microsoft Academic Search

    Kikuo Nakano; Yukio Ohmori; Akira Nishimura; Masahiro Fujita; Ichiro Honda; Hidesada Takahashi; Sokoh Mayama; Noboru Tanaka; Yoshio Koike

    1981-01-01

    A 62-year-old woman with a precancerous duodenal polyp in the suprapapillary region of the second portion of the duodenum\\u000a was surgically treated by pancreato-duodenectomy. The postoperative course and follow-up was uneventful. A statistical analysis\\u000a of primary duodenal tumor cases (excluding tumors of the duodenal papilla) reported in Japan during the period from 1962 to\\u000a 1977 was also reported.

  9. Acute corneal hydrops mimicking full thickness perforation

    PubMed Central

    SW, Ch’ng; MB, Pillai; S, Aazeem; KL, Tu

    2012-01-01

    A 26-year-old Caucasian female with keratoconus presented with an acutely painful and red left eye. Visual acuity on presentation was 3/60. Slit lamp examination revealed localised Descemet’s membrane break with iris partially plugging it. There was a bulging stromal cyst which would intermittently flatten and reform. The appearance when the cyst was flattened mimicked a full thickness corneal perforation. However, no obvious overlying epithelial defect was detected and an intermittent leakage through micro-perforations in the corneal epithelium was the probable cause of the variable appearance. The anterior chamber reformed and iris plug freed following an insertion of a bandage contact lens and taped eyelid. On follow-up, the Descement’s membrane had healed with visual acuity improving to 6/18. Our case illustrates the importance of identifying corneal hydrops mimicking a full thickness perforation as conservative management has a greater chance of recovery. PMID:22605867

  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. Laparoscopic cholecystectomy for traumatic gallbladder perforation

    PubMed Central

    Hamilton, C; Carmichael, SP; Bernard, AC

    2012-01-01

    In trauma, laparoscopic surgery is commonly utilized as a diagnostic rather than therapeutic measure (1). Its use is often negated because of exigency or limitations in visibility due to haemorrhage. In the present case, a 35-year-old male was involved in a motor vehicle collision and arrived haemodynamically stable with abdominal pain. Abdominal CT revealed liver laceration and active contrast extravasation near the gallbladder fossa. Although angiography with embolization would normally be used, exploratory laparoscopy was performed because of concern for gallbladder injury. The gallbladder was found to be perforated and nearly completely avulsed from the fossa. Laparoscopic cholecystectomy was performed and the patient recovered uneventfully. Gallbladder perforation after trauma is typically an incidental finding during operation for haemorrhagic shock or other indication. Early diagnosis and swift surgical intervention are required, usually via laparotomy. However, when diagnosed preoperatively in the stable trauma victim, gallbladder perforation can be treated successfully with laparoscopy. PMID:24960682

  12. The Iatrogenic Effects of Group Intervention for Antisocial Youth: Premature Extrapolations?

    Microsoft Academic Search

    Michael L. Handwerk; Clinton E. Field; Patrick C. Friman

    2000-01-01

    Group intervention for antisocial youth has received harsh criticism in recent years. This paper reviews relevant research focused on the influence of contact with delinquent peers on the development of antisocial activity. Also reviewed are studies reporting outcomes of group intervention for antisocial youth. Although a few studies have found iatrogenic effects for group intervention with antisocial youth, the majority

  13. Endovascular embolization of iatrogenic lumbar artery pseudoaneurysm following extreme lateral interbody fusion (XLIF).

    PubMed

    Santillan, Alejandro; Patsalides, Athos; Gobin, Y Pierre

    2010-10-01

    Iatrogenic lumbar artery pseudoaneurysm is a very rare complication of spinal surgery. To the best of our knowledge, this is the first report of a lumbar artery pseudoaneurysm after extreme lateral interbody fusion (XLIF). The lesion was diagnosed by catheter spinal angiography and was effectively treated with embolization. PMID:20675335

  14. Iatrogenic burns from the use of hot packs in paraplegic insensate patients

    Microsoft Academic Search

    M. A. Khan; B. Jamnadas-Khoda; M. Gorman; S. Jay; K. Zafeiris; S. J. Ghosh

    2011-01-01

    Conservative therapy for lower back pain can involve physiotherapy employing a variety of modalities including the use of heat. The gel packs designed for heat therapy called “hot packs” usually consist of a silicate gel called Bentonite and are placed directly into contact with the area to be treated for a fixed duration of time. Iatrogenic injury from these ‘therapeutic’

  15. Quasistatic Droplets in Randomly Perforated Domains

    NASA Astrophysics Data System (ADS)

    Guillen, Nestor; Kim, Inwon

    2015-01-01

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

  16. Attenuation of an air shock wave by perforated baffles

    SciTech Connect

    Klapovskii, V.E.; Grigor'ev, G.S.; Logvenov, A.Y.; Mineev, V.N.; Vershinin, V.Y.

    1984-03-01

    One of the ways of attenuating an air shock wave (ASW) is to use a perforated shield; the parameters of the ASW behind a perforated baffle in the form of a steel sheet with holes are determined by the amplitude of the incident ASW and the sheet perforation coefficient. The authors examine the effects of the perforated shield structure on the ASW behind it and examples are given where the results can be used in the design of test chambers.

  17. Oriented Perforation to Prevent Casing Collapse for Highly Inclined Wells

    Microsoft Academic Search

    Nobuo Morita; Harry McLeod

    1995-01-01

    This paper shows that the oriented-perforation technique is an effective method to control casing collapse problems for highly inclined wells. Three wells were perforated with 180° phasing in the maximum in-situ stress direction. These three wells did not experience casing collapse, while surrounding wells with the standard perforation technique did. Two of the three wells with oriented perforations experienced significantly

  18. Incompetent Perforating Veins are Associated with Recurrent Varicose Veins

    Microsoft Academic Search

    E. E. Rutherford; B. Kianifard; S. J. Cook; J. M. Holdstock; M. S. Whiteley

    2001-01-01

    Aims: we suspected incompetent perforating veins of having a role in the development of recurrent varicose veins in some patients. The aim was to look for an association between perforators and recurrent varicose veins.Methods: a consecutive group of patients presenting with varicose veins were examined using colour duplex ultrasonography by an experienced vascular technologist. Pathological perforating veins were defined as

  19. Parameter Estimation for the Heat Equation on Perforated Domains

    E-print Network

    Parameter Estimation for the Heat Equation on Perforated Domains H.T. Banks1 , D. Cioranescu2 , A for simulated data for heat flow in a porous medium. We consider data simulated from a model on a perforated Words: Inverse problems, parameter estimation, perforated domains, homogeniza- tion, thermal diffusion

  20. Parameter Estimation for the Heat Equation on Perforated Domains

    E-print Network

    Parameter Estimation for the Heat Equation on Perforated Domains H.T. Banks1 , D. Cioranescu2 , A: Inverse problems, parameter estimation, perforated domains, homogeniza- tion, thermal diffusion, ordinary porous samples by use of solutions of a heat equation on a randomly perforated domain. As noted

  1. Homogenization of the demagnetization field operator in periodically perforated domains

    E-print Network

    Paris-Sud XI, Université de

    Homogenization of the demagnetization field operator in periodically perforated domains Kévin field operator in periodically perforated domains using the two-scale convergence method dates back from Bensoussan et al [4]. In perforated domains, it has been studied by Cioranescu et al

  2. 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 2012, Nantes, France 965 #12;Lightweight Micro-Perforated Panels (MPP) backed by an air cavity-mode analysis explains the nature of the observed spectral peaks for a wide range of perforation ratio

  3. Ginzburg-Landau minimizers in perforated domains with prescribed degrees

    E-print Network

    Paris-Sud XI, Université de

    Ginzburg-Landau minimizers in perforated domains with prescribed degrees Leonid Berlyand(1) , Petru, 1, . . . , j, j = 1...k. In the perforated domain A = \\ ( k j=0 j) we consider the class J|2 )2 ; u J . (1.1) Here, E is a GL type energy (without magnetic field), A is a 2D perforated

  4. The periodic unfolding method in perforated Doina CIORANESCU

    E-print Network

    Paris-Sud XI, Université de

    The periodic unfolding method in perforated domains Doina CIORANESCU , Patrizia DONATO and Rachad in domains with holes, introducing the unfolding operator for functions defined on periodically perforated do for functions defined on periodically perforated domains. We also define in Section 5 a boundary unfolding

  5. Managing Performance vs. Accuracy Trade-offs With Loop Perforation

    E-print Network

    Rinard, Martin

    Managing Performance vs. Accuracy Trade-offs With Loop Perforation Stelios Sidiroglou Sasa-hoc, domain-specific techniques developed specifically for the computation at hand. Loop perforation provides of their iterations. A criticality testing phase filters out critical loops (whose perforation produces unacceptable

  6. Operative Treatment of Typhoid Perforation of the Bowel

    PubMed Central

    Archampong, E. Q.

    1969-01-01

    One hundred and twenty-one proved cases of typhoid perforation were seen in a three-year period; the incidence of perforation, 17·9%, is the highest recorded. All patients were treated by laparotomy with closure and drainage. The mortality was 29·8%, but 76% when operation was performed after the fifth day of perforation. PMID:5800367

  7. 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

  8. Small bowel perforation in the premature neonate: congenital or acquired?

    Microsoft Academic Search

    A. J. A. Holland; A. Shun; H. C. O. Martin; C. Cooke-Yarborough; J. Holland

    2003-01-01

    To determine the potential aetiological factors of small bowel perforation in the premature neonate, we performed a retrospective chart review of those neonates with spontaneous intestinal perforation (SIP) of the small bowel seen in our tertiary paediatric hospital between January 1980 and December 2000. Data were collected on gestational feto-maternal health, medical interventions prior to perforation and the subsequent operative

  9. Low yield of routine duodenal biopsies for evaluation of abdominal pain

    PubMed Central

    Dubin, Sterling M; Kwong, Wilson T; Kalmaz, Denise; Savides, Thomas J

    2015-01-01

    AIM: To determine the yield of biopsying normal duodenal mucosa for investigation of abdominal pain. METHODS: This is a retrospective chart review of consecutive patients who underwent esophagogastroduodenoscopy (EGD) with duodenal biopsies of normal appearing duodenal mucosa for an indication that included abdominal pain. All the patients in this study were identified from an electronic endoscopy database at a single academic medical center and had an EGD with duodenal biopsies performed over a 4-year period. New diagnoses that were made as a direct result of duodenal biopsies were identified. All duodenal pathology reports and endoscopy records were reviewed for indications to perform the examination as well as the findings; all the medical records were reviewed. Exclusion criteria included age less than 18 years, duodenal mass, nodule, or polyp, endoscopic duodenitis, duodenal scalloping, known celiac disease, positive celiac serology, Crohns disease, or history of bone marrow transplant. Information was collected in a de-identified database with pertinent demographic information including human immunodeficiency virus (HIV) status, and descriptive statistics were performed. RESULTS: About 300 patients underwent EGD with biopsies of benign appearing or normal appearing duodenal mucosa. The mean age of patients was 44.1 ± 16.8 years; 189 of 300 (63%) were female. A mean of 4.3 duodenal biopsies were performed in each patient. In the subgroup of patients with abdominal pain without anemia, diarrhea, or weight loss the mean age was 43.4 ± 16.3 years. Duodenal biopsies performed for an indication that included abdominal pain resulting in 4 new diagnoses (3 celiac disease and 1 giardiasis) for an overall yield of 1.3%. 183 patients with abdominal pain without anemia, diarrhea, or weight loss (out of the total 300 patients) underwent duodenal biopsy of duodenal mucosa resulting in three new diagnoses (two cases of celiac disease and one giardiasis) for a yield of 1.6%. Duodenal biopsies of 19 HIV patients presenting for evaluation of abdominal pain did not reveal any new diagnoses. Information pertaining to new diagnoses is provided. CONCLUSION: Routine biopsy of normal appearing duodena in patients with abdominal pain should be reserved for those with a high pre-test probability given its low diagnostic yield. PMID:26139995

  10. Eicosanoid synthesis in duodenal ulcer disease: decrease in leukotriene C4 by colloidal bismuth subcitrate.

    PubMed Central

    Ahmed, A; Salmon, P R; Cairns, C R; Hobsley, M; Hoult, J R

    1992-01-01

    The release of immunoreactive prostaglandin E2 (PGE2) and leukotriene C4 (LTC4) from antral and duodenal mucosal biopsy specimens taken from 20 patients with duodenal ulcer disease was measured by radioimmunoassay before and four weeks after treatment with colloidal bismuth subcitrate. Gastroscopic and histological examination showed complete ulcer healing in 15/18 patients and duodenal histology looked normal (n = 15) or improved (n = 3): two patients failed to attend for a second endoscopy. Analysis of the supernatant from incubations of biopsy tissue in vitro showed that unstimulated antral release of PGE2 was significantly more than that from the duodenal mucosa (p less than 0.05), whereas basal release of LTC4 was significantly lower from antral biopsy specimens (p less than 0.05). Subsequent incubation of specimens with calcium ionophore A23187 caused an increase in LTC4 but not in PGE2 generation. The ability of antral and duodenal mucosa to form ionophore mediated LTC4 in patients with duodenal ulcer disease was significantly greater (p less than 0.05; p less than 0.01 respectively) than that of normal gastroduodenal mucosa. After colloidal bismuth subcitrate treatment, basal synthesis of PGE2 was unchanged in duodenal and antral specimens. In contrast, basal duodenal LTC4 was reduced (p less than 0.05), and the capacity for ionophore mediated duodenal LTC4 formation was substantially and significantly reduced after treatment (p less than 0.001). These results indicate that after therapeutic healing of duodenal ulcer (accompanied by clearance of inflammatory cell infiltrate), there is a reduced ability of duodenal mucosa to generate proinflammatory peptidoleukotrienes. PMID:1541409

  11. A parametric study of perforated muzzle brakes

    Microsoft Academic Search

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

    1993-01-01

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

  12. Nambu-Goldstone explosion under brane perforation

    E-print Network

    Gal'tsov, D V; Zamani-Mogaddam, S

    2010-01-01

    We show that perforation of the three-brane by mass impinging upon it from the five-dimensional bulk excites Nambu-Goldstone spherical wave propagating outwards with the velocity of light. It is speculated that such an effect can give rise to "`unmotivated" energy release events in the brane-world cosmological models.

  13. Perforation of woven fabric by spherical projectiles

    SciTech Connect

    Shim, V.P.W.; Tan, V.B.C.; Tay, T.E. [National Univ. of Singapore (Singapore)

    1995-12-31

    Rectangular specimens of Twaron{reg_sign} fabric, clamped on two opposite sides, are subjected to impact perforation by 9.5 mm diameter spherical steel projectiles at speeds ranging from 140 m/s to 420 m/s. This plain woven fabric, comprising PPTA (poly-paraphenylene terepthalamide) fibers, is commonly employed in flexible an-nor applications. Its perforation response is examined in terms of residual velocity, energy absorbed and resulting deformation patterns. The existence of a critical or transition impact velocity, beyond which there is a significant reduction in energy absorbed by perforation, is observed. Differences in creasing and deformation induced in specimens are also demarcated by this transition impact velocity. Effects of difference in boundary conditions (clamped and free) on yarn breakage are also noted. A numerical model, based on an initially orthogonal network of pin-jointed bars interconnected at nodes, is formulated to simulate the fabric. Fiber yam mechanical properties are represented via a three-element spring-dashpot model which encapsulates viscoelastic behavior and fiber failure. Numerical results exhibit good correlation with experimental observations in terms of prediction of threshold perforation velocity, energy absorbed, occurrence of a transition critical velocity and fabric deformation characteristics.

  14. Mathematical Model for Estimating Perforation Penetration Depth

    Microsoft Academic Search

    A. C. Seibi; F. H. Boukadi; S. Salmi; A. Bemani

    2008-01-01

    This article presents a simplified mathematical model based on the energy-work method to estimate the penetration depth in well perforation. The model uses casing and formation properties in the estimation. It uses the initial speed of the bullet and the failure strengths of the materials resisting penetration as model input. An automated computer program was developed to compute the penetration

  15. Colonic perforation associated with neostigmine administration

    PubMed Central

    McDonald, Christopher R.; Tonkin, Darren; Hewett, Peter

    2013-01-01

    Neostigmine is an acetylcholinesterase inhibitor that is increasingly used as a medical treatment in cases of pseudo-obstruction. It has a well-recognized side-effect profile that includes bradycardia and bronchospasm. We present a case of colonic perforation after administration of neostigmine in the treatment of pseudo-obstruction. PMID:24964452

  16. Perforated patch recording with beta-escin.

    PubMed

    Fan, J S; Palade, P

    1998-11-01

    Perforated patch recording with nystatin, amphotericin B and gramicidin can be more difficult in the hands of some investigators than others. In addition, it is difficult to introduce low molecular weight substances such as dyes into the cytoplasm in such experiments. We have determined that beta-escin represents a convenient, easy-to-use alternative to less water-soluble ionophores. PMID:9799421

  17. POSSUM: A Scoring System for Perforative Peritonitis

    PubMed Central

    Renganathan, D.N.

    2015-01-01

    Background and Objectives Perforative peritonitis carries considerable morbidity and mortality with the postoperative period unpredictable most of the times. It therefore becomes necessary for a scoring system that predicts the post-operative outcome. POSSUM (Physiological and Operative Severity Score for the enumeration of Mortality and Morbidity) helps in predicting the post-operative morbidity and mortality in these patients. POSSUM scores are based on 12 physiological factors and 6 operative factors. In our study, we included two more factors, which are specifically important in perforative peritonitis; they are, perforation to operation time and the presence of co-morbidity. The presence of these factors significantly affects the post-operative status. Through this prospective study, we can predict which patients are at a higher risk of death or complication and give appropriate management as necessary. Materials and Methods Our sample size was 50 patients with perforative peritonitis. The study was conducted in single unit from September 2013 to August 2014. Data was collected based on POSSUM scoring system. Outcome of the patients was recorded as death / alive; complicated / uncomplicated and statistical analysis was done by comparing the expected and observed outcomes. Results By applying linear analysis, an observed to expected ratio of 1.005 was obtained for mortality and 1.001 for morbidity. There was no statistically significant difference between the observed and expected mortality rates (?2 = 3.54, p = 0.316) and morbidity rates (?2 = 2.40, p = 0.792). It was found to be comparable with other studies. The factors independently studied; perforation to operation time and presence of co-morbidity were statistically significant with respect to outcome (p<0.05). Conclusion Although a small sample size is the limitation of this study, POSSUM scoring system is a good indicator of postoperative outcome in patients with perforative peritonitis and was applicable in our setup. It is useful in identifying high risk patients and give preferential care to them for better outcome. Inclusion of factors like perforation to operation time and co-morbid status can improve the scoring system and better care can be provided.

  18. Effects of rapeseed oil duodenal infusion on adipose tissue lipolytic activities of dairy cows during early lactation

    E-print Network

    Paris-Sud XI, Université de

    Effects of rapeseed oil duodenal infusion on adipose tissue lipolytic activities of dairy cows the effects of rapeseed oil duodenal infusion in early lactating dairy cows that are mobiliz- ing their body

  19. Optimal design of perforating completion for gas well

    SciTech Connect

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

    1995-10-01

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

  20. Oriented perforation to prevent casing collapse for highly inclined wells

    SciTech Connect

    Morita, Nobuo [Waseda Univ., Tokyo (Japan); McLeod, H. [Conoco Inc., Houston, TX (United States)

    1995-09-01

    This paper shows that the oriented-perforation technique is an effective method to control casing collapse problems for highly inclined wells. Three wells were perforated with 180{degree} phasing in the maximum in-situ stress direction. These three wells did not experience casing collapse, while surrounding wells with the standard perforation technique did. Two of the three wells with oriented perforations experienced significantly reduced sand problems. Numerical analysis was conducted to compare how effective orient perforations were in minimizing casing failure when a sheared zone was created around a well during drilling and production.

  1. Risk factors affecting morbidity in typhoid enteric perforation

    Microsoft Academic Search

    E. Gedik; S. Girgin; I. H. Taçy?ld?z; Y. Akgün

    2008-01-01

    Introduction  Typhoid enteric perforation is a cause of high morbidity and mortality. This study aim is to determine the factors affecting\\u000a morbidity in patients with typhoid enteric perforation.\\u000a \\u000a \\u000a \\u000a Materials and methods  Ninety-six patients with typhoid enteric perforation were reviewed. The variables are defined as follows: Age, gender, complaints,\\u000a perforation–operation interval, typhoid fever treatment before the perforation or not, white blood cell (WBC)

  2. 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

  3. Radioselenium in duodenal aspirate as an assessment of pancreatic exocrine function.

    PubMed

    Youngs, G R; Agnew, J E; Levin, G E; Bouchier, I A

    1971-05-01

    A new test of pancreatic exocrine function is described in which radioselenium is measured in duodenal aspirate after an intravenous injection of (75)Se-selenomethionine and administration of a Lundh test meal. Duodenal (75)Se activity gave good separation between normals and subjects with disease of the exocrine pancreas and correlated well with trypsin levels in the aspirate. PMID:5572384

  4. Rumen metabolism and duodenal nutrient flow as affected by ration composition and antimicrobials in sheep

    E-print Network

    Paris-Sud XI, Université de

    in the rumen was increased by F + AVO diet. Duodenal flow of total N, total AA, essential AA was unaffected by additives. Both non ammonia N passage and non essential AA flow were lower for F + SAL than F. SalinomycinRumen metabolism and duodenal nutrient flow as affected by ration composition and antimicrobials

  5. 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

  6. Does treatment of Helicobacter pylori with antibiotics alone heal duodenal ulcer? A randomised double blind placebo controlled study

    Microsoft Academic Search

    S K Lam; C K Ching; K C Lai; B C Wong; C L Lai; C K Chan; L Ong

    1997-01-01

    BACKGROUND: Treatment of Helicobacter pylori infection prevents duodenal ulcer relapse. It has not been established if treatment of the infection heals duodenal ulcer. AIM: To test the hypothesis that treatment of the infection was associated with healing of duodenal ulcer. METHODS: A randomised, double blind placebo controlled trial was performed to study the efficacy of an antibiotic only regimen consisting

  7. 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

  8. Estrogen Regulation of Duodenal Bicarbonate Secretion and Sex-Specific Protection of Human Duodenum

    PubMed Central

    Tuo, Biguang; Wen, Guorong; Wei, Jinqi; Liu, Xuemei; Wang, Xue; Zhang, Yalin; Wu, Huichao; Dong, Xiao; Chow, Jimmy Y.C.; Vallon, Volker; Dong, Hui

    2011-01-01

    BACKGROUND & AIMS The reason that women have a lower prevalence of duodenal ulcer is not clear. We investigated whether estrogen regulates human duodenal bicarbonate secretion (DBS) and whether this process accounts for sex differences in the prevalence of duodenal ulcer. METHODS We performed an epidemiological study to correlate duodenal ulcer prevalence with sex and age. Proximal DBS was measured from healthy subjects. Estrogen receptor expression was examined in human duodenal mucosa by immunoblot and immunohistochemical analyses. RESULTS Among women, the prevalence of duodenal ulcer was significantly lower than among men. The reduced prevalence was greatest among premenopausal women (20–49 years), who were 3.91–5.09-fold less likely to develop duodenal ulcers than age-matched men; the difference was reduced to ?1.32-fold among subjects 60 years or older. Premenopausal (20–29 years), but not post-menopausal (60–69 years) women, had significantly higher basal and acid-stimulated DBS than the age-matched men. Basal and acid-stimulated DBS in premenopausal women (20–29 years) were significantly higher than in post-menopausal women (60–69 years), whereas there were no significant differences in basal or acid-stimulated DBS between men that were 20–29 years old or 60–69 years old. Serum levels of estradiol changed in parallel with basal and acid-stimulated DBS during the physiological menstrual cycle in premenopausal women. 17?-estradiol-stimulated DBS was independent of age or sex. Estrogen receptors- and - were detected on plasma membrane and in cytosol of human duodenal epithelial cells. CONCLUSIONS Estrogen regulates human DBS, which could reduce the risk for duodenal ulcer in women and contribute to sex differences in prevalence of duodenal ulcer. PMID:21699784

  9. 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.

  10. [Iatrogenic trachea and esophagus injury in intensive care practice: the surgeon's view"].

    PubMed

    Parshin, V D; Vyzhigina, M A; Eremenko, A A; Nikoda, V V; Rusakov, M A; Vishnevskaia, G A; Parshin, V V

    2013-01-01

    From 1963 to 2011 in the Department of lung and mediastinum surgery were treated 879 patients with trachea stenosis and 107 patients with benign tracheoesopageal fistula were treated in the Department of lung and mediastinum surgery from 1963 to 2011. latrogenic trachea and the esophagus damage was caused by long-term ALV in 87% of cases. Patients were aged from 5 to 79 years. 47.2% of patients came with functioning tracheostome. 25.7% of patients had a clinically significant respiratory disorder at admission, 10.2 % of which were life-threatening. Iatrogenic damage of the trachea was identified before extubation or decannulation only in 27% of patients. In such circumstances, prevention and diagnostics of iatrogenic injuries, as well as initial care alternatives takes on special significance. PMID:24000652

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

    PubMed Central

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

    2014-01-01

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

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

    PubMed

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

    2014-12-01

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

  13. Bilateral dissemination of malignant pleural mesothelioma via iatrogenic buffalo chest: a rare route of disease progression.

    PubMed

    Ikezoe, Kohei; Tanaka, Eisaku; Tanizawa, Kiminobu; Hashimoto, Seishu; Shindo, Toru; Noma, Satoshi; Kobashi, Yoichiro; Taguchi, Yoshio

    2012-09-01

    Buffalo chest refers to the pleuro-pleural communication that results in a single pleural cavity. Iatrogenic buffalo chest can occur following heart or heart-lung transplantation and other major thoracic surgeries. We present the case of malignant pleural mesothelioma in which iatrogenic buffalo chest after extended thymectomy caused bilateral pneumothoraces and contralateral dissemination of the disease. The free communication between bilateral pleural cavities had facilitated the rapid progression of tumor and the consequent bilateral malignant pleural effusions had made the management of disease much more difficult, leading to the early fatal outcome. To our knowledge, this is the first case of buffalo chest that was associated with bilateral malignant pleural effusions. PMID:22580971

  14. Acute iatrogenic polycythemia induced by massive red blood cell transfusion during subtotal abdominal colectomy.

    PubMed

    Chiapaikeo, David; Rohani, Pejman

    2015-02-24

    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. PMID:25852846

  15. 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

  16. 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

  17. Iatrogenic pseudoaneurysm of the brachiocephalic artery: a rare complication of Hickman line insertion

    Microsoft Academic Search

    Glykeria Petrocheilou; Constantinos Kokkinis; Sotiria Stathopoulou; Loukia Fragopoulou; Petros Mihos; Paraskevi J. Papadaki; Marianna Vlychou

    2008-01-01

    Central venous catheterization is widely used for hemodialysis for patients with renal failure. A number of short and long-term\\u000a complications have been reported in literature. We describe a rare case of a lethal iatrogenic injury of the brachiocephalic\\u000a artery (BA) in a 65-year-old woman following subclavian venous catheterization with a Hickman catheter. Contrast-enhanced\\u000a CT-scan and reconstruction images demonstrated a pseudoaneurysm

  18. 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.

  19. 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.

  20. Perforation of domain wall by point mass

    E-print Network

    D. V. Gal'tsov; E. Yu. Melkumova; P. A. Spirin

    2013-12-30

    We investigate collision of a point particle and an infinitely thin planar domain wall interacting gravitationally within the linearized gravity in 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 excitation of the spherical shock branon 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, being applicable to the problem of cosmological domain walls.

  1. Perforation of domain wall by point mass

    E-print Network

    Gal'tsov, D V; Spirin, P A

    2013-01-01

    We investigate collision of a point particle and an infinitely thin planar domain wall interacting gravitationally within the linearized gravity in 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 excitation of the spherical shock branon 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, being applicable to the problem of cosmological domain walls.

  2. Gallbaldder perforation causing a subcutaneous abscess

    PubMed Central

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

    2014-01-01

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

  3. Esophageal perforation in a sword swallower.

    PubMed

    Scheinin, S A; Wells, P R

    2001-01-01

    We present the case of a 59-year-old man who sustained an esophageal perforation as a result of sword swallowing. An esophagogram established the diagnosis, and surgical repair was attempted. However, 19 days later, a persistent leak and deterioration of the patient's condition necessitated a transhiatal esophagectomy with a left cervical esophagogastrostomy. The patient recovered and has resumed his daily activities at the circus, with the exception of sword swallowing. This case report presents an unusual mechanism for a potentially lethal injury. Our search of the English-language medical literature revealed no other report of esophageal perforation resulting from sword swallowing. Management of such an injury is often difficult, and a favorable outcome is dependent on prompt diagnosis and treatment. PMID:11330747

  4. Esophageal Perforation in a Sword Swallower

    PubMed Central

    Scheinin, Scott A.; Wells, Patrick R.

    2001-01-01

    We present the case of a 59-year-old man who sustained an esophageal perforation as a result of sword swallowing. An esophagogram established the diagnosis, and surgical repair was attempted. However, 19 days later, a persistent leak and deterioration of the patient's condition necessitated a transhiatal esophagectomy with a left cervical esophagogastrostomy. The patient recovered and has resumed his daily activities at the circus, with the exception of sword swallowing. This case report presents an unusual mechanism for a potentially lethal injury. Our search of the English-language medical literature revealed no other report of esophageal perforation resulting from sword swallowing. Management of such an injury is often difficult, and a favorable outcome is dependent on prompt diagnosis and treatment. PMID:11330747

  5. Calcium transport by rat duodenal villus and crypt basolateral membranes

    SciTech Connect

    Walters, J.R.F.; Weiser, M.M.

    1987-02-01

    Rat duodenal cells were isolated sequentially to give fractions enriched for villus and crypt cells. From each of these fractions, basolateral-enriched membrane vesicles were prepared and ATP-dependent calcium uptake was studied. Calcium uptake was sensitive to temperature, was inhibited by vanadate and by A23187, and was lower in vitamin D-deficient animals. In normal animals, (UVCa)-transport was approximately twofold greater in villus-tip than in crypt cell-fraction basolateral membranes though the affinity of the uptake for calcium was similar (K/sub m/ = 0.3 M). In vitamin D-deficient animals, the crypt-to-villus gradient was reduced, and in all fractions, calcium transport was similar to or lower than that in the crypts of normal animals. Six hours after vitamin D-deficient animals were repleted with 1,25-dihydroxycholecalciferol, a significant increase in calcium transport by everted gut sacs was present; however, basolateral calcium transport was significantly increased in only the mid-villus fractions, and no change was seen in the villus-tip fractions. Thus vitamin D appears necessary for the development of increased basolateral membrane calcium pump activity in duodenal villus cells, but not all cells in vitamin D-deficient rats are able to respond to 1,25-dihydroxycholecalciferol.

  6. An experimental study of perforated muzzle brakes

    NASA Astrophysics Data System (ADS)

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

    1984-06-01

    A firing test was conducted to examine the recoil efficiency and blast characteristics of perforated muzzle brakes fitted to a 20 mm cannon. Recoil impulse blast overpressures, muzzle velocity, sequential spark shadowgraphs, and photographs of the muzzle flash structure were obtained. Three different nuzzle devices were used with one device equipped with pressure transducers to measure the static pressure in the brake. Experimental results are compared with the earlier predictions of Dillon and Nagamatsu.

  7. Boosterless perforating gun and method of assembly

    SciTech Connect

    Donovan, J.F.; Stout, G.W.; Schmuck, P.W.

    1987-01-13

    A perforating gun is described for a subterranean well comprising: shaped charge containers, each container having a primer containing end; carrier means for mounting the containers in vertically and angularly spaced relation; fusible tube means defining a continuous axial passage adjacent the primer ends of the shaped charge containers; a continuous length of primer cord extending through the continuous axial passage; and means for detonating one end of the primer cord, thereby melting the fusible tube means and firing the shaped charges.

  8. Perforation of thin unreinforced concrete slabs

    Microsoft Academic Search

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

    1993-01-01

    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

  9. Traumatic Tympanic Membrane perforation: An aetiological profile

    PubMed Central

    2009-01-01

    Background Traumatic perforation of the tympanic membrane may be due to direct or indirect source. The aim of the study is to profile the various aetiologies of traumatic tympanic membrane perforation in Ilorin, north central Nigeria. A retrospective review of 64 patients seen at the University of Ilorin Teaching hospital, Ilorin, Nigeria over a ten year period (January 1998 to Dec 2007) with history of traumatic tympanic membrane perforation from various causes, these also included multiply injured patients with bleeding from middle ear as part of their presentations. The data retrieved included the biodata, the clinical presentations, source of injury, the clinical findings and the treatment outcome. The data were entered into an SPSS version 11 computer soft ware and analyzed descriptively. Findings Sixty four (64) ears were analysed, Age range 6 months to 50 yrs, mean age of 29.2 yrs 7.9% of them were ?5 years, 29.7% between 21-34 years, and 37.7% were 35 years and above. The male to female ratio was 2.5:1.0. Commonest aetiology was from slaps, then road traffic injury (RTI) in 35.9% and 23.5%, Majority of the slap injury were from fights (30.5%), security agents, senior students and cultists at schools (17.4% each). Sudden hearing loss was a typical presentation (95.3%), majority of the patient defaulted from follow up once the symptoms of bleeding and pain subsided. Only 7.8% had neomembrane formation on follow up Conclusion Traumatic perforation of the tympanic membrane is an uncommon injury that is under-reported, there is the need to educate on alternative punitive measure among students and security agents, unskilled removal of foreign body, early identification, evaluation and referral of patients reduces the attendant morbidity. PMID:19930586

  10. 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.

  11. 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

  12. Gallbladder perforation: a single center experience of 32 cases

    PubMed Central

    Gunasekaran, Gopalakrishnan; Gupta, Ashwani; Bhandari, Vimal; Kuppusamy, Manigandan; Kumar, Gaind; Chishi, Niuto S

    2015-01-01

    Backgrounds/Aims Gallbladder perforation is a rare but potentially fatal disease. We herein present our clinical experience in diagnosis and management of 32 cases of gallbladder perforation. Methods This retrospective study was conducted with inclusion of all cases of gallbladder perforation that presented to our hospital from January 2012 to November 2014. Cases of traumatic gallbladder perforation and patients younger than 12 years of age were excluded from this study. Results This study included 32 patients (13 males and 19 females). The mean age of patients was 55.9 years. Gallbladder perforation was most common in the 5th and 6th decade of life. The mean age of patients with type I, II, and III gallbladder perforation was 57.0 years, 57.6 years, and 49.8 years, respectively. The most common site of perforation was the fundus, followed by the body and Hartmann's pouch (24 : 5 : 2). Most of the type I gallbladder perforations were diagnosed intraoperatively, type II gallbladder perforations were diagnosed by enhanced abdominal computed tomography, and type III gallbladder perforations were diagnosed during laparoscopic cholecystectomy converted to open cholecystectomy for cholelithiasis. Mortality was highest in patients with type I gallbladder perforation. The mean hospital stay was 10.1 days, 6.4 days, and 9.2 days in patients with type I, II, and III gallbladder perforation, respectively. The histopathologic analysis in 28 patients who were operated on showed acute cholecystitis in 19 cases, acute-on-chronic cholecystitis in 4 cases, chronic cholecystitis in 4 cases, and mucinous adenocarcinoma of the gallbladder in a single case. Conclusions Gallbladder perforation represents a special diagnostic and surgical challenge. Appropriate classification and management are essential.

  13. [Contact transendoscopic thermometry via a tube in active gastric and duodenal ulcer].

    PubMed

    Tenev, T

    1982-01-01

    The temperature of the gastric and duodenal mucosa was taken by a contact method in 473 patients with active ulcer disease, 118 of them being with gastric ulcers and 355--with duodenal ulcers. Sixty four of the gastric ulcers were with superficial gastritis, 54 gastric ulcers were with atrophic gastritis, 298 duodenal ulcers--with superficial inflammatory process and 57 duodenal ulcers with atrophic inflammatory process. The control group consisted of 31 healthy subjects without ulcer niche. In all patients, the temperature of the gastric and duodenal mucosa and in the periulcer niche was transendoscopically taken, at 6 separate levels. Four determinations were performed at each level (at the lesser curvature, greater curvature, anterior and posterior walls). A higher temperature, as compared with the control group, was found in the presence of ulcer defect in the region of duodenum and stomach. In case of superficial inflammatory process no temperature change developed in the mucosa, thus maintaining a statistically significant discrepancy in the region of the ulcer niche. The atrophic process reduced the temperature in the gastric zone in case of active gastric ulcer. The atrophic inflammatory process, in case of active duodenal ulcer, had no statistically significant effect on the higher temperature in the zones of duodenum and pylorous (T1 and T2) in the sites of the ulcer and around it, very likely due to the less manifested atrophic process in the duodenal mucosa as compared with the gastric one. PMID:7113182

  14. Effects of perforation entry friction on bottomhole treating analysis

    SciTech Connect

    Crump, J.B.; Conway, M.W.

    1986-01-01

    Analysis of field and laboratory data shows that variations in pressure drop due to changing perforation entry friction tends to strongly influence the prediction of fracturing treatment performance. This paper presents experimental data on perforation entry friction as it affects fracturing treatment design. Pre- fracturing treatment planning practices include examination of numerous treating pressure charts in an effort to determine formation type curves, which are used to anticipate fracturing treatment performance and screenout modes. Perforation entry friction may vary greatly because of erosion of the perforation and near wellbore fracture, and this changing friction pressure is often not properly accounted for in planning. This paper presents the following: 1.Discussion and data (laboratory and field showing the degree of perforation erosion encountered in fracturing operations. 2. Proposed guidelines to determine when to alter proppant schedule to account for proppant erosion to perforations, cement sheath, and formation.

  15. Effects of perforation-entry friction on bottomhole treating analysis

    SciTech Connect

    Crump, J.B.; Conway, M.W.

    1988-08-01

    Analysis of field and laboratory data shows that variations in pressure drop caused by changing perforation-entry friction tends to influence the prediction of fracturing treatment performance. This paper presents experimental data on perforation-entry friction as it affects fracturing treatment design. Prefracturing treatment planning practices include examination of numerous treating-pressure charts to determine formation type curves, which are used to anticipate fracturing treatment performance and screenout modes. Perforation-entry friction may vary greatly because of erosion of the perforation and near-wellbore fracture, and this changing friction pressure is often not properly accounted for in planning. This paper presents discussion and data (laboratory and field) that show the degree of perforation erosion encountered in fracturing operations and proposed guidelines to determine when to alter pumping schedules to account for proppant erosion to perforations, cement sheath, and formation.

  16. Pancreatitis and duodenal obstruction due to periampullary carcinoma associated with familial polyposis coli.

    PubMed

    Clarke, D N; Smith, J A; Norman, J N; Brunt, P W

    1978-06-01

    Duodenal lesions are being reported in cases with familial polyposis of the colon. A case is described presenting with duodenal obstruction and pancreatitis complicating a peri-ampullary carcinoma in a patient with familial polyposis (adenomatosis of the colon and rectum). Upper gastrointestinal lesions notably in the duodenum include duodenal polyps and carcinoma and peri-ampullary malignancy. It is suggested that endoscopy and hypotonic duodenography be considered in patients with adenomatosis of the colon and rectum presenting with non-colonic alimentary symptoms. PMID:683914

  17. Esophageal perforation. An unusual presentation with a benign clinical course.

    PubMed

    DeLuca, R F; Tedesco, F J; Ballan, K; Wortzel, E; Rogers, A I

    1977-04-01

    A case of esophageal perforation occurring in a 75-year-old man is presented. The clinical presentation was benign and the diagnosis of esophageal perforation was made incidental to an upper gastrointestinal barium examination. Conservative management consisting of nasogastric suctioning, antibiotics and antacids was effective in minimizing the clinical course. This represents a rare instance of a successful nonsurgical approach to esophageal perforation. PMID:879153

  18. Vaginal laceration and perforation resulting from first coitus.

    PubMed

    Hoffman, R J; Ganti, S

    2001-04-01

    Vaginal laceration resulting from coitus is not uncommon and is well described. Perforation of the vagina during coitus is a very rare occurrence, and there is scant literature reporting it. This is a case of a 14-year-old female who suffered both laceration and perforation of the vagina as a result of her first coitus, which was consensual. The characteristics of vaginal laceration and perforation, presentation, treatment, complications, as well as predisposing factors, are discussed. PMID:11334091

  19. PIV investigation of flowfield behind perforated Gurney-type flaps

    Microsoft Academic Search

    Tim Lee; L. S. Ko

    2009-01-01

    The flow behind perforated Gurney-type flaps was investigated by using particle image velocimetry (PIV) at Re = 5.3 × 104. The PIV measurements were supplemented by force balance and surface pressure data. The near wake was disrupted and narrowed,\\u000a indicative of a reduced drag, with increasing flap perforation and had a drastically suppressed fluctuating intensity. Depending\\u000a on the strength of the perforation-generated jet, the

  20. Conservative treatment of a large facial midroot perforation.

    PubMed

    Kerner, Stephane; 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. PMID:25838948

  1. 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. PMID:25838948

  2. Bowel perforation in the newborn: diagnosis with metrizamide

    SciTech Connect

    Cohen, M.D.; Weber, T.R.; Grosfeld, J.L.

    1984-01-01

    Although the diagnosis of bowel perforation is frequently straightforward, it may be difficult in the neonate. Clinical signs may be limited to abdominal distension. If the patient is on assisted ventilation, pneumoperitoneum may be due to air tracking down from the chest rather than perforation. Perforation in infants in whom the diagnosis could not readily be made from the clinical findings and plain radiographs was apparent when oral metrizamide was employed. This suggests that metrizamide can be a valuable adjunct in some cases of neonatal bowel perforation.

  3. Underbalanced perforation characteristics as affected by differential pressure

    SciTech Connect

    Regalbuto, J.A.; Riggs, R.S.

    1988-02-01

    Underbalanced, tubing-conveyed completions are increasing because of the apparent advantages of cleaner perforations, reduced completion times, and stimulation treatments. Radial-flow Berea sandstone core specimens are used to determine the perforation characteristics resulting from time-dependent pressure differentials between core pressure and wellbore pressure during the completion process. The primary perforation characteristic studied (radial flow ratio (RFR)) is defined as the ratio of the perforated flow rate to the flow rate of the unperforated core. The perforation flow tests included pressure differentials from 500 psi (3450 kPa) overbalanced to 1,000 psi (6900 kPa) underbalanced, with immediate or delayed surging. The RFR was affected most by the 500-psi and 1,000-psi (3450- and 6900-kPa) underbalance. The surged RFR's were from 50 to 58% greater than the no-surge RFR's. Perforation hole volumes were increased as much as 55% by the surge, indicating some elimination of the compacted, damaged-zone material. Underbalanced surge conditions (1,000 psi (6900 kPa)) increased hole volume to four times that resulting from 500 psi (3450 kPa) overbalanced, no-surge conditions. Underbalanced surging, either at the instant of perforation or subsequently, appears to improve the flow characteristics of shaped-charge perforations by simultaneously reducing the thickness of the low-permeability crushed zone and increasing the perforation surface area.

  4. 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

  5. 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

  6. Successful laparoscopic repair of a large traumatic sigmoid perforation.

    PubMed

    de Bakker, Jk; Bruin, Sc

    2012-01-01

    Bowel perforation can be potentially fatal. We describe the case of a 42-year-old male who presented with severe abdominal pain following anal fisting. Clinical examination revealed tenderness of the complete abdomen with signs of peritonism. A CT-scan with rectal contrast showed a perforation of the sigmoid 40 cm above the anus. At laparoscopy, a perforation in the sigmoid colon was found and successfully repaired. Patient recovered uneventful and was discharged in 5 days. We present a unique case of a sigmoid perforation after anal fisting which was laparoscopically repaired without formation of a protective colostomy. PMID:24960779

  7. Successful laparoscopic repair of a large traumatic sigmoid perforation

    PubMed Central

    de Bakker, JK; Bruin, SC

    2012-01-01

    Bowel perforation can be potentially fatal. We describe the case of a 42-year-old male who presented with severe abdominal pain following anal fisting. Clinical examination revealed tenderness of the complete abdomen with signs of peritonism. A CT-scan with rectal contrast showed a perforation of the sigmoid 40 cm above the anus. At laparoscopy, a perforation in the sigmoid colon was found and successfully repaired. Patient recovered uneventful and was discharged in 5 days. We present a unique case of a sigmoid perforation after anal fisting which was laparoscopically repaired without formation of a protective colostomy. PMID:24960779

  8. Anatomy of anteromedial thigh perforators: CT-angiography study.

    PubMed

    Visconti, Giuseppe; Salgarello, Marzia; Visconti, Emiliano; Cipriani, Antonio; Cina, Alessandro; Bonomo, Lorenzo

    2015-03-01

    The anatomy of perforator for anteromedial thigh (AMT) flap is a very much-debated issue. In this article, we report AMT perforator vascular anatomy by CT-Angiography (CTA) evaluation of 68 consecutive healthy thighs. Perforators emergence, caliber, length, course, and source vessel in the central three fifth of the thigh were studied by a virtual coordinate system. A mean 4.94?±?1.75 perforators per thigh (average length, 2.6?±?0.99 cm) from superficial femoral artery (SFA) were found, emerging medial and lateral to sartorius muscle. A mean 0.4?±?0.74 perforators per thigh (average length, 2.45?±?0.97 cm) branched from rectus femoris artery, of which 80% were emerging lateral to sartorius muscle. A mean 0.62?±?0.91 perforators per thigh (average length, 3.1?±?1.23 cm) branched from an unnamed branch of SFA, of which 88% were emerging lateral to the sartorius muscle. Perforators' calibre was inferior to 1-5 mm in 177 perforators (51.6%), between 1.5 and 2 mm in 159 (46.7%), and over 2 mm in 7 (2%). The findings from this study show that AMT region is plenty of reliable perforators with overlapping fascial emergence but branching from three different source arteries. PMID:25043682

  9. 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

  10. Parietal cell vagotomy and dilatation for peptic duodenal stricture.

    PubMed Central

    Mente?, A S

    1990-01-01

    Gastric outlet obstruction due to peptic duodenal stricture (pyloric stenosis) was treated with parietal cell vagotomy and dilatation of the stricture in 32 patients. Follow-up is in the range of 5 years in 37.4% of the patients, while 6 to 10 years follow-up is available in 62.4% of the patients. At their last follow-up, 74.9% of the patients were in either Visick 1 or 2 clinical status. Recurrence rates have been 3.1% at 1 year, 9.3% at 5 years, and 21.8% after 6 to 10 years follow-up. There has been only one instance (3.1%) of restenosis. Two patients required reoperation because of recurrence and one of them died. PMID:2241315

  11. 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

  12. 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

  13. A modified Rendezvous ERCP technique in duodenal diverticulum

    PubMed Central

    Odabasi, Mehmet; Yildiz, Mehmet Kamil; Abuoglu, Haci Hasan; Eris, Cengiz; Ozkan, Erkan; Gunay, Emre; Aktekin, Ali; Muftuoglu, MA Tolga

    2013-01-01

    AIM: To postoperative endoscopic retrograde cholangiopancreatography (ERCP) failure, we describe a modified Rendezvous technique for an ERCP in patients operated on for common bile duct stone (CBDS) having a T-tube with retained CBDSs. METHODS: Five cases operated on for CBDSs and having retained stones with a T-tube were referred from other hospitals located in or around Istanbul city to the ERCP unit at the Haydarpasa Numune Education and Research Hospital. Under sedation anesthesia, a sterile guide-wire was inserted via the T-tube into the common bile duct (CBD) then to the papilla. A guide-wire was held by a loop snare and removed through the mouth. The guide-wire was inserted into the sphincterotome via the duodenoscope from the tip to the handle. The duodenoscope was inserted down to the duodenum with a sphincterotome and a guide-wire in the working channel. With the guidance of a guide-wire, the ERCP and sphincterotomy were successfully performed, the guide-wire was removed from the T-tube, the stones were removed and the CBD was reexamined for retained stones by contrast. RESULTS: An ERCP can be used either preoperatively or postoperatively. Although the success rate in an isolated ERCP treatment ranges from up to 87%-97%, 5%-10% of the patients require two or more ERCP treatments. If a secondary ERCP fails, the clinicians must be ready for a laparoscopic or open exploration. A duodenal diverticulum is one of the most common failures in an ERCP, especially in patients with an intradiverticular papilla. For this small group of patients, an antegrade cannulation via a T-tube can improve the success rate up to nearly 100%. CONCLUSION: The modified Rendezvous technique is a very easy method and increases the success of postoperative ERCP, especially in patients with large duodenal diverticula and with intradiverticular papilla. PMID:24255749

  14. Bladder perforation during laparoscopic donor nephrectomy.

    PubMed

    Metcalfe, P D; Hickey, L; Lawen, J G

    2004-12-01

    We present two cases of bladder perforation during laparoscopic donor nephrectomy at our institution. Neither of the surgeries was otherwise complicated, and the diagnoses were made post-operatively. The kidneys were extracted through a Pfannenstiel incision and used blunt dissection to penetrate the peritoneum. Both patients had previous tubal ligations, adhesions from which may have increased the chance of injury. We believe that this is a previously unreported complication that merits attention. Care should be taken with the peritoneal incision and dissection as the bladder may be susceptible to injury. PMID:15636672

  15. Perforated marginal ulcers after laparoscopic gastric bypass

    Microsoft Academic Search

    Edward L. Felix; John Kettelle; Elijah Mobley; Daniel Swartz

    2008-01-01

    Background  Perforated marginal ulcer (PMU) after laparoscopic Roux-en-Y gastric bypass (LRYGB) is a serious complication, but its incidence\\u000a and etiology have rarely been investigated. Therefore, a retrospective review of all patients undergoing LRYGB at the authors’\\u000a center was conducted to determine the incidence of PMU and whether any causative factors were present.\\u000a \\u000a \\u000a \\u000a Methods  A prospectively kept database of all patients at the

  16. Evaluation of a duodenal digesta sampling system PH Robinson M Gill2

    E-print Network

    Paris-Sud XI, Université de

    Evaluation of a duodenal digesta sampling system PH Robinson M Gill2 'Fredericton Research Centre to solid ratio has not been questioned, Robinson and Kennelly (1990, J Dairy Sci, 73, 3146-3157) challenged

  17. 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.

  18. [Mechanical duodenal stump suture. Report of experiences: metal staples versus resorbable staples].

    PubMed

    Tonus, C; Böckmann, U; Nier, H

    1996-03-01

    The main observation criterion of the present retrospective study is the insufficiency rate after machine closing of the duodenal stump (TA-clip seam device, Auto-Suture), as a consequence of gastrectomy, resection of the stomach with Billroth II respective Roux-Y reconstruction, depending on the used type of clip. Between January 1, 1985 and October 2, 1989 the closing of the duodenal stump was routinely carried out with metal clips (n = 253) in the City Hospital Offenbach. Between October 3, 1989 and December 31, 1991 polysorb staples (n = 96) were exclusively used. The patient collectives were comparable regarding age, sex, health status, basic diseases, accompanying diseases and surgical methods. Closing of the duodenal stump by polysorb staples demonstrated with 13.5% more dehiscent seams than with metal clips (4.7%). As a result of the present study, we cannot recommend the use of polysorb clips for the closing of the duodenal stump. PMID:8681699

  19. Probabilistic Accuracy Bounds for Perforated Programs A New Foundation for Program Analysis and Transformation

    E-print Network

    Rinard, Martin

    Probabilistic Accuracy Bounds for Perforated Programs A New Foundation for Program Analysis, Accuracy, Verification, Program Analysis, Program Transformation Keywords Loop Perforation, Program an inherent perfor- mance versus accuracy trade-off -- the more computational re- sources (such as time

  20. Congenital duodenal diaphragms in adults: a delayed cause of intestinal obstruction.

    PubMed Central

    Cooperman, A M; Adachi, M; Rankin, G B; Sivak, M

    1975-01-01

    Congenital duodenal diaphragms in the adult are uncommon, unsuspected lesions that infrequently cause intestinal obstruction. The diaphragms may be single or multiple and are usually located near the ampulla of Vater. Three cases are summarized and the recent literature reviewed. At least 35 cases have been reported. Treatment most often consisted of duodenotomy,excision of the web and duodenal closure. Images Fig. 1. Fig. 2. Fig. 3. PMID:1103761

  1. Bacterial density of Helicobacter pylori predicts the success of triple therapy in bleeding duodenal ulcer

    Microsoft Academic Search

    Bor-Shyang Sheu; Hsiao-Bai Yang; Ih-Jen Su; Shu-Chu Shiesh; Chih-Hsein Chi; Xi-Zhang Lin

    1996-01-01

    Background: We studied whether different initial bacterial densities of Helicobacter pylori would alter the eradication rate of H. pylori by triple therapy (amoxicillin 500 mg t.i.d. and metronidazole 500 mg t.i.d. for 14 days; bismuth subcitrate 120 mg t.i.d. for 28 days) in patients with duodenal ulcer bleeding. Method: One hundred thirty-six cases with duodenal ulcer bleeding and H. pylori

  2. Duodenal mucosal damage associated with chronic use of anti-inflammatory drugs.

    PubMed

    Tanaka, M; Uchiyama, M; Ikeda, S

    1977-08-01

    As duodenofiberscopy becomes popular, duodenal mucosal damage associated with aspirin ingestion has come to draw more attention than before. Duodenal mucosal injury, with or without gastric lesions, related to long-term use of anti-inflammatory drugs such as aspirin, indomethacin, ibuprofen, diclofenac or others are reported in three patients, in which the diagnosis was confirmed by emergency endoscopy after hematemesis. Some possible explanations for pathogenetic mechanisms are discussed. PMID:913366

  3. Comparative Study for the Efficacy of Small Bore Catheter in the Patients with Iatrogenic Pneumothorax

    PubMed Central

    Noh, Tae Ook

    2011-01-01

    Background It has recently become most general to use the small bore catheter to perform closed thoracostomy in treating iatrogenic pneumothorax. This study was performed for analysis of the efficacy of treatment methods by using small bore catheter such as 7 F (French) central venous catheter, 10 F trocar catheter, 12 F pigtail catheter and for analysis of the appropriateness of each procedure. Materials and Methods From March 2007 to February 2010, Retrospective review of 105 patients with iatrogenic pneumothorax, who underwent closed thoracostomy by using small bore catheter, was performed. We analyzed the total success rate for all procedures as well as the individual success rate for each procedure, and analyzed the cause of failure, additional treatment method for failure, influential factors of treatment outcome, and complications. Results The most common causes of iatrogenic pneumothorax were presented as percutaneous needle aspiration(PCNA) in 48 cases (45.7%), and central venous catheterization in 26 cases (24.8%). The mean interval to thoracostomy after the procedure was measured as 5.2 hours (1~34 hours). Total success rate of thoracostomy was 78.1%. The success rate was not significantly difference by tube type, with 7 F central venous catheter as 80%, 10 F trocar catheter as 81.6%, and 12 F pigtail catheter as 71%. Twenty one out of 23 patients that had failed with small bore catheter treatment added large bore conventional thoracostomy, and another 2 patients received surgery. The causes for treatment failure were presented as continuous air leakage in 12 cases (52.2%) and tube malfunction in 7 cases (30%). The causes for failure did not present significant differences by tube type. Statistically significant factors affecting treatment performance were not discovered. Conclusion Closed thoracostomy with small bore catheter proved to be effective for iatrogenic pneumothorax. The success rate was not difference for each type. However, it is important to select the appropriate catheter by considering the patient status, pneumothorax aspect, and medical personnel in the cardiothoracic surgery department of the relevant hospital. PMID:22324027

  4. Iatrogenic Aortic Dissection During Left Subclavian Artery Stenting: Immediate Detection by Calcium Sign Under Fluoroscope

    SciTech Connect

    Wang, Yi-Chih, E-mail: med011@seed.net.tw; Hwang, Juey-Jen; Lai, Ling-Ping; Tseng, Chuen-Den, E-mail: cdtseng@ha.mc.ntu.edu.tw [National Taiwan University Hospital, Department of Internal Medicine, Taiwan (China)

    2011-02-15

    Calcified aorta with acute iatrogenic aortic dissection is a potential but rarely reported complication of subclavian or innominate artery intervention. We report a patient who developed aortic dissection during stenting for left subclavian artery. A newly developed 'calcium sign,' signifying displacement of the intimal calcification from the outer soft-tissue margin and which is traditionally recognized on chest radiograph, was detected by real-time fluoroscopy and served as the diagnostic clue. Type B aortic dissection was further confirmed by chest computed tomography.

  5. 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.

  6. Critical aspects of urine and stone analysis. Appearance of iatrogenic urinary calculi.

    PubMed

    Asper, R; Schmucki, O

    1986-01-01

    In 25% of the samples the often applied qualitative chemical analysis of urinary stones leads to entirely wrong results with severe therapeutic consequences. The appropriate techniques for stone analysis are infrared spectroscopy and X-ray powder diffraction. These techniques make also possible the identification of iatrogenic urinary calculi. Four types of such stones were detected here, caused by modern medication. N4-acetylsulfamethoxazole, N4-acetylsulfadiazine, mefenamic acid and silicon dioxide. It is only the correct preanalytical treatment of urine samples that prevents considerable impairment of analytical results. Without precautions especially, the oxalate concentration in urine may be doubled or tripled during one day of storage. PMID:3811034

  7. 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

  8. Embryonic stem cells enhance the healing of tympanic membrane perforations

    Microsoft Academic Search

    Magnus von Unge; Joris J. J Dirckx; N. Petri Olivius

    2003-01-01

    Objective: Tympanic membrane perforations may cause hearing impairment and otorhea. It is a common indication for ear surgery. The aim of the study was to test whether stem cells may enhance the healing of fresh tympanic membrane perforations. Methods: In a first assay, the status of the tympanic membrane at 5 days after myringotomy was tested in five Mongolian gerbils

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

    E-print Network

    Papamoschou, Dimitri

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

  10. Evaluation of the Relative Importance of Parameters Influencing Perforation Cleanup

    SciTech Connect

    Detwiler, R L; Morris, J P; Karacan, C O; Halleck, P M; Hardesty, J

    2003-10-22

    Completion of cased and cemented wells by shaped-charge perforation results in damage to the formation, which can significantly reduce well productivity. Typically, underbalanced conditions are imposed during perforation in an effort to remove damaged rock and shaped-charge debris from the perforation tunnel. Immediately after the shaped-charge jet penetrates the formation, there is a transient surge of fluid from the formation through the perforation and into the well bore. Experimental evidence suggests that it is this transient pressure surge that leads to the removal of damaged rock and charge debris leaving an open perforation tunnel. We have developed a two-stage computational model to simulate the perforation process and subsequent pressure surge and debris removal. The first stage of the model couples a hydrocode with a model of stress-induced permeability evolution to calculate damage to the formation and the resulting permeability field. The second stage simulates the non-Darcy, transient fluid flow from the formation and removes damaged rock and charge debris from the perforation tunnel. We compare the model to a series of API RP43 section 4 flow tests and explore the influence of fluid viscosity and rock strength on the final perforation geometry and permeability.

  11. About empirical models predicting the missile perforation of concrete barriers

    Microsoft Academic Search

    J. Baroth; L. Daudeville; Y. Malecot

    2012-01-01

    This paper deals with empirical formulae predicting the perforation of reinforced concrete barriers. These formulae are usually validated for hard impacts only. Consequently, on the one hand, a simple method is proposed in case of soft impacts. For various tests, experimental and model predictions of perforation show a good agreement. On the other hand, recent tests at the material scale

  12. Acoustic Transmission Loss of Perforated Plates Vincent Phong1

    E-print Network

    Papamoschou, Dimitri

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

  13. Perforation of the colon complicating colonoscopy: Report of a case

    Microsoft Academic Search

    J. C. B. Penfold

    1975-01-01

    PERFORATION OF THE COLON during colonoscopy occurs under peculiar clinical conditions; the colon is scrupulously clean, and the patient is under analgesia and sedation. These conditions may so alter the clinical presentation of a catastrophe such as perforation of the colon that it is overlooked. This paper reports such a case in detail, highlighting the relatively asymptomatic presentation of colonic

  14. Determinants of Conductive Hearing Loss in Tympanic Membrane Perforation

    PubMed Central

    Park, Hanaro; Hong, Seung No; Kim, Hyo Sang; Han, Jae Joon; Chung, Juyong; Seo, Myung-Whan; Oh, Seung-Ha; Chang, Sun-O

    2015-01-01

    Objectives Tympanic membrane perforations are common, but there have been few studies of the factors determining the extent of the resulting conductive hearing loss. The aims of this study were to determine whether the size of tympanic membrane perforation, pneumatization of middle ear & mastoid cavity, and location of perforation were correlated with air-bone gap (ABG) of patients. Methods Forty-two patients who underwent tympanoplasty type I or myringoplasty were included and preoperative audiometry were analyzed. Digital image processing was applied in computed tomography for the estimation of middle ear & mastoid pneumatization volume and tympanic membrane photograph for the evaluation of perforation size and location. Results Preoperative mean ABG increased with perforation size (P=0.018), and correlated inversely with the middle ear & mastoid volume (P=0.005). However, perforations in anterior versus posterior locations showed no significant differences in mean ABG (P=0.924). Conclusion The degree of conductive hearing loss resulting from a tympanic membrane perforation would be expected with the size of perforation and pneumatization of middle ear and mastoid.

  15. 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)

  16. 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.

  17. Theoretical development of flow into a well through perforations

    SciTech Connect

    Ahmed, G.; Horne, R.N.; Brigham, W.E.

    1990-08-01

    A theoretical solution to flow into a well via perforations is synthesized using Green's functions. The solution is three dimensional and applies to steady-state single phase homogenous flow. The complete solution for a cylindrical perforation involves double infinite summation and triple integration and is difficult to compute. A useful approximation is made by treating the perforation as a line-sink; this reduces the solution to a double infinite summation and a single integration. The solution contains expressions of Bessel functions and their derivatives. The infinite summation is over the order and the argument of these functions. An array of eigenvalues are first computed from an implicit equation. These engienvalues are then used for computation of a solution. The solution involves five physical parameters: wellbore diameter, perforation diameter, perforation length, perforation density (vertical spacing ) and phasing (angular spacing). These parameters influence the cost as well as the efficiency of a well completion. A sensitivity analysis can be done for an optimization of the completion design using this analytical solution. Perforation length is the most important parameter and performance improves with increasing length. Initially, even a small increase in length gives a significant improvement. Perforation density is an important parameter, but beyond an optimum number of shots per foot there is little gain in productivity ratio. This result will lead to a saving of cost, since a higher shot density is generally used by industry. The phasing of perforations influences the performance. A phasing of 90{degrees} in the same horizontal plane or along a spiral gives a significant advantage over 0{degrees} phasing, and this improvement increases with an increase in perforation length. 38 refs., 35 figs., 5 tabs.

  18. Preoperative color Doppler assessment in planning of gluteal perforator flaps.

    PubMed

    Isken, Tonguc; Alagoz, M Sahin; Onyedi, Murat; Izmirli, Hakki; Isil, Eda; Yurtseven, Nagehan

    2009-02-01

    Gluteal artery perforator flaps have gained popularity due to reliability, preservation of the muscle, versatility in flap design without restricting other flap options, and low donor-site morbidity in ambulatory patients and possibility of enabling future reconstruction in paraplegic patients. But the inconstant anatomy of the vascular plexus around the gluteal muscle makes it hard to predict how many perforators are present, what their volume of blood flow and size are, where they exit the overlying fascia, and what their course through the muscle will be. Without any prior investigations, the reconstructive surgeon could be surprised intraoperatively by previous surgical damage, scar formation, or anatomic variants.For these reasons, to confirm the presence and the location of gluteal perforators preoperatively we have used color Doppler ultrasonography. With the help of the color Doppler ultrasonography 26 patients, 21 men and 5 women, were operated between the years 2002 and 2007. The mean age of patients was 47.7 (age range: 7-77 years). All perforator vessels were marked preoperatively around the defect locations. The perforator based flap that will allow primary closure of the donor site and the defect without tension was planned choosing the perforator that showed the largest flow in color Doppler ultrasonography proximally. Perforators were found in the sites identified with color Doppler ultrasonography in all other flaps. In our study, 94.4% flap viability was ensured in 36 perforator-based gluteal area flaps. Mean flap elevation time was 31.9 minutes. We found that locating the perforators preoperatively helps to shorten the operation time without compromising a reliable viability of the perforator flaps, thus enabling the surgeon easier treatment of pressure sores. PMID:19158526

  19. Electrocardiogram and X-ray findings associated with iatrogenic pulmonary venous gas embolism.

    PubMed

    Cooney, Derek R; Kassem, Jawad; McCabe, John

    2011-01-01

    Iatrogenic venous gas embolism (VGE) has been described in cases of patients with hemodialysis catheters and other thoracic central lines. When VGE is present, it may lead to large gas bubbles in the right heart or pulmonary circulation. We reviewed a case of a 52-year-old male hemodialysis patient who inadvertently received an unknown amount of air through a faulty connection in his line during hemodialysis treatment. The patient was symptomatic with chest pain and was found to have an ECG indicative of acute right heart strain and an unusual bulging of his right mediastinum on X-ray. An emergency consult was called for hyperbaric oxygen therapy (HBO2T) due to the known indications for therapy. The patient had a full recovery after HBO2T and had complete relief of his chest pain after compression. Repeat decubitus chest X-ray and ECG post-HBO2T showed resolution of the mediastinal bulge, and ECG had reverted to the patient's baseline tracing. Iatrogenic pulmonary VGE may be diagnosed with the aid of ECG and X-ray findings when correlated with historical and other clinical elements. HBO2 treatment success may be correlated with reversal of ECG and X-ray findings in patients with clinical improvement. PMID:21510269

  20. Iatrogenic major vascular injury during lumbar discectomy: report of three cases.

    PubMed

    Keskin, Metin; Serin, Kursat Rahmi; Genc, Fatih Ata; Aksoy, Murat; Yanar, Fatih; Kurtoglu, Mehmet

    2013-01-01

    Iatrogenic vascular injury rarely occurs during lumbar disc surgery and can be fatal if it is not recognized instantly. In this paper we aim to introduce three iatrogenic vascular injuries that occurred during the lumbar disc surgery. The first case was consulted because of the sudden hypotension attack during lumbar disc surgery. The left common iliac artery and bilateral common iliac vein injuries were detected in emergency laparotomy, and repaired primarily. The second case was consulted to our clinic because of the hypotension attack at the first postoperative day. Left common iliac artery and vein injuries were diagnosed by CT angiography. Left common iliac vein was ligated and left common iliac arterial injury was repaired primarily by laparotomy. The third case was referred to our clinic for left lower extremity ischemia. Left common iliac artery injury was diagnosed by simple physical examination. Reconstruction by PTFE graft interposition was performed. The first patient died due to disseminated intravascular coagulation at the early postoperative period. Pulmonary embolus developed in the iliac vein ligated patient but was well treated by anticoagulant therapy. The last patient was discharged without any problem. Two of the patients are well on long-term follow-up. PMID:23756980

  1. ‘Above all, do no harm’: safeguarding pluripotent stem cell therapy against iatrogenic tumorigenesis

    PubMed Central

    2014-01-01

    Human pluripotent stem cells are the foundations of regenerative medicine. However, the worst possible complication of using pluripotent stem cells in therapy could be iatrogenic cancerogenesis. Nevertheless, despite the rapid progress in the development of new techniques for induction of pluripotency and for directed differentiation, risks of cancerogenic transformation of therapeutically implanted pluripotent stem cells still persist. 'Above all, do no harm', as quoted from the Hippocratic Oath, is our ultimate creed. Therefore, the primary goal in designing any therapeutic regimes involving stem cells should be the elimination of any possibilities of their neoplasmic transformation. I review here the basic strategies that have been designed to attain this goal: sorting out undifferentiated, pluripotent stem cells with antibodies targeting surface-displayed biomarkers; sorting in differentiating cells, which express recombinant proteins as reporters; killing undifferentiated stem cells with toxic antibodies or antibody-guided toxins; eliminating undifferentiated stem cells with cytotoxic drugs; making potentially tumorigenic stem cells sensitive to pro-drugs by transformation with suicide-inducing genes; eradication of differentiation-refractive stem cells by self-triggered transgenic expression of human recombinant DNases. Every pluripotent undifferentiated stem cell poses a risk of neoplasmic transformation. Therefore, the aforementioned or other novel strategies that would safeguard against iatrogenic transformation of these stem cells should be considered for incorporation into every stem cell therapy trial. PMID:25158017

  2. Perforating eye injury in Allegheny County, Pennsylvania.

    PubMed Central

    Landen, D; Baker, D; LaPorte, R; Thoft, R A

    1990-01-01

    From 1980 through 1986, acute perforating eye injury (ICD codes 871.0-871.9) was diagnosed in 345 residents of Allegheny County, Pennsylvania. The mean incidence rate was 3.49 per 100,000 person years. There was no significant change in incidence over the seven-year period. The largest number of injuries occurred among individuals working with tools, of which 47 percent were occupational. Males had a 6.5-fold risk of injury relative to females. Blacks had a risk of 2.2 times that of Whites, mainly due to an excess of assaultive injuries. Individuals who had had recent ocular surgery accounted for 4.6 percent of cases overall, and for 31.6 percent of cases in those over age 60. PMID:2382754

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

    PubMed

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

    2013-07-01

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

  4. Esophageal perforation during or after conformal radiotherapy for esophageal carcinoma

    PubMed Central

    Chen, Hai-yan; Ma, Xiu-mei; Ye, Ming; Hou, Yan-li; Xie, Hua-Ying; Bai, Yong-rui

    2014-01-01

    The aim of this study was to analyze the risk factors and prognosis for patients with esophageal perforation occurring during or after radiotherapy for esophageal carcinoma. We retrospectively analyzed 322 patients with esophageal carcinoma. These patients received radiotherapy for unresectable esophageal tumors, residual tumors after operation, or local recurrence. Of these, 12 had radiotherapy to the esophagus before being admitted, 68 patients had concurrent chemoradiotherapy (CRT), and 18 patients had esophageal perforation after RT (5.8%). Covered self-expandable metallic stents were placed in 11 patients. Two patients continued RT after stenting and control of infection; one of these suffered a new perforation, and the other had a massive hemorrhage. The median overall survival was 2 months (0–3 months) compared with 17 months in the non-perforation group. In univariate analysis, the Karnofsky performance status (KPS) being ?70, age younger than 60, T4 stage, a second course of radiotherapy to the esophagus, extracapsular lymph nodes (LN) involving the esophagus, a total dose >100 Gy (biologically effective dose?10), and CRT were risk factors for perforation. In multivariate analysis, age younger than 60, extracapsular LN involving the esophagus, T4 stage, and a second course of radiotherapy to the esophagus were risk factors. In conclusion, patients with T4 stage, extracapsular LN involving the esophagus, and those receiving a second course of RT should be given particular care to avoid perforation. The prognosis after perforation was poor. PMID:24914102

  5. Local Skin Warming Enhances Color Duplex Imaging of Cutaneous Perforators.

    PubMed

    Li, Haizhou; Du, Zijing; Xie, Feng; Zan, Tao; Li, QingFeng

    2015-07-01

    The perforator flap is one of the most useful techniques in reconstructive surgery. The operative procedure for these flaps will be greatly simplified if accurate localization of the course of the perforator can be preoperatively confirmed. However, small vessels with diameters less than 0.5 mm cannot be readily traced with conventional imaging techniques. Local skin warming temporarily increases cutaneous blood flow and vasodilation. In this study, we established a local skin warming procedure, and performed this before color duplex imaging to improve preoperative perforator mapping and enable precise flap design. PMID:23903089

  6. Perforation of a Long-standing Ileocolonic Anastomosis During Colonoscopy

    PubMed Central

    Phillips, Benjamin; McCue, Peter; Baliff, Jeffrey; Kastenberg, David

    2015-01-01

    Colonoscopy is a valuable diagnostic and therapeutic procedure. Colonic perforation is a serious complication of colonoscopy that must be promptly recognized to limit morbidity and mortality. We present a 69-year-old woman who, during colonoscopy, had a perforation secondary to barotrauma of a long-standing ileocolonic anastomosis proximal to the point of colonoscopic intubation. To our knowledge, this is the first case report of a perforation of a well-established anastomosis proximal to the point of endoscope intubation during colonoscopy.

  7. Time to Appendectomy and Risk of Perforation in Acute Appendicitis

    PubMed Central

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

    2014-01-01

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

  8. Biliary peritonitis due to gall bladder perforation after percutaneous nephrolithotomy

    PubMed Central

    Ranjan, Nikhil; Singh, Rana Pratap; Tiwary, Rajesh

    2015-01-01

    A 19-year-old male patient underwent right percutaneous nephrolithotomy (PNL) for right renal 1.5 × 1.5 cm lower pole stone. The procedure was completed uneventfully with complete stone clearance. The patient developed peritonitis and shock 48 h after the procedure. Exploratory laparotomy revealed a large amount of bile in the abdomen along with three small perforations in the gall bladder (GB) and one perforation in the caudate lobe of the liver. Retrograde cholecystectomy was performed but the patient did not recover and expired post-operatively. This case exemplifies the high mortality of GB perforation after PNL and the lack of early clinical signs.

  9. Relationship between duodenal cytosolic aconitase activity and iron status in the mouse.

    PubMed

    Rabie, A; Simpson, R J; Bomford, A; Cunninghame-Graham, D; Peters, T J

    1995-12-14

    Cytosolic aconitase activity was assayed in duodenal mucosa from mice subjected to a variety of manipulations known to modulate duodenal iron status and duodenal iron absorption. No changes in cytosolic aconitase activity were observed 1 h after oral FeSO4 dosing or intramuscular desferrioxamine treatment. Three days of hypoxic exposure and two weeks treatment with intramuscular iron dextran also had no effect on cytosolic aconitase. Three weeks growth on an iron deficient diet significantly reduced cytosolic aconitase activity. In no situation was there any evidence for significant amounts of inactive aconitase which could be activated in vitro with FeSO4/cysteine. These data suggest that duodenal cytosolic aconitase is not sensitive to acute changes in mucosal iron levels and is generally much less sensitive to body iron status than is duodenal iron absorption. There is evidence that chronic iron depletion reduces cytosolic aconitase to a relatively small degree but generally activity is maintained, consistent with an important metabolic role for the enzyme. PMID:8541321

  10. Effect of cysteamine on redox-sensitive thiol-containing proteins in the duodenal mucosa.

    PubMed

    Khomenko, Tetyana; Deng, Xiaoming; Jadus, Martin R; Szabo, Sandor

    2003-10-01

    Recent studies from our laboratory demonstrated that Egr-1 is upregulated in the rat duodenal mucosa during cysteamine-induced duodenal ulceration and that antisense egr-1 oligonucleotide aggravates the duodenal ulcers. This study was aimed to determine the effects of cysteamine on redox-sensitive Egr-1 transcriptional activity and on other thiol-containing proteins such as redox factor-1 (Ref-1) and thioredoxin (Trx). Here we demonstrate for the first time that cysteamine increases the expression and nuclear translocation of Egr-1, Ref-1, and Trx, and activates binding of Egr-1 to DNA. Moreover, we also show that Egr-1 forms a complex with other redox-sensitive transcription factors (e.g., AP-1, AP-2, NFATc, Sp1, PAX-5, MTF-1, c-Myb, and CREB) in rat duodenal mucosa and that cysteamine enhances the formation of these complexes. The antioxidant ebselen markedly elevated the nuclear Ref-1 expression and Egr-1/DNA binding, and decreased the ulcerogenic effect of cysteamine as did catalase. Thus, redox-sensitive signaling systems seem to play an important role in cysteamine-induced duodenal ulceration. PMID:13679060

  11. An investigation of critical parameters for optimum perforation clean-up

    SciTech Connect

    Hovem, K.; Joeranson, H.; Espedal, A. [Statoil, Stavanger (Norway); Wilson, S. [TerraTek, Inc., Salt Lake City, UT (United States)

    1995-12-31

    Field data presented in the paper suggest that an open-choke perforating practice improves perforation clean-up. An experimental and numerical investigation of this technique confirmed that an open-choke perforating practice leads to higher core flow efficiency compared to closed-choke perforating with subsequent clean-up flow.

  12. AIP/123-QED Acoustic properties of plates with unevenly distributed macro perforations backed by

    E-print Network

    Paris-Sud XI, Université de

    AIP/123-QED Acoustic properties of plates with unevenly distributed macro perforations backed with macro- perforations that can be unevenly distributed on the plate surface and backed by woven or precision woven meshes with microscopic perforations is pro- posed. The plate perforations may

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

    E-print Network

    Yakovlev, Vadim

    Modeling of Microwave Ovens with Perforated Metal Walls Erin M. Kiley and Vadim V. Yakovlev ovens with perforated regions of metal walls. The technique relies on replacement of perforated segments-parameters obtained by FDTD simulation of a perforated sheet in a waveguide. This approach is employed in FDTD

  14. Toxic dilatation and perforation in inflammatory bowel disease.

    PubMed Central

    Schofield, P. F.

    1982-01-01

    The diagnosis and management of dilatation of the colon and free intestinal perforation in inflammatory or infective bowel disease are reviewed with reference to 32 cases seen during an 8-year period. Toxic dilatation of the colon occurred in 20 patients, including 6 with infective colitis. Ileostomy with subtotal colectomy and mucous fistula is a satisfactory operation for toxic dilatation due to inflammatory bowel disease. Patients with infective colitis can generally be treated without operation. Free intestinal perforation was seen in 12 patients. Colonic perforation may occur in association with toxic dilatation, but more usually it occurs without dilatation as a complication of Crohn's disease. Free perforation of the ileum was seen after a short illness in patients with Crohn's disease. PMID:7114766

  15. Oblique Perforation of Thick Metallic Plates by Rigid Projectiles

    NASA Astrophysics Data System (ADS)

    Chen, Xiaowei; Li, Qingming; Fan, Saucheong

    2006-08-01

    Oblique perforation of thick metallic plates by rigid projectiles with various nose shapes is studied in this paper. Two perforation mechanisms, i.e., the hole enlargement for a sharp projectile nose and the plugging formation for a blunt projectile nose, are considered in the proposed analytical model. It is shown that the perforation of a thick plate is dominated by several non-dimensional numbers, i.e., the impact function, the geometry function of projectile, the non-dimensional thickness of target and the impact obliquity. Explicit formulae are obtained to predict the ballistic limit, residual velocity and directional change for the oblique perforation of thick metallic plates. The proposed model is able to predict the critical condition for the occurrence of ricochet. The proposed model is validated by comparing the predictions with other existing models and independent experimental data.

  16. Pulmonary Artery Perforation Repair During Thrombectomy Using Microcoil Embolization

    SciTech Connect

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

    2006-02-15

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

  17. Transmission of Microwave Through Perforated Flat Plates of Finite Thickness

    Microsoft Academic Search

    Chao-Chun Chen

    1973-01-01

    Transmission characteristics of a thick conducting plate perforated with either circular or rectangular holes are presented. Simple explicit formulas for predicting energy leakage through a reflector surface are derived.

  18. Enterocutaneous Fistula From A Billroth II Afferent Limb: Successful Closure With Endoclips

    PubMed Central

    Knodell, Robert; Choueiri, Nabil

    2014-01-01

    Recently, indications for endoscopic clips have expanded to include closure of gastrointestinal fistulae and perforations. A 62-year-old man with remote history of surgery for peptic ulcer underwent right hemicolectomy for a large hepatic flexure mass with proximal colonic dilatation. During surgery, inadvertent pinpoint duodenotomy of the afferent Billroth II limb resulted in a duodeno-cutaneous fistula. Despite total parental nutrition, cutaneous bile drainage persisted. The duodenal fistula was closed during upper endoscopy using three endoclips. Cutaneous bile drainage stopped, and the abdominal wall defect healed. This is the first published case of endoclip closure of an iatrogenic duodenal fistula from a Billroth II afferent limb.

  19. The effects of ruminal and duodenal casein infusion on dry matter (DM) intake of red clover silage and rumen pool

    E-print Network

    Boyer, Edmond

    The effects of ruminal and duodenal casein infusion on dry matter (DM) intake of red clover silage clover-timothy (75:25) silage fed ad libitum. Four ruminally and duodenally cannulated Ayrshire cows, J Anim Sci, 70, 3528-3540). Ruminal casein infusion tended to increase (P

  20. 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

  1. 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

  2. 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

  3. Iatrogenic hyperadrenocorticism during topical steroid therapy: assessment of systemic effects by metabolic criteria.

    PubMed

    Cook, L J; Freinkel, R K; Zugerman, C; Levin, D L; Radtke, R

    1982-06-01

    Systemic absorption of topically applied glucocorticoids in quantities sufficient to replace endogenous production is not uncommon. However, iatrogenic Cushing's syndrome resulting from the use of topical corticosteroids is very rare. Thus the possibility that systemic absorption may cause hyperglucocorticism has been deemphasized and examined only sporadically. We have studied changes in carbohydrate metabolism induced by topical glucocorticoids in a psoriatic patient who had developed Cushing's syndrome from topical desoximetasone (Topicort). The results indicated that (1) fasting hyperglycemia and increased insulin-glucose ratios could be induced within 24 hours of administration of topical glucocorticoids, (2) insulin resistance accompanied abnormal carbohydrate tolerance, and (3) fluctuations in circulating leukocytes paralleled the changes in carbohydrate metabolism. The findings suggest that metabolic indexes of glucocorticoid action action may provide useful parameters for assessing systemic absorption of topical glucocorticoids. glucose relationship as one such index to assess the risk of treatment of extensive chronic skin disease with potent topical glucocorticoids. PMID:7047591

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

    PubMed

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

    2014-05-01

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

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

    SciTech Connect

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

    1998-03-15

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

  6. 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.

  7. Influence of overall structural response on perforation of concrete targets

    Microsoft Academic Search

    Q. M. Li; Z. Q. Ye; G. W. Ma; S. R. Reid

    2007-01-01

    The influence of the overall structural response on the perforation of a concrete target is studied in this paper. The local perforation of the concrete target is idealized as a combined penetration and cone-plugging model. The overall structural response is simplified as an elastic, perfectly-plastic single degree of freedom (SDoF) model. A dimensional analysis is conducted to identify influential non-dimensional

  8. Wave interaction with a new type perforated breakwater

    Microsoft Academic Search

    Yong Liu; Yucheng Li; Bin Teng

    2007-01-01

    In this study examined is the wave interaction with a new modified perforated breakwater, consisting of a perforated front\\u000a wall, a solid back wall and a wave absorbing chamber between them with a two-layer rock-filled core. The fluid domain is divided\\u000a into three sub-domains according to the components of the breakwater. Then by means of the matched eigenfunction expansion\\u000a method,

  9. Magnet induced perforated appendicitis and ileo-caecal fistula formation

    PubMed Central

    Robinson, Andrew J; Bingham, Janne; Thompson, Ronald LE

    2009-01-01

    Foreign body ingestion is a common paediatric problem. In the majority of cases spontaneous passage occurs. Magnet ingestion is rare and solitary magnet ingestion usually does not cause any complications. A number of gastrointestinal complications have been reported, such as fistula formation, perforation and volvulus following multiple magnet ingestion. We review magnet ingestion and describe the first case in the literature of magnet induced perforated appendicitis with an associated ileo-caecal fistula. PMID:19252721

  10. 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

  11. Tacalcitol in the Treatment of Acquired Perforating Collagenosis

    PubMed Central

    Escribano-Stablé, J.C.; Doménech, C.; Matarredona, J.; Pascual, J.C.; Jaen, A.; Vicente, J.

    2014-01-01

    Acquired perforating collagenosis (APC) is a rare perforating dermatosis characterized by transepidermal collagen elimination. We describe a 65-year-old patient, with long-standing type 2 diabetes mellitus and a 2-year history of itchy hyperkeratotic nodules situated on the back, who was subsequently diagnosed with APC. Treatment included topical corticosteroids and antihistamines, without improvement of the lesions. However, therapy with topical tacalcitol administered for 2 months produced a significant response leading to complete remission of APC. PMID:24707254

  12. [Dependence of clinical course and outcome of chronic duodenitis on some features of its pathogenesis].

    PubMed

    Bogachev, R S

    1996-01-01

    The effects of acid, infectious (Helicobacter pylori) and neuroendocrine factors on the course and outcome of chronic duodenitis were studied in 57 patients aged 15-35 years. Within 5-year follow-up ulcer emerged in 26% of duodenitis patients. Ulceration occurred as a result of high acid production in the basal and stimulated phases, contamination of pyloric-antral mucosa with Helicobacter pylori, unbalance of serum hormones T4, TTH, FSH, ACTH. In risk of ulcerogenesis there were psychological shifts with appearance of pathological reaction to the disease. Consideration of pathogenetic specificity of different duodenitis forms and basing on objective and subjective criteria allow identification of ulcer risk group and early start of optimal therapy. PMID:8926702

  13. Size of typmanic membrane perforation and hearing loss.

    PubMed

    Bhusal, C L; Guragain, R P S; Shrivastav, R P

    2006-01-01

    This prospective study was done to assess the level of preoperative hearing impairment in different sizes of pars tensa perforation in patients with chronic suppurative otitis media (CSOM) tubo-tympanic type undergoing myringoplasty. A total of 50 patients were recruited from the outpatient Department of Otorhinolaryngology - Head and Neck Surgery from June 2003 to May 2004. Cases of CSOM tubo-tympanic type with dry central perforation, conductive type of hearing loss were subjected to myringoplasty. Preoperative audiometric evaluations were done. While operating under microscope diameter of perforations were measured and perforations were grouped according to the size. It was observed that greater hearing loss was reported in group D perforation (44 dB), where as in group A, it was 31 dBHL. The average hearing loss at 500 Hz was 46.40 dB, at 1000 Hz was 30.90 dB and at 2000 Hz it was 31.9 dB. This shows that the hearing loss is more at lower frequencies and less as the frequencies increase. This study shows that as the size of perforation is increased, the hearing loss also increases. The hearing loss is more marked at lower frequencies as compared to higher frequencies. PMID:17160091

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

    PubMed

    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

  16. Resolving sphincter of Oddi incontinence for primary duodenal Crohn's disease with strictureplasty

    PubMed Central

    Alemanno, G.; Sturiale, A.; Bellucci, F.; Giudici, F.; Tonelli, F.

    2012-01-01

    INTRODUCTION Crohn's involvement of duodenum is a rare event and may be associated to proteiform symptoms and uncommon pathological aspects which make diagnosis and treatment complex. PRESENTATION OF CASE The peculiar aspect of this case was a suspected duodeno-biliary fistula. The patient (female, 22 years old) was affected by duodenal Crohn's disease. Magnetic resonance imaging showed a dilated common bile duct, whose final part linked to a formation containing fluid, and characterized by filling of the contrast medium in the excretory phase. Abdominal ultrasound showed intra-hepatic and intra-gallbladder aerobilia. At surgery, the duodenum was mobilized showing an inflammatory stricture and a slight dilatation of the common bile duct, with no signs of fistulas. The opened duodenum was anastomized side to side to a transmesocolic loop of the jejunum. After surgery, the general condition of the patient improved. DISCUSSION Only two cases of fistula between a narrow duodenal bulb and the common bile duct have been described in literature and the Authors were not be able to verify the occurrence of a duodenal biliary fistula at surgery. The association between duodenal Crohn's disease and Sphincter of Oddi incontinence is a very rare finding with different etiology: chronic intestinal pseudo-obstruction, common bile duct stones, progressive systemic sclerosis. CONCLUSION The treatment to resolve Sphincter of Oddi incontinence for primary duodenal Crohn's disease is not clear. Strictureplasty could be the treatment of choice, because, resolving the stricture, the duodenal pressure is likely to decrease and the reflux through the incontinent sphincter can be avoided. PMID:23276753

  17. Factors That Influence Perforator Thrombosis and Predict Healing Perforator Sclerotherapy for Venous Ulceration Without Axial Reflux

    PubMed Central

    Kiguchi, Misaki M.; Hager, Eric S.; Winger, Daniel G.; Hirsch, Stanley A.; Chaer, Rabih A.; Dillavou, Ellen D.

    2014-01-01

    OBJECTIVES Refluxing perforators contribute to venous ulceration. We sought to describe patient characteristics and procedural factors that (1) impact rates of incompetent perforator vein (IPV) thrombosis with ultrasound-guided sclerotherapy (UGS) and (2) impact the healing of venous ulcers (CEAP 6) without axial reflux. METHODS Retrospective review of UGS of IPV injections from 1/2010–11/2012 identified 73 treated venous ulcers in 62 patients. Patients had no other superficial/axial reflux and were treated with standard wound care and compression. Ultrasound was used to screen for refluxing perforators near ulcer(s), and these were injected with sodium tetradecyl sulfate or polidocanol foam and assessed for thrombosis at 2 weeks. Demographic data, comorbidities, treatment details and outcomes were analyzed. Univariate and multivariable modeling was performed to determine covariates predicting IPV thrombosis and ulcer healing. RESULTS 62 patients with active ulcers for an average of 28 months with compression therapy prior to perforator treatment had an average age of 57.1 years, were 55% male, 36% had a history of DVT and 30% had deep venous reflux. 32 patients (52%) healed ulcers, while 30 patients (48%) had non-healed ulcer(s) in mean follow-up of 30.2 months. Ulcers were treated with 189 injections, with average thrombosis rate of 54%. Of 73 ulcers, 43 ulcers healed (59%), and 30 ulcers did not heal (41%). Patients that healed ulcers had an IPV thrombosis rate of 69 % vs. 38% in patients who did not heal (P<.001). Multivariate models demonstrated male gender and warfarin use negatively predicted thrombosis of IPVs (P=.03, P=.01). Multivariate model for ulcer healing found complete IPV thrombosis was a positive predictor (P=.02), while large initial ulcer area was a negative predictor (P=.08). Increased age was associated with fewer ulcer recurrences (P=.05). Hypertension and increased follow-up time predicted increased ulcer recurrences (P=.04, P=.02). Calf vein thrombosis occurred after 3% (6/189) of injections. CONCLUSIONS Thrombosis of IPVs with UGS increases venous ulcer healing in a difficult patient population. Complete closure of all IPVs in an ulcerated limb was the only predictor of ulcer healing. Men and patients on warfarin have decreased rates of IPV thrombosis with UGS. PMID:24406088

  18. Simulating Perforation Permeability Damage and Cleanup

    SciTech Connect

    Morris, J.P.; Lomov, I.N.; Glenn, L.A.

    2000-09-01

    Completion of cased and cemented wells by shaped charge perforation causes its own damage to the formation, potentially reducing well productivity. In practice it is found that underbalance conditions clean up the damaged zone to some extent, however, the mechanisms of these processes are poorly understood. Most hydrocodes typically used to simulate rock response to shaped charge penetration do not provide permeability estimates. Furthermore, the time scales for formation clean up are potentially much longer than the period of jet penetration. We have developed a simple, yet accurate model for the evolution of porosity and permeability which can easily be incorporated into existing hydrocodes using information from the history of each cell. In addition, we have developed a code that efficiently simulates fines migration during the post-shot surge period using initial conditions taken directly from hydrocode simulations of jet penetration. Results from a one-dimensional model simulation are in excellent agreement with measured fines and permeability distributions. We also present two-dimensional numerical results which qualitatively reproduce experimentally obtained permeability maps for different values of underbalance. Although initial results have been promising, further comparison with experiment is essential to tune the coupling between the hydrocode and fines migration simulator. Currently the permeability model is most appropriate for high permeability sandstones (such as Berea), but with little effort, the model can be extended to other rock types, given sufficient experimental data.

  19. Simulating perforation permeability damage and cleanup

    SciTech Connect

    Morris, J P; Lomov, I N; Glenn, L A

    2000-12-15

    Completion of cased and cemented wells by shaped charge perforation causes its own damage to the formation, potentially reducing well productivity. In practice it is found that underbalance conditions clean up the damaged zone to some extent, however, the mechanisms of these processes are poorly understood. Most hydrocodes typically used to simulate rock response to shaped charge penetration do not provide permeability estimates. Furthermore, the time scales for formation clean up are potentially much longer than the period of jet penetration. We have developed a simple, yet accurate model for the evolution of porosity and permeability which can easily be incorporated into existing hydrocodes using information from the history of each cell. In addition, we have developed a code that efficiently simulates fines migration during the post-shot surge period using initial conditions taken directly from hydrocode simulations of jet penetration. Results from a one-dimensional model simulation are in excellent agreement with measured permeability distributions. We also present two-dimensional numerical results which qualitatively reproduce experimentally obtained permeability maps for different values of underbalance. Although initial results have been promising, further comparison with experiment is essential to tune the coupling between the hydrocode and fines migration simulator. Currently the permeability model is most appropriate for high permeability sandstones (such as Berea), but with little effort, the model can be extended to other rock types, given sufficient experimental data.

  20. 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.

  1. Neonatal gastric perforation: A single center experience

    PubMed Central

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

    2014-01-01

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

  2. PATTERN OF TYMPANIC MEMBRANE PERFORATION IN IBADAN: A RETROSPECTIVE STUDY

    PubMed Central

    Olowookere, S.A; Ibekwe, T.S; Adeosun, A.A.

    2008-01-01

    Background: Tympanic membrane perforations vary in size, shape and position. The degree of conductive deafness varies with the size and position of the tympanic membrane perforation. Objective: This study is to determine the pattern and causes of tympanic membrane perforation. Method: Hospital based study at the ENT Clinic, UCH, Ibadan. Consecutive patients seen during the period of study with ear symptoms were interviewed and examined by ENT surgeons. This information was entered into computer and analyzed using SPSS v 11. Result: Thirty-three (13.5%) of the 244 patients were found to have tympanic membrane perforation. Fifteen (45.5%) patients were new while 18 (54.5%) were follow up patients. There were 13 (39.4%) males and 20 (60.6%) females. The type of perforation seen were central 57.6%, subtotal 33.3%, total 6.1%, marginal 3.0%. The sides affected were left ear 45.5%, right ear 15.2%, and both ears 39.4%. The causes found were chronic suppurative otitis media (CSOM) 90.9%, acute suppurative otitis media (ASOM) 6.1%, and trauma to the affected ear 3.0%. CSOM was the cause of tympanic membrane perforation seen in children. Conclusion: There is need for early diagnosis and treatment of all cases of tympanic membrane perforation and proper education of parents and guardians on proper method of ear care and early referral. There is also need to train all healthcare workers especially primary health care providers on how to manage these cases. PMID:25161451

  3. Distal common bile duct stenosis secondary to benign duodenal ulceration: report of a case.

    PubMed

    Van Steenbergen, W; Ponette, E; Marchal, G; Fevery, J; De Groote, J

    1990-01-01

    Obstructive jaundice is a very rare complication of peptic ulcer disease. We report a patient who presented with symptoms suggestive of malignant distal common bile duct stenosis. A final diagnosis of benign duodenal ulcer with stricture of the common bile duct was made. A short review of the literature is also presented. PMID:2340997

  4. Imbalance in the composition of the duodenal microbiota of children with coeliac disease

    Microsoft Academic Search

    Inmaculada Nadal; Esther Donant; Carmen Ribes-Koninckx; Miguel Calabuig; Yolanda Sanz

    2007-01-01

    Coeliac disease (CD) is the most common immune-mediated enteropathy characterized by chronic inflammation of the small intestinal mucosa. The ingestion of gluten is responsible for the symptoms of CD, but other environmental factors are also thought to play a role in this disorder. In this study, the composition of the duodenal microbiota of coeliac children with active disease, symptom-free CD

  5. Cystic dystrophy of the duodenal wall is not always associated with chronic pancreatitis

    PubMed Central

    Pezzilli, Raffaele; Santini, Donatella; Calculli, Lucia; Casadei, Riccardo; Morselli-Labate, Antonio Maria; Imbrogno, Andrea; Fabbri, Dario; Taffurelli, Giovanni; Ricci, Claudio; Corinaldesi, Roberto

    2011-01-01

    Cystic dystrophy of the duodenal wall is a rare form of the disease which was described in 1970 by French authors who reported the presence of focal pancreatic disease localized in an area comprising the C-loop of the duodenum and the head of the pancreas. German authors have defined this area as a “groove”. We report our recent experience on cystic dystrophy of the paraduodenal space and systematically review the data in the literature regarding the alterations of this space. A MEDLINE search of papers published between 1966 and 2010 was carried out and 59 papers were considered for the present study; there were 19 cohort studies and 40 case reports. The majority of patients having groove pancreatitis were middle aged. Mean age was significantly higher in patients having groove carcinoma. The diagnosis of cystic dystrophy of the duodenal wall can now be assessed by multidetector computer tomography, magnetic resonance imaging and endoscopic ultrasonography. These latter two techniques may also add more information on the involvement of the remaining pancreatic gland not involved by the duodenal malformation and they may help in differentiating “groove pancreatitis” from “groove adenocarcinoma”. In conclusion, chronic pancreatitis involving the entire pancreatic gland was present in half of the patients with cystic dystrophy of the duodenal wall and, in the majority of them, the pancreatitis had calcifications. PMID:22110260

  6. 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.

  7. Intramural Duodenal Hematoma with Acute Pancreatitis in a Patient With an Overt Pancreatic Malignancy

    PubMed Central

    Shah, Apeksha; Ali, Ijlal; Islam, Raafa; Siddiqui, Ali A.

    2014-01-01

    Intramural hematomas have rarely been associated with pancreatitis, and to date there is only 1 case report of an intramural hematoma occurring with pancreatic adenocarcinoma. We describe a patient who presented with gastric outlet obstruction secondary to a spontaneous intramural duodenal hematoma and was found to have a pancreatic adenocarcinoma on endoscopic ultrasound (EUS) after it was not visualized by computed tomography (CT).

  8. Effect of food on H2-receptor blockade in normal subjects and duodenal ulcer patients

    Microsoft Academic Search

    H S Merki; F Halter; C Wilder-Smith; P Allemann; L Witzel; M Kempf; J Roehmel; R P Walt

    1990-01-01

    Two separate studies of 24 hour intragastric acidity were carried out in normal volunteers and duodenal ulcer patients to define the interaction of food and the antisecretory effects of H2-receptor blockers. Both investigations were double blind randomised comparisons using ranitidine 300 mg with either different meal times or ad libitum snacks after an evening meal. Meals taken after drug administration

  9. [5-fluorouracil treatment of acute pancreatitis and of pancreatic and duodenal fistulae].

    PubMed

    Georgescu, T; Naftali, Z; Varga, A; Simon, G; Pan?, C; Cr?ciun, C; Nistor, V; Ilniczky, P; Bo?ianu, A; Kovács, M

    1990-01-01

    In acute pancreatitis the mechanism involved in the auto-amplification of morbid phenomena can be suppressed in most of the cases by inhibiting the pancreatic secretion. This can also enhance the repair of pancreatic, duodenal and jejunal fistulae. On the basis of experimental studies carried out by Johnson, and on the clinical studies of Guttmann, as well as on original studies done by the authors, Ftorafur was included in the complex therapy of acute pancreatitis, and of pancreatic and duodenal fistulae. A group of 14 cases of acute pancreatitis, were treated. These included 5 necrotic-haemorrhagic pancreatitis, and 9 oedematous pancreatitis. The drug was given by continuous intravenous perfusion in doses of 1,200-1,600 mg per day, for a period of 6-12 days. In all the cases the clinical improvement of the patients as well as recovery of normal values of blood amylase were spectacular, and full recovery was achieved in all the cases. Ftorafur was also used in 3 cases of pancreatic fistulae, and in 2 cases of duodenal fistulae, and recovery was also achieved in a very short time. On the basis of this experience, although small, the authors recommend the introduction of Ftorafur in the complex therapy of acute pancreatitis, as well as in that of pancreatic and duodenal fistulae. Following administration of Ftorafur no adverse effects were noted, and in the doses mentioned above this drug did not delay the repair of surgical wounds. PMID:2149191

  10. 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

  11. Duodenal carbonic anhydrase: mucosal protection, luminal chemosensing, and gastric acid disposal.

    PubMed

    Kaunitz, Jonathan D; Akiba, Yasutada

    2006-09-01

    The duodenum serves as a buffer zone between the stomach and jejunum. Over a length of only 25 cm, large volumes of strong acid secreted by the stomach must be converted to the neutral-alkaline chyme of the hindgut lumen, generating large volumes of CO2, which the duodenum then absorbs. The duodenal mucosa consists of epithelial cells connected by low-resistance tight junctions, forming a leaky epithelial barrier. Despite this high permeability, the epithelial cells, under intense stress from luminal mineral acid and highly elevated P(CO2), maintain normal functioning. Furthermore, the duodenum plays an active role in foregut acid-base homeostasis, absorbing large amounts of H+ and CO2 that are recycled by the gastric parietal cells. Prompted by the high expression of cytosolic and membrane carbonic anhydrase (CAs) in duodenal epithelial cells, and the intriguing observation that CA activity appears to augment cellular acid stress, we formulated a novel hypothesis regarding the role of CA in duodenal acid absorption, epithelial protection, and chemosensing. In this review, we will describe how luminal CO2/H+ traverses the duodenal epithelial cell brush border membrane, acidifies the cytoplasm, and is sensed in the subepithelium. PMID:17008801

  12. Determination of the Ruminal Escape Value and Duodenal Amino Acid Flow of Rapeseed Meal

    Microsoft Academic Search

    G. P. Lardy; G. E. Catlett; M. S. Kerley; J. A. Paterson

    ABSTRACT: A 4 x 4 Latin square metabolism,trial was conducted to evaluate protein escape potential, duodenal amino acid (AA) flows, and ruminal diges- tion effects of rapeseed,meal,(RSM) when,fed with non-endophyte-infected,tall fescue, .05) by

  13. Early Endoscopy of Oesophagus, Stomach, and Duodenal Bulb in Patients with Haematemesis and Melaena

    Microsoft Academic Search

    P. B. Cotton; M. T. Rosenberg; R. P. L. Waldram; A. T. R. Axon

    1973-01-01

    Oesophago-gastro-duodenoscopy was successfully performed in 196 of 208 patients admitted with haematemesis or melaena, or both. A precise visual diagnosis was made in 80% of all patients and in 96% of those where the final diagnosis lay within the oesophagus, stomach, and first two parts of the duodenum. Bleeding oesophagitis was more common and bleeding duodenal ulcer less common than

  14. 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

  15. 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

  16. Laparoscopic repair of duodenal atresia in a low birth weight neonate.

    PubMed

    Rosales-Velderrain, Armando; Betancourt, Abraham; Alkhoury, Fuad

    2014-09-01

    The small volume of the infant abdomen limits the application of laparoscopic procedures. We successfully repaired a duodenal atresia in a 2-kg female infant using a standard diamond-shaped anastomosis and intracorporeal suturing and knot-tying techniques. Anesthesia and positive pressure ventilation assured adequate gas exchange during pneumoperitoneum during the procedure. PMID:25197863

  17. Effect of pentagastrin on histamine output from the stomach in patients with duodenal ulcer

    Microsoft Academic Search

    W K Man; J H Saunders; C Ingoldby; J Spencer

    1981-01-01

    The role of histamine in acid secretion is controversial. Improvements in the techniques of histamine assay allow a better assessment of the relationship of histamine to acid secretion. Patients with duodenal ulcers were studied to determine the mucosal histamine responses to pentagastrin stimulation to relate the appearance of histamine in the gastric juice to acid production during stimulation, and to

  18. PREDICTING EQUATIONS OF N DUODENAL FLOW IN DAIRY CATTLE EFFECTS OF LEVEL OF FEEDING AND PROPORTION

    E-print Network

    Boyer, Edmond

    take into account the needs of microorganisms for soluble nitrogen degrada- ble in ammonia. The two was to predict the Non Ammonia Nitrogen (NAN) duodenal flow for dairy cows (principally) at different levels prece- ding factors and the level of energy supply compared to energy needs were studied. Material

  19. 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

  20. Characterizing flow through a perforation using ultrasonic Doppler

    SciTech Connect

    Razi, M.; Morriss, S.L.; Podio, A.L.

    1995-12-31

    The flow velocity of the one dimensional, single phase flow within an individual perforation is determined using an ultrasonic Doppler technique. This new technique takes advantage of the fact that flow in an individual perforation is often single phase even when flow in the wellbore is not. Existing techniques for determining multi-phase flow rates in a well bore have many limitations, due in large part to the complexity of the many possible flow regimes. An innovative approach which partially circumvents this problem has been investigated experimentally. Work has been done using an experimental set-up simulating a well bore, with water as the fluid. Since the diameter of perforations for a known gun type and casing can be reasonably estimated, flow rate within an individual perforation can be determined from velocity. Comparison of the calculated flow rates with actual flow rates are encouraging, both in turbulent and laminar flows. It is envisioned that a televiewer-like tool could be developed to scan the entire perforated interval while logging, providing a complete description of flow entries and exits.

  1. Advances in understanding perforator penetration and flow performance

    SciTech Connect

    Halleck, P.M. [Pennsylvania State Univ., University Park, PA (United States)

    1994-12-31

    Planning of optimum completion procedures and interpretation of well test results require accurate estimates of perforation penetration and flow performance. New test procedures and results promise improved estimates of in situ penetration depths. The nature of perforation damage and underbalance surge mechanism are being studied using new flow tests supplemented by X-ray CT and pressure transient analysis. Some recent observations are: (1) permeability and mechanical damage may extend several inches from the perforation and is not limited to the visible crushed zone; (2) permeability damage is less severe near the tip of the perforation; (3) for low viscosity fluid and high permeability rock, the majority of surge cleanup occurs in less than 1 second. Surge flow volume is not an important factor, as long as sufficient underbalance is used. New models of perforation cleanup assume cleanup of debris and/or formation permeability damage depends on Darcy flow velocity exceeding a critical value. The critical velocity depends on rock and fluid properties and may be related to Reynold`s number. Such models illustrate the dynamics of cleanup and confirm that most of the cleanup occurs at early times and after small surge volumes.

  2. Estimating perforation flow performance from variations in indentation hardness

    SciTech Connect

    Halleck, P.M. [Pennsylvania State Univ., University Park, PA (United States); Poyol, E.; Santarelli, F.J.

    1995-12-01

    The authors mapped the hardness of the rock surrounding shaped-charge perforations with an indentation technique based on the Brinell method. They fired conventional perforators (3.2-g explosive weight) into a friable sandstone (approximately 6.9 MPa unconfined compressive strength) under 10.3 MPa effective stress. They observed substantial reductions in hardness extending more than 10 cm away from the perforation tunnel. The severity and extent of the damage wa snot uniform and was greatest near the perforation at the entrance hole, decreasing toward its tip. A comparison with a similar test with a drilled hole demonstrated that the observed damage was caused by the impact of the shaped-charge jet on the rock. The extent of the damage was independent of the diameter of the rock specimen used during the test. By assuming that permeability reduction is proportional to mechanical damage (i.e., hardness reduction), they obtained numerical simulations of flow rate and distribution. The calculated flow rates were consistent with those measured after perforating the samples. Careful analysis of the data suggested that the mechanical damage and permeability reduction were related to increases in finer particle sizes and smaller pore sizes that were observed by other workers. These led to increased tortuosity in the flow paths.

  3. Optimizing perforation performance for the Armada gas condensate development

    SciTech Connect

    Bird, K.; Dunmore, S.

    1995-12-31

    The Armada field development will bring onto production three gas condensate discoveries in Quadrants 16 and 22 of the Central Area of the United Kingdom (UK), North Sea. The largest field, Fleming, will be developed concurrently with the other two deeper reservoirs, Drake and Hawkins. Over one trillion cubic feet of recoverable gas are present. Peak platform production rates of 450 MMscf/d will initially be obtained from eight wells. The degree of underbalance has a significant impact on well performance and perforation geometry. This paper presents an experimental study to evaluate the effect of underbalance on perforation performance in the Fleming gas-condensate reservoir. Fleming analogue rock cores were perforated with single shaped charge perforators, and flow tested under simulated downhole conditions. Nitrogen gas was used as the pore fluid for all tests. A brief description of the test facility is included. Cores were taken from outcrop rock chosen to match, as closely as reasonably possible, selected properties of the Fleming reservoir sandstone; in particular, unconfined compressive strength, porosity, permeability, grain size distribution, sorting and shape. The perforated cores were examined in detail using flow performance comparison, rock mechanical tests, probe permeameter tests, microscopic examination and x-ray scans.

  4. 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.

  5. Covered stents for exclusion of iatrogenic common carotid artery-internal jugular vein fistula and brachiocephalic artery pseudoaneurysm.

    PubMed

    Kooraki, Soheil; Grohmann, Jochen; Elshikh, Samer; Urbach, Horst; Meckel, Stephan

    2015-01-01

    Covered stents have rarely been used in neuroendovascular procedures. We report the case of a 74-year-old woman with a complex iatrogenic vascular injury from attempted insertion of a hemodialysis catheter: concurrent brachiocephalic artery pseudoaneurysm and common carotid artery to internal jugular vein fistula. Both lesions were excluded successfully by using two balloon-expandable covered stents with a satisfactory short-term clinical and angiographic outcome. PMID:26106173

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

    PubMed

    Sommansson, Anna; Nylander, Olof; Sjöblom, Markus

    2013-04-01

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

  7. Iatrogenic vitamin D toxicity in an infant--a case report and review of literature.

    PubMed

    Ketha, Hemamalini; Wadams, Heather; Lteif, Aida; Singh, Ravinder J

    2015-04-01

    Public concern over vitamin D deficiency has led to widespread use of over the counter (OTC) vitamin D (-D3 or -D2) supplements, containing up to 10,000 IU/unit dose (400 IU=10?g). Overzealous use of such supplements can cause hypercalcemia due to vitamin D toxicity. Infants are particularly vulnerable to toxicity associated with vitamin D overdose. OTC supplements are not subject to stringent quality control regulations from FDA and high degree of variability in vitamin D content in OTC pills has been demonstrated. Other etiologies of vitamin D induced hypercalcemia include hyperparathyroidism, granulomatous malignancies like sarcoidosis and mutations in the CYP24A1 gene. The differential diagnosis of hypercalcemia should include iatrogenic and genetic etiologies. C24-hydroxylation and C3-epimerization are two important biochemical pathways via which 25-hydroxyvitamin D3 (25(OH)D3) is converted to its metabolites, 24,25-dihydroxyvitamin D3 (24,25(OH)2D3) or its C3 epimer, 3-epi-25-OH-D3 respectively. Mutations in the CYP24A1 gene cause reduced serum 24,25(OH)2D3 to 25(OH)D3 ratio (<0.02), elevated serum 1,25-dihydroxyvitamin D (1,25(OH)2D3), hypercalcemia, hypercalciuria and nephrolithiasis. Studies in infants have shown that 3-epi-25(OH)D3 can contribute 9-61.1% of the total 25(OH)D3. Therefore, measurements of parathyroid hormone (PTH) and vitamin D metabolites 25(OH)D3, 1,25(OH)2D3, 3-epi-25(OH)D3 and 24,25(OH)2D3 are useful to investigate whether the underlying cause of vitamin D toxicity is iatrogenic versus genetic. Here we report a case of vitamin D3 associated toxicity in a 4-month-old female who was exclusively breast-fed and received an oral liquid vitamin D3 supplement at a dose significantly higher than recommended on the label. The vitamin D3 content of the supplement was threefold higher (6000 IU of D/drop) than listed on the label (2000 IU). Due to overdosing and higher vitamin D3 content, the infant received ?50,000 IU/day for two months resulting in severe hypercalcemia, hypercalciuria and nephrocalcinosis. We also review the relevant literature on vitamin D3 toxicity in this report. PMID:25636720

  8. Metformin activates a duodenal Ampk-dependent pathway to lower hepatic glucose production in rats.

    PubMed

    Duca, Frank A; Côté, Clémence D; Rasmussen, Brittany A; Zadeh-Tahmasebi, Melika; Rutter, Guy A; Filippi, Beatrice M; Lam, Tony K T

    2015-05-01

    Metformin is a first-line therapeutic option for the treatment of type 2 diabetes, even though its underlying mechanisms of action are relatively unclear. Metformin lowers blood glucose levels by inhibiting hepatic glucose production (HGP), an effect originally postulated to be due to a hepatic AMP-activated protein kinase (AMPK)-dependent mechanism. However, studies have questioned the contribution of hepatic AMPK to the effects of metformin on lowering hyperglycemia, and a gut-brain-liver axis that mediates intestinal nutrient- and hormone-induced lowering of HGP has been identified. Thus, it is possible that metformin affects HGP through this inter-organ crosstalk. Here we show that intraduodenal infusion of metformin for 50 min activated duodenal mucosal Ampk and lowered HGP in a rat 3 d high fat diet (HFD)-induced model of insulin resistance. Inhibition of duodenal Ampk negated the HGP-lowering effect of intraduodenal metformin, and both duodenal glucagon-like peptide-1 receptor (Glp-1r)-protein kinase A (Pka) signaling and a neuronal-mediated gut-brain-liver pathway were required for metformin to lower HGP. Preabsorptive metformin also lowered HGP in rat models of 28 d HFD-induced obesity and insulin resistance and nicotinamide (NA)-streptozotocin (STZ)-HFD-induced type 2 diabetes. In an unclamped setting, inhibition of duodenal Ampk reduced the glucose-lowering effects of a bolus metformin treatment in rat models of diabetes. These findings show that, in rat models of both obesity and diabetes, metformin activates a previously unappreciated duodenal Ampk-dependent pathway to lower HGP and plasma glucose levels. PMID:25849133

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

    PubMed

    Graham, David Y

    2014-05-14

    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

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

    PubMed

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

    2014-01-01

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

  11. 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

  12. Caecal perforation from TB and the Law of Laplace.

    PubMed

    Khan, Amad N; Khalid, Salema; Chaudhry, Mohammad Naushad; Ho, Cherrie

    2015-01-01

    A 43-year-old man presented to the hospital with haemoptysis. When worked up, his history and examination were highly suggestive of pulmonary tuberculosis (TB). He subsequently developed a massive upper gastrointestinal bleed and underwent an emergency laparotomy, which revealed a massively dilated caecum measuring ?20 cm in diameter. The caecum had perforated due to acute decompensation of intestinal TB. Though common in developing countries, TB is rare in the UK, especially the intestinal kind. The most striking feature of this case is, however, the size of the caecal distension caused by the tubercular inflammation and subsequent perforation-something unheard of in the literature. This massive caecal distention would be explained by the Law of Laplace. In conclusion, massive distension and caecal perforation are possible consequences of intestinal TB, especially in the 48-72 h immediately after starting anti-tubercular therapy. PMID:25972412

  13. Typhoid glomerulonephritis and intestinal perforation in a Nigerian child.

    PubMed

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

    2014-01-01

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

  14. 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. PMID:25893175

  15. Right main bronchus perforation detected by 3D-image

    PubMed Central

    Bense, László; Eklund, Gunnar; Jorulf, Hakan; Farkas, Árpád; Balásházy, Imre; Hedenstierna, Göran; Krebsz, Ádám; Madas, Balázs Gergely; Strindberg, Jerker Eden

    2011-01-01

    A male metal worker, who has never smoked, contracted debilitating dyspnoea in 2003 which then deteriorated until 2007. Spirometry and chest x-rays provided no diagnosis. A 3D-image of the airways was reconstructed from a high-resolution CT (HRCT) in 2007, showing peribronchial air on the right side, mostly along the presegmental airways. After digital subtraction of the image of the peribronchial air, a hole on the cranial side of the right main bronchus was detected. The perforation could be identified at the re-examination of HRCTs in 2007 and 2009, but not in 2010 when it had possibly healed. The occupational exposure of the patient to evaporating chemicals might have contributed to the perforation and hampered its healing. A 3D HRCT reconstruction should be considered to detect bronchial anomalies, including wall-perforation, when unexplained dyspnoea or other chest symptoms call for extended investigation. PMID:22679238

  16. PIV investigation of flowfield behind perforated Gurney-type flaps

    NASA Astrophysics Data System (ADS)

    Lee, Tim; Ko, L. S.

    2009-06-01

    The flow behind perforated Gurney-type flaps was investigated by using particle image velocimetry (PIV) at Re = 5.3 × 104. The PIV measurements were supplemented by force balance and surface pressure data. The near wake was disrupted and narrowed, indicative of a reduced drag, with increasing flap perforation and had a drastically suppressed fluctuating intensity. Depending on the strength of the perforation-generated jet, the vortex shedding process behind the flap could be eliminated. The flap porosity also led to reduced positive camber effects and the decompression of the cavity flow (upstream of the flap), as well as decreased upper and lower surface pressures, compared to the solid flap. The reduction in the drag, however, outweighed the loss in lift and rendered an improved lift-to-drag ratio.

  17. Practical Considerations for Perforator Flap Thinning Procedures Revisited

    PubMed Central

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

    2014-01-01

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

  18. Successful Surgical Management of Airway Perforation in Preterm Infants

    PubMed Central

    Gien, Jason; Ing, Richard J; Twite, Mark D; Campbell, David; Mitchell, Max; Kinsella, John P.

    2014-01-01

    Traumatic airway perforation during endotracheal intubation is an uncommon but life-threatening complication in preterm infants. Death usually occurs at the time of the injury, but in rare cases where the infant survives the initial resuscitation, therapeutic options include conservative versus surgical management. We describe three cases of airway perforation treated successfully with surgical intervention and without lung resection, utilizing novel graft material and cardiopulmonary bypass to facilitate repair. In preterm infants who survive the initial injury we advocate for early identification and surgical management with cardiopulmonary bypass when feasible. PMID:24791225

  19. 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. PMID:25802765

  20. 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

  1. Perforation of inferior vena cava during filter placement.

    PubMed

    Piecuch, J; Wiewiora, M; Nowowiejska-Wiewiora, A; Szkodzinski, J; Polonski, L

    2011-03-01

    The placement of an inferior vena cava (IVC) filter is a therapeutic method for selected patients with deep venous thrombosis and pulmonary embolism. However, insertion and placement of the filter may be associated with certain complications. For instance, retroperitoneal hematoma resulting from perforation of the wall by the filter is such a very rare but serious complication. We report the case of a 64-year-old woman with perforation of the IVC wall and consecutive hematoma caused by the filter who was treated surgically. PMID:21500182

  2. Introduction to and benefits of tubing-conveyed perforating

    SciTech Connect

    Robson, M.K. (Schlumberger Perforating and Testing Ctr., Rosharon, TX (US))

    1990-02-01

    Tubing-conveyed perforating (TCP) technology has grown dramatically during the past 5 years. This paper presents a general overview of state-of-the-art TCP systems and operating techniques and discusses the TCP benefits and the tradeoffs involved in the use of conventional wireline perforating. The TCP gun string, and the guns are positioned across the zones of interest. When the TCP string is positioned with a nuclear-type logging device, the surface well-control equipment installed, and the desired pressure underbalance established.

  3. Esophageal perforation after radiofrequency ablation for atrial fibrillation.

    PubMed

    Manouchehri, Namdar; Turner, Simon R; Lockwood, Evan; Sterns, Laurence D; Bédard, Eric Lr

    2014-11-01

    A 69-year-old man underwent left atrial radiofrequency ablation for atrial fibrillation. After 10 minutes, the procedure was terminated due to pericardial tamponade secondary to perforation during mapping. Pericardiocentesis resolved the tamponade. Ablation was completed one week later, and the patient was discharged. Two days later, he presented with odynophagia. Computed tomography demonstrated small bilateral pleural effusions. He was judged to be stable and was discharged again, but returned 2 days later with chest pain. He was found to have esophageal perforation with empyema, which was repaired using a muscle patch and esophageal stenting, successfully treating the lesion with minimal morbidity. PMID:24887888

  4. Hydrophilic polymer emboli: an under-recognized iatrogenic cause of ischemia and infarct.

    PubMed

    Mehta, Rupal I; Mehta, Rashi I; Solis, Orestes E; Jahan, Reza; Salamon, Noriko; Tobis, Jonathan M; Yong, William H; Vinters, Harry V; Fishbein, Michael C

    2010-07-01

    With the increased use of percutaneous intravascular diagnostic and therapeutic devices, there is potential for embolization of materials introduced into the vasculature. We report nine cases of foreign body emboli in patients who underwent vascular procedures using hydrophilic-coated medical devices. The procedures performed included cardiac catheterization (four cases), diagnostic cerebral angiography (two cases), therapeutic cerebral angiography with coil embolization of intracerebral aneurysm (one case), lower extremity angiography (one case), and/or orthotopic cadaveric organ transplantation (three cases). Other procedures in these patients included hemodialysis and peripheral arterial or central venous catheterization. Clinical sequelae ranged from undetectable (no symptoms) to pulmonary infarction, stroke, ongoing gangrene, and/or death occurring within days to weeks of suspected embolization of foreign material. Microscopic findings in biopsy or autopsy tissue revealed aggregates of amorphous or lamellated, non-refractile, non-polarizable, predominantly basophilic foreign substances occluding intrapulmonary, intracerebral, or peripheral arteries. This is the largest series documenting embolization of polymer gel materials. Polymer gel is now widely used on several devices for interventional procedures worldwide, and we suspect that complications associated with iatrogenic embolization of this substance are under-recognized. PMID:20305613

  5. 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

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

    PubMed

    Marik, Paul E

    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

  7. 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

  8. 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

  9. Infratemporal fossa cellulitis caused by a remnant iatrogenic foreign body after a bimaxillary operation.

    PubMed

    Park, Do Yang; Choo, Oak-Sung; Hong, Sang Young; Kim, Hyun Jun

    2015-05-01

    Infratemporal fossa cellulitis is rare and mostly occurs because of sinusitis and dental procedures. Furthermore, cellulitis caused by iatrogenic foreign bodies is very rare.A 28-year-old woman who had previously undergone cosmetic bimaxillary operation visited our hospital complaining of left facial swelling, oppressive pain, and nasal obstruction since 2 years. She had been attending another clinic, but despite having additional procedures and taking medications, her symptoms persisted. A subsequent operation was performed, during which we found a remnant surgical gauze from the previous operation, which was decomposed and trapped around the necrotic soft tissue and had eroded the bony structure around the pterygoid fossa. The material was successfully removed by endoscopic surgery, and the necrotic tissue was debrided. After the operation, all symptoms disappeared, and the patient was discharged without sequelae.During any procedure, surgeons must meticulously check for remnant material. Additionally, physicians must carefully note patient history and perform a physical examination, even in patients without serious symptoms. We report a case of advanced infratemporal fossa cellulitis due to remnant gauze material during a previous operation that was undetected. PMID:25950522

  10. Disabling chronic low back pain as an iatrogenic disorder: a qualitative study in Aboriginal Australians

    PubMed Central

    Lin, Ivan B; O'Sullivan, Peter B; Coffin, Juli A; Mak, Donna B; Toussaint, Sandy; Straker, Leon M

    2013-01-01

    Objectives To determine the low back pain beliefs of Aboriginal Australians; a population previously identified as protected against the disabling effects of low back pain due to cultural beliefs. Design Qualitative study employing culturally appropriate methods within a clinical ethnographic framework. Setting One rural and two remote towns in Western Australia. Participants Thirty-two Aboriginal people with chronic low-back pain (CLBP; 21 men, 11 women). Participants included those who were highly, moderately and mildly disabled. Results Most participants held biomedical beliefs about the cause of CLBP, attributing pain to structural/anatomical vulnerability of their spine. This belief was attributed to the advice from healthcare practitioners and the results of spinal radiological imaging. Negative causal beliefs and a pessimistic future outlook were more common among those who were more disabled. Conversely, those who were less disabled held more positive beliefs that did not originate from interactions with healthcare practitioners. Conclusions Findings are consistent with research in other populations and support that disabling CLBP may be at least partly iatrogenic. This raises concerns for all populations exposed to Western biomedical approaches to examination and management of low back pain. The challenge for healthcare practitioners dealing with people with low back pain from any culture is to communicate in a way that builds positive beliefs about low back pain and its future consequences, enhancing resilience to disability. PMID:23575999

  11. Evidence of the principle of similitude in modern fatal iatrogenic events.

    PubMed

    Teixeira, M Z

    2006-10-01

    Samuel Hahnemann attributed fundamental importance to the principle of similitude, promoting it to a 'natural law'. Observing that enantiopathic or allopathic treatment produced enduring aggravation of the disease symptoms after a brief and transitory initial relief, he systematised homeopathic treatment, prescribing substances that provoke similar symptoms in healthy individual. Based on clinical and experimental observations, he anticipated the concept of homeostasis, dividing the effects of substances into: primary action of the medicine followed by secondary action or reaction of the organism. This reaction, known as the rebound effect or paradoxical action by modern pharmacology, used to awake the curative response of the body when the principle of similitude is applied, is responsible for several iatrogenic diseases when used on the basis of the principle of contraries. This study discusses the role of this paradoxical reaction of the organism in the fatal side effects of four important drugs, used according to the model of enantiopathic treatment of the symptoms. I present evidence relating to acetylsalicylic acid, rofecoxib, antidepressants and long-acting bronchodilators. The consequences of the allopathic treatment could be decreased if health professionals valued homeostasis, minimising the rebound effect of the organism by gradual suspension of palliative drugs. PMID:17015194

  12. 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

  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. Treatment of a Malignant Esophageal Perforation with a Prototype Conical Wallstent

    SciTech Connect

    Scott-Mackie, Pauline L. [Department of Radiology, Guy's and St. Thomas NHS Trust, Guy's Hospital, St. Thomas Street, London SE1 9RT (United Kingdom); Morgan, Robert A. [Department of Radiology, St. Mary's Hospital, Praed Street, London W2 1NY (United Kingdom); Mason, Robert [Department of General Surgery, Guy's and St. Thomas NHS Trust, Guy's Hospital, St. Thomas Street, London SE1 9RT (United Kingdom); Adam, Andreas [Department of Radiology, Guy's and St. Thomas NHS Trust, Guy's Hospital, St. Thomas Street, London SE1 9RT (United Kingdom)

    1998-11-15

    A 60-year-old man with a malignant esophageal perforation could not be treated by conventional covered metallic stents because the upper esophagus was dilated. The perforation was eventually closed by deployment of a prototype, conical covered Wallstent.

  15. NEW RESULTS ON THE ASYMPTOTIC BEHAVIOUR OF DIRICHLET PROBLEMS IN PERFORATED DOMAINS

    E-print Network

    Garroni, Adriana

    NEW RESULTS ON THE ASYMPTOTIC BEHAVIOUR OF DIRICHLET PROBLEMS IN PERFORATED DOMAINS GIANNI DAL MASO behaviour of the solutions of elliptic equations with Dirichlet boundary conditions in perforated domains

  16. 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 ...

  17. The "strange term" in the periodic homogenization for multivalued Leray-Lions operators in perforated

    E-print Network

    Boyer, Edmond

    in perforated domains. Alain Damlamian and Nicolas Meunier 1er octobre 2010 R´esum´e Nous ´etudions par la m´erateurs maximaux monotones et le domaine est perfor´e compos´e de trous de taille p´eriodiquement r´epartis dans = f, with u,(x), d,(x) A(x) in a perforated domain with holes of size periodically distributed

  18. Two-parameter homogenization for a GL problem in a perforated domain

    E-print Network

    Berlyand, Leonid

    Two-parameter homogenization for a GL problem in a perforated domain Leonid Berlyand(1) , Petru the notations: o = o, i = i so that A = o i. We next define a perforated domain A obtained by "punching" holes, a point x R2 and define Z = {m + x + P A}. Then the perforated domain is defined as follows: A = A \\ m

  19. Radial cracks in perforated thin sheets Romain Vermorel, Nicolas Vandenberghe, and Emmanuel Villermaux

    E-print Network

    Paris-Sud XI, Université de

    Radial cracks in perforated thin sheets Romain Vermorel, Nicolas Vandenberghe, and Emmanuel that the number of cracks is selected at the beginning of the perforation process and then remains stable in thin sheets perforated quasistatically by a rigid cone. Our analysis emphasizes the geometry

  20. Transmittance and transparency of subwavelength-perforated conducting films in the presence of a magnetic field

    E-print Network

    Strelniker, Yakov M.

    Transmittance and transparency of subwavelength-perforated conducting films in the presence theoretically and numerically studied the transmission of light through a subwavelength-perforated metal film of a static magnetic field. Both the perforated and the homogeneous metal films are found to exhibit

  1. Perforated Layer Structures in Liquid Crystalline Rod-Coil Block Copolymers

    E-print Network

    Wan, Xin-hua

    Perforated Layer Structures in Liquid Crystalline Rod-Coil Block Copolymers Kishore K. Tenneti of the tetragonal perforated layer structures in a series of rod- coil liquid crystalline block copolymers (BCPs microscopy (TEM) techniques were used to investigate these rod-coil molecules, and a perforated layer

  2. On the effect of perforated plates on the acoustics of annular combustors

    E-print Network

    Paris-Sud XI, Université de

    On the effect of perforated plates on the acoustics of annular combustors E. Gullaud1 CERFACS the influence of perforated plates on the acoustic modes in aeronautical gas turbines combustion chambers for the effect of perforated plates. First, an analytic test case is used to validate the coding in the acoustic

  3. Numerical Investigation of the Acoustic Behavior of a Multi-perforated Liner

    E-print Network

    Eldredge, Jeff

    Numerical Investigation of the Acoustic Behavior of a Multi-perforated Liner Jeff D. Eldredge, Stanford, CA, 94305, USA The acoustic response of a turbulent flow through an aperture in a multi-perforated, turbine, and the downstream-traveling sound created by the fan. In particular, multi-perforated liners

  4. 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 understand how perforations interact with closed-cell foam microstructure and how it modifies the sound

  5. Acoustic modeling of perforated plates with bias flow for Large-Eddy Simulations

    E-print Network

    Mendez, Simon

    Acoustic modeling of perforated plates with bias flow for Large-Eddy Simulations S. Mendez a,, J. D of California, Los Angeles, Los Angeles, CA 90095, USA. Abstract The study of the acoustic effect of perforated to provide data on the flow around a perforated plate and the associated acoustic damping is demonstrated

  6. Perforation of sandwich plates with graded hollow sphere cores under impact loading , S.Pattofattoa

    E-print Network

    Paris-Sud XI, Université de

    1 Perforation of sandwich plates with graded hollow sphere cores under impact loading H.B.Zenga , S) are studied. The experiments at 45m/s were performed with an inversed perforation setup using SHPB system available) to better understand the perforation process. With these experimental and numerical tools

  7. Laboratory investigations of low frequency sound attenuation over combustion flat perforated wall sheet

    E-print Network

    Boyer, Edmond

    Laboratory investigations of low frequency sound attenuation over combustion flat perforated wall 2012 Nantes Conference 23-27 April 2012, Nantes, France 3191 #12;Steel perforated liners have been used perforated liners could be used for attenuating the combustion noise, especially for low frequency noise

  8. HOMOGENIZATION OF THE NEUMANN PROBLEM IN PERFORATED DOMAINS: AN ALTERNATIVE APPROACH

    E-print Network

    HOMOGENIZATION OF THE NEUMANN PROBLEM IN PERFORATED DOMAINS: AN ALTERNATIVE APPROACH MARCO of functions in the space SBV (Special functions of Bounded Variation) defined on periodically perforated , consider for any > 0 the perforated domain := P. Let (u) SBV p (), p > 1, be such that ´ |u| p dx

  9. Simulating Perforation of Thin Plates Using Molecular Dynamics Approach Anton M. Krivtsov

    E-print Network

    Krivtsov, Anton M.

    1 Simulating Perforation of Thin Plates Using Molecular Dynamics Approach Anton M. Krivtsov or molecules, but as elements of the mesoscale level, such as material grains [4,5]. Fig.1: Oblique perforation of plate by ogive-nose projectile. This approach is used in the current work to simulate perforation

  10. Permeability through a perforated domain for the incompressible 2D Euler equations

    E-print Network

    Bonnaillie-Noël, Virginie

    Permeability through a perforated domain for the incompressible 2D Euler equations V. Bonnaillie-No¨el, C. Lacave and N. Masmoudi June 17, 2013 Abstract We investigate the influence of a perforated domain in the case of the square), the limit behavior of the ideal fluid does not feel the effect of the perforated

  11. Magneto-optical features and extraordinary light transmission through perforated metal films filled with liquid crystals

    E-print Network

    Strelniker, Yakov M.

    Magneto-optical features and extraordinary light transmission through perforated metal films filled a metal film perforated by a periodic array of subwavelength holes has stimulated worldwide interest to perforated metal film made from metals traditionally used in such cases, such as Ag, Au, or Al , whose holes

  12. Special Perforated Steel Plate Shear Walls with Reduced Beam Section Anchor Beams. I: Experimental Investigation

    E-print Network

    Bruneau, Michel

    Special Perforated Steel Plate Shear Walls with Reduced Beam Section Anchor Beams. I: Experimental presents results of an experimental investigation of specially detailed ductile perforated steel plate history of increasing displacements to a minimum drift of 3%. The perforated panel reduced the elastic

  13. An adiabatic homogeneous model for the flow around a multi-perforated plate

    E-print Network

    Mendez, Simon

    An adiabatic homogeneous model for the flow around a multi-perforated plate S. Mendez CERFACS homogeneous model to account for multi-perforated lin- ers in combustion chamber flow simulations is described, the real perforated plate being replaced by a homogeneous boundary condition where the model is applied

  14. Large-Eddy Simulation of the Acoustic Response of a Perforated Plate

    E-print Network

    Mendez, Simon

    Large-Eddy Simulation of the Acoustic Response of a Perforated Plate Jean Dass´e and Simon Mendez response of a multi-perforated plate submitted to normal acoustic excitation with Large-Eddy Simulation (LES). It consists in simulating an infinite perforated plate, the periodicity of the geometry allowing

  15. Perforation of the Esophagus Secondary to Insertion of Covered Wallstent Endoprostheses

    SciTech Connect

    Farrugia, Mark; Morgan, Robert A.; Latham, Jennifer A.; Glynos, Michael; Mason, Robert C.; Adam, Andreas [Department of Radiology, Guy's and St. Thomas' Hospitals, London Bridge, London SE1 9RT (United Kingdom)

    1997-11-15

    Perforation of the esophagus is a very rare complication of metallic esophageal stent insertion. Two cases are presented in which esophageal perforations were caused by the sharp ends of metallic stents impinging on the esophageal wall. In retrospect, both perforations might have been prevented by additional stent insertion.

  16. Special Perforated Steel Plate Shear Walls with Reduced Beam Section Anchor Beams. II: Analysis and

    E-print Network

    Bruneau, Michel

    Special Perforated Steel Plate Shear Walls with Reduced Beam Section Anchor Beams. II: Analysis detailed ductile perforated steel plate shear walls SPSWs . These SPSWs had low yield strength steel infill, recommendations for the design of these special detailed perforated SPSWs are presented. DOI: 10.1061/ ASCE 0733

  17. Large-Eddy Simulation of a Turbulent Flow around a Multi-Perforated Plate

    E-print Network

    Mendez, Simon

    Large-Eddy Simulation of a Turbulent Flow around a Multi-Perforated Plate Simon Mendez1 , Franck and used in Reynolds-Averaged Navier-Stokes methods cannot predict momen- tum/heat transfer on perforated plate are reported. Large-Eddy Simulations of the flow created by an infinite multi-perforated plate

  18. L'UTILISATION DES CARTES PERFORES POUR L'ANALYSE POLLINIQUE DES MIELS

    E-print Network

    Paris-Sud XI, Université de

    spectres polliniques. ' I,e système que nous avons étudié est celui des cartes perforables sur toute leur perforations) nous les enregistrons tout d'abord dans un cahier, ce qui permet de leur attribuer un numéro d faire une perforation ronde de 1,5 mm de diamètre au moyen d'un poin- çon. On dispose d'une table de

  19. Endoscopic subfascial sectioning of incompetent perforating veins in treatment of primary varicosis

    Microsoft Academic Search

    M. Jugenheimer; Th. Junginger

    1992-01-01

    Subfascial elimination of incompetent perforating veins is the most effective therapeutic principle in the treatment of trophic skin disorders associated with varicosis. A recently developed endoscopic technique allows accurate sectioning of perforating veins with direct observation of the veins and minor trauma. From November 1986 to July 1991 endoscopic sectioning of perforating veins was performed in 72 patients (103 legs).

  20. Perforated gastric carcinoma: a report of 10 cases and review of the literature

    Microsoft Academic Search

    Franco Roviello; Simone Rossi; Daniele Marrelli; Giovanni De Manzoni; Corrado Pedrazzani; Paolo Morgagni; Giovanni Corso; Enrico Pinto

    2006-01-01

    BACKGROUND: Perforation is a rare complication of gastric carcinoma, accounting for less than 1% of all gastric cancer cases. The aim of the present study is to evaluate the prognostic value of perforation and to point out the surgical treatment options. METHODS: A total of 10 patients with perforated gastric carcinoma were retrospectively reviewed among 2564 consecutive cases of gastric

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

    PubMed

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

    2014-07-01

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

  2. Method and apparatus for perforating at cutting with a solid fueled gas mixture

    Microsoft Academic Search

    A. J. Woytek; J. T. Lileck; E. J. Steigerwalt

    1984-01-01

    A method for cutting pipe casings and concrete liners or perforating the same and localized portions of surrounding strata in an earth bore is set forth wherein a gas phase cutting or perforating jet mixture of fluorine and nitrogen trifluoride is delivered to the cutting or perforation site from the decomposition of a solid, normally stable, perfluoroammonium salt. An appropriate

  3. An experimental investigation of techniques to suppress edgetones from perforated wind tunnel walls

    Microsoft Academic Search

    N. S. Dougherty Jr.; C. F. Anderson; R. L. Parker Jr.

    1975-01-01

    The aerodynamic noise emitted by perforated walls in transonic wind tunnels has been under study for several years at AEDC. This report presents a summary of recent experimental tests to suppress perforated wall noise in transonic test sections. The mechanism of noise generation from perforated walls having 60-deg inclined holes is the edgetone phenomenon where the shear layer over each

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

    Microsoft Academic Search

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

    1996-01-01

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

  5. Treatment and outcomes of oesophageal perforation in a tertiary referral centre

    Microsoft Academic Search

    A. D Muir; J White; J. A McGuigan; K. G McManus; A. N Graham

    2003-01-01

    Objective: The diagnosis and management of oesophageal perforation continues to challenge clinicians. We present our experience of perforated oesophagus in a Tertiary Referral Centre for Thoracic and Oesophageal Surgery. Methods: Between 1985 and 2000, 75 patients (40 male) with oesophageal perforation were treated in out unit; age range 24–89, median 63. Retrospective review of these cases has been performed. Results:

  6. Peritoneoscopic placement of peritoneal dialysis catheter and bowel perforation: experience of an interventional nephrology program

    Microsoft Academic Search

    Arif Asif; Patricia Byers; Cristovao F Vieira; Donna Merrill; Florin Gadalean; Jacques J Bourgoignie; Baudouin Leclercq; David Roth; Merit F Gadallah

    2003-01-01

    Background: Bowel perforation is an uncommon but serious complication of peritoneoscopic peritoneal dialysis (PD) catheter insertion. The approach to diagnosis of bowel perforation utilizing this technique has not been previously published. The authors report their experience with the diagnosis and management of bowel perforation in the context of peritoneoscopic placement of PD catheters. Methods: The authors retrospectively reviewed the records

  7. 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

  8. 5Hydroxytryptamine contributes significantly to a reflex pathway by which the duodenal mucosa protects itself from gastric acid injury

    Microsoft Academic Search

    Anders J. Smith; Alfred E. Chappell; Andre G. Buret; Kim E. Barrett; Hui Dong

    2006-01-01

    Although duodenal mucosal bicarbonate secretion (DMBS) is currently accepted as an important defense mechanism against acid-induced duodenal in- jury, the mechanism and the regulation of DMBS are largely unknown. 5-HT may regulate DMBS, but little is known about its physiological relevance in DMBS and the underlying mechanism(s). Thus, the aims of the present study were to demonstrate the role of

  9. 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

  10. Transient response of perforated plate matrix heat exchangers

    Microsoft Academic Search

    P. Ramesh; G. Venkatarathnam

    1998-01-01

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

  11. Transmission through a Conducting Screen Perforated Periodically with Apertures

    Microsoft Academic Search

    Chao-Chun Chen

    1970-01-01

    A general solution to the problem of determining first the aperture field distribution and then the transmission and reflection coefficients of an infinite planar conducting sheet perforated periodically with apertures has been formulated. The excitation is considered to be a plane wave incident at any arbitrary angle. The aperture dimensions and array element spacings were assumed to be comparable with

  12. Patch antennas on externally perforated high dielectric constant substrates

    Microsoft Academic Search

    Joseph S. Colburn; Yahya Rahmat-Samii

    1999-01-01

    Smaller physical size and wider bandwidth are two antenna engineering goals of great interest in the wireless world. To this end, the concept of external substrate perforation is applied to patch antennas in this paper. The goal was to overcome the undesirable features of thick and high dielectric constant substrates for patch antennas without sacrificing any of the desired features,

  13. Retrosternal hernia (Morgagni) with colonic perforation due to incarceration

    Microsoft Academic Search

    Özden Çakmak; Osman Pektas; Didem Baskin

    1990-01-01

    Retrosternal (Morgagni) hernias in children are usually asymptomatic or may be associated with mild respiratory distress or gastrointestinal symptoms. Incarceration of bowel in a retrosternal hernia is unusual. This report describes a complete colonic obstruction with incarceration and perforation in a Morgagni hernia.

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

    PubMed

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

    2015-07-01

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

  15. Normal perforation of reinforced concrete target by rigid projectile

    Microsoft Academic Search

    X. W. Chen; X. L. Li; F. L. Huang; H. J. Wu; Y. Z. Chen

    2008-01-01

    An analytical model on the normal perforation of reinforced concrete slabs is constructed in the present paper. The effect of reinforcing bars is further hybridized in a general three-stage model consisting of initial crater, tunnelling and shear plugging. Besides three dimensionless numbers, i.e., the impact function I, the geometry function of projectile N and the dimensionless thickness of concrete target

  16. Penetration and perforation of reinforced-concrete targets

    SciTech Connect

    Forrestal, M.J.; Hightower, M.M.; Luk, V.K.; Christensen, B.K.

    1988-01-01

    The authors developed penetration equations for rigid, ogival nose projectiles that penetrated and perforated reinforced-concrete targets at normal incidence. The closed-form, penetration equations depend on the impact velocity, geometry and mass of the projectile, and the material properties of the target. Predictions from the models showed good agreement with test data.

  17. Migrated biliary plastic stent causing double sigmoid colon perforation.

    PubMed

    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. Corneal perforation and intraocular lens prolapse in Serratia marcescens endophthalmitis.

    PubMed

    Sharma, Neil S; Ooi, Ju-Lee; Downie, John A; Coroneo, Minas T

    2007-01-01

    A 72-year-old lady was referred with bacterial endophthalmitis secondary to complicated left cataract extraction. The organism was identified as Serratia marcescens. Despite aggressive treatment the eye continued to deteriorate with corneal perforation and prolapse of the intraocular contents. PMID:17539795

  19. Jejunal perforation due to porcupine quill ingestion in a horse

    PubMed Central

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

    2014-01-01

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

  20. Necrotizing fasciitis caused by perforated appendicitis: a case report

    PubMed Central

    Hua, Jie; Yao, Le; He, Zhi-Gang; Xu, Bin; Song, Zhen-Shun

    2015-01-01

    Acute appendicitis is one of the most common causes of acute abdominal pain. Accurate diagnosis is often hindered due to various presentations that differ from the typical signs of appendicitis, especially the position of the appendix. A delay in diagnosis or treatment may result in increased risks of complications, such as perforation, which is associated with increased morbidity and mortality rates. Necrotizing fasciitis caused by perforated appendicitis is extremely rare. We herein report a case of 50-year-old man presenting with an appendiceal abscess in local hospital. After ten days of conservative treatment with intravenous antibiotics, the patient complained about pain and swelling of the right lower limb and computed tomography (CT) demonstrated a perforated appendix and gas and fluid collection extending from his retroperitoneal cavity to the subcutaneous layer of his right loin and right lower limb. He was transferred to our hospital and was diagnosed with necrotizing fasciitis caused by perforated appendicitis. Emergency surgery including surgical debridement and appendectomy was performed. However, the patient died of severe sepsis and multiple organ failure two days after the operation. This case represents an unusual complication of a common disease and we should bear in mind that retroperitoneal inflammation and/or abscesses may cause necrotizing fasciitis through lumbar triangles.

  1. Jejunal perforation due to porcupine quill ingestion in a horse.

    PubMed

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

    2014-02-01

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

  2. Mechanisms of gold nanoparticle mediated ultrashort laser cell membrane perforation

    NASA Astrophysics Data System (ADS)

    Schomaker, M.; Baumgart, J.; Motekaitis, D.; Heinemann, D.; Krawinkel, J.; Pangalos, M.; Bintig, W.; Boulais, E.; Lachaine, R.; St.-Louis Lalonde, B.; Ngezahayo, A.; Meunier, M.; Heisterkamp, A.

    2011-03-01

    The gold nanoparticle (AuNP) mediated ultrashort laser cell membrane perforation has been proven as an efficient delivery method to bring membrane impermeable molecules into the cytoplasm. Nevertheless, the underlying mechanisms have not been fully determined yet. Different effects may occur when irradiating a AuNP with ultrashort laser pulses and finally enable the molecule to transfer. Depending on the parameters (pulse length, laser fluence and wavelength, particle size and shape, etc.) light absorption or an enhanced near field scattering can lead to perforation of the cell membrane when the particle is in close vicinity. Here we present our experimental results to clarify the perforation initiating mechanisms. The generation of cavitation and gas bubbles due to the laser induced effects were observed via time resolved imaging. Additionally, pump-probe experiments for bubble detection was performed. Furthermore, in our patch clamp studies a depolarization of the membrane potential and the current through the membrane of AuNP loaded cell during laser treatment was detected. This indicates an exchange of extra- and intra cellular ions trough the perforated cell membrane for some milliseconds. Additionally investigations by ESEM imaging were applied to study the interaction of cells and AuNP after co incubation. The images show an attachment of AuNP at the cell membrane after several hours of incubation. Moreover, images of irradiated and AuNP loaded cells were taken to visualize the laser induced effects.

  3. 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

  4. Glove perforation and contamination in primary total hip arthroplasty.

    PubMed

    Al-Maiyah, M; Bajwa, A; Mackenney, P; Port, A; Gregg, P J; Hill, D; Finn, P

    2005-04-01

    We conducted a randomised, controlled trial to determine whether changing gloves at specified intervals can reduce the incidence of glove perforation and contamination in total hip arthroplasty. A total of 50 patients were included in the study. In the study group (25 patients), gloves were changed at 20-minute intervals or prior to cementation. In the control group (25 patients), gloves were changed prior to cementation. In addition, gloves were changed in both groups whenever there was a visible puncture. Only outer gloves were investigated. Contamination was tested by impression of gloved fingers on blood agar and culture plates were subsequently incubated at 37 degrees C for 48 hours. The number of colonies and types of organisms were recorded. Glove perforation was assessed using the water test. The incidence of perforation and contamination was significantly lower in the study group compared with the control group. Changing gloves at regular intervals is an effective way to decrease the incidence of glove perforation and bacterial contamination during total hip arthroplasty. PMID:15795210

  5. Temporary double exclusion of the perforated esophagus using absorbable staples.

    PubMed

    Bardini, R; Bonavina, L; Pavanello, M; Asolati, M; Peracchia, A

    1992-12-01

    A new method for double exclusion of the esophagus is presented. Temporary closure of the cervical and intraabdominal esophagus using absorbable staples allows effective healing of esophageal perforations. The procedure should be routinely combined with drainage of the periesophageal abscess. Complete recanalization of the esophagus occurs 1 to 2 weeks after operation. PMID:1449304

  6. 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

  7. Scour around a perforated disk modeling a marine hydrokinetic device

    NASA Astrophysics Data System (ADS)

    Beninati, M. L.; Soliani, G.; Zhou, C. C.; Krane, M.; Fontaine, A.

    2013-12-01

    A study was conducted to investigate the behavior of scour hole dimensions and scour rates around a bottom-mounted cylindrical support structure of a perforated disk. The experiments focus on collecting temporal variations of scour depth around the support structure of the perforated disk for two scour regimes: transitional (ReD = 8500 and 9400) and live-bed (ReD = 10200). A perforated disk is used to approximate the drag of a submerged, horizontal axis, marine hydrokinetic (MHK) turbine. The goal is to compare the scour behavior around a perforated disk to that of a marine hydrokinetic (MHK) device. This study is motivated by the need to predict the environmental effect of MHK devices on an erodible bed. Testing is conducted in the small-scale hydraulic flume facility (1.2 m wide, 0.38 m deep, and 9.75 m long) at Bucknell University. The base of the support structure is marked incrementally to allow for time based observations of changes in scour depth. Bed form topologies are then acquired after a three hour time interval using a 2D sediment bed profiler. Experimental results show that scour rate is dependent on flow speed. Additionally, an increase in scour hole size occurs as the scour conditions are varied from transitional to live-bed.

  8. Management of acquired punctal stenosis with perforated punctal plugs

    PubMed Central

    Ozgur, Ozlen Rodop; Akcay, Levent; Tutas, Nesrin; Karadag, Onur

    2015-01-01

    Purpose To evaluate the efficiency of perforated punctal plug in acquired punctal stenosis. Materials and methods Forty-five eyes of 33 patients who had epiphora due to punctal stenosis were included in this study. After biomicroscopic examination and lacrimal dilatation punctal stenosis was managed with the perforated punctal plugs in all patients. In the following period epiphora, plug tolerance, lacrimal drainage were evaluated and graded. Lacrimal drainage was evaluated with fluorescein dye disappearing test. Results The age of the patients ranged between 31 and 80 (mean 55.78 ± 13.11). Preoperatively punctal dilatation and lacrimal system irrigations were performed on all patients. Lacrimal system irrigation was positive in all patients. Perforated punctal plugs were placed in the inferior puncti in all patients. The plugs were explanted 6 months after operation. The follow-up period ranged between 6 and 24 months. Plug tolerance was good in 97.8% of the eyes in the 1st month visit. Epiphora decreased remarkably in 88.9% of the patients 1 month after plug implantation, except one whose plug dropped off spontaneously in 2 weeks. Fluorescein disappearing times were found under 3 min in 97.8% of the eyes after plug explanations. Conclusion Punctum stenosis is one of the several disorders that cause lacrimal drainage obstruction. Perforated punctal plugs are found convenient and effective in managing punctal stenosis.

  9. Effect on gastric and duodenal mucosal prostaglandins of repeated intake of therapeutic doses of naproxen and etodolac in rheumatoid arthritis.

    PubMed Central

    Taha, A S; McLaughlin, S; Holland, P J; Kelly, R W; Sturrock, R D; Russell, R I

    1990-01-01

    The synthesis of gastric and duodenal mucosal prostaglandin E2, prostaglandin I2, and thromboxane B2 during a 60 minute incubation of biopsy specimens, the degree of endoscopic and histological damage, and the anti-inflammatory response were all studied after a four week, double blind study of therapeutic doses of two non-steroidal anti-inflammatory drugs, naproxen and etodolac, received by 27 patients with active rheumatoid arthritis (13 receiving naproxen, 14 etodolac). Prostaglandin values after treatment did not differ from the baseline levels when all the patients were analysed as one group. Subgroup analysis showed that naproxen suppressed gastric prostaglandin E2 from a median of 29 to 9 ng/mg protein, duodenal prostaglandin E2 from 34 to 11 ng/mg, and duodenal prostaglandin I2 from 62 to 15 ng/mg protein. No overall suppression occurred with etodolac. Also, on the second assessment patients receiving naproxen had lower gastric and duodenal prostaglandin E2 and prostaglandin I2, but higher values of duodenal thromboxane B2, than patients receiving etodolac. Both drugs had comparable anti-arthritic activity and caused microscopic gastritis in similar proportions of patients. No correlation was detected between prostaglandin values and the mucosal damage which developed in seven patients receiving naproxen (54%) and three receiving etodolac (21%). These findings indicate that, unlike naproxen, etodolac does not seem to affect gastric or duodenal prostaglandin synthesis; other mechanisms of injury need to be considered. PMID:2143369

  10. Duodenal ulcers induced by diethyldithiocarbamate, a superoxide dismutase inhibitor, in the rat: role of antioxidative system in the pathogenesis.

    PubMed

    Takeuchi, K; Nishiwaki, H; Niida, H; Ueshima, K; Okabe, S

    1991-11-01

    Pathogenesis of duodenal ulcers induced by diethyldithiocarbamate (DDC), a superoxide dismutase (SOD) inhibitor, was investigated in the rat. Repeated s.c. administration of DDC (750 mg/kg) every 12 hr induced duodenal ulcers in the fed rats, and the severity of the ulcers reached the maximum after three injections. DDC not only reduced basal acid output but also impaired duodenal alkaline secretion. These ulcers were significantly prevented by antioxidative agents such as SOD (50000 units/kg, s.c.), allopurinol (50 mg/kg, s.c.) or glutathione (200 mg/kg, s.c.) as well as the antisecretory agent cimetidine (100 mg/kg, s.c.). The impaired HCO3- response caused by DDC was partially but significantly reversed by either SOD (15000 units/kg/hr, i.v.), allopurinol or glutathione; and SOD by itself significantly elevated the rate of basal alkaline secretion. 16,16-Dimethyl prostaglandin E2 (10 micrograms/kg, s.c.) increased duodenal HCO3- output in the presence of DDC and significantly prevented the development of duodenal ulcers in response to DDC. These results suggest that the mucosal antioxidative system including SOD may play a role in the regulatory process of alkaline secretion and contribute to the mucosal defensive ability in the duodenum. The insufficiency of this system may be involved in the pathogenesis of DDC-induced duodenal ulcers. PMID:1667532

  11. Release of antral and duodenal gastrin in response to an intestinal meal.

    PubMed Central

    Llanos, O L; Villar, H V; Konturek, S J; Rayford, P L; Thompson, J C

    1977-01-01

    In dogs prepared with isolated, innervated antral pouches, intraduodenal perfusion with liver extract at pH 7, with the atrum buffered at pH 7, resulted in a significant release of gastrin selectively from the antrum and from the duodenum. Acidification of the meal to pH 1 abolished both antral and duodenal gastrin release, whereas acidification of the antrum abolished only the antral gastrin response. After antrectomy, liver extract at pH 7 caused a diminished but significant release of duodenal gastrin. These studies provide evidence that an intestinal meal may release (in addition to a specific intestinal phase hormone) gastrin from the intestine, and from antrum, by means of a pH-sensitive mechanism which may involve a humoral agent (enterobombesin?) from the small bowel. PMID:21638

  12. The effects on gastrin and gastric secretion of five current operations for duodenal ulcer.

    PubMed Central

    Thompson, J C; Fender, H R; Watson, L C; Villar, H V

    1976-01-01

    We have measured serum gastrin and gastric acid secretion in 66 duodenal ulcer patients before and after vagotomy and pyloroplasty (V + P--15 patients), selective proximal vagotomy without drainage (SPV - D--11 patients), and with drainage (SPV + D--19 patients), and vagotomy, antrectomy, and either gastroduodenostomy (V + BI--15 patients) or gastrojejunostomy (V + BII--6 patients). Basal and peak postprandial gastrin levels were increased in postoperative V + P, SPV - D, and SPV + D patients. Basal and peak postprandial levels of gastrin were unchanged after V + BII, indicative of duodenal release of gastrin. Gastrin response to food was abolished in V + BII patients. Acid output was reliably reduced after all five operations; reduction was greatest in patients after antrectomy and least in patients after SPV. No beneficial results were found with drainage in SPV patients. Acid secretion increased with time in SPV patients, especially those with drainage. PMID:1275599

  13. 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.

  14. 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

  15. Novel oesophago-gastro-duodenal stenting for gastric leaks after laparoscopic sleeve gastrectomy.

    PubMed

    Liu, Shirley Yuk-Wah; Wong, Simon Kin-Hung; Ng, Enders Kwok-Wai

    2015-01-01

    The management of gastric leak after laparoscopic sleeve gastrectomy (LSG) can be complex and challenging. Whilst operative interventions are mostly complicated and reserved for unstable or refractory cases, endoscopic self-expandable metal stenting (SEMS) is increasingly preferred as a safer treatment option. Yet, SEMS carries the problems of frequent stent migration and inconsistent healing as ordinary SEMS is designed mainly for stenotic disease. We hereby present two cases of early and chronic post-LSG leakage that were respectively failed to be treated by surgery and ordinary SEMS but were successfully managed by a dedicated extra-long oesophago-gastro-duodenal stent. In oesophago-gastro-duodenal stenting, the characteristics of extra-long stent length allow total gastric exclusion between the mid-oesophagus and the first part of duodenum to prevent stent migration and to equalise high pressure gradient within the gastric sleeve to promote fistula healing. PMID:25534492

  16. 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

  17. Clarithromycin-resistant helicobacter pylori in patients with duodenal ulcer in the united states

    Microsoft Academic Search

    Nimish Vakil; Beth Hahn; D. McSorley

    1998-01-01

    Background: Clarithromycin is a key component of several antimicrobial treatment regimens for Helicobacter pylori. Cure rates with clarithromycin-containing regimens are significantly decreased when resistance is present. Resistance develops by a point mutation in the ribosomal RNA of some organisms exposed to clarithromycin. We studied the prevalence of clarithromycin-resistant organisms in patients with duodenal ulcer in the United States from 1993–96.

  18. Gastric cell c-AMP stimulating autoantibodies in duodenal ulcer disease

    Microsoft Academic Search

    F De Lazzari; R Mirakian; L Hammond; C Venturi; R Naccarato; G F Bottazzo

    1988-01-01

    Gastric cell c-AMP stimulating antibodies (GCS-Ab) were studied in 30 patients with duodenal ulcer (DU) disease. Semipurified immunoglobulin (Ig) preparations from 13\\/30 patients stimulated c-AMP production in parietal cell enriched gastric cell suspensions obtained from male guinea pig stomachs. Maximum stimulation (varying between 260 and 547%) was reached after four hours incubation with 2 and 4 mg\\/ml Ig concentrations. The

  19. Expression, purification, and characterization of recombinant human pancreatic duodenal homeobox-1 protein in Pichia pastoris

    Microsoft Academic Search

    Shi-Wu Li; Yuping Sun; William Donelan; Hongfang Yu; Joanna Scian; Dongqi Tang; Li-Jun Yang

    2010-01-01

    Pancreatic duodenal hemeobox-1 (PDX1) is essential for the development of the embryonic pancreas and plays a key role in pancreatic ?-cell differentiation, maturation, regeneration, and maintenance of normal pancreatic ?-cell insulin-producing function. Purified recombinant PDX1 (rPDX1) may be a useful tool for many research and clinical applications, however, using the Escherichia coli expression system has several drawbacks for producing quality

  20. [Serologic detection of Helicobacter pylori antibodies after surgery for stomach and duodenal ulcer].

    PubMed

    Kopa?ski, Z; Cienciata, A

    1993-01-01

    The occurrence of IgG antibodies to Helicobacter pylori was measured by means of ELISA in 175 patients who had undergone surgery for duodenal or gastric ulcer. There was a significant correlation between surgery with resection and the absence of IgG to Helicobacter pylori in about 80% of cases. In patients undergoing surgery without resection there was no influence of the surgical technique on the presence of Helicobacter pylori antibodies. PMID:8367977