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1

Iatrogenic perforations during colonoscopy.  

PubMed

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

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

2014-01-01

2

Endoscopic duodenal perforation: surgical strategies in a regional centre  

PubMed Central

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

2014-01-01

3

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

PubMed Central

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.

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

2014-01-01

4

Silent perforation: an iatrogenic complication of colonoscopy.  

PubMed

A 55-year-old woman presented with a complaint of 3 months of bloody diarrhea with an approximately 8 stools per day. She initially underwent a flexible sigmoidoscopy at an outside hospital with biopsies showing acute and chronic colitis. She was started on asacol 2 tablets 3 times per day. Her symptoms persisted and she was placed on prednisone with only transient improvement in her symptoms. She continued to have diarrhea and malaise with 30-lb weight loss over 2 months. Outpatient colonoscopy was performed for evaluation of this change in bowel habit. Colonoscopy showed 2-cm terminal ileal polyp, focal ulcer of the cecum, and severe ulcerative colitis from mid-ascending colon to rectum, with touch friability, spontaneous bleeding, pseudopolyps, and ulceration. Multiple biopsies were taken of the friable and ulcerated regions. After colonoscopy, the patient remained stable with no complaints of pain. She was then taken for computed tomographic enterography showing severe colitis but also reflecting a large amount of air surrounding the right abdominal structures including the liver, gallbladder, right kidney, and right side of the colon. Air extended inferiorly into the right thigh and superiorly into the chest where it reached the mediastinum and pericardium. There was also a small amount of air in the peritoneal cavity under the diaphragm and adjacent to the liver. These findings were thought most likely secondary to asymptomatic colonic perforation secondary to colonoscopy. The patient remained stable, afebrile, and pain-free small bowel pathology from colonoscopy revealed carcinoid tumor of the terminal ileum. The patient remained stable despite intraperitoneal, retroperitoneal, and subcutaneous free air on follow-up x-ray. Patient underwent elective ileocecectomy 2 weeks later with postoperative films showing no evidence of free air. Iatrogenic perforation of the colon is a rare but feared complication of coloscopy with an incidence in some studies of 0.03% to 0.09%. This case demonstrates asymptomatic colonic perforation to a dramatic effect. PMID:18049414

Jafri, Syed-Mohammed R; Arora, Amindra

2007-10-01

5

Duodenal perforation associated with norovirus and rotavirus gastroenteritis  

PubMed Central

Key Clinical Message Norovirus (NoV) and rotavirus (RV) gastroenteritis are usually self-limiting. However, few pediatric cases of bowel perforation and no duodenal perforation with NoV gastroenteritis were reported. We describe two children with duodenal perforation due to NoV or RV gastroenteritis. Suspicion for this association enables prompt intervention, preventing lethal outcomes of these common infections.

Ueda, Norishi; Shimotake, Takashi; Ohama, Kazunori

2013-01-01

6

Duodenal perforation: an unusual complication of sickle cell anemia  

PubMed Central

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.

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

2014-01-01

7

Perforated duodenal ulcer: an unusual complication of gastroenteritis.  

PubMed Central

A 7 year old boy was admitted to hospital with gastroenteritis, which was complicated by an acute perforated duodenal ulcer. After oversewing of the perforation he made an uncomplicated recovery. Peptic ulceration is under-diagnosed in childhood and this leads to delay in diagnosis and appropriate management. Ulceration is associated with severe illness and viral infections, but perforation is rare. Images p991-a PMID:2221974

Wilson, J M; Darby, C R

1990-01-01

8

Perforated duodenal diverticulae: importance for the surgeon and gastroenterologist.  

PubMed

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

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

2014-01-01

9

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

PubMed

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

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

2014-08-01

10

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

PubMed

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

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

2014-01-01

11

Iatrogenic esophageal perforation in children: Patterns of injury, presentation, management, and outcome  

Microsoft Academic Search

Iatrogenic esophageal perforations in children are rare. To evaluate patterns of injury, clinical presentation, and treatment options for such patients, the authors reviewed the case records of 11 children who had sustained transmural injury to the esophagus during a dilatation procedure at their institution between 1967 and 1994. Strictures requiring dilatation were attributable to caustic ingestion in eight, esophageal atresia

E Panieri; A. J. W Millar; H Rode; R. A Brown; S Cywes

1996-01-01

12

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

PubMed Central

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

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

2014-01-01

13

Laparoscopic Primary Colorrhaphy for Acute Iatrogenic Perforations during Colonoscopy  

PubMed Central

Purpose. We present our experience with laparoscopic colorrhaphy as definitive surgical modality for the management of colonoscopic perforations. Methods. Over a 17-month period, we assessed the outcomes of consecutive patients presenting with acute colonoscopic perforations. Patient characteristics and perioperative parameters were tabulated. Postoperative outcomes were evaluated within 30 days following discharge. Results. Five female patients with a mean age of 71.4 ± 9.7 years (range: 58–83), mean BMI of 26.4 ± 3.4?kg/m2 (range: 21.3–30.9), and median ASA score of 2 (range: 2-3) presented with acute colonoscopic perforations. All perforations were successfully managed through laparoscopic colorrhaphy within 24 hours of development. The perforations were secondary to direct trauma (n = 3) or thermal injury (n = 2) and were localized to the sigmoid (n = 4) or cecum (n = 1). None of the patients required surgical resection, diversion, or conversion to an open procedure. No intra- or postoperative complications were encountered. The mean length of hospital stay was 3.8 ± 0.8 days (range: 3–5). There were no readmissions or reoperations. Conclusion. Acute colonoscopic perforations can be safely managed via laparoscopic primary repair without requiring resection or diversion. Early recognition and intervention are essential for successful outcomes. PMID:23476761

Haas, Eric M.; Pedraza, Rodrigo; Ragupathi, Madhu; Mahmood, Ali; Bartley Pickron, T.

2013-01-01

14

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

PubMed Central

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

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

2011-01-01

15

Laparoscopic versus open management of duodenal perforation: a comparative study at a District General Hospital  

PubMed Central

Introduction Duodenal perforation is one of the common pathologies in patients presenting in emergency with acute abdominal pain in an emergency ward and requires prompt surgery as life saving and curative intervention. The present study was conducted to determine whether the minimal access approach by laparoscopy was equally feasible as the open method. Aim To compare laparoscopic vs. open management duodenal perforation in all aspects. Material and methods Inclusion criteria: patients presenting to the emergency ward with acute pain in the abdomen with clinical signs of peritonitis and air under the diaphragm on X-ray abdomen standing were selected. Exclusion criteria were: patient age < 15 years and > 70 years, presentation > 2 days, shock with systolic blood pressure < 90 mm Hg which did not improve after hydration with 2000 ml of Ringer lactate solution, respiratory distress, history of cardiac disorder or respiratory disorders such as ischemic heart disease, arrhythmias, chronic obstructive pulmonary disease or asthma, bleeding and clotting disorders, pregnancy in females, previous upper abdominal surgery, and intra-operatively patients having perforation other than duodenal perforation. After excluding patients fitting the above criteria, two groups – test and control – were formed. Results We found that complications both early and late were significantly fewer in patients treated by laparoscopy. Thus laparoscopy was both feasible and had comparable mortality and leakage rate. Conclusions Laparoscopic management of perforated duodenal ulcer is feasible, effective and decreases morbidity and overall treatment time and cost if performed in properly selected patients. PMID:24868276

Motewar, Ashish; Tilak, Mandar; Bhamare, Nikhil; Bhople, Laxmikant

2013-01-01

16

Occult duodenal perforation complicating cerebral infarction: new problems in diagnosis of Cushing's ulcer.  

PubMed

Cushing's ulcers of the duodenum are well known complications of neurosurgery, head trauma, and other causes of increased intracranial pressure. Perforation of Cushing's ulcer of the duodenum is infrequently described. That the use of high-dose corticosteroids for cerebrovascular infarct in an aphasic patient may obscure the symptomatology and physical findings of a perforated Cushing's ulcer has not been described to our knowledge. We report a patient with a large left hemispherical infarct and resultant aphasia who developed a perforated duodenal ulcer and extensive chemical peritonitis while receiving high dose corticosteroids for increased intracranial pressure. She was unable to register any complaints and the typical physical findings of perforated duodenal ulcer with chemical peritonitis were virtually absent. A high index of suspicion must be maintained for a perforated Cushing's duodenal ulcer in the patient receiving high dose dexamethasone despite the presence of nonspecific symptomatology and abdominal findings. Elevated serum gastrin levels, as in this patient, may also indicate the patients with increased intracranial pressure who are at greater risk for developing Cushing's ulcer. PMID:7114024

Walsh, T J; Raine, T; Chamberlin, W H; Rice, C L

1982-09-01

17

Duodenal perforation due to compression necrosis by the tip of percutaneous endoscopic gastrostomy tube.  

PubMed

Percutaneous endoscopic gastrostomy (PEG) is a common and safe procedure for enteral nutrition. There are few reports concerning its complications. We managed a 31-y-old bedridden case with punched out duodenal perforation without inflammation, from which the tip of the PEG tube protruded. Simple x-ray and computed tomography showed incarceration of the balloon in the duodenal bulb and extravasation of the tip of the tube. We performed simple closure with omental patching for duodenal perforation. Postoperative gastrointestinal fiberscopy on the 11th day revealed scar phase. Some PEG tubes have a balloon, which can prevent the removal of the tube, fix the position of the tube, and prevent the leakage of gastric contents from fistula. However, in our case, the inflated balloon was transferred into the duodenal bulb according to gastric strong peristalsis. This pathophysiologic mechanism is the same as ball bulb syndrome, which is known as gastroduodenal obstruction by incarceration of the gastric submucosal tumor. There is a risk of wedging of the inflated balloon of the PEG tube and perforation of the duodenum. We must not insert the tube too deeply, must not continue to inflate the balloon for a long time, and must check its position using a stethoscope, simple x-ray examination, or ultrasound. PMID:21497055

Moriwaki, Yoshihiro; Arata, Shinju; Tahara, Yoshio; Toyoda, Hiroshi; Kosuge, Takayuki; Suzuki, Noriyuki

2011-09-01

18

[Perforation and haemorrhage duodenal bulbar ulcers in a child: a case report].  

PubMed

A perforation rarely reveals a primary duodenal ulcer. The occurring of digestive haemorrhage in post operative followings evokes spontaneously a stress ulcer. We report an observation of a child who presented on fourth day delay after operation an ulcer of the anterior duodenal bulbar face and a haemorrhage of the posterior bulbar face. A 7-year-old girl with no particular pathological antecedent was admitted for abdominal pain, bile vomiting and constipation evolving since 6 days. Clinical examination revealed a general state thickening, an infectious syndrome, a meteoric and general abdominal sensitivity. The abdominal radiography without preparation showed a pneumoperitoneum. The surgical exploration discovered a perforated ulcer on the bulbar anterior face. A simple closure associated with omental patch was performed. Four days after operation, she presented an abundant digestive haemorrhage with shock. The resuscitation did not improve the patient's general state. The upper digestive endoscopy revealed a haemorrhage of the posterior bulbar face. An adrenalin injection stopped the bleeding. The treatment by neutron pump inhibitors and an eradicating treatment of Helicobacter pylori permitted the healing of the ulcers. The occurring of digestive haemorrhage in the followings of surgical intervention for perforated ulcer involves an upper digestive endoscopy. This examination can reveal misdiagnosed ulcer during the surgical exploration and permits to perform a haemostatic act. PMID:19102114

Ngom, G; Diouf, M L; Fall, M; Konaté, I; Sankalé, A A; Diop, M; Fall, I; Ndoye, M

2008-01-01

19

Combined use of metallic endoclips and endoloops using a single-channel scope in closing iatrogenic perforations and fistulas: two case reports and a literature review.  

PubMed

Iatrogenic perforation of the gastrointestinal tract is a rare complication of endoscopic procedures, whereas anastomotic leakage after surgery is not uncommon. Both conditions are associated with gut wall defects leading to significant morbidity and mortality of the patients. We describe two case reports, a colonic perforation and an esophagogastric anastomosis leakage successfully managed endoscopically using the combined technique with endoclips and endoloops. A literature review is performed on similar endoscopic techniques aiming to avoid surgical treatment in these patients. PMID:24284373

Ladas, Spiros D; Kamberoglou, Dimitrios; Vlachogiannakos, Jiannis; Tomos, Periklis

2014-01-01

20

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

PubMed Central

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

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

2013-01-01

21

Evaluation of repair in duodenal perforation with human amniotic membrane: An animal model (dog)  

PubMed Central

Background: There is a growing tendency toward application of human amniotic membrane (HAM) as a biologic substitute in various tissue injuries where a significant tissue loss is a matter of concern. In gastrointestinal injuries especially duodenal ones, some potential limitations in current surgical techniques contribute to not fully acceptable healing outcomes. Thus, this study was carried out to assess repair with HAM patch for duodenal defect in comparison with simple duodenoraphy in an animal model (dog). Materials and Methods: A total of 15 male German shepherd dogs weighing 23-27 kg were randomly divided into two groups. Group A with 10 dogs, which were a candidate for duodenal repair by amniotic membrane patch and Group B consisted of 5 dogs perform simple duodenorraphy. A precise control was made to match all conditions except surgical technique. Macroscopic and microscopic features of the healed duodenal lumen in both groups were recorded. Results: Gross evaluation revealed no difference in luminal diameter in both groups. Statistical analysis of duodenal diameter between both groups after operation also showed no significant difference (Pv = 0.789). Histological assessment indicated less inflammation with better wound healing in Group A. Conclusion: It seems that repairing duodenal wall defect with HAM would result in better histological outcomes compared with what is seen in simple duodenoraphy in animal models. However, there is no significant difference regarding surgical findings. PMID:24804187

Ghahramani, Leila; Jahromi, Ali Bagherpour; Dehghani, Mohammad Reza; Ashraf, Mohammad Javad; Rahimikazerooni, Salar; Rezaianzadeh, Abbas; Safarpour, Ali Reza; Hosseini, Seyed Vahid

2014-01-01

22

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

PubMed

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

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

2010-01-01

23

Esophageal perforation.  

PubMed

Esophageal perforation is uncommon but carries a high morbidity and mortality, particularly if the injury is not detected early before the onset of systemic signs of sepsis. The fact that it is an uncommon problem and it produces symptoms that can mimic other serious thoracic conditions, such as myocardial infarction, contributes to the delay in diagnosis. Patients at risk for iatrogenic perforations (esophageal malignancy) frequently have comorbidities that increase their perioperative morbidity and mortality. The optimal treatment of esophageal perforation varies with respect to the time of presentation, the extent of the perforation, and the underlying esophageal pathologic conditions. PMID:24267495

Nirula, Raminder

2014-02-01

24

Iatrogenic neurology.  

PubMed

Iatrogenic disease is one of the most frequent causes of hospital admissions and constitutes a growing public health problem. The most common type of iatrogenic neurologic disease is pharmacologic, and the central and peripheral nervous systems are particularly vulnerable. Despite this, iatrogenic disease is generally overlooked as a differential diagnosis among neurologic patients. The clinical picture of pharmacologically mediated iatrogenic neurologic disease can range from mild to fatal. Common and uncommon forms of drug toxicity are comprehensively addressed in this chapter. While the majority of neurologic adverse effects are listed and referenced in the tables, the most relevant issues are further discussed in the text. PMID:24365439

Sposato, Luciano A; Fustinoni, Osvaldo

2014-01-01

25

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

Microsoft Academic Search

Complex fistulas of the duodenum and biliary tree are severe complications of gastric surgery. The association of duodenal and major biliary fistulas occurs rarely and is a major challenge for treatment. They may occur during virtually any kind of operation, but they are more frequent in cases complicated by the presence of difficult duodenal ulcers or cancer, with a mortality

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

2010-01-01

26

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.

27

Perforation from endoscopic small bowel biopsy.  

PubMed Central

Two patients, having undergone an apparently straightforward endoscopy with small bowel biopsy, developed a perforation. One, who proved to have normal small bowel mucosa, needed laparotomy and suturing of the duodenal perforation. The other, who had coeliac disease, settled with conservative management. PMID:8432444

Scott, B; Holmes, G

1993-01-01

28

Spectrum of Perforation Peritonitis  

PubMed Central

Introduction: Perforation peritonitis mostly results from the perforation of a diseased viscus. Other causes of perforation include abdominal trauma, ingestion of sharp foreign body and iatrogenic perforation. The diagnosis is mainly based on clinical grounds. Plain abdominal X-rays (erect) may reveal dilated and oedematous intestines with pneumoperitoneum. Ultrasound and CT scan may diagnose up to 72% and 82% of perforation respectively. The present study was carried out to study various etiological factors, modes of clinical presentation, morbidity and mortality patterns of perforation peritonitis presented in the RIMS hospital, Imphal, India. Material and Methods: The study was conducted from September 2010 to August 2012 on 490 cases of perforation peritonitis admitted and treated in the Department of Surgery. Initial diagnosis was made on the basis of detailed history, clinical examination and presence of pneumoperitoneum on erect abdominal X-ray. Results: A total of 490 patients of perforation peritonitis were included in the study, with mean age of 48.28 years. 54.29% patients were below 50 years and 45.71% patients were above 50 years. There were 54.29% male patients and 45.71% female patients. Only 30% patients presented within 24 hours of onset of symptoms, 31.43% patients presented between 24 to 72 hours and 38.57% patients presented 72 hours after the onset of symptoms. Mean duration of presentation was 54.7 hours. Overall 469 patients were treated surgically and 21 patients were managed conservatively. Overall morbidity and mortality recorded in this study were 52.24% and 10% respectively. PMID:24392388

Chakma, Sujit M.; Singh, Rahul L.; Parmekar, Mahadev V.; Singh, K.H. Gojen; Kapa, Buru; Sharatchandra, K.H.; Longkumer, Amenla T.; Rudrappa, Santhosh

2013-01-01

29

Management of complicated duodenal diverticula.  

PubMed

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

Oukachbi, N; Brouzes, S

2013-06-01

30

[Surgical treatment of duodenal ulcer].  

PubMed

The medical and endoscopic treatment of duodenal ulcer are decreasing the frequency of surgical treatment in this disease. The authors study the operations performed for duodenal ulcer within the period 1989-1999 in the County Hospital Baia Mare. The decrease of the rate of surgical interventions is the pure effect of the medical treatment, as long as the endoscopic treatment is not yet available in our service. The rate of ulcer--induced perforations remained, however, unmodified (48% of total operatory indications), as well as the postoperative morbidity and--mortality (18% respectively 9%). The last category seems not to be influenced by the type of chosen surgical procedure, but by the patient's age, duration of the disease, and associated pathology. PMID:12731191

Lese, M; Naghi, I; Pop, C

2001-01-01

31

Gastrointestinal perforation: ultrasonographic diagnosis.  

PubMed

Gastrointestinal tract perforations can occur for various causes such as peptic ulcer, inflammatory disease, blunt or penetrating trauma, iatrogenic factors, foreign body or a neoplasm that require an early recognition and, often, a surgical treatment.Ultrasonography could be useful as an initial diagnostic test to determine, in various cases the presence and, sometimes, the cause of the pneumoperitoneum.The main sonographic sign of perforation is free intraperitoneal air, resulting in an increased echogenicity of a peritoneal stripe associated with multiple reflection artifacts and characteristic comet-tail appearance.It is best detected using linear probes in the right upper quadrant between the anterior abdominal wall, in the prehepatic space.Direct sign of perforation may be detectable, particularly if they are associated with other sonographic abnormalities, called indirect signs, like thickened bowel loop and air bubbles in ascitic fluid or in a localized fluid collection, bowel or gallbladder thickened wall associated with decreased bowel motility or ileus.Neverthless, this exam has its own pitfalls. It is strongly operator-dependant; some machines have low-quality images that may not able to detect intraperitoneal free air; furthermore, some patients may be less cooperative to allow for scanning of different regions; sonography is also difficult in obese patients and with those having subcutaneous emphysema. Although CT has more accuracy in the detection of the site of perforation, ultrasound may be particularly useful also in patient groups where radiation burden should be limited notably children and pregnant women. PMID:23902744

Coppolino, Ff; Gatta, G; Di Grezia, G; Reginelli, A; Iacobellis, F; Vallone, G; Giganti, M; Genovese, Ea

2013-07-15

32

Duodenal somatostatinoma  

Microsoft Academic Search

Aim -Background  Somatostatinomas is a very rare neuroendocrine tumour of the gastrointestinal tract, first described in the pancreas in 1977\\u000a and in the duodenum in 1979. We present the case a 67-year-old woman with duodenal somatostatinoma that was resected with\\u000a a pancreaduodenectomy procedure and also provide a brief review of the literature.\\u000a \\u000a \\u000a \\u000a \\u000a Method  Databases from Pubmed and Medline were searched using a

Ch. Kontovounisios; M. Korontzi; C. Zaharioudakis; V. Armoutides; Ch. Karaliotas; S. Lanitis; G. Sgourakis

2010-01-01

33

Iatrogenic lesions of the colon and rectum.  

PubMed

Our ability to document a number of examples of iatrogenic lesions of the colon and rectum in three general hospitals confirms the multiplicity of these lesions as presented in the literature. It appears that the careful surgeon and his associates would well heed the old admonition known as Murphy's law, that "Anything that can go wrong will go wrong." In the daily practice of the general surgeon and proctologist, it is apparent that gentleness in approaching any anal-rectal examination for either diagnostic or therapeutic purposes is mandatory. The insertion of any foreign object, be it an examining finger, a thermometer, enema tip, or proctoscope, may subject the patient to an inadvertent injury of significant proportion. The dangers inherent in the evaluation and treatment of patients with recognized disease processes is significantly greater than that associated with routine and screening examinations. Morbidity and mortality have been shown to be associated with the barium enema as well as with the barium enema as well as with some of the newer radiologic procedures such as mesenteric angiography. The use of tap water for enemas has produced morbidity both from thermal injuries and from electrolyte depletion. Antibiotics and chemotherapeutic drugs frequently result in colon and rectal disease, and therapeutic procedures directed at organs adjacent to the colon and rectum have resulted in a number of iatrogenic lesions. This reviews confirms reports of others that iatrogenic lesions of the colon and rectum are not solely due to the physician's inexperience, as significant numbers of these lesions were the result of the diagnostic or therapeutic efforts of men of considerable experience and skill. Advanced age of the patient and diseases leading to changes in the character of the bowel wall frequently were factors in the production of these lesions. A poorly prepared bowel has led to increased morbidity and mortality associated with iatrogenic perforations. The early recognition of these lesions and prompt medical and surgical management diminishes both the morbidity and mortality associated with such injuries. PMID:1103307

Classen, J N; Martin, R E; Sabagal, J

1975-11-01

34

Iatrogenic nerve injuries  

PubMed Central

Thirty-one examples of iatrogenic peripheral nerve injuries have been collected from a review of the case records of one neurological referral centre over a 7-year period. The clinical details are described to call attention to the special care needed with the management of patients subjected to certain invasive procedures. PMID:7100035

Winer, J. B.; Harrison, M. J. G.

1982-01-01

35

Iatrogenic tracheobronchial rupture  

PubMed Central

Abstract Iatrogenic tracheobronchial ruptures most frequently occur during tracheal intubation, but they can also be produced during tracheobronchial endoscopy or thoracic surgery. The clinical presentation can be brutal, with respiratory failure, cervical emphysema, pneumothorax and hemoptysis. There are also less symptomatic presentations. The diagnosis is confirmed by bronchoscopy. The therapeutic approach can be differentiated, surgical or conservative, although the criteria are not universally accepted. This article aims to review the indications and therapeutic options. PMID:25408752

Paraschiv, M

2014-01-01

36

Perforation peritonitis and the developing world.  

PubMed

Background. Perforation peritonitis is the one of the commonest emergency encountered by surgeons. The aim of this paper is to provide an overview of the spectrum of perforation peritonitis managed in a single unit of a tertiary care hospital in Delhi. Methods. A retrospective study was carried out between May 2010 and June 2013 in a single unit of the department of Surgery, Lok Nayak Hospital, Delhi. It included 400 patients of perforation peritonitis (diffuse or localized) who were studied retrospectively in terms of cause, site of perforation, surgical treatment, complications, and mortality. Only those patients who underwent exploratory laparotomy for management of perforation peritonitis were included. Results. The commonest cause of perforation peritonitis included 179 cases of peptic ulcer disease (150 duodenal ulcers and 29 gastric ulcers) followed by appendicitis (74 cases), typhoid fever (48 cases), tuberculosis (40 cases), and trauma (31). The overall mortality was 7%. Conclusions. Perforation peritonitis in India has a different spectrum as compared to the western countries. Peptic ulcer perforation, perforating appendicitis, typhoid, and tubercular perforations are the major causes of gastrointestinal perforations. Early surgical intervention under the cover of broad spectrum antibiotics preceded by adequate aggressive resuscitation and correction of electrolyte imbalances is imperative for good outcomes minimizing morbidity and mortality. PMID:25006512

Bali, Rajandeep Singh; Verma, Sushant; Agarwal, P N; Singh, Rajdeep; Talwar, Nikhil

2014-01-01

37

Iatrogenic Intraspinal Epidermoid Cyst  

PubMed Central

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

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

2014-01-01

38

Perforation of the mesenteric small bowel: etiologies and CT findings.  

PubMed

The purpose of this article is to illustrate and discuss the various etiologies of perforation of the mesenteric small bowel and associated findings on abdominal CT. Perforation of the mesenteric small bowel is an uncommon cause of an acute abdomen and can be due to various etiologies. In underdeveloped countries, infection is probably the most common cause, while in industrialized nations, perforation may be due to Crohn disease, diverticulitis, foreign body, trauma, tumor, mechanical obstruction, primary ischemic event, or iatrogenic causes. CT is usually the initial imaging examination in patients with an acute abdomen and is sensitive in diagnosing small bowel perforation. CT findings in the setting of small bowel perforation are often subtle, but when present, may help the radiologist determine a specific cause of perforation. The aims of this pictorial essay are to review the various causes of mesenteric small bowel perforation and to discuss and illustrate the CT findings that can help arrive at the diagnosis. PMID:23212537

Hines, John; Rosenblat, Juliana; Duncan, Dameon R; Friedman, Barak; Katz, Douglas S

2013-04-01

39

An Option of Conservative Management of a Duodenal Injury Following Laparoscopic Cholecystectomy  

PubMed Central

Duodenal injury following laparoscopic cholecystectomy is rare complications with catastrophic sequelae. Most injuries are attributed to thermal burns with electrocautery following adhesiolysis and have a delayed presentation requiring surgical intervention. We present a case of a 47-year-old gentleman operated on for laparoscopic cholecystectomy with a bilious drain postoperatively; for which an ERC was done showing choledocholithiasis with cystic duct stump blow-out and a drain in the duodenum suggestive of an iatrogenic duodenal injury. He was managed conservatively like a duodenal fistula and recovered without undergoing any intervention.

Modi, MA; Deolekar, SS; Gvalani, AK

2014-01-01

40

[Congenital duodenal stenosis in adulthood].  

PubMed

A high-grade duodenal stenosis in adults can, in rare cases, be congenital, and its cause is found in an intraduodenally sited membrane. The anamnesis reveals growth disorders with vomiting and meteorism and abdominal complaints. A perforation opening in this membrane is the reason for survival into adulthood. The X-ray appearance and deep duodenoscopy make the diagnosis easy. Volvulus in cases of malrotation, Ladd's ligaments, annular pancreas, and compression of the duodenum by mesenteric vessels must be considered in the differential diagnosis. When the intraduodenal membrane is resected it is most important to expose the papilla Vateri, since this not uncommonly ends in the area of the septum. If necessary, a duodenoduodenostomy is performed. If the windsock web abnormality is present the duodenum should be opened at the point of attachment of the diaphragm. The construction of a gastrojejunostomy should be avoided. PMID:8145619

Klein, P; Anetsberger, R; Stangl, R; Hümmer, H P

1994-01-01

41

Perforated Eardrum  

MedlinePLUS

... the eardrum, a thin membrane that separates the ear canal and the middle ear, is called a perforated ... or stick) is pushed too far into the ear canal Middle ear infections may cause pain, hearing loss, ...

42

Gastrointestinal perforation  

MedlinePLUS

The most common serious complication of perforation, even with surgery, is infection. Infections can be either inside the abdomen (abdominal abscess), or throughout the whole body. Body-wide infection is called sepsis . It can be very serious and can ...

43

Gastroduodenal perforation.  

PubMed

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

Nirula, Raminder

2014-02-01

44

Computed tomography of iatrogenic complications of upper gastrointestinal endoscopy, stenting, and intubation.  

PubMed

Intraluminal procedures for the gastrointestinal tract range from simple intubation for feeding or bowel decompression to endoscopic procedures including stenting and pancreatobiliary ductal catheterization. Each of these procedures and interventions carries a risk of iatrogenic injury, including bleeding, perforation, infection, adhesions, and obstruction. An understanding of how anatomy and function may predispose to injury, and the distinct patterns of injury, can help the radiologist identify and characterize iatrogenic injury rapidly at computed tomography (CT) imaging. Furthermore, selective use of intravenous or oral CT contrast material can help reveal injury and triage clinical management. PMID:25173658

Valenzuela, David M; Behr, Spencer C; Coakley, Fergus V; Wang, Z Jane; Webb, Emily M; Yeh, Benjamin M

2014-09-01

45

Bleeding from duodenal lymphangiectasia.  

PubMed Central

An 8 year old girl with recurrent upper gastrointestinal bleeding was found to have localised duodenal lymphangiectasia by fibreoptic endoscopy. She did not show physical signs or laboratory evidence of significant enteric protein loss. A low fat diet seemed to prevent further bleeding. Duodenal lymphangiectasia may be associated with gastrointestinal bleeding in children. Images p153-a PMID:1994845

Perisic, V N; Kokai, G

1991-01-01

46

Wellbore perforating  

SciTech Connect

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

Dunn, M.D.

1988-08-02

47

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

PubMed

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

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

1989-04-01

48

Iatrogenic Limbal Stem Cell Deficiency  

Microsoft Academic Search

Although little has been written about iatrogenic limbal stem cell deficiency, patients with this disorder are probably more common than the literature might suggest. It is important to recognize this disorder as a limbal deficiency, since standard medical therapies will not address its etiology. The sequelae of this condition include stromal scarring and significant loss of vision. Fortunately, phacoemulsification has

Gary S. Schwartz; Edward J. Holland

49

Perforated monolayers  

SciTech Connect

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

Regen, S.L.

1992-01-01

50

Duodenal Malignant Somatostatinoma  

PubMed Central

The authors report a case of hormonally silent duodenal somatostatinoma. The main clinical features, the natural history and the currently available therapies of these rare neoplasms are described on the basis of this case and of the scientific literature. Although the antiblastic therapies are still debated, the patient showed a surprising outcome following chemotherapy. PMID:18612476

Ferrante, A. M. R.; Frontera, D.; Doglietto, G. B.; de Santis, G.; Viola, G.; Crucitti, F.

1995-01-01

51

Perforated monolayers  

SciTech Connect

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

Regen, S.L.

1992-12-01

52

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

PubMed

Abstract 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 angio graphy using Onyx. PMID:25110834

Asouhidou, I; Katsaridis, V

2014-12-01

53

Management of iatrogenic ureteral injury  

PubMed Central

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

Burks, Frank N.

2014-01-01

54

Acute duodenal ulcer.  

PubMed Central

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

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

1989-01-01

55

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

PubMed

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

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

2009-05-01

56

Acute phlegmonous gastritis complicated by delayed perforation  

PubMed Central

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

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

2014-01-01

57

Gastro-duodenal Crohn's disease  

PubMed Central

Gastro-duodenal Crohn's disease is rare. Thirty-one previously reported cases are briefly reviewed; histological confirmation of the diagnosis was not always possible. Details are given of a patient with pyloro-duodenal involvement accompanied by terminal ileitis and appendicitis where surgical specimens were available for study. The differential diagnosis is considered from the clinical and pathological aspects. Images PMID:14100012

Pryse-Davies, J.

1964-01-01

58

Imaging of iatrogenic conditions of the thorax.  

PubMed

Common medical interventions performed by cardiologists, radiologists, surgeons, dentists, and alternative practitioners can result in complications within the thorax that lead to significant patient morbidity. Prompt radiologic identification of iatrogenic complications of medical procedures in the thorax is essential to guide patient triage and treatment. Understanding the approach to common thoracic interventions and the placement of thoracic medical devices can aid radiologists in the evaluation of iatrogenic complications. PMID:25173652

Meyersohn, Nandini M; Avery, Laura L

2014-09-01

59

[Iatrogenic surgical injuries of the peripheral nerves].  

PubMed

Iatrogenic nerve injuries in operative area are undesirable but relatively common complications in relation to the total number of nerve injuries. These injuries are mostly caused by objective factors, especially by the nature of surgical lesion. Unfortunately, the role of surgeon is not irrelevant in large number of cases. The authors analyze a series of 39 iatrogenic surgical nerve injuries and the results of 30 repaired cases. PMID:1792573

Pajevi?, N; Grujici?, D; Samardzi?, M

1991-01-01

60

Iatrogenic disease or doctor-patient collusion?  

PubMed

"Iatrogenic disease" may be a misnomer and would be better termed "syndyadogenic disease"--literally, a disease caused by two people working together. Most iatrogenic disease is a result of an unconscious coequal collusion between doctor and patient. Using the psychoanalytic concepts of transference and countertransference, three patterns of doctor-patient collusion are seen: the needy child-omnipotent parent posture, the Pollyanna posture and the persecutor-victim posture. PMID:7270373

Twemlow, S W; Gabbard, G O

1981-09-01

61

Laparoscopic Duodenal Switch  

Microsoft Academic Search

Laparoscopic biliopancreatic diversion with duodenal switch (BPD-DS) is one of the most effective weight loss procedures currently\\u000a available. Both short- and long-term weight loss exceed that of any other bariatric operation. BPD-DS involves a 150- to 200-cc\\u000a sleeve or vertical gastrectomy, a duodenoileal anastomosis, and a long Roux-en-Y with a 150-cm alimentary limb and a 100-cm\\u000a common channel (Fig. 14.1).

Manish Parikh; Michel Gagner; Alfons Pomp

62

Multiple Giant Gastrointestinal Diverticula Complicated by Perforated Jejunoileal Diverticulitis in Marfan Syndrome  

Microsoft Academic Search

Gastrointestinal complications of Marfan syndrome are rare. We report a case of multiple giant gastric, duodenal, small intestinal and colonic diverticula, complicated by perforated jejunoileal diverticulitis, in a patient with Marfan syndrome. Recovery followed resection of the entire involved small bowel. Whereas the association of colonic diverticula with Marfan syndrome has been sporadically reported, the presence of small intestinal diverticula

Oz Shapira; Eliezer Mavor; Dan Simon; Harry Rothstein; Reuven Pfeffermann

1992-01-01

63

Endoscopic duodenal "windsock" diverticulotomy.  

PubMed

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

Stevens, Tyler; Chand, Bipan; Winans, Charles

2013-04-01

64

Comparison of the surgical outcomes of laparoscopic versus open surgery for colon perforation during colonoscopy  

PubMed Central

Purpose Colonoscopy is a safe and commonly used method for the screening of colon cancer, but sometimes major complications, such as, colonic perforation or hemorrhage occur during the procedure. The aim of this study was to compare the surgical outcomes of laparoscopic and open surgery for colon perforation after colonoscopy. Methods A retrospective review of patient records was performed on 25 patients with iatrogenic colon perforation during colonoscopy during the 7-year period from January 2005 to June 2012. Demographic data, operative procedures, operation times, postoperative complications, hospital course, and morbidities in the laparoscopic surgery group (LG) and open surgery group (OG) were compared. Results Seventeen of the 25 patients underwent laparoscopic surgery (68%) and 8 patients open surgery (32%). The most common surgical methods were primary repair in the LG, and Hartmann's operation in the OG. Average time to first flatus was 2.9 days in the LG and 4.5 days in the OG, and average times to first meals were 4.5 days and 5 days, respectively. Mean hospital stays were 10.8 days in the LG and 17 days in the OG. After surgery, complications occurred in two patients in the LG, but no complication occurred in the OG. Conclusion Laparoscopic repair for iatrogenic colonic perforation during colonoscopy seems to be useful and safe surgical method in early period after perforation. However, open surgery is also needed for the delayed cases after perforation. PMID:25247167

Kim, Jeongsoo; Lee, Gil Jae; Lee, Won-Suk

2014-01-01

65

Treatment for superficial non-ampullary duodenal epithelial tumors  

PubMed Central

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

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

2014-01-01

66

Iatrogenic Cushing's Syndrome in an Infant  

PubMed Central

A high potency, long acting and/or the extended use of oral corticosteroids, particularly in children, may cause suppression of the hypothalamo-pituitary-adrenal axis. However, the iatrogenic Cushing’s syndrome in the infantile age group is rare and only few patients have been reported to date in the literature. Here, we are reporting a case of iatrogenic Cushing’s syndrome in a 5-month-old male child, whose parents brought him to the hospital for puffiness of the face and overweight. PMID:23542874

Namburu, Rajendra Prasad; T.S., Karthik; Reddy P., Amaresh

2013-01-01

67

[Duodenal fistula following Port-à-cath--a rare complication of regional hepatic chemotherapy].  

PubMed

Arterial port systems are frequently used in the adjuvant and palliative therapy of colorectal hepatic metastasis. Specific complications are rarely documented in literature. The perforation of an arterial Port-à-cath followed by duodenal fistula is an uncommon complication of regional hepatic chemotherapy. Besides systemic disorders caused by the chemotherapeutic agents, such as vomiting, sickness, or gastritis and duodenitis, gastroduodenal ulcers can occur as a local complication of treatment. Thrombosis of the hepatic artery or occlusion of the port device are the most common reasons for withdrawal of treatment in our series. Based on our experience and the case report of a duodenal fistula we recommend angiography of the port system prior to each cycle of chemotherapy. PMID:10501673

Ophoff, K; Truong, S; Riesener, K P; Schippers, E; Schumpelick, V

1999-09-01

68

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

PubMed Central

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

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

2014-01-01

69

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

PubMed Central

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

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

2013-01-01

70

Spontaneous asymptomatic gallbladder perforation  

PubMed Central

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

Seçil, Mustafa

2014-01-01

71

Acquired duodenal obstruction in children.  

PubMed

Traumatic intramural hematoma of the duodenum is a rare cause of acquired duodenal obstruction in children, and a high degree of suspicion is therefore required to make an early and accurate diagnosis. We report a 6-year-old boy whose epigastrium was impacted by the handlebar of his bicycle during a traffic accident. The boy then experienced epigastralgia. Six days later, progressive bilious vomiting suggestive of gastrointestinal obstruction was noted. Imaging studies revealed a large hematoma extending from the fourth portion of the duodenum to the jejunum. Conservative methods of treatment failed to manage his condition. He underwent laparoscopic surgery to evacuate the hematoma. We also report a case of duodenal obstruction in a previously healthy 2-year-old girl who presented for the first time with acute symptoms of proximal intestinal obstruction. Contrast examinations showed apparent barium retention over the stomach and proximal duodenum. She underwent surgery due to persistent obstruction, and a mushroom-like foreign body was detected embedded in the orifice of the windsock duodenal web. After duodenoduodenostomy and removal of the bezoar, she had a smooth recovery and tolerated feeding well. We conclude that blunt abdominal trauma and incomplete duodenal obstruction, such as that caused by duodenal web, should be considered as possible causes of acquired proximal gastrointestinal obstruction in previously healthy children, despite their rarity. PMID:19133572

Chien, Jen-Hung; Ho, Tsyr-Yuh; Shih-Peng, Lin; Lee, Chi-Ling; Ou, Shan-Fu

2008-10-01

72

Sonographic windsock sign of a duodenal web.  

PubMed

We report a neonate with a duodenal web demonstrating the windsock appearance on US. In neonates, duodenal web is rare and its windsock appearance is also rarely seen. The windsock sign of duodenal web has been a well-known finding on upper gastrointestinal series. The corresponding windsock appearance may be demonstrated on US. Duodenal web can, therefore, be accurately diagnosed by identifying the sonographic windsock sign even in neonates. PMID:11727020

Yoon, C H; Goo, H W; Kim, E A; Kim, K S; Pi, S Y

2001-12-01

73

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

PubMed

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

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

2014-06-01

74

Treatment of iatrogenic abdominal contour irregularities.  

PubMed

In many countries, liposuction is the most frequently performed aesthetic procedure. The procedure is promoted as a safe, easy-to-learn, outpatient procedure. The increasing number of liposuction procedures, often performed by inadequately trained physicians, has led to a growing number of iatrogenic postliposuction contour deformities and skin irregularities. This report describes a treatment protocol for iatrogenic abdominal contouring deformities. For patients who present with contour deformities but no skin flaccidity, the type 1 treatment plan (syringe-assisted lipectomy and lipografting) is the suggested approach. In cases of contour deformities and infraumbilical skin flaccidity, the type 2 treatment plan (mini-lipoabdominoplasty and lipografting procedures) is used. Finally, in the case of contour deformities as well as supra- and infraumbilical flaccidity, the type 3 treatment plan (lipoabdominoplasty and lipografting procedures) is indicated. PMID:18752022

Pereira, Luiz Haroldo; Sterodimas, Aris

2010-04-01

75

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

PubMed Central

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.

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

2014-01-01

76

Chronic duodenitis in Zaria, northern Nigeria.  

PubMed

Thirty-four consecutive patients presenting to the Endoscopy clinic of the Ahmadu Bello University Teaching Hospital, Zaria with symptoms of upper abdominal pain were investigated for chronic duodenitis by endoscopy and histology and for associated diseases. Twenty-two patients had histological evidence of chronic duodenitis. No clinical features separated these from those who had no duodenitis. Endoscopy was a good enough tool for diagnosis. Stool parasites were significantly commoner in those with histological duodenitis. Gastritis was also commoner in those with duodenitis. Ranitidine appeared superior to polycrol in relieving symptoms. Endoscopy is useful in the diagnosis of severe duodenitis. Specific ulcer healing drugs may be tried in treating symptoms associated with duodenitis, though their effectiveness is still open to further research. PMID:7685620

Malu, A O; Kazmi, R; Wali, S S; Fakunle, Y M; Bhusnurmath, S R

1993-01-01

77

Spontaneous gallbladder perforation  

SciTech Connect

Acute gallbladder perforation is an infrequent, although not uncommon, complication of cholecystitis. It is rarely diagnosed preoperatively and the delay in making the definitive diagnosis usually accounts for the increased incidence of morbidity and mortality associated with this complication. A case of a 92-year-old patient in whom acute gallbladder perforation was suspected peroperatively at ultrasonography of the abdomen and confirmed by technetium-99m disofenin radionuclide biliary scan is reported.

Simmons, T.C.; Miller, C.; Weaver, R.

1989-05-01

78

Spontaneous neonatal gastric perforation  

Microsoft Academic Search

Over a 7-year period (1990-1997) spontaneous gastric perforation was diagnosed in five neonates. The mean gestational age and birth weight were 33\\/40 weeks and 1.83 kg, respectively. All patients presented with severe abdominal distention and frank pneumoperitoneum on roentgenograms. All perforations were on the anterior wall of the greater curvature and were managed by prompt laparotomy and primary closure of

Akram J. Jawad; A. Al-Rabie; Anjum Hadi; A. Al-Sowailem; A. Al-Rawaf; Bashar Abu-Touk; T. Al-Karfi; A. Al-Sammarai

2002-01-01

79

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

PubMed Central

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

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

2014-01-01

80

Extra-ampullary Duodenal Adenocarcinoma.  

PubMed

Extra-ampullary duodenal adenocarcinomas are rare, and when studied, frequently have been grouped with jejunoileal adenocarcinomas. Nevertheless, anecdotal experiences suggest that these neoplasms may present 2 or more distinct phenotypes. To better characterize these neoplasms, we performed a retrospective review of 38 cases with a special focus on the morphologic and immunophenotypic characteristics and their clinicopathologic significance. Our cohort of extra-ampullary duodenal adenocarcinomas was classified on the basis of the morphologic features into gastric type (n=19, 50%), intestinal type (n=14, 37%), pancreaticobiliary type (n=2, 5%), and others (n=3, 8%). Most gastric-type adenocarcinomas (n=18, 95%) developed in the proximal duodenum, whereas the other types were located equally in the proximal and distal duodenum. Intestinal-type dysplasia was present at the periphery of 8 (57%) intestinal-type adenocarcinomas, and 8 (42%) gastric-type adenocarcinoma were associated with gastric-type dysplasia. Gastric foveolar metaplasia (n=12) and Brunner gland hyperplasia (n=10) were exclusively recognized adjacent to gastric-type adenocarcinomas. Notably, intestinal-type histology and the absence of lymph node metastasis were significantly associated with favorable disease-free survival in univariate and multivariate analyses. In summary, this study demonstrated that 2 major subsets of extra-ampullary duodenal adenocarcinoma, intestinal type and gastric type, are associated with distinct histopathologic features and clinical behavior. PMID:25310836

Ushiku, Tetsuo; Arnason, Thomas; Fukayama, Masashi; Lauwers, Gregory Y

2014-11-01

81

Gastrointestinal Tract Perforation: MDCT Findings according to the Perforation Sites  

PubMed Central

Our objective is to describe the characteristic CT findings of gastrointestinal (GI) tract perforations at various levels of the gastrointestinal system. It is beneficial to localize the perforation site as well as to diagnose the presence of bowel perforation for planning the correct surgery. CT has been established as the most valuable imaging technique for identifying the presence, site and cause of the GI tract perforation. The amount and location of extraluminal free air usually differ among various perforation sites. Further, CT findings such as discontinuity of the bowel wall and concentrated free air bubbles in close proximity to the bowel wall can help predict the perforation site. Multidetector CT with the multiplanar reformation images has improved the accuracy of CT for predicting the perforation sites. PMID:19182505

Kim, Sung Hwan; Jeong, Yong Yeon; Heo, Suk Hee; Kim, Jin Woong; Kang, Heoung Keun

2009-01-01

82

[Iatrogenic perforation of the intrathoracic colon after a late traumatic diaphragmatic hernia].  

PubMed

A case of delayed presentation of traumatic diaphragmatic hernia and colonic injury leading to a review of the literature. Relative diagnostic difficulty in this type of lesions and its acute presentation make managements by mistake, as this one. In a patient with very important acute respiratory embarrassment and chest pain, an Argyle tube was placed because pneumothorax was suspected; the patient improved, but a fluid bowel content was obtained through the drainage tube; TAC and barium enema film showed the colon into the thorax. The patient underwent thoracotomy and laparotomy. In her history, she suffered from a stab wound on the left abdominal flank four years ago; it did not require surgical treatment but it caused the start of the colon movement into the thorax. The ways of presentation and its development are reviewed with the aim of remembering that it must be borne in mind if a patient present a penetrating trauma in the lower chest or upper abdomen, especially if surgical operation was not required, as it happened in this case. A careful history, examination, and review of follow up chest X-ray appears to be the easiest mechanism to avoid delays in diagnosis and reduce the morbi-mortality of this important disease. PMID:7986620

Collazo, E; Díaz Iglesias, C

1994-10-01

83

Pictorial review CT of duodenal pathology  

Microsoft Academic Search

This pictorial review presents the CT findings in different pathological entities of the duodenum. The aim of the article is to demonstrate the contribution of a common imaging modality, i.e. abdominal CT, in the diagnosis of various duodenal disorders. The current widespread use of abdominal CT has resulted in the detection, sometimes as an incidental finding, of various duodenal abnorm-

R ZISSIN; A OSADCHY; G GAYER; M SHAPIRO-FEINBERG

84

Duodenal mucosal permeability: Relevance to ulcerogenesis  

Microsoft Academic Search

Duodenal mucosal integrity is determined by the balance between physiological defense mechanisms and aggressive factors. Derangements in any of the defense mechanisms or excessive aggressive forces will most likely result in a disturbance of mucosal integrity and eventually in gastroduodenal disease. To better understand the pathogenesis of duodenal ulcers and other gastrointestinal disorders, it is of importance to characterize the

Olof Nylander; Anneli Hällgren

1998-01-01

85

Duodenal obstruction in Nigerian newborns and infants.  

PubMed

Experience with the management of congenital duodenal obstruction in a tropical environment is analysed with a view to highlighting some of the problems and suggesting solutions. 30 infants with duodenal obstruction were treated at the Lagos University Teaching Hospital between 1978 and 1985. 15 (50%) infants had duodenal atersia. 7 (23%) had Ladd's bands, 6 (20%) had duodenal diaphragm and there was one bay with partial duodenal obstruction caused by a duplication cyst. The associated abnormalities encountered in 7 infants are distal bowel atresia (3), partial situs inversus (3) and Trisomy 21 (1). Delay in presentation and inadequate facilities constituted the major constraints. 7 of the 25 infants that had corrective surgery died, a mortality of 28%. All the infants that were treated within the first 8 days of life survived. After this period survival was restricted to those with incomplete obstruction. Mortality can be reduced by the provision of adequate facilities and health education. PMID:3508631

Adeyemi, S D

1986-01-01

86

Rat endovascular perforation model.  

PubMed

Experimental animal models of aneurysmal subarachnoid hemorrhage (SAH) have provided a wealth of information on the mechanisms of brain injury. The rat endovascular perforation (EVP) model replicates the early pathophysiology of SAH and hence is frequently used to study early brain injury following SAH. This paper presents a brief review of historical development of the EVP model and details the technique used to create SAH and considerations necessary to overcome technical challenges. PMID:25213427

Sehba, Fatima A

2014-12-01

87

Perforator Pedicled Propeller Flaps  

Microsoft Academic Search

\\u000a Hyakusoku et al. [1] presented a propeller flap for reconstruction of axilla and cubitus in 1991. The original propeller flap\\u000a has been used for intact fossa and was elevated as a subcutaneous pedicled island flap. Nowadays, this propeller flap has\\u000a been refined and various types of propeller flaps have been reported [2–11]. The represented one is the perforator pedicled\\u000a propeller

Hiko Hyakusoku; Musa A. Mateev; T. C. Teo

88

Selection of appropriate endoscopic therapies for duodenal tumors: An open-label study, single-center experience  

PubMed Central

AIM: To determine an appropriate compartmentalization of endoscopic submucosal dissection (ESD) or endoscopic mucosal resection (EMR) for duodenal tumors. METHODS: Forty-six duodenal lesions (excluding papillary lesions) from 44 patients with duodenal tumors treated endoscopically between 2005 and 2013 were divided into the ESD and EMR groups for retrospective comparison and analysis. RESULTS: The mean age was 65 ± 9 years (35-79 years). There were 24 lesions from men and 22 from women. The lesions consisted of 6 early cancers, 31 adenomas and 9 neuroendocrine tumors. Lesion location was the duodenal bulb in 15 cases and the descending part of the duodenum in 31 cases. The most common macroscopic morphology was elevated type in 21 cases (45.6%). Mean tumor diameter was 11.9 ± 9.7 mm (3-60 mm). Treatment procedure was ESD (15 cases) vs EMR (31 cases). The examined parameters in the ESD vs EMR groups were as follows: mean tumor diameter, 12.9 ± 14.3 mm (3-60 mm) vs 11.4 ± 6.7 mm (4-25 mm); en bloc resection rate, 86.7% vs 83.9%; complete resection rate, 86.7% vs 74.2%; procedure time, 86.5 ± 63.1 min (15-217 min) vs 13.2 ± 17.0 min (2-89 min) (P < 0.0001); intraprocedural perforation, 3 cases vs none (P = 0.0300); delayed perforation, none in either group; postprocedural bleeding, 1 case vs none; mean postoperative length of hospitalization, 8.2 ± 2.9 d (5-16 d) vs 6.1 ± 2.0 d (2-12 d) (P = 0.0067); recurrence, none vs 1 case (occurring at 7 mo postoperatively). CONCLUSION: ESD was associated with a longer procedure time and a higher incidence of intraprocedural perforation; EMR was associated with a lower rate of complete resection. PMID:25024618

Matsumoto, Satohiro; Yoshida, Yukio

2014-01-01

89

Selective Embolization of Large Symptomatic Iatrogenic Renal Transplant Arteriovenous Fistula  

SciTech Connect

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

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

2006-12-15

90

Iatrogenic left main artery dissection: A catastrophic complication  

PubMed Central

Iatrogenic left main artery (LM) dissection is a catastrophic complication of coronary angiography and angioplasty that requires prompt management using stenting. Although LM dissection can be prevented, it cannot always be avoided and has a reported incidence rate of 0.02%. In the present report, a case of iatrogenic LM dissection that was successfully treated with multiple stents is presented and followed by a brief review of the literature. PMID:23592948

Namazi, Mohammad Hassan; Rostami, Reza Tajik; Mohammadi, Afsaneh; Amini, Abdol Latifi; Safi, Morteza; Saadat, Habibollah; Vakili, Hosein; Motamedi, Mohammad Reza; Movahed, Mohammad Reza

2012-01-01

91

A Rare Case of Upper Ureter Rupture: Ureteral Perforation Caused by Urinary Retention  

PubMed Central

Perforation of the ureter is a rare condition that causes a series of problems including retroperitoneal urinoma, urosepsis, abscess formation, infection, and subsequent renal impairment. There are causative factors that induce ureteric rupture, including malignancy, urinary calculi, idiopathic retroperitoneal fibrosis, recent iatrogenic manipulation, external trauma, degenerative kidney conditions, urography with external compression, and spontaneous causes. We report a rare case of ureteric rupture caused by urinary retention. The patient was treated with temporary percutaneous drainage and antibiotics. The present case illustrates that urinary retention can induce not only bladder rupture, but also ureteric rupture. It is thus of paramount importance to effectively manage patients with voiding problems. PMID:22379594

Choi, Seung-Kwon; Lee, Solmin; Kim, Sunchan; Kim, Tae Gu; Yoo, Koo Han; Lee, Hyung-Lae

2012-01-01

92

[Complicated postbulbar duodenal ulcer: the characteristics of its diagnosis and surgical technic and management].  

PubMed

The paper reports on the authors experience used on 90 patient with complicated postbulbar ulcers (10% of the duodenal ulcers) with hemorrhage (23 cases), perforation (7 cases), duodenal stenosis (19 cases) and penetration pancreatic hepato-biliary (41 cases) period 1987-1996. The frequency of hemorrhagic complication was of 25%. As the hemorrhage due to postbulbar ulcer is favoured by vascular fistula, the sever character of the hemorrhage and the frequency of the recurrence, mainly the cataclysmic one, impose the radical surgery as early as possible. The following were used: large Reichel-Polya's gastrectomy (13 cases) Pean's gastro-duodenectomy + vagotomy (9 cases), gastrectomy for exclusion with hemostasis "in situ" and ligature of gastroduodenal artery + vagotomy (7 case). In 7 cases with perforation: Reichel-Polya's gastrectomy in 2 patients, Pean's gastrectomy in 2 cases, excision pyloroplasty (Judd) and vagotomy (3 cases). In the postbulbar ulcers penetrating into the pancreas or into hepatic pedicle the following were performed: Reichel-Polya's gastrectomy (8 cases), Pean's gastrectomy (11 cases of which 8 with vagotomy) gastrectomy for exclusion of ulcer in 22 cases of which 20 with vagotomy. In 14 patients with stenosed ulcers, Reichel-Polya's gastric resection (4 cases), Pean's gastrectomy (8 cases), gastrectomy for exclusion (7 cases). The conclusions may be drawn that the postbulbar ulcers are complicated ulcers that require differential surgical treatment, as early as possible for diminishing the postsurgical morbidity and mortality (6.6% mortality). PMID:10756748

Cotîrle?, A; Ivan, I; Anghel, R; Balcan, O; Ghius, D

1997-01-01

93

Mesenteric infarction due to iatrogenic polycythemia  

PubMed Central

BACKGROUND: Polycythemia vera is defined as a chronic myeloproliferative disorder characterized by increased red blood cell count. There have been no reports on mesenteric thrombosis resulting from iatrogenic polycythemia. METHODS: We present a patient with a history of non-small cell lung cancer undergoing maintenance oral chemotherapy on tarceva and adjunctive use of procrit. The patient presented to our emergency department with an acute abdomen and was found to have ischemic bowel from unmonitored procrit, which lead to hyperviscosity of blood and mesenteric infarction. RESULTS: The patient remained intubated with ventilator support. He refused a tracheostomy. He continued on feeding through the J port of the nasojejunal tube. His white cell count, and hematocrit and creatinine levels remained normal. Procrit use and chemotherapy were not restarted. He was transferred to a subacute nursing facility for further treatment. CONCLUSIONS: Procrit and other erythropoiesis stimulating drugs can cause significant morbidity and mortality with an increased risk of cardiovascular events, gastrointestinal bleeding, thromboembolism and stroke. This case report suggests that without closely monitoring hematocrit levels, epoetin may also be associated with an increased risk of mesenteric infarction.

Skoog, Katrina; Carmelle-Elie, Marie; Ferguson, Kevin

2013-01-01

94

Iatrogenic causes of salivary gland dysfunction  

SciTech Connect

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

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

1987-02-01

95

Gastric emptying abnormal in duodenal ulcer  

SciTech Connect

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

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

1986-07-01

96

Eccentrically actuated perforating guns  

SciTech Connect

Apparatus is described for perforating a well casing comprising, in combination: a side pocket mandrel including an elongate mandrel body intersected by a longitudinal production bore and by an offset receptacle bore extending alongside the production bore, an upper body section attached to the upper end of said mandrel body, said upper body section having a main passage formed therethrough in alignment with the production bore and having an offset sidewall forming a belly chamber for receiving a kick over tool, said belly chamber providing kick over tool access to the receptacle bore, said upper body section having means for connecting its upper end to a tubing string, and the side pocket mandrel having means for connecting its lower end to a tubing string; and, a perforator tool including a gun mandrel attached to the lower end of said side pocket mandrel body and having detonator means disposed within the side pocket receptacle bore, said detonator means being disposed for striking engagement by a kick over tool.

George, F.R.; Restarick, H.L.; Merritt, D.T.

1993-07-06

97

Well perforating apparatus and method  

Microsoft Academic Search

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

1980-01-01

98

Duodenal adenomatosis in familial adenomatous polyposis  

PubMed Central

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

Bulow, S; Bjork, J; Christensen, I J; Fausa, O; Jarvinen, H; Moesgaard, F; Vasen, H F A

2004-01-01

99

Congenital duodenal diaphragm and enteroliths: A Unique complication  

PubMed Central

We report an unusual case of duodenal diaphragm (DD) with “wind-sock” anomaly in a 6-year-old male. The child presented with an acute duodenal obstruction precipitated by multiple pigmented stones completely blocking the duodenum. PMID:20419028

Bhat, Nisar Ahmad

2009-01-01

100

[Impact of iatrogenic preterm birth on newborn morbidity].  

PubMed

The incidence of premature births is not decreasing in developed countries, but rather shows a tendency to increase. This rise is primarily due to an increase in the number iatrogenic late preterm births at a gestational age between 34?+?0 and 36?+?6 weeks. Late preterm births account for up to 80% of all preterm births and these newborns have higher morbidity and mortality rates and a higher rate in neurodevelopmental long-term impairment in comparison to term infants. In order to reduce iatrogenic preterm birth, it is necessary to apply standardised treatment algorithms especially in cases of mild preeclampsia and intrauterine growth restriction. PMID:21863527

Beinder, E

2011-08-01

101

DWI Findings in an Iatrogenic Lumbar Epidermoid Cyst  

PubMed Central

Summary Epidermoid cysts comprise less than 1% of intraspinal tumors. They can be congenital, frequently associated with other spinal malformations, or iatrogenic, resulting from the implantation of epidermal cells within the spinal canal during the execution of a variety of procedures such as spinal puncture. At MR imaging epidermoid tumors can mimic cystic lesions with fluid content such as arachnoid cysts. DWI can help obtain a correct diagnosis. We describe a case of iatrogenic lumbar epidermoid cyst with DWI findings in a young woman who had undergone epidural anesthesia for Cesarean section three years before the onset of symptoms. PMID:24007735

Manzo, G.; De Gennaro, A.; Cozzolino, A.; Martinelli, E.; Manto, A.

2013-01-01

102

Oesophageal perforation in extreme prematurity  

PubMed Central

Management of oesophageal perforation in extremely premature babies is a challenge and carries a high morbidity. The authors report their experience of three separate cases of oesophageal perforation they encountered over the last 18 months in extremely premature neonates. In the first case, the diagnosis of oesophageal perforation was known in an otherwise stable baby who was treated conservatively with a good outcome. In the second and third cases, the patients proceeded to thoracotomy before the diagnosis of a perforated oesophagus was unveiled. A subsequent diagnosis of trisomy 18 and complex cardiac anomalies in the second case proved incompatible with life and treatment was withdrawn. In the final case, an oesophagostomy was fashioned with a gastrostomy for feeding postoperatively and gastric interposition is planned later this year. PMID:22669028

Jones, Katherine Elizabeth; Wagener, Silke; Willetts, Ian Edward; Lakhoo, Kokila

2012-01-01

103

Duodenal diverticula: potential complications and common imaging pitfalls.  

PubMed

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

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

2014-10-01

104

["Spontaneous perforation" of Douglas' pouch].  

PubMed

"Spontaneous" perforations of Douglas's pouch are a rare complication following gynecological surgery. Three patients are reported, in which Wertheim-Meigs-operation, abdominal and vaginal hysterectomy had been performed. Laceration of the vaginal vault with opening of Douglas's pouch occurred "spontaneously" at sexual intercourse. In another patient rupture of the pelvic floor with prolapse of the intestinum was observed 7 months after colpocleisis. Small perforations may be closed through the vagina; prolapse of the intestinum requires laparotomy. PMID:11127771

Borgmann, U; Heidenreich, W

2000-01-01

105

Study of Slanted Perforated Jets  

NASA Astrophysics Data System (ADS)

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.

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

2013-12-01

106

Iatrogenic pseudoaneurysm of the innominate artery in a neonate.  

PubMed

A 2.8-kg infant underwent urgent repair of a large iatrogenic pseudoaneurysm of the innominate artery, which was compressing the airway and superior vena cava, creating critical respiratory instability. The pseudoaneurysm was repaired with complete resolution of all respiratory symptoms. PMID:22273485

Philip, Ranjit R; Boston, Umar S; Ballweg, Jean A; Goldberg, Steven P; Knott-Craig, Christopher J

2012-03-01

107

[Iatrogenic false aneurysm of the splenic artery after cephalic duodenopancreatectomy].  

PubMed

Splenic artery aneurysms are rare entities with many causes. Rupture can be fatal and usually occurs when the aneurismal diameter is greater than 2 cm. Nevertheless, smaller aneurysms, especially false aneurysms, can also rupture. We report a case of iatrogenic, false aneurysm of the splenic artery subsequent to percutaneous drainage of a retrogastric collection after cephalic duodenopancreatectomy. Splenectomy enabled favorable recovery. PMID:22197585

Michel, P; Jarry, J; Pagliano, G

2012-02-01

108

A case of chronic adrenocortical insufficiency with iatrogenic anasarca.  

PubMed

The decrease in active hormones that characterizes chronic adrenal insufficiency results in hypovolemia. In some patients, residual adrenal function, mineralocorticoid therapy, and concomitant heart or liver failure, or both, can paradoxically provoke edema. The case report that follows describes a patient with iatrogenically induced anasarca resulting from the unhappy confluence of usually appropriate therapy and coexisting medical conditions. PMID:11010057

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

2000-01-01

109

Unusual Birth Trauma Involving Face: A Completely Preventable Iatrogenic Injury  

PubMed Central

Birth injuries involving face are easily recognizable, but are often under-reported. Most of these injuries are associated with face presentation. We report an iatrogenic, but potentially preventable facial birth injury sustained by an unborn child in institutional setup. PMID:25024983

Sharmila, Vijayan; Babu, Thirunavukkarasu Arun

2014-01-01

110

Choledochoduodenal fistula at the anterior wall of the duodenal bulb: a rare complication of duodenal ulcer.  

PubMed

A 38 year-old man was admitted to our hospital with the chief complaint of epigastralgia. His laboratory data revealed leukocytosis and increased serum amylase, and abdominal ultrasonography revealed diffuse swelling of the pancreas. Thus, he was diagnosed as having acute pancreatitis. Moreover, abdominal computed tomography showed pneumobilia in the gallbladder and the common bile duct. Gastroduodenal fiberscopy demonstrated peptic ulcer scars around a foramen with smooth margins at the anterior wall of the duodenal bulb. The bile juice flowed from the bottom of the foramen. Endoscopic retrograde cholangiopancreatography revealed the fistula between the common bile duct and the anterior wall of the duodenal bulb, but not the posterior wall. However, there was no pancreatico-biliary maljunction and no stones in the gallbladder or bile duct. This is a rare case of choledochoduodenal fistula at the anterior wall of the duodenal bulb caused by duodenal peptic ulcer disease. PMID:10228804

Shimao, K; Yamaue, H; Nishimoto, N; Terasawa, H; Saigan, S; Onishi, H; Tanimura, H; Hashimoto, T

1999-01-01

111

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

PubMed

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

Goldner, Bryan; Stabile, Bruce E

2014-10-01

112

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...

113

Duodenal web presenting with acute pancreatitis.  

PubMed

An 8-year-old boy presented with acute pancreatitis and was found to have a fenestrated duodenal web (windsock) and associated anomalies. After partial excision of the web and duodenoplasty, he has remained well with no further symptoms. PMID:9269984

Alizai, N K; Puntis, J W; Stringer, M D

1997-08-01

114

Pancreatic arteriovenous malformation with duodenal ulcer  

Microsoft Academic Search

Summary We report the color Doppler ultrasonography features of arteriovenous malformation (AVM) of the pancreas, a very rare disease. The patient was a 52-year-old man with congenital AVM of the pancreas and a duodenal ulcer that had been resistant to medication. Endoscopic color Doppler ultrasonography (color Doppler EUS) revealed many abnormal color signals showing pulsatile wave form at the portion

Shigeo Tano; Norio Ueno; Tomio Ueno; Shin-Ichi Wada; Toshiyuki Aizawa; Ken Kimura

1996-01-01

115

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

PubMed

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

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

2013-01-01

116

Laparoscopic treatment of perforated appendicitis  

PubMed Central

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

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

2014-01-01

117

Anatomy and physiology of perforator flaps of the upper limb.  

PubMed

Perforator flaps are an excellent reconstructive option for a functional upper limb reconstruction. This article explores the physiology and general principles of perforator flaps and their indications for use in reconstruction of the upper extremity. Workhorse perforator flaps of the upper extremity, such as the radial artery perforator, ulnar artery perforator, lateral arm perforator, posterior interosseous artery, first dorsal metacarpal artery perforator and perforator-based propeller flaps, are discussed in greater detail. PMID:24731605

Appleton, Sarah E; Morris, Steven F

2014-05-01

118

A case of diffuse large B-cell lymphoma transformed from primary duodenal follicular lymphoma.  

PubMed

Primary intestinal follicular lymphoma (FL) is a variant of FL characterized by frequent duodenal involvement and a very indolent clinical behavior without therapy. Unlike nodal FL, there have been no reports of histologic transformation (HT) or death attributable to primary intestinal FL. Here, we report the first case of primary duodenal FL showing HT. A Grade 1 FL in the duodenum was incidentally detected in a 73-year-old man. A watch-and-wait strategy was adopted because the disease was stage IE. Six months later, bone marrow involvement was suspected. The intestinal lesions had not changed during the first year since the initial diagnosis. Sixty-two months after the initial diagnosis, a biopsy specimen showed diffuse large B-cell lymphoma (DLBCL). A perforation of the intestine occurred before chemotherapy was started. Partial resection was performed and subsequent chemotherapy was administered. The clone of the initial FL and DLBCL were identical according to PCR analysis, indicating that the primary intestinal FL had transformed into DLBCL. Although HT is rare, it could occur in some patients with primary intestinal FL. Based on this case, it may be necessary to re-evaluate the clinical watch-and-wait strategy for primary intestinal FL in some patients. PMID:25186289

Miyata-Takata, Tomoko; Takata, Katsuyoshi; Sato, Yasuharu; Taniguchi, Kohei; Takahashi, Yuka; Ohara, Nobuya; Yoshino, Tadashi

2014-10-01

119

Perforated Diode Fabrication for Neutron Detection  

Microsoft Academic Search

Excessive leakage current in perforated pin diodes was identified and addressed through simple changes in processing techniques. The first pulse height spectra from a perforated diode operated as a radiation detector is reported. Also, methods to load 6LiF neutron absorbing material into deep perforations are reported.

W. J. McNeil; S. L. Bellinger; T. C. Unruh; E. L. Patterson; J. K. Shultis; D. S. McGregor

2006-01-01

120

Perforation of honeycomb sandwich plates by projectiles  

Microsoft Academic Search

An analytical solution for the ballistic limit of a honeycomb plate subjected to normal impact by blunt and spherical projectiles is presented. The solution involves a three-stage, perforation process that results in complete perforation of the sandwich. Stages 1–3 describe perforation of the top facesheet, honeycomb core, and bottom facesheet, respectively. Residual velocities in Stages 1 and 2 are found

M. S. Hoo Fatt; K. S. Park

2000-01-01

121

A perforated diverticulum in Cushing's disease  

PubMed Central

We report a case of perforated colonic diverticulum in Cushing's disease. Although perforated diverticuli have been described in patients with Cushing's syndrome secondary to exogenous glucocorticoids, this complication has not been described in patients with Cushing's disease. Patients with hypercortisolism, from either exogenous or endogenous sources, should be monitored for diverticular perforation. PMID:22096731

de Havenon, Adam; Ehrenkranz, Joel

2011-01-01

122

Imaging of chemotherapy-related iatrogenic abdominal and pelvic conditions.  

PubMed

Oncologic therapy is constantly evolving to improve patient outcomes, especially with regard to chemotherapy. The use of combination therapies and development and implementation of molecular targeted therapy lead to iatrogenic conditions that the radiologist must be aware of in interpreting studies of and caring for the oncologic patient. Knowledge of the chemotherapeutic agents and the imaging appearances of associated toxicities can impact patient management and decrease patient morbidity and mortality. PMID:25173656

Viswanathan, Chitra; Truong, Mylene; Sagebiel, Tara; Garg, Naveen; Bhosale, Priya

2014-09-01

123

Duodenal ulceration: review of 110 cases.  

PubMed Central

This paper describes 110 cases of childhood duodenal ulcer, which were diagnosed over 26 years: 63 were diagnosed by barium meal examination; 47 by upper gastrointestinal endoscopy. The mean age at diagnosis was 11.2 years, with symptoms reported in 46% before 10 years and in 15% before 6 years of age. There was often a considerable delay in diagnosis, particularly in the younger age group. Nocturnal pain (61%) and a close family history of duodenal ulcer disease (62%) were the most valuable pointers to the diagnosis. Fifteen children had required surgery for persistent symptoms. Thirty four had received treatment with an H2 receptor antagonist, and all but four had had a satisfactory initial response. Seventy per cent relapsed within six months of discontinuing treatment, and long term maintenance treatment may therefore be necessary. PMID:3619471

Murphy, M S; Eastham, E J; Jimenez, M; Nelson, R; Jackson, R H

1987-01-01

124

Intramural duodenal diverticulum mimicking a periampullary neoplasm.  

PubMed

A 34-year-old woman presented with epigastric pain, nausea, and dyspepsia. Contrast-enhanced computerized tomography revealed a small mass in the duodenal wall mimicking a periampullary neoplasm and, at endoscopic examination, a periampullary submucosal tumor was suspected. The diagnosis of intramural duodenal diverticulum (IDD) was made by an x-ray barium meal that showed a finger-like sac filled with barium, the so-called "windsock sign." IDD is a rare congenital abnormality caused by an anomalous process of recanalization of the primitive foregut. The intermittent filling and emptying of the IDD is responsible for epigastric pain, nausea, and vomiting. When IDD is symptomatic, surgical or endoscopic treatment is recommended. PMID:18614138

Clemente, Gennaro; Sarno, Gerardo; Giordano, Marco; De Rose, Agostino M; Nuzzo, Gennaro

2008-10-01

125

Human Thrombin Injection for the Percutaneous Treatment of Iatrogenic Pseudoaneurysms  

SciTech Connect

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.

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

126

Aortic Perforation During Lumbar Laminectomy  

Microsoft Academic Search

umbar laminectomy is a common and usually routine operation, but it can occasionally result in sudden, life-threatening complications. Such events usually require rapid therapy, so it is essential that anesthesiologists be aware of these potential com- plications, as well as their manifestations and treat- ment. We report the occurrence of aortic perforation, an uncommon but potentially fatal complication of lumbar

Christian W. Hiinemann; Gerhard Brodner; Hugo Van Aken; Ulrich Ruta; Marcel E. Durieux; Thomas Mollhoff

1998-01-01

127

Refractory Duodenal Crohn's Disease Successfully Treated with Infliximab  

PubMed Central

Crohn's disease (CD) may involve any part of the gastrointestinal tract, from the mouth to the anus. Approximately >90% of cases occur in the small bowel and colon. Upper gastrointestinal involvement, especially duodenal manifestation, is relatively rare. Therefore, adequate medical treatment for duodenal CD has not yet been established. We report a case of CD with duodenal involvement. A 46-year-old man with Crohn's ileocolitis presented to our hospital with right upper quadrant pain. An endoscopy showed a deep excavated ulcer with deformity at the duodenal bulb, and he was initially treated with azathioprine (1 mg/kg), Pentasa (3.0 g/day), and a proton pump inhibitor for 1 year. However, the deep ulcer did not heal. Therefore, infliximab infusion therapy was initiated, and the duodenal lesion completely resolved on follow-up esophagogastroduodenoscopy. We report a case of duodenal CD that completely resolved following infliximab infusion, with a review of the literature. PMID:25349566

Kim, You Lim; Park, Eun Kyoung; Park, Dae Rim; Choi, Gyu Sik; Ahn, Sang Bong; Kim, Seong Hwan; Jo, Yun Ju

2014-01-01

128

Portal hypertensive duodenal polyp: A case report  

PubMed Central

Abnormalities of gastric mucosa in patients with portal hypertension are well documented. Manifestations of portal hypertension in small bowel and colon are less common. Colonic polypoid lesions microscopically consisting of a normal mucosa, with dilatation of submucosal vessels, have been described. We here report the first case of portal hypertensive duodenal polyp, responsible for gastro-intestinal bleeding. Endoscopic treatment turned out to be successful. PMID:17457981

Zeitoun, Jean-David; Chryssostalis, Ariane; Terris, Benoit; Prat, Frederic; Gaudric, Marianne; Chaussade, Stanislas

2007-01-01

129

Diagnosis and management of intraluminal duodenal diverticulum  

Microsoft Academic Search

The descending part of duodenum is the principal site for an intraluminally projecting mucosal pouch or diverticulum, but\\u000a this unusual lesion may also occur elsewhere in the upper gastrointestinal tract. We report three patients in whom a large\\u000a intraluminal duodenal diverticulum (IDD) was diagnosed radiographically at the ages of 15, 27, and 68 years, respectively.\\u000a Fiberoptic duodenoscopy was performed in

Monty P. Karoll; Gary G. Ghahremani; Ronald B. Port; James L. Rosenberg

1983-01-01

130

Duodenal osmolality drives gallbladder emptying in humans  

Microsoft Academic Search

The effect of duodenal osmoreceptor stimulation on gallbladder motility was evaluated in 18 normal subjects during intraduodenal infusion of 280, 560 and 840 mosmlliters NaCl solutions. Gallbladder emptying was found to be dose-dependent between 560 and 840 mosm\\/liter (P,indicating that cholinergic and endorphinergic pathways may be involved in regulating this reflex. Since proglumide, a cholecystokinin (CCK) antagonist, did not affect

Stefano Fiorucci; Rachele Bosso; Antonio Morelli

1990-01-01

131

Successful Treatment of Duodenal Variceal Bleeding by Endoscopic Clipping  

PubMed Central

Duodenal varix bleeding is an uncommon cause of gastrointestinal bleeding in patients with portal hypertension but can cause severe and potentially fatal bleeding. However, the incidence is low and a good treatment method has not been well established yet. Duodenal variceal bleeding can be treated surgically or nonsurgically. We have successfully treated a patient with duodenal variceal bleeding secondary to liver cirrhosis using hemoclips to control the bleeding. PMID:23964340

Park, Su Bin; Kim, Jin Hee; Lee, Hyun Jung; Jang, Sung Pil; Lee, Jae Nam; Hwang, Jong Ho

2013-01-01

132

Acquired reactive perforating collagenosis: current status.  

PubMed

Acquired reactive perforating collagenosis is a unique perforating dermatosis, characterized clinically by umbilicated hyperkeratotic papules or nodules and histologically by a focal hyperkeratosis in direct contact with transepidermal perforating dermal collagen. Several inflammatory or malignant systemic diseases may coexist with acquired reactive perforating collagenosis. The possible biochemical or immunological mechanisms of the systemic diseases, potentially responsible for the development and appearance of acquired reactive perforating collagenosis, are still under investigation. Several topical treatments, ultraviolet B phototherapy and allopurinol p.o. administration may be effective. PMID:20629824

Karpouzis, Anthony; Giatromanolaki, Alexandra; Sivridis, Efthimios; Kouskoukis, Constantin

2010-07-01

133

Chorioretinectomy for perforating eye injuries  

PubMed Central

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

Ozdek, S; Hasanreisoglu, M; Yuksel, E

2013-01-01

134

Electromagnetic measurements of duodenal digesta flow in cannulated sheep  

E-print Network

Electromagnetic measurements of duodenal digesta flow in cannulated sheep C. PONCET, M. IVAN M of duodenal digesta flow were made in sheep implanted with an electromagnetic flowmeter probe on the ascending to frequent oscillation of the digesta. It was concluded that accurate quantitative electromagnetic

Paris-Sud XI, Université de

135

Duodenal Switch: Long-Term Results  

Microsoft Academic Search

\\u000a Background  This report summarizes our 15-year experience with duodenal switch (DS) as a primary procedure on 1,423 patients from 1992\\u000a to 2005.\\u000a \\u000a \\u000a \\u000a Methods  Within the last 2 years, follow-up of these patients, including clinical biochemistry evaluation by us or by their local physician\\u000a is 97%.\\u000a \\u000a \\u000a \\u000a Results  Survival rate was 92% after DS. The risk of death (Excess Hazard Ratio (EHR)) was 1.2, almost that

Picard Marceau; Simon Biron; Frédéric-Simon Hould; Stéfane Lebel; Simon Marceau; Odette Lescelleur; Laurent Biertho; Serge Simard

2007-01-01

136

Iatrogenic Penile Glans Amputation: Major Novel Reconstructive Procedure  

PubMed Central

Circumcision is a very common urological practice. Even though it is relatively safe, it is not a complication-free procedure. We describe a patient that underwent a neonatal circumcision complicated by iatrogenic complete glans amputation. Reconstructive repair of a neoglans using a modified traditional method was used. Postoperative followup to 90 days is illustrated. Despite being a simple procedure, circumcision in unprofessional hands can have major complication impacting the emotional and sexual life of patients. Surgical reconstruction is possible with varying satisfactory results. PMID:24379983

Nasr, Rami; Traboulsi, Samer L.; Abou Ghaida, Rami R.; Bakhach, Joseph

2013-01-01

137

Accidental and iatrogenic causes of acute kidney injury  

PubMed Central

Purpose of review Ingestions and iatrogenic administration of drugs are all too common causes of acute kidney injury. This review will discuss these preventable causes of acute kidney injury. Recent findings Recent studies have examined the pathophysiology of acute kidney injury by several commonly used drugs. These studies have shown that drugs and toxins can cause acute kidney injury by altering renal hemodynamics, direct tubular injury or causing renal tubular obstruction. Summary Knowledge of the drugs that cause acute kidney injury and how this injury is manifested can lead to improved diagnosis and treatment with the ultimate goal of prevention. PMID:21293274

Twombley, Katherine; Baum, Michel; Gattineni, Jyothsna

2014-01-01

138

Refractory ulcerative colitis and iatrogenic colorectal Kaposi's sarcoma.  

PubMed

Colorectal Kaposi's sarcoma, a human herpes virus-8 associated mesenchymal tumour, is exceedingly rare in human immunodeficiency virus-negative subjects and almost always reported in association with severe, refractory, inflammatory bowel disease. In this paper we report a case--the second from Italy--of a colorectal Kaposi's sarcoma in a human immunodeficiency virus-negative, heterosexual man with severe refractory ulcerative colitis. Kaposi's sarcoma developed after starting glucocorticosteroid therapy, supporting the theory that colorectal Kaposi's sarcoma associated with ulcerative colitis is iatrogenic. PMID:18054849

Girelli, C M; Serio, G; Rocca, E; Rocca, F

2009-02-01

139

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

PubMed Central

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

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

1984-01-01

140

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

PubMed

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

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

2013-12-01

141

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

PubMed Central

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

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

2013-01-01

142

Intraluminal duodenal diverticulum in the adult.  

PubMed Central

Four patients with intraluminal diverticulum of the duodenum are presented and compared with those reported previously. This lesion is a rare congenital disorder that usually becomes symptomatic in adult life. It is located in the second portion of the duodenum within the lumen, extending distally. It has the appearance of a "thumb of a glove" and it is lined by mucosa on both surfaces. It develops betweeen the fourth and eighth week of the embryo's life, but it increases in size during adult life. It usually presents with typical or atypical symptoms of peptic ulcer disease, but sometimes manifestations such as gastrointestinal bleeding, duodenal obstructions or pancreatitis may predominate and may be severe and life-threatening. The diagnosis is best made with hypotonic duodenography, which demonstrates the lesion as a barium coated pouch within the air filled duodenal lumen. The treatment of choice is duodenotomy and excision of the lesion. Proper identification of the papilla of the ampulla of Vater is important since this structure is often adjacent to the diverticulum. No recurrences have been noted in the three patients operated upon. Images Fig. 1. Fig. 2. Fig. 3. Fig. 4. Fig. 5. PMID:402122

Economides, N G; McBurney, R P; Hamilton, F H

1977-01-01

143

Endovascular Management of Iatrogenic Native Renal Arterial Pseudoaneurysms  

SciTech Connect

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

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

2012-12-15

144

Prognosis of perforating eye injury.  

PubMed Central

The assessment of visual function in a series of 130 consecutive patients of perforating eye injuries, revealed that visual acuity of 6/12 or better was regained in 63 per cent, between 6/60 and 6/18 in 9-2 per cent, less than 6/60 in 15-3 per cent, and enucleation was necessary in 9-2 per cent. In 3 per cent, the eyes were retained as blind, symptomfree, and cosmetically satisfactory organs. Two eyes were found to develop complete traumatic aniridia. None in the series was found to have sympathetic ophthalmitis. PMID:1009049

Adhikary, H P; Taylor, P; Fitzmaurice, D J

1976-01-01

145

Symptomatic duodenal Crohn's disease: is strictureplasty the right choice?  

PubMed

Primary duodenal localization of Crohn's disease (CD) is rare. Medical therapy can control symptoms, but surgery is required when progressive obstructive symptoms occur. Surgical options include bypass, resection, or strictureplasty, but it is still not clear which should be the treatment of choice. Reviewing the medical records of 1253 patients undergoing surgery for CD between January 1986 and December 2011 at the Digestive Surgery Unit of the Department of Clinical Physiopathology of the University of Florence, 10 patients (6 males and 4 females) underwent operations for duodenal CD. Four patients had only a duodenal localization, 6 patients had synchronous involvement of other intestinal tracts. Strictures were distributed in all the duodenal portions: in 7 patients there were single lesions, in 3 patients there were multiple lesions. Eight patients were treated with strictureplasty: 5 with the Heineke-Mikulicz technique, 2 with Jaboulay, and 1 with a pedunculated jejunal patch. Two patients were treated with resection: one with a B2 gastro-duodenal resection, and 1 with a duodenal-jejunal resection and an end to side duodeno-jejunal anastomosis. Follow up of the patients was from 2 to 18 years. No recurrence of duodenal CD was observed in the 2 patients treated with resection, while 2 of the 8 patients treated with strictureplasty had a recurrence. In our experience, strictureplasty is indicated when less than 2 strictures are present in the 2nd or 3rd duodenal portion. In cases with multiple strictures localized in the 1st or the distal duodenal portion, resection is preferable. PMID:23165121

Tonelli, Francesco; Alemanno, Giovanni; Bellucci, Francesco; Focardi, Adriana; Sturiale, Alessandro; Giudici, Francesco

2013-11-01

146

Imaging diagnosis--duodenal diverticulum in a dog.  

PubMed

A young female Boxer had a history of chronic soft stool. Survey abdominal radiographs were unremarkable. A duodenal diverticulum was identified in abdominal ultrasound and barium upper-gastrointestinal contrast examinations. Before surgery a 99mTc-pertechnetate study was performed to evaluate for ectopic gastric mucosa in the duodenal diverticulum. Focal abnormal increased radioactivity was identified in the right caudal abdominal quadrant. The diverticulum was excised. Upon histopathologic examination of the duodenal diverticulum, ectopic gastric mucosa was not identified but ectopic pancreatic tissue was found. Mild eosinophilic inflammation within the diverticulum was suspected to be the cause of the mild 99mTc uptake seen in this dog. PMID:20166396

Polf, Holly; Poteet, Brian

2010-01-01

147

Duodenal obstruction due to a preduodenal portal vein.  

PubMed

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

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

2014-01-01

148

Diagnosis and treatment of gallbladder perforation  

Microsoft Academic Search

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

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

149

The dorsal metatarsal artery perforator flap.  

PubMed

Few options exist for the resurfacing of web-space and small soft tissue defects of the dorsum of the distal foot. The study examines the anatomy of the second to fourth dorsal metatarsal arteries in 16 fresh frozen cadavers to determine if the anatomy correlates to that in the hand, permitting the design of local flaps based on perforators of these vessels. A clinical case is also presented, illustrating the efficacy of such a perforator-based flap.Sixteen Asian cadaveric lower limbs were used for this study. The specimens were prepared with latex dye injection. Dissection under loupe magnification was carried out to determine the position and caliber of the cutaneous perforators from the dorsal metatarsal arteries, and the spread of the latex dye in the skin from these cutaneous perforators. One clinical case illustration of this perforator-based flap for distal foot defect resurfacing is presented.In our cadaveric study, each second to fourth dorsal metatarsal artery had between 2 and 5 cutaneous perforators with calibers of 0.5 to 0.7 mm in diameter. The most distal cutaneous perforator was present consistently, always arising between the heads of the respective metatarsals.In conclusion, the vascular anatomy of the second to fourth dorsal metatarsal arteries is similar to that in the hand, thus allowing for the design of reliable perforator-based flaps for distal foot resurfacing. PMID:23722578

Yeo, Chong Jin; Sebastin, Sandeep J; Ho, Samuel Y M; Tay, Shian Chao; Puhaindran, Mark E; Lim, Aymeric Y T

2014-10-01

150

Prevalence of Perforated Sigmoid Diverticulitis Is Increasing  

Microsoft Academic Search

INTRODUCTION: The population of Finland is aging fast, and dietary fiber consumption has decreased during the past few decades; the prevalence of sigmoid diverticular perforation can therefore be anticipated to increase. This study presents our experience concerning the outcome of 133 patients admitted to a university hospital for diverticular perforation during a 15-year period. METHODS: One hundred thirty-three patients admitted

Jyrki Mäkelä; Heikki Kiviniemi; Seppo Laitinen

2002-01-01

151

Diverticular perforation masquerading as maxillary sinusitis  

Microsoft Academic Search

Although diverticular perforation and diverticulitis is usually a straightforward diagnosis, an occasional case can be difficult. In this report, we describe a patient who initially presented with symptoms suggestive of maxillary sinusitis and hip fracture. Findings of subcutaneous craniofacial emphysema eventually led to the diagnosis of a perforated sigmoid diverticulum with abscess.

Michael C. Hollingshead; David M. Warshauer

2006-01-01

152

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

PubMed

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

Algin, Oktay; Mustafayev, Assanaly; Ozmen, Evrim

2014-05-01

153

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

PubMed Central

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

2014-01-01

154

A multifactorial analysis of factors related to lethality after treatment of perforated gastroduodenal ulcer. 1935-1985.  

PubMed Central

One thousand one hundred and twenty-eight patients treated for perforated gastroduodenal ulcer during the years 1935-1985 were studied at the Haukeland University Hospital. The majority of patients (97.7%) were treated surgically. The data was analyzed by contingency tables and chi square testing, and a stepwise logistic regression analysis was performed in order to reveal interactions between variables and to elucidate time trends in lethality rates. The total postperforation lethality was 7.4%, the postsurgical death rate was 6.6%, and the death rate among conservatively treated patients was 42.3%. Lethality was significantly influenced by year of hospital admission and increased markedly with the age of the patients. For all age groups, the lethality decreased markedly with time. Treatment delay was associated with a moderate but significant increase in lethality. In patients with gastric ulcer the lethality was 3.6 times higher than in those with duodenal ulcer. The death rate was similar in the duodenal and pyloric ulcer groups. Death rate decreased with time in both stomach ulcer, duodenal, and pyloric ulcer patients. There was no sex difference and no difference between patients treated with simple suture or gastric resection. PMID:2930287

Svanes, C; Salvesen, H; Espehaug, B; S?reide, O; Svanes, K

1989-01-01

155

Iatrogenic vertebral artery pseudoaneurysm due to central venous catheterization  

PubMed Central

Central venous lines have become an integral part of patient care, but they are not without complications. Vertebral artery pseudoaneurysm formation is one of the rarer complications of central line placement. Presented is a rare case of two pseudoaneurysms of the vertebral and subclavian artery after an attempted internal jugular vein catheterization. These were successfully treated with open surgical repair and bypass. Open surgical repair remains the gold standard of treatment. Endovascular repair of vertebral artery pseudoaneurysms has been described with promising outcomes, but long-term results are lacking. Ultimately, the best treatment of these iatrogenic injuries should start with prevention. Well-documented techniques to minimize mechanical complications, including inadvertent arterial puncture, should be practiced and taught in training programs to avoid the potentially devastating consequences. PMID:21566753

Vasquez, Jay

2011-01-01

156

Iatrogenic cerebrospinal fluid leak and intracranial hypotension after gynecological surgery.  

PubMed

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

Tu, Albert; Creedon, Kerry; Sahjpaul, Ramesh

2014-09-01

157

The H2-receptor antagonist era in duodenal ulcer disease.  

PubMed Central

This paper reviews the remarkable impact of H2-receptor antagonists on duodenal ulcer management. The development and the scientific rationale of these agents are presented, and efficacy and safety aspects in the short- and long-term treatment of duodenal ulcer disease discussed. Attention is focused on the possible role of "acid rebound" in ulcer relapse following the withdrawal of therapy and on the clinical relevance of prolonged suppression of acid secretion in patients on long-term therapy. PMID:1364125

Marks, I. N.

1992-01-01

158

Further Experience with Epigastric Pain Reproduction Test in Duodenal Ulceration  

Microsoft Academic Search

Further evidence is presented that the epigastric pain of duodenal ulceration, situated between the rib margins and just below the xiphisternum, arises from the lower oesophagus.One-hundred patients with duodenal ulceration were divided into those with epigastric pain (61) and those with pain in the upper abdomen but not in the epigastrium (39). Perfusion of 0·1 N HCl into the lower

Richard J. Earlam

1972-01-01

159

CT-appearance of intraluminal duodenal diverticulum. The "halo" sign.  

PubMed

The barium appearance of intraluminal duodenal diverticulum has been classically described as a "windsock" appearance. However, the CT-scan appearance of this abnormality has not been well documented. A case report of a patient with intraluminal duodenal diverticulum is presented. The authors believe the CT-scan findings in the patient are virtually pathognomonic for this lesion and propose the term "halo" sign be applied to this previously undescribed finding. PMID:9745949

Tu, A S; Tran, M H; Larsen, C R

1998-01-01

160

Ipilimumab-induced colonic perforation  

PubMed Central

Biologic immune modulators such as ipilimumab have demonstrated the efficacy against metastatic melanoma. We present a recent case of a 52-year-old male who initially developed mild colitis following the initiation of ipilimumab treatment for metastatic melanoma. Despite initial improvement with immediate cessation of drug and initiation of high-dose steroid therapy his clinical condition worsened and the patient presented to our facility in extremis from colonic perforation. Following an extended right hemicolectomy his postoperative period was extended due to continued symptomatic enteritis. After 3 weeks colonoscopy revealed that the autoimmune event had begun to subside;  his condition improved, resulting in discharge. We discuss this particular side effect with respect to ipilimumab adjuvant therapy in melanoma. PMID:24876393

Burdine, Lyle; Lai, Keith; Laryea, Jonathan A.

2014-01-01

161

A microdissection study of perforating vessels in the perineum: implication in designing perforator flaps.  

PubMed

The objective of this study is to determine the quantity, position, and caliber of perforating vessels in the perineum, and to provide an anatomic basis for designing perineal perforator flaps. Eleven adult cadavers (22 sides) were dissected under an operating microscope (x10). Microstructures, including perforating arteries, vena comitantes, vascular anastomoses, and cutaneous nerves, were measured with a sliding caliper (accurate to 0.2 mm). There were 4 relatively constant perforating arteries in the perineum: inguinal and perineal perforating branches of the superficial external pudendal artery, a perforating branch of the anterior cutaneous branch of the obturator artery, and a perforating branch of the lateral branch of the posterior scrotal (pudendal) artery. All 4 arteries were direct perforating branches. These perforating arteries and accompanying veins overlapped with each other and formed the upper, middle, and lower parts of the vascular anastomosis in deep fascia above the adductor wall. There were 4 important cutaneous nerves in the region originating from the following nerves: the genitofemoral nerve, ilioinguinal nerve, posterior scrotum (labium) major nerve, and rami perineales nervi cutanei femoris posterioris. The perineum has abundant blood supply, venous return, and innervation. Due to its covert location and manoeuvrability, perforator flaps from this region are good sources of donor tissue for perineal reconstruction. PMID:19887931

Jin, Bai; Hasi, Wulan; Yang, Chao; Song, Jianxing

2009-12-01

162

Duodenal web associated with malrotation and review of literature  

PubMed Central

Intestinal obstruction due to midgut malrotation in neonates is well known. The incidence of malrotation in newborns is around 1:500 and the symptomatic incidence is 1:6000 births. Duodenal web as a cause of intestinal obstruction is less common and is reported to be 1:10 000–1:40 000. Malrotation is known to be associated with other congenital obstructive anomalies including duodenal atresia, stenosis and duodenal web. But, intestinal obstruction due to malrotation associated with duodenal web has been reported only rarely with a few published cases in our literature review. We present a case of intestinal obstruction diagnosed in the prenatal period via sonogram. A plain X-ray of the abdomen after birth showed a distended duodenum with paucity of air distally suggesting duodenal obstruction. An exploratory laparotomy showed a duodenal web proximal to the sphincter of oddi. The patient also had an associated malrotation and underwent Ladd's procedure and appendectomy. The post-operative period was uneventful. PMID:24968440

Eksarko, Polikseni; Nazir, Sharique; Kessler, Edmund; LeBlanc, Patrick; Zeidman, Michael; Asarian, Armand P.; Xiao, Philip; Pappas, Peter J.

2013-01-01

163

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

SciTech Connect

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

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

1987-08-01

164

The effect of perforating conditions on well performance  

SciTech Connect

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.

McLeod, H.O.

1983-02-01

165

The effect of perforating conditions on well performance  

SciTech Connect

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.

McLeod, H.O. Jr.

1983-01-01

166

Iatrogenic injury to oral branches of the trigeminal nerve: records of 449 cases  

Microsoft Academic Search

The aims of this study were threefold: (1) to describe iatrogenic lesions to oral branches of the trigeminal nerve, signs\\u000a and symptoms, and functional status, (2) to report on a simple neurosensory examination method, and (3) to discuss means of\\u000a prevention of iatrogenic injury. The etiology and functional status of 449 injuries to oral branches collected over 18 years\\u000a were retrospectively

Søren Hillerup

2007-01-01

167

Massive Thoracoabdominal Aortic Thrombosis in a Patient with Iatrogenic Cushing Syndrome  

PubMed Central

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

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

2014-01-01

168

Clinical profile and outcome of surgical treatment of perforated peptic ulcers in Northwestern Tanzania: A tertiary hospital experience  

PubMed Central

Background Perforated peptic ulcer is a serious complication of peptic ulcers with potential risk of grave complications. There is paucity of published reports on perforated peptic ulcer disease in our local environment. This study was conducted to evaluate the clinical presentation, management and outcome of patients with peptic ulcer perforation in our setting and to identify predictors of outcome of these patients. Methods This was a combined retrospective and prospective study of patients who were operated for perforated peptic ulcers at Bugando Medical Centre between April 2006 and March 2011. Data were collected using a pre-tested and coded questionnaire and analyzed using SPSS computer software version 15.0. Ethical approval to conduct the study was obtained from relevant authority before the commencement of the study. Results A total of 84 patients were studied. Males outnumbered females by a ratio of 1.3: 1. Their median age was 28 years and the modal age group was 21-30 years. The median duration of illness was 5.8 days. The majority of patients (69.0%) had no previous history of treatment for peptic ulcer disease. The use of non-steroidal anti-inflammatory drugs, alcohol and smoking was reported in 10.7%, 85.7% and 64.3% respectively. Eight (9.5%) patients were HIV positive with a median CD4 count of 220 cells/?l. Most perforations were located on the duodenum {90.4%) with the duodenal to gastric ulcers ratio of 12.7: 1. Graham's omental patch (Graham's omentopexy) of the perforations was performed in 83.3% of cases. Complication and mortality rates were 29.8% and 10.7% respectively. The factors significantly related to complications were premorbid illness, HIV status, CD 4 count < 200 cells/?l, treatment delay and acute perforation (P < 0.001). Mortality rate was high in patients who had age ? 40 years, delayed presentation (>24 hrs), shock at admission (systolic BP < 90 mmHg), HIV positivity, low CD4 count (<200 cells/?l), gastric ulcers, concomitant diseases and presence of complications (P < 0.001). The median overall length of hospital stay was 14 days. Excellent results using Visick's grading system were obtained in 82.6% of surviving patients. Conclusion Perforation of peptic ulcer remains a frequent clinical problem in our environment predominantly affecting young males not known to suffer from PUD. Simple closure with omental patch followed by Helicobacter pylori eradication was effective with excellent results in majority of survivors despite patients' late presentation in our center. PMID:21871104

2011-01-01

169

Correlation of tissue transglutaminase antibody with duodenal histologic marsh grading.  

PubMed

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

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

2014-07-01

170

Sigmoid diverticulitis with perforation and generalized peritonitis  

Microsoft Academic Search

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

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

1985-01-01

171

Perforating Dermatosis in a Patient Receiving Azathioprine  

PubMed Central

Azathioprine (AZA) is an imidazole derivative of mercaptopurine. It antagonizes purine metabolism, and it may inhibit synthesis of DNA, RNA, and proteins. The 6-thioguanine nucleotides appear to mediate the majority of AZAs immunosuppressive and toxic effects. While cutaneous adverse side-effects are not uncommon, perforating dermatosis has not been reported in association to AZA. We speculate that immunological disorders induced by AZA in susceptible individuals could be related to perforating dermatosis. PMID:23716824

Grillo, Emiliano; Vano-Galvan, Sergio; Moreno, Carmen; Jaen, Pedro

2013-01-01

172

Anesthetic management for patients with perforation peritonitis  

PubMed Central

Perforation peritonitis is a common surgical emergency. Anesthesia in patients with perforation peritonitis can be challenging. Delayed presentations, old age, hemodynamic instability, presence of sepsis and organ dysfunction are some of the predictors of poor outcome in such patients. Pre-operative optimization can reduce intraoperative and post-operative morbidity and mortality, but surgery should not be unnecessarily delayed. Intensive care in critical care settings may be essential. PMID:24249978

Sharma, Kiran; Kumar, Mritunjay; Batra, Upma Bhatia

2013-01-01

173

Right-Sided Sigmoid Diverticular Perforation  

PubMed Central

Diverticulosis is a common disorder among geriatric patients, of whom 10% to 25% go on to develop diverticulitis. Known complications of diverticulitis include formation of phlegmon, fistula, bowel obstruction, bleeding, perforation, and colonic abscess. A less common complication is perforation with formation of an extra-abdominal necrotizing abscess. This case is a report of an 83-year-old female who presented to the emergency department with a necrotizing abdominal wall abscess secondary to right-sided diverticular microperforation. PMID:22461936

Little, Andrew; Culver, Andy

2012-01-01

174

A hypervelocity projectile launcher for well perforation  

SciTech Connect

Current oil well perforation techniques use low- to medium-velocity gun launchers for completing wells in soft rock. Shaped-charge jets are normally used in harder, more competent rock. A 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.

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

1989-01-01

175

Risk of cardiovascular events in people prescribed glucocorticoids with iatrogenic Cushing's syndrome: cohort study  

PubMed Central

Objective To investigate whether there is an increased risk of cardiovascular events in people who exhibit iatrogenic Cushing’s syndrome during treatment with glucocorticoids. Design Cohort study. Setting 424 UK general practices contributing to The Health Improvement Network database. Participants People prescribed systemic glucocorticoids and with a diagnosis of iatrogenic Cushing’s syndrome (n=547) and two comparison groups: those prescribed glucocorticoids and with no diagnosis of iatrogenic Cushing’s syndrome (n=3231) and those not prescribed systemic glucocorticoids (n=3282). Main outcome measures Incidence of cardiovascular events within a year after diagnosis of iatrogenic Cushing’s syndrome or after a randomly selected date, and association between iatrogenic Cushing’s syndrome and risk of cardiovascular events. Results 417 cardiovascular events occurred in 341 patients. Taking into account only the first event by patient (coronary heart disease n=177, heart failure n=101, ischaemic stroke n=63), the incidence rates of cardiovascular events per 100 person years at risk were 15.1 (95% confidence interval 11.8 to 18.4) in those prescribed glucocorticoids and with a diagnosis of iatrogenic Cushing’s syndrome, 6.4 (5.5 to 7.3) in those prescribed glucocorticoids without a diagnosis of iatrogenic Cushing’s syndrome, and 4.1 (3.4 to 4.8) in those not prescribed glucocorticoids. In multivariate analyses adjusted for sex, age, intensity of glucocorticoid use, underlying disease, smoking status, and use of aspirin, diabetes drugs, antihypertensive drugs, lipid lowering drugs, or oral anticoagulant drugs, the relation between iatrogenic Cushing’s syndrome and cardiovascular events was strong (adjusted hazard ratios 2.27 (95% confidence interval 1.48 to 3.47) for coronary heart disease, 3.77 (2.41 to 5.90) for heart failure, and 2.23 (0.96 to 5.17) for ischaemic cerebrovascular events). The adjusted hazard ratio for any cardiovascular event was 4.16 (2.98 to 5.82) when the group prescribed glucocorticoids and with iatrogenic Cushing’s syndrome was compared with the group not prescribed glucocorticoids. Conclusion People who use glucocorticoids and exhibit iatrogenic Cushing’s syndrome should be aggressively targeted for early screening and management of cardiovascular risk factors. PMID:22846415

2012-01-01

176

Plasma total homocysteine levels during short-term iatrogenic hypothyroidism.  

PubMed

Hypothyroidism is associated with increased cardiovascular morbidity, which cannot be fully explained by the atherogenic lipid profile observed in these patients. We have previously found elevated levels of the cardiovascular risk factor, plasma total homocysteine (tHcy), in hypothyroidism. We conducted a longitudinal study on 17 patients who had undergone total thyroidectomy for thyroid cancer. During 6 weeks of discontinued T4 substitution before radioscintigraphy (phase I), they attained a hypothyroid state, which was reversed by resupplementation (phase II). Plasma tHcy, serum creatinine, serum and red blood cell folate, serum cobalamin, and serum cholesterol were determined at 2-week intervals throughout phases I and II. There was a progressive and parallel increase in tHcy (mean, 27%), serum creatinine (37%), and serum cholesterol (100%) during phase I, and these values returned to the original level within 4-6 weeks after reinitiating T4 therapy. Serum and red blood cell folate levels showed only minor, but statistically significant, changes. In a bivariate model, serum creatinine and serum cholesterol were strongly associated with the changes observed in tHcy during short term hypothyroidism. In conclusion, we found a transient increase in both plasma tHcy and serum cholesterol during short term iatrogenic hypothyroidism, and the tHcy response is probably mainly explained by concurrent changes in renal function. The increase in both plasma tHcy and serum cholesterol may confer increased cardiovascular risk in hypothyroid patients. PMID:10720038

Lien, E A; Nedrebø, B G; Varhaug, J E; Nygård, O; Aakvaag, A; Ueland, P M

2000-03-01

177

Iatrogenic possibilities of orthodontic treatment and modalities of prevention  

PubMed Central

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

Meeran, Nazeer Ahmed

2013-01-01

178

Percutaneous Management of Postoperative Duodenal Stump Leakage with Foley Catheter  

SciTech Connect

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

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

2013-10-15

179

Surface studies of duodenal lesions induced by thoracic irradiation  

SciTech Connect

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

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

1986-01-01

180

Laparoscopic partial cystectomy with mucosal stripping of extraluminal duodenal duplication cysts  

PubMed Central

Duodenal duplication cysts are rare congenital anomalies. Duodenal duplication should be considered in the differential diagnosis of patients who present with abdominal symptoms with cystic structures neighboring the duodenum. Here, we present an 8-year-old girl with a duodenal duplication cyst treated with partial cystectomy with mucosal stripping performed laparoscopically. Laparoscopic surgery can be considered as a treatment option for duodenal duplication cysts, especially in extraluminal locations. PMID:24574788

Byun, Jeik; Oh, Hyoung-Min; Kim, Soo-Hong; Kim, Hyun-Young; Jung, Sung-Eun; Park, Kwi-Won; Kim, Woo-Sun

2014-01-01

181

Periampullary duodenal duplication cyst masquerading as a choledochocele.  

PubMed

Enteric duplication cysts are rare congenital anomalies of unclear etiology. While they can occur anywhere in the gastrointestinal tract, they typically occur in the ileum or ileocecal region and very rarely in the duodenum. Here, we report a case of a periampullary duodenal duplication cyst in a 13-year-old male who presented with clinical and laboratory evidence of small bowel obstruction, hepatitis, and pancreatitis. Based on radiologic imaging, the patient was thought to have a type III choledochal cyst (choledochocele) within the duodenal lumen. Intraoperative findings and postoperative pathological evaluation, however, revealed that the lesion was a duodenal duplication cyst masquerading as a choledochal cyst. Interestingly, the duplication cyst was communicating with the common bile duct, simultaneously causing biliary and small bowel obstruction. PMID:22752148

Koffie, Robert M; Lee, Sang; Perez-Atayde, Antonio; Mooney, David P

2012-10-01

182

Effect of perforating conditions on well performance. [Natural gas wells  

SciTech Connect

The productivity of a perforated gas well is strongly affected 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 the perforation condition, can be used with perforation dimensions to predict gas well performance. An approach is presented for the problem of turbulent flow in perforated wells that are not gravel-packed. It can be used to analyze producing gas wells, or it can be combined with flowing well analysis to calculate the perforations needed to complete a gas well in a consolidated or competent formation. 13 refs.

McLeod, H.O. Jr.

1982-01-01

183

Colonoscopic Perforation in Inflammatory Bowel Disease  

PubMed Central

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

Makkar, Rohit

2013-01-01

184

Treatment of early and delayed esophageal perforation.  

PubMed

Esophageal perforations are life threatening emergencies associated with high morbidity and mortality. We report on 22 consecutive patients (age 20-86; 13 female and 9 male) with an oesophageal perforation treated at the university hospital Duesseldorf. The patients' charts were reviewed and follow-up was completed for all patients until demission, healed reconstruction or death. Patients' history, clinical presentation, time interval to surgical presentation, and treatment modality were recorded and correlated with patients' outcome. Six esophageal perforations were due to a Boerhaave-syndrome, eleven caused by endoscopic perforation, two after osteosynthesis of the cervical spine and three foreign body induced. In 7 patients a primary local suture was performed, in 4 cases a supplemental muscle flap was interposed, and 7 patients underwent an oesophageal resection. Four patients were treated without surgery (three esophageal stent implantations, one conservative treatment). Eleven patients (50 %) were presented within 24 h of perforation, and 11 patients (50 %) afterwards. Time delay correlates with survival. In 17 (80.9 %) cases a surgical sufficient reconstruction could be achieved. One (4.7 %) patient is waiting for reconstruction after esophagectomy. Four (18.2 %) patients died. A small subset of patients can be treated conservatively by stenting of the Esophagus, if the patient presents early. In the majority of patients a primary repair (muscle flap etc.) can be performed with good prognosis. If the patient presents delayed with extensive necrosis or mediastinitis, oesophagectomy and secondary repair is the only treatment option with high mortality. PMID:24465104

Kroepil, F; Schauer, M; Raffel, A M; Kröpil, P; Eisenberger, C F; Knoefel, W T

2013-12-01

185

Iatrogenic QT Abnormalities and Fatal Arrhythmias: Mechanisms and Clinical Significance.  

PubMed

Severe and occasionally fatal arrhythmias, commonly presenting as Torsade de Pointes [TdP] have been reported with Class III-antiarrhythmics, but also with non-antiarrhythmic drugs. Most cases result from an action on K(+) channels encoded by the HERG gene responsible for the IKr repolarizing current, leading to a long QT and repolarization abnormalities. The hydrophobic central cavity of the HERG-K+ channels, allows a large number of structurally unrelated drugs to bind and cause direct channel inhibition. Some examples are dofetilide, quinidine, sotalol, erythromycin, grepafloxacin, cisapride, dolasetron, thioridazine, haloperidol, droperidol and pimozide. Other drugs achieve channel inhibition indirectly by impairing channel traffic from the endoplasmic reticulum to the cell membrane, decreasing channel membrane density (pentamidine, geldalamicin, arsenic trioxide, digoxin, and probucol). Whereas, ketoconazole, fluoxetine and norfluoxetine induce both direct channel inhibition and impaired channel trafficking. Congenital long QT syndrome, subclinical ion-channel mutations, subjects and relatives of subjects with previous history of drug-induced long QT or TdP, dual drug effects on cardiac repolarization [long QT plus increased QT dispersion], increased transmural dispersion of repolarization and T wave abnormalities, use of high doses, metabolism inhibitors and/or combinations of QT prolonging drugs, hypokalemia, structural cardiac disease, sympathomimetics, bradycardia, women and older age, have been shown to increase the risk for developing drug-induced TdP. Because most of these reactions are preventable, careful evaluation of risk factors and increased knowledge of drugs use associated with repolarization abnormalities is strongly recommended. Future genetic testing and development of practical and simple provocation tests are in route to prevent iatrogenic TdP. PMID:20676275

Cubeddu, Luigi X

2009-08-01

186

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

PubMed

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

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

2014-09-01

187

Correction for the iatrogenic form of banana fold and sensuous triangle deformity.  

PubMed

The "banana fold," or the infragluteal fold, is a fat deposit on the posterior thigh near the gluteal crease and parallel to it. The "sensuous triangle" is found at the junction of the lateral buttocks, the lateral thigh, and the posterior thigh. The iatrogenic forms of banana fold and sensuous triangle deformity are produced by excessive liposuction. The authors' experience using autologous fat transplantation to treat tissue defects led them to use this technique for correcting iatrogenic forms of banana fold and sensuous triangle deformity. The simplicity of the procedure, the low incidence of complications, and the high satisfaction rate makes autologous fat transplantation an attractive option for correcting iatrogenic complications of liposuction. PMID:18663513

Pereira, Luiz Haroldo; Sterodimas, Aris

2008-11-01

188

Duration of Survival after Peptic Ulcer Perforation  

Microsoft Academic Search

Background  The long-term course after peptic ulcer perforation is unclear, but because the ulcer population is generally older and has\\u000a concomitant disease, the long-term prognosis may be expected to be poor.\\u000a \\u000a \\u000a \\u000a Methods  In a study based on prospective data collection, all patients with peptic ulcer perforation treated at the Department of Surgery\\u000a at the Heinrich-Heine-University in Dusseldorf, Germany, were documented between 1986

Michael Imhof; Stefan Epstein; Christian Ohmann; Hans-Dietrich Röher

2008-01-01

189

Spontaneous Perforation of Augmented Bladder after Exstrophy Repair  

Microsoft Academic Search

A patient with spontaneous perforation of an augmented bladder following exstrophy repair is presented. Apart from the clinical presentation the various causes for augmented bladder perforation are discussed and the literature reviewed.

Stefan Möllhoff; Mark Goepel; Axel Bex

1991-01-01

190

Spontaneous perforation of augmented bladder after exstrophy repair.  

PubMed

A patient with spontaneous perforation of an augmented bladder following exstrophy repair is presented. Apart from the clinical presentation the various causes for augmented bladder perforation are discussed and the literature reviewed. PMID:1771708

Möllhoff, S; Goepel, M; Bex, A

1991-01-01

191

Choledochoduodenal fistula secondary to duodenal peptic ulcer. A case report.  

PubMed

Spontaneous choledochoduodenal fistula (CDDF) is a rare form of biliary enteric fistula which usually occurs as a complication of duodenal peptic ulcer disease. The more common form is cholecystoduodenal fistula (CCDF) which is generally associated with gallbladder disease. We report on a case of ulcerogenic CDDF diagnosed by upper gastrointestinal barium study, ultrasonography, and gastroduodenal endoscopy. PMID:9394658

Topal, U; Savci, G; Sadikoglu, M Y; Tuncel, E

1997-11-01

192

Review article Estimation of the duodenal flow of microbial nitrogen  

E-print Network

on cattle and sheep fed diets with for- age only. A statistical analysis of YMP was conducted with neutral,isapoorindicationfortheduodenalflowofmicrobialN(g·kg­1 DMintake)inruminants fed diets with forages only. rumen / microbial nitrogen / legumes / grasses was to evaluate the estimation of the duodenal flow of micro- bial nitrogen (N) in ruminants fed forage only, per

Paris-Sud XI, Université de

193

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...

194

Life events and chronic duodenal ulcer: a case control study  

Microsoft Academic Search

The frequency of life events during the two years before an exacerbation of ulcer in a duodenal ulcer population was compared with the frequency of these events over the same time period in an age-sex matched probability sample of the community population. The mean number of events and the associated distress and life change scores were similar for both groups.

D W Piper; J H McIntosh; D E Ariotti; J V Calogiuri; R W Brown; C M Shy

1981-01-01

195

Low back pain caused by a duodenal ulcer  

Microsoft Academic Search

The common diagnoses in low back pain are lumbar strain, lumbosacral radiculopathy, osteoarthritis, degenerative disc disease, spinal stenosis, and sacroiliac joint dysfunction. Unusual causes of low back pain that have been previously identified include abdominal aortic aneurysms, pelvic neoplasms, and retroperitoneal hemorrhages. This report describes a case of back pain that was apparently caused by a duodenal ulcer. A 54-year-old

David J. Weiss; Theodore Conliffe; Narayan Tata

1998-01-01

196

Very-low dose antacid in treatment of duodenal ulcer  

Microsoft Academic Search

Antacid (AA) in a very low dose (88 mmol\\/day) was compared to the standard 800-mg dose of cimetidine in healing duodenal ulcers. The influence of sex, age, symptom duration at entry, night pain, smoking, coffee consumption, and alcohol on ulcer healing was studied. The antacid was given in two different schedules: group I-20 ml 1 hr after breakfast and at

S. Zaterka; F. Cordeiro; L. G. C. Lyra; M. M. Toletino; S. J. Miszputen; J. L. Jorge; E. P. Silva; F. E. Vieira; J. L. Modena; H. K. Massuda; J. N. Eisig; D. Chinzon; A. A. Pereira; L. Altieri; C. E. Gantois; R. B. Wilson; M. C. B. Martins; H. Rosa; E. Dallaverde Neto

1991-01-01

197

Duodenal Toxicity After Fractionated Chemoradiation for Unresectable Pancreatic Cancer  

SciTech Connect

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

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

2013-03-01

198

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

PubMed Central

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

2013-01-01

199

Bare Stent Implantation in Iatrogenic Dissecting Pseudoaneurysm of the Superior Mesenteric Artery  

SciTech Connect

Iatrogenic arterial dissection leading to the development of dissecting pseudoaneurysms of the superior mesenteric artery (SMA) is a rare complication of angiography. Surgical and endovascular treatment options exist for this important condition. We report a case of bare stent implantation in dissecting pseudoaneurysm of the SMA that developed after angiography in a patient with acute mesenteric ischemia. Although it is rarely published, iatrogenic arterial dissection causing pseudoaneurysm can occur after diagnostic and interventional angiography. Bare stent implantation in dissecting pseudoaneurysm of the SMA could be an advantageous endovascular treatment option in selected cases due its to potential preservation of important side branches of the SMA.

Kutlu, Ramazan [Inonu University School of Medicine, Department of Radiology (Turkey)], E-mail: rkutlu@inonu.edu.tr; Ara, Cengiz [Inonu University School of Medicine, Department of General Surgery (Turkey); Sarac, Kaya [Inonu University School of Medicine, Department of Radiology (Turkey)

2007-02-15

200

Iatrogenic Arteriovenous Fistula in the Arm in an Infant: Diagnostic and Therapeutic Considerations  

PubMed Central

Iatrogenic arteriovenous fistulas (AVF) are well described in adults; however, this complication is rarely described and reported in infants. We report the case of a 3-month-old infant with complicated gastroschisis requiring multiple venipunctures who presented with signs and symptoms suggestive of traumatic arteriovenous fistula. Ultrasound imaging confirmed the presence of a wide-necked AVF between the brachial artery and vein. The fistula was surgically repaired. This case report describes the clinical imaging and treatment options for infants with iatrogenic AVF. PMID:22102366

Kotagal, Meera; Reiss, Aya; Vo, Nghia; Feldman, Kenneth; Drugas, George; Avansino, Jeffrey R.

2014-01-01

201

Attenuation of an air shock wave by perforated baffles  

SciTech Connect

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.

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

1984-03-01

202

Operative Treatment of Typhoid Perforation of the Bowel  

Microsoft Academic Search

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.

E. Q. Archampong

1969-01-01

203

Correlating the site of tympanic membrane perforation with Hearing loss  

Microsoft Academic Search

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

Titus S Ibekwe; Onyekwere G Nwaorgu; Taiwo G Ijaduola

2009-01-01

204

Operative Treatment of Typhoid Perforation of the Bowel  

PubMed Central

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

Archampong, E. Q.

1969-01-01

205

Extensive Tympanic Membrane Cholesteatoma with Marginal Perforation: An Unusual Case  

PubMed Central

The migration of squamous epithelium of external ear through a tympanic membrane perforation into the middle ear forms a cholesteatoma. But it is extremely a rare condition to observe extensive cholesteatoma on the medial surface of tympanic membrane with perforation. This condition is termed tympanic membrane cholesteatoma (TMC). We herein present an exceptional case of extensive TMC with marginal perforation. PMID:23956906

Sakalli, Erdal; Kaya, Deniz; Celikyurt, Cengiz; Erdurak, Selcuk Cem

2013-01-01

206

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

PubMed

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

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

1977-03-01

207

Surgical complications of typhoid fever: Enteric perforation  

Microsoft Academic Search

Typhoid fever remains a prevalent disease in developing nations as the result of adverse socioeconomic factors. The most frequent complication, and principal cause of mortality, is perforation of the terminal ileum. This report presents our experience with 96 patients surgically treated at Cayetano Heredia University Hospital in Lima, Peru from 1972 to 1986. The clinical characteristics and the diverse surgical

Miguel Santillana

1991-01-01

208

Nambu-Goldstone explosion under brane perforation  

E-print Network

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.

D. V. Gal'tsov; E. Yu. Melkumova; S. Zamani-Mogaddam

2010-12-13

209

Traumatic oesophageal perforation due to haematoma  

PubMed Central

INTRODUCTION Traumatic oesophageal perforation is a rare, life-threatening emergency that requires early recognition and prompt surgical management. PRESENTATION OF CASE We present an unusual case of a patient on warfarin treatment developed an intramural oesophageal haematoma following blunt thoracic trauma leading to perforation on the 18th day. DISCUSSION In treatment of oesophageal haematoma in patients on vitamin-K antagonists, strict control of the International Normalized Ratio (INR) is essential along with total parenteral nutrition therapy and refrainment through nasogastric tubes. Three explanations postulated to be the cause for late perforation which might be due to esophageal wall ischemia from pressure built up between the hematoma, azygos vein and the lower part of thoracic trachea; or could be an immediate rupture walled-off until the patient became symptomatic; or the intramural hematoma gradually lysed and causing late perforation. CONCLUSION Although extremely rare, an oesophageal haematoma and late complications must be considered in patients on anti-coagulant therapy following blunt thoracic trauma and complaining only of chest pain. PMID:25194598

Gr?nh?j Larsen, Christian; Brandt, Bodil

2014-01-01

210

Small intestinal perforation and peritonitis after liposuction.  

PubMed

A case of small intestinal perforation and peritonitis after tumescent liposuction performed in an ambulatory setting elsewhere is presented. Only four other cases were reported earlier. In all cases, the diagnosis had been missed initially. Unique problems in diagnosis, preventive steps, and risk reduction are discussed. PMID:17659408

Mallappa, Mahesh; Rangaswamy, Mohan; Badiuddin, Mohamed Faruq

2007-01-01

211

Nambu-Goldstone explosion under brane perforation  

E-print Network

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.

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

2010-01-01

212

Perforated Small Bowel Diverticulitis After Gastric Bypass  

PubMed Central

We report a rare case of complicated jejunal diverticulitis in a patient with previous bariatric surgery. Small bowel diverticulosis is generally considered an inoffensive disease. In this report we describe a case of small bowel perforation in an obese subject who had undergone laparoscopic Roux-en-Y gastric bypass. PMID:24680159

Pavel, Mihai; Lacy, Antonio

2014-01-01

213

Colonic perforation associated with neostigmine administration.  

PubMed

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

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

2013-01-01

214

Colonic perforation associated with neostigmine administration  

PubMed Central

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

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

2013-01-01

215

Endothelial reaction to perforating and non-perforating excimer laser excisions in rabbits  

Microsoft Academic Search

With an ArF excimer laser (193 nm, 750 mJ\\/cm2, 20 Hz) and a special slit-mask system, perforating and non-perforating linear keratectomies were performed in 55 rabbit corneas with a follow-up from 1 hour to 6 months. Varying the pulse number according to ablation rate (0.8 micron\\/pulse) and corneal thickness, four linear radial excisions (3 mm length, 70 microns width) of

J. W. Koch; G. K. Lang; G. O. Naumann

1991-01-01

216

Gender-Specific Protection of Estrogen against Gastric Acid-Induced Duodenal Injury: Stimulation of Duodenal Mucosal Bicarbonate Secretion  

PubMed Central

Because human duodenal mucosal bicarbonate secretion (DMBS) protects duodenum against acid-peptic injury, we hypothesize that estrogen stimulates DMBS, thereby attributing to the clinically observed lower incidence of duodenal ulcer in premenopausal women than the age-matched men. We found that basal and acid-stimulated DMBS responses were 1.5 and 2.4-fold higher in female than male mice in vivo, respectively. Acid-stimulated DMBS in both genders was abolished by ICI 182,780 and tamoxifen. Estradiol-17? (E2) and the selective estrogen receptor (ER) agonists of ER? [1,3,5-Tris(4-hydroxyphenyl)-4-propyl-1H-pyrazole] and ER? [2,3-bis(4-hydroxyphenyl) propionitrile], but not progesterone, rapidly stimulated ER-dependent murine DMBS in vivo. E2 dose dependently stimulated murine DMBS, which was attenuated by a Cl?/HCO3? anion exchanger inhibitor 4,4?-didsothio- cyanostilbene-2, 2?-disulfonic acid, removal of extracellular Cl?, and in cystic fibrosis transmembrane conductance regulator knockout female mice. E2 stimulated murine DMBS in vitro in both genders with significantly greater response in female than male mice (female to male ratio = 4.3). ER? and ER? mRNAs and proteins were detected in murine duodenal epithelium of both genders; however, neither ER? nor ER? mRNA and protein expression levels differed according to gender. E2 rapidly mobilized intracellular calcium in a duodenal epithelial SCBN cell line that expresses ER? and ER?, whereas BAPTA-AM abolished E2-stimulated murine DMBS. Thus, our data show that E2 stimulates DMBS via ER dependent mechanisms linked to intracellular calcium, cystic fibrosis transmembrane conductance regulator, and Cl?/HCO3? anion exchanger. Gender-associated differences in basal, acid- and E2-stimulated DMBS may have offered a reasonable explanation for the clinically observed lower incidence of duodenal ulcer in premenopausal women than age-matched men. PMID:18499763

Smith, Anders; Contreras, Cheyanne; Ko, Kwang Hyun; Chow, Jimmy; Dong, Xiao; Tuo, Biguang; Zhang, Hong-hai; Chen, Dong-bao; Dong, Hui

2008-01-01

217

Risk factors affecting morbidity in typhoid enteric perforation  

Microsoft Academic Search

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)

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

2008-01-01

218

Oriented perforation to prevent casing collapse for highly inclined wells  

SciTech Connect

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.

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

1995-09-01

219

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

SciTech Connect

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.

Szabo, S.; Cho, C.H.

1988-01-01

220

Iatrogenic lip and facial burns caused by an overheated surgical instrument.  

PubMed

An unusual case of an iatrogenic superficial burn of the lip and face during third molar surgery is presented. The burn was caused by a heated surgical instrument after sterilization. Although completely healed within three weeks, the burn had a negative influence on the patient-doctor trust. The surgical team must avoid using recently sterilized instruments in an unsafe manner. PMID:18856171

Zadik, Yehuda

2008-09-01

221

[Four cases of hemorrhages after surgical repair of iatrogenic tracheal stenosis (author's transl)].  

PubMed

In our series of 23 patients, operated 27 times, for a iatrogenic stenosis of the trachea, there were 4 deaths by hemorrhage of the innominate artery. Three resulted from shearing of the artery by the tracheal sutures. One came from erosion by a tracheostomy cannula. This fatal complication should be prevented by preserving healthy tissues between the artery and the trachea. PMID:331817

Putz, P; Vanderhoeft, P; Rocmans, P

1977-01-01

222

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

PubMed

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

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

2014-01-01

223

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

Microsoft Academic Search

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

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

2000-01-01

224

Mycobacterium leprae and Mycobacterium haemophilum co-infection in an iatrogenically immunosuppressed patient.  

PubMed

We present the case of a native Texan who was diagnosed with tuberculoid leprosy and later developed a cutaneous infection with M. haemophilum following iatrogenic immunosuppression. To our knowledge, there are no such reports of M. haemophilum and M. leprae infection occurring simultaneously in the same host. PMID:24439137

SoRelle, Jeffrey A; Beal, Stacy G; Scollard, David M; Gander, Rita M; Cohen, Jack; Nuara, Anthony; Nations, Sharon; Cavuoti, Dominick

2014-04-01

225

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

PubMed Central

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

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

2013-01-01

226

[Paraplegia after surgical treatment of primary aorto-duodenal fistula].  

PubMed

A 68-year-old patient with chronic cirrhosis underwent surgical repair of the subrenal abdominal aorta presenting an aorto-duodenal fistula. The fistula was considered to be a primary fistula because it occurred without prior surgery and because the aorta had ruptured without formation of an aneurysm. The postoperative period was complicated by paraplegia further compromising the outcome in this severe condition. In general, there are several problems involved in the management of aorto-duodenal fistulae. Neither computed tomography of the abdomen nor gastroduodenal endoscopy are able to provide the diagnosis in all cases before surgery. Surgical treatment is most often conducted in an emergency setting requiring repair of both the digestive tract and of the vascular lesions. It is also important to recognize the risk of neurological events occurring intra-operatively. Prognosis is usually poor. PMID:8668690

Picard, E; Demaria, R; Branchereau, P; Meunier, J P; Frapier, J M; Chaptal, P A

1996-04-13

227

Intraluminal duodenal diverticulum causing recurrent pancreatitis: treatment by endoscopic incision.  

PubMed Central

Intraluminal duodenal diverticulum is a recognised but rare cause of acute pancreatitis. This patient had three attacks of pancreatitis, each requiring a stay in hospital, within a four month period. The apex of the diverticulum was incised endoscopically, whereupon peas and food debris gushed from the incision site. The patient has had no further symptoms in the 12 months since the endoscopic procedure. Images Figure 1 Figure 2 Figure 3 PMID:8174997

Finnie, I A; Ghosh, P; Garvey, C; Poston, G J; Rhodes, J M

1994-01-01

228

Peripheral Neuropathy and Severe Malnutrition following Duodenal Switch  

Microsoft Academic Search

Severe thiamine (vitamin B-1) deficiency is a medical emergency that has long been recognized as a potential complication\\u000a of bariatric surgery. The incidence of this rare complication is largely unknown. We describe a super-obese male patient with\\u000a extreme lower limb weakness 3 months following a duodenal switch operation, occurring in association with persisting vomiting.\\u000a Excessive malabsorption led to severe malnutrition, with

Erlend T. Aasheim; Dag Hofsø; Jøran Hjelmesæth; Rune Sandbu

2008-01-01

229

Surgical Excision of Duodenal/Pancreatic Metastatic Renal Cell Carcinoma  

PubMed Central

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

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

2014-01-01

230

Spontaneous Corneal Perforation in Ocular Rosacea  

PubMed Central

Rosacea is a dermatologic condition that affects the midfacial region. Ocular rosacea is most frequently diagnosed when cutaneous signs and symptoms are also present. Ocular manifestations are essentially confined to the eyelids and ocular surface. Ocular involvement ranges from minor irritation, dryness, and blurry vision to potentially severe ocular surface disruption including corneal ulcers, vascularization and rarely perforation. We present a 49-year-old Saudi Arabian female with the diagnosis of rosacea who presented with a peripheral corneal performation. The perforation was successfully managed by surgical repair, oral doxycycline and topical steroid. The final best corrected visual acuity was 20/30 after treatment. Early referral to an ophthalmologist and careful long-term follow-up are recommended. PMID:20616930

Al Arfaj, Khalid; Al Zamil, Waseem

2010-01-01

231

Splenosis mimicking an extramural duodenal mass: A case report  

PubMed Central

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

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

2014-01-01

232

Duodenal cytochrome B and hephaestin expression in patients with iron deficiency and hemochromatosis  

Microsoft Academic Search

Background & Aims: An increased duodenal expression of the iron transporters, divalent-metal-transporter-1, and ferroportin is observed in patients with iron deficiency or hereditary hemochromatosis. Two oxidoreductases, termed duodenal cytochrome b and hephaestin, are proposed to co-operate with divalent-metal-transporter-1 and FPN1, respectively, to transfer iron from the duodenal lumen to the circulation. Methods: In the present study, we investigated the mRNA

Heinz Zoller; Igor Theurl; Robert O. Koch; Andrew T. Mckie; Wolfgang Vogel; Gü Weiss

2003-01-01

233

Tobacco cigarette smoke attenuates duodenal ulcer margin hyperemia in the rat  

Microsoft Academic Search

The hyperemia at the duodenal ulcer margin is important for ulcer healing. We studied the effect of tobacco cigarette smoke on the hyperemia at the margin of mepirizole-induced duodenal ulcer. Duodenal mucosal blood flow values measured by iodo[14C]antipyrine (IAP) autoradiography and hydrogen gas clearance (HGC) were compared. Twenty-four hours after rats were injected with an ulcerogenic dose of mepirizole, they

Fumihiro Iwata; Oscar U. Scremin; Felix W. Leung

1995-01-01

234

Perforation of thin unreinforced concrete slabs  

Microsoft Academic Search

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

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

1993-01-01

235

Perforating devices for use in wells  

DOEpatents

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

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

2002-01-01

236

Endothelial reaction to perforating and non-perforating excimer laser excisions in rabbits.  

PubMed

With an ArF excimer laser (193 nm, 750 mJ/cm2, 20 Hz) and a special slit-mask system, perforating and non-perforating linear keratectomies were performed in 55 rabbit corneas with a follow-up from 1 hour to 6 months. Varying the pulse number according to ablation rate (0.8 micron/pulse) and corneal thickness, four linear radial excisions (3 mm length, 70 microns width) of increasing depth (70%, 80%, 90%, 100% perforation) were produced. The corneas were processed for light microscopy, scanning and transmission electron microscopy, and vital staining of the endothelium. Except for mild cell contact alterations and discrete single cell damage in the 90% deep excisions, no endothelial damage could be detected after non-perforating keratectomies. Minute (less than 20 microns) and small (20 to 100 microns maximal diameter) perforations induced cell enlargement, formation of pseudopodia, rosette-like figures, multi-nucleated giant cells, and ultimately uniform reformation of the cell pattern (1 hour to 7 days postoperatively). Larger excimer laser defects of Descemet's membrane (greater than 100 microns) were overgrown by dedifferentiated endothelial cells producing a new PAS-positive basement membrane. Vital staining revealed the complete and stable reorganization of the endothelium over these lesions within 6 months. Our observations are similar to those reported on the endothelial repair process following other surgical manipulations (knife incisions, direct Nd:YAG-laser trauma) and support the applicability of excimer lasers for corneal trephination in patients. PMID:2069914

Koch, J W; Lang, G K; Naumann, G O

1991-01-01

237

Endothelial reaction to perforating and non-perforating excimer laser excisions in rabbits  

SciTech Connect

With an ArF excimer laser (193 nm, 750 mJ/cm2, 20 Hz) and a special slit-mask system, perforating and non-perforating linear keratectomies were performed in 55 rabbit corneas with a follow-up from 1 hour to 6 months. Varying the pulse number according to ablation rate (0.8 micron/pulse) and corneal thickness, four linear radial excisions (3 mm length, 70 microns width) of increasing depth (70%, 80%, 90%, 100% perforation) were produced. The corneas were processed for light microscopy, scanning and transmission electron microscopy, and vital staining of the endothelium. Except for mild cell contact alterations and discrete single cell damage in the 90% deep excisions, no endothelial damage could be detected after non-perforating keratectomies. Minute (less than 20 microns) and small (20 to 100 microns maximal diameter) perforations induced cell enlargement, formation of pseudopodia, rosette-like figures, multi-nucleated giant cells, and ultimately uniform reformation of the cell pattern (1 hour to 7 days postoperatively). Larger excimer laser defects of Descemet's membrane (greater than 100 microns) were overgrown by dedifferentiated endothelial cells producing a new PAS-positive basement membrane. Vital staining revealed the complete and stable reorganization of the endothelium over these lesions within 6 months. The authors observations are similar to those reported on the endothelial repair process following other surgical manipulations (knife incisions, direct Nd:YAG-laser trauma) and support the applicability of excimer lasers for corneal trephination in patients.

Koch, J.W.; Lang, G.K.; Naumann, G.O. (Department of Ophthalmology, University Erlangen-Nuernberg (Germany))

1991-05-01

238

A Preoperative Marking Template for Deep Inferior Epigastric Artery Perforator Flap Perforators in Breast Reconstruction  

PubMed Central

Preoperative perforator marking for deep inferior epigastric artery perforator flaps is vital to the success of the procedure in breast reconstruction. Advances in imaging have facilitated accurate identification and preselection of potentially useful perforators. However, the reported imaging accuracy may be lost when preoperatively marking the patient, due to 'mapping errors', as this relies on the use of 2 reported vectors from a landmark such as the umbilicus. Observation errors have been encountered where inaccurate perforator vector measurements have been reported in relation to the umbilicus. Transcription errors have been noted where confusing and wordy reports have been typed or where incorrect units have been given (millimetres vs. centimetres). Interpretation errors have also occurred when using the report for preoperative marking. Furthermore, the marking process may be unnecessarily time-consuming. We describe a bespoke template, created using an individual computed tomography angiography image, that increases the efficiency and accuracy of preoperative marking. The template is created to scale, is individually tailored to the patient, and is particularly useful in cases where multiple potential suitable perforators exist. PMID:24665427

Pywell, Matthew; Floyd, David

2014-01-01

239

Perforation of thin unreinforced concrete slabs  

SciTech Connect

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

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

1993-10-01

240

Mechanisms of gastric and esophageal perforations during laparoscopic Nissen fundoplication.  

PubMed Central

OBJECTIVE: The purpose of this study was to determine possible mechanisms of 17 gastric and esophageal perforations that occurred during laparoscopic Nissen fundoplication. METHODS: Specific details of each perforation relating to mechanism of injury, surgeon experience, diagnosis, treatment, and outcome were obtained. For each perforation, an attempt was made to accurately determine the mechanism of perforation. RESULTS: Three mechanisms accounted for the 17 perforations, the majority of which occurred within the first ten laparoscopic Nissen fundoplications performed by the surgeon. Ten perforations resulted from injuries related to improper retroesophageal dissection, five occurred during passage of the bougie dilator or nasogastric tube, and two occurred after surgery secondary to suture pullthrough. Six patients received a delayed diagnosis, which adversely affected outcome. Most of the perforations were successfully managed by primary closure and wrap to include the repair. Morbidity was significantly increased for perforations recognized late. One death, attributed to sepsis, occurred in association with a delay in diagnosis. CONCLUSIONS: Gastric and esophageal perforations are serious complications of the new laparoscopic method of Nissen fundoplication. The mechanisms of these complications are specifically related to limitations of the laparoscopic technique. Prevention of these potentially lethal complications requires a full understanding of the detailed anatomy of the gastroesophageal region and awareness of the recognized mechanisms of perforation. Images Figure 2. PMID:8554418

Schauer, P R; Meyers, W C; Eubanks, S; Norem, R F; Franklin, M; Pappas, T N

1996-01-01

241

Correlating the site of tympanic membrane perforation with Hearing loss  

PubMed Central

Background It is recognized that the size of tympanic membrane(TM) perforation is proportional to the magnitude of hearing loss, however, there is no clear consensus on the effect of the location (site) of the perforation on the hearing loss. Hence the study is set to investigate the relationship between the location of perforation on TM and hearing loss. Methods A cross-sectional prospective study of consecutive adult patients with perforated TM conducted in the ENT clinic of University College Hospital Ibadan between January 1st 2005 and July 31st 2006. Instruments used for data collection/processing include questionnaires, video and micro-otoscopy, Pure tone audiometer, image J and SPSS packages. Results Sixty-two patients (22-males, 40-females), aged 16–75 years (mean = 35.4 +/- 4) with 77 perforated ear drums were studied and 15(24.2%) had bilateral TM perforations, 21 (33.9%) right unilateral and 26(41.9%) left unilateral. The locations of the TM perforations were 60(77.9%) central, 6(9.6%) antero-inferior, 4(5.2%) postero-inferior, 4(5.2%) antero-superior and 3(3.9%) postero-superior respectively with sizes ranging from 1.51%–89.05%, and corresponding hearing levels 30 dB – 80 dB (59% conductive and 41% mixed). Fifty-nine percent had pure conductive hearing loss and the rest mixed. Hearing losses (dBHL) increased with the size of perforations (P = 0.01, r = 0.05). Correlation of location of perforations with magnitude of hearing loss in acute TM perorations was (P = 0.244, r = 0.273) and for chronic perforations (p = 0.047 & r = 0.31). Conclusion The location of perforation on the tympanic membrane (TM) has no effect on the magnitude of hearing loss in acute TM perforations while it is significant in chronic ones. PMID:19121227

Ibekwe, Titus S; Nwaorgu, Onyekwere G; Ijaduola, Taiwo G

2009-01-01

242

Surgical treatment of perforated diverticulitis of the sigmoid colon  

Microsoft Academic Search

A retrospective review of 1353 cases of acute perforated sigmoid diverticulitis treated surgically demonstrates that those\\u000a operations that resect or exteriorize the perforated segment at the first operation are associated with a lower operative\\u000a mortality rate than procedures that fail to remove the perforated segment at the initial operation. These results are true\\u000a for both diffuse peritonitis and localized abscess.

Jon M. Greif; Gregory Fried; Charles K. McSherry

1980-01-01

243

Prompt Management Is Most Important for Colonic Perforation After Colonoscopy  

PubMed Central

Purpose The incidence of complications after colonoscopy is very low. The complications after colonoscopy that are of clinical concern are bleeding and perforation. The present study was conducted to determine the clinical outcomes and the risk factors of a colostomy or a colectomy after colonoscopic colon perforation. Methods From March 2009 to December 2012, the records of all patients who were treated for colorectal perforation after colonoscopy were reviewed retrospectively. The following parameters were evaluated: age, sex, purpose of colonoscopy, management of the colonic perforation, and interval from colonoscopy to the diagnosis of a colonic perforation. A retrospective analysis was performed to determine the risk factors associated with major surgery for the treatment of a colon perforation after colonoscopy. Results A total 27 patients were included in the present study. The mean age was 62 years, and 16 were males. The purpose of colonoscopy was diagnostic in 18 patients. The most common perforation site was the sigmoid colon. Colonic perforation was diagnosed during colonoscopy in 14 patients, just after colonoscopy in 5 patients, and 24 hours or more after colonoscopy in 8 patients. For the treatment of colonic perforation, endoscopic clipping was performed in 3 patients, primary closure in 15 patients, colon resection in 2 patients, Hartmann's procedures in 4 patients, and diverting colostomy in 3 patients. If the diagnosis of perforation after colonoscopy was delayed for more than 24 hours, the need for major treatment was increased significantly. Conclusion Although a colonic perforation after colonoscopy is rare, if the morbidity and the mortality associated with the colonic perforation are to be reduced, prompt diagnosis and management are very important.

Kim, Hyun-Ho; Kye, Bong-Hyeon; Cho, Hyeon-Min

2014-01-01

244

Two cases of keratoconus associated with spontaneous corneal perforation.  

PubMed

We present 2 cases of spontaneous corneal perforation in patients with keratoconus. The first patient developed a corneal scleral fistula 1 year after her initial diagnosis of hydrops. We conclude that adequate eye care education, allergy prophylaxis, and fall precautions may be necessary in patients with keratoconus to prevent corneal perforations. Medical and surgical treatments are both viable first-line treatments for corneal perforations. PMID:20489602

Mostafavi, David; Chu, David S

2010-07-01

245

Ear drum perforations in children after ventilation tube treatment.  

PubMed

About 1% of ears treated with straight Teflon tubes get permanent drum perforations after extrusion of the tubes, according to the literature. This paper reports the results of treatment of 20 ears in 17 children who underwent myringoplasty to repair such perforations at a mean age of 9.6 years and with a mean follow-up of 2.4 years. The following history was found: 60% (12/20) perforated after 1 insertion, 47% (9/19) perforated within 12 months after insertion. Seventy percent (14/20) had recurrent infectious problems during tube-treatment and after the perforation was diagnosed. The mean preoperative air-bone gap was 17.9 dB. In 85% (17/20) there was a pure perforation at the site of the previous tube while 3 children had perforations combined with retractions. All drums healed after surgery without serious ventilation problems except in one child. There was no serious infectious problems. The mean postoperative air-bone gap was 10.6 dB. Active removal of long-lasting tubes (> 12 months) is not motivated considering the positive effects of tube treatment in many children and the few perforations that occur. A Teflon tube is a good choice as a standard tube with few perforations that can be successfully surgically treated if self-ventilation and good ear-hygiene is instituted. PMID:8056500

Hydén, D

1994-04-01

246

Spontaneous free perforation of the small intestine in adults  

PubMed Central

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

Freeman, Hugh James

2014-01-01

247

Endoscopic retrograde cholangiopancreatography-related perforation: Management and prevention  

PubMed Central

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

Prachayakul, Varayu; Aswakul, Pitulak

2014-01-01

248

Endoscopic retrograde cholangiopancreatography-related perforation: Management and prevention.  

PubMed

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

Prachayakul, Varayu; Aswakul, Pitulak

2014-10-16

249

Nonoperative management of iatrogenic lesions of celiac branches by using transcatheter arterial embolization.  

PubMed

We present our experience in the nonoperative management of iatrogenic lesions of celiac branches by using transcatheter arterial embolization. We treated 6 pseudoaneurysms (5 intrahepatic and 1 of the gastroduodenal artery), 6 vessel lacerations (1 common hepatic artery, 1 right hepatic artery, 1 gastroduodenal artery, 2 pancreatoduodenal, 1 polar intrasplenic artery), 1 arterioportal fistula, and 1 arteriobiliary fistula; all the bleeding lesions were secondary to surgical, endoscopic, or interventional radiologic procedures. PMID:15492656

Basile, Antonio; Saluzzo, Cesare Massa; Lupattelli, Tommaso; Carbonatto, Paolo; Bottari, Antonio; Mundo, Elena; Certo, Antonio

2004-10-01

250

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

Microsoft Academic Search

Calcified aorta with acute iatrogenic aortic dissection is a potential but rarely reported complication of subclavian or innominate\\u000a artery intervention. We report a patient who developed aortic dissection during stenting for left subclavian artery. A newly\\u000a developed “calcium sign,” signifying displacement of the intimal calcification from the outer soft-tissue margin and which\\u000a is traditionally recognized on chest radiograph, was detected

Yi-Chih Wang; Juey-Jen Hwang; Ling-Ping Lai; Chuen-Den Tseng

2011-01-01

251

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

PubMed Central

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

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

2013-01-01

252

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

SciTech Connect

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

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

2000-07-15

253

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

Microsoft Academic Search

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

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

2009-01-01

254

Iatrogenic subclavian arteriovenous fistula: rare complication of plate osteosynthesis of clavicle fracture.  

PubMed

Iatrogenic subclavian arteriovenous fistula is rare and has not been reported as a complication of plate osteosynthesis of clavicle fracture. This article describes the first case of iatrogenic subclavian arteriovenous fistula caused by plate osteosynthesis. A 36-year-old man sustained a right middle clavicle fracture in an injury and underwent open reduction and internal fixation with clavicular compression plate 3 days later in a local hospital. On the second postoperative day, a pulsatile mass and thrill were detected at the right supraclavicular region. The patient was discharged 3 days postoperatively with no extra inspection. Three months later, he was admitted to our institution because the mass was getting bigger and weakness was felt in his right upper limb. Digital subtraction angiography confirmed a subclavian arteriovenous fistula. Vascular surgeons treated the patient successfully using endovascular techniques. The subclavian arteriovenous fistula was eliminated with a fully expanded stent graft, and the plate was removed simultaneously. The result was satisfactory, and the postoperative course was uneventful. This case demonstrated that subclavian arteriovenous fistula could be an iatrogenic complication of screw-and-plate osteosynthesis of clavicle fracture. The operative manipulation in the process of fracture reduction and hole drilling should be meticulous, and the screw length must be accurate. Orthopedic surgeons should be aware of this uncommon complication with plate osteosynthesis of clavicle fracture. We recommend using an endovascular surgical technique for treatment of this complication. PMID:22310422

Ding, Muliang; Hu, Jianzhong; Ni, Jiangdong; Lv, Hongbin; Song, Deye; Shu, Chang

2012-02-01

255

Pressure enhanced penetration with shaped charge perforators  

DOEpatents

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

Glenn, Lewis A. (Danville, CA)

2001-01-01

256

MR enterography of perforated acute Meckel diverticulitis.  

PubMed

Meckel diverticulum is the most common congenital anomaly of the small intestine that generally comes to attention due to a variety of complications, such as gastrointestinal tract bleeding, bowel obstruction or acute inflammation. These diverticula frequently are difficult to prospectively diagnose by imaging. Clinically, acute Meckel diverticulitis can be mistaken for acute appendicitis or Crohn disease. We present a 6-year-old boy with perforated acute Meckel diverticulitis that mimicked Crohn disease both clinically and by CT imaging and was definitively diagnosed using MR enterography. PMID:21594546

Hegde, Shilpa; Dillman, Jonathan R; Gadepalli, Samir; Rabah, Raja; Ladino-Torres, Maria F

2012-02-01

257

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

SciTech Connect

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

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

2009-07-15

258

Is there a role for pyloric exclusion after severe duodenal trauma?  

PubMed

Duodenal trauma is an infrequent injury, but linked to high morbidity and mortality. Surgical management of duodenal injuries is dictated by: patient's hemodynamic status, injury severity, time of diagnosis, and presence of concomitant injuries. Even though most cases can be treated with primary repair, some experts advocate adjuvant procedures. Pyloric exclusion (PE) has emerged as an ancillary method to protect suture repair in more complex injuries. However, the effectiveness of this procedure is debatable. The "Evidence Based Telemedicine - Trauma & Acute Care Surgery" (EBT-TACS) Journal Club performed a critical appraisal of the literature and selected three relevant publications on the indications for PE in duodenal trauma. The first study retrospectively compared 14 cases of duodenal injuries greater than grade II treated by PE, with 15 cases repaired primarily, all of which penetrating. Results showed that PE did not improve outcome. The second study, also retrospective, compared primary repair (34 cases) with PE (16 cases) in blunt and penetrating grade > II duodenal injuries. The authors concluded that PE was not necessary in all cases. The third was a literature review on the management of challenging duodenal traumas. The author of that study concluded that PE is indicated for anastomotic leak management after gastrojejunostomies. In conclusion, the choice of the surgical procedure to treat duodenal injuries should be individualized. Moreover, there is insufficient high quality scientific evidence to support the abandonment of PE in severe duodenal injuries with extensive tissue loss. PMID:25140657

Cruvinel Neto, José; Pereira, Bruno Monteiro Tavares; Ribeiro, Marcelo Augusto Fontenelle; Rizoli, Sandro; Fraga, Gustavo Pereira; Rezende-Neto, João Baptista

2014-01-01

259

Antibody to parietal cells in patients with duodenal ulcer, and relationship to pernicious anaemia.  

PubMed

Of 160 patients with pernicious anaemia, none had current duodenal ulceration, whereas in a random population of similar age and sex distribution some 5% would be expected to have a duodenal ulcer. Parietal-cell antibody was detected in serum from 8 of 169 men (4-7%) and from 2 to 31 women (6-4%) with duodenal ulceration. None of the 200 duodenal ulcer patients had antibody to intrinsic factor. The prevalence of these antibodies in duodenal ulcer patients was not significantly different from that in control subjects of similar age and sex distribution. The decreased prevalance of duodenal ulcer in pernicious anaemia patients implies that pernicious anaemia must be less prevalent in duodenal ulcer patients than in a random population; but it appears that this cannot be attributed to an absence of gastric autoimmunity in patients with duodenal ulcer. To resolve this disrepancy, we suggest that pernicious anaemia is determined not only by autoimmune reactions, but also by independent genetic and environmental factors which influence the state of the gastric mucosa. PMID:1018665

Ungar, B; Francis, C M; Cowling, D C

1976-12-11

260

Reevaluation of duodenal endoscopic markers in the diagnosis of celiac disease  

Microsoft Academic Search

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

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

2000-01-01

261

A Case Report of Primary Duodenal Tuberculosis Mimicking a Malignant Tumor  

PubMed Central

Tuberculosis remains a serious infectious disease with primary features of pulmonary manifestation in Korea. However, duodenal tuberculosis is rare in gastrointestinal cases of extrapulmonary tuberculosis. Here, we report a case of primary duodenal tuberculosis mistaken as a malignant tumor and diagnosed with QuantiFERON-TB GOLD (Cellestis Ltd.) in an immunocompetent male patient. PMID:25133123

Jung, Ji Hye; Kim, Min Jeong; Cho, Young Kwan; Ahn, Sang Bong; Son, Byoung Kwan; Jo, Yun Ju; Park, Young Sook

2014-01-01

262

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

PubMed Central

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

2013-01-01

263

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

E-print Network

Craphy. 52 55 66 FIG LTiES Page 1. Flow Diagram of &&uipment 2. Photograph of the "ouipmvnt 10 Sketch of Perforated Plate with i!achined Insert . . 4. Typioal Supportinq and Recov"ry Volocitl' Curves for a 15 Perforation Disaster Study 22 5.... Supporting Velocity versus Liquid Iiei'ht by Dif. eront Definitions. 6A. Supporting Velocity versus Perforation ziamoter with Four Inohes of Water on the Plate 27 63. Supportin. Velocity versus Perforation Diameter with o. ' Inches oi' iqater on *he...

Cottle, John Ernest

2012-06-07

264

Choroidal detachment in perforated corneal ulcers: frequency and management  

PubMed Central

Aims To determine the frequency of choroidal detachment (CD) in eyes with non?traumatic corneal ulcer perforation and, also, to assess the efficacy and safety of cyanoacrylate glue in sealing corneal perforations. Methods 18 eyes of 17 patients were studied. Inclusion criterion was any patient with a non?traumatic perforated corneal ulcer. All patients had a thorough history taken and complete ophthalmic examination including B?scan ultrasonography. Patient demographics, presence of CD, and efficacy of corneal gluing were assessed. Results Eight of the 18 eyes (44%) were documented to have a CD. Among perforations of >2?mm2, six eyes (75%) were documented to have CD compared with two eyes (20%) with perforations of ?2?mm2 (p?=?0.054). No correlation could be determined between perforation duration and incidence of CD. Of the 15 eyes that underwent gluing, there were 13 successes (87%) and two failures (13%). Within the successes four patients (27%) required re?gluing because of infection (one patient) or progression of melt and glue loosening (three patients). Failure was the result of severe progression of melting (one patient) and a very large perforation (one patient). Conclusion Choroidal detachment following corneal ulcer perforation is common and is more likely in larger corneal perforations. Preoperative B?scan should be considered in cases of large corneal perforations requiring therapeutic keratoplasty to document choroidal detachment, which if large may require drainage. Cyanoacrylate glue is an effective and safe method for sealing small corneal perforations. A vigil must be maintained for infection while the glue and bandage contact lens are in situ. PMID:16723362

Singh, R; Umapathy, T; Abedin, A; Eatamadi, H; Maharajan, S; Dua, H S

2006-01-01

265

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

PubMed Central

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

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

2013-01-01

266

Flexibility in Men's Sexual Practices in Response to Iatrogenic Erectile Dysfunction after Prostate Cancer Treatment  

PubMed Central

Introduction Prostate cancer (PCa) treatments are associated with a high incidence of erectile dysfunction (ED). Interventions to help men with iatrogenic ED have largely focused on penile tumescence adequate for vaginal penetration. Less research has been undertaken on sex practices other than penile/vaginal intercourse. Aim The aim of this study was to explore forms of sexual practice engaged in by men following treatment for PCa. We focused in particular on anal intercourse (AI) as practiced by both nonheterosexual (i.e., gay-identified men and other men who have sex with men) and heterosexual men. We sought to determine how common AI was subsequent to PCa treatment and how flexible AI practitioners were in their modes (e.g., from insertive to receptive) when faced with iatrogenic ED. Methods An international online survey was conducted in 2010–2011 of men treated for PCa, where participants (N = 558) were asked explicitly about their sexual practices before and after PCa treatment. Main Outcome Measures The outcome measures were the numbers and percentages of men who practiced AI before and after PCa treatment as well as the percentage who changed AI practice after PCa treatment. Results Five hundred twenty-six men (90 nonheterosexual men; 436 heterosexual men) answered questions on AI practices. A proportion of nonheterosexual (47%) and heterosexual men (7%) practiced AI following PCa treatment, and did so in all modes (insertive, receptive, and “versatile”). Many nonheterosexual men continued to be sexually active in the face of iatrogenic ED by shifting from the insertive to receptive modes. A few men, both heterosexual and nonheterosexual, adopted AI for the first time post-PCa treatment. Conclusions Flexibility in sexual practice is possible for some men, both nonheterosexual and heterosexual, in the face of iatrogenic ED. Advising PCa patients of the possibilities of sexual strategies that include AI may help them in reestablishing a sex life that is not erection dependent. Dowsett GW, Lyons A, Duncan D, and Wassersug RJ. Flexibility in men's sexual practices in response to iatrogenic erectile dysfunction after prostate cancer treatment. Sex Med 2014;2:115–120. PMID:25356308

Dowsett, Gary W; Lyons, Anthony; Duncan, Duane; Wassersug, Richard J

2014-01-01

267

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

PubMed Central

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

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

268

Palliation of Malignant Biliary and Duodenal Obstruction with Combined Metallic Stenting  

SciTech Connect

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

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

2007-11-15

269

Jejunal perforation caused by abdominal angiostrongyliasis.  

PubMed

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

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

1999-01-01

270

Small bowel perforation caused by advanced melanoma.  

PubMed

The incidence of melanoma has been increasing over the years and it remains, despite the heterogeneous survival for different stages, a disease with high mortality. Dissemination occurs primarily by the lymphatic route, followed by the hematogenous route. Gastrointestinal metastases do occur, but they are mainly intraluminal mucosal melanomas. Peritoneal or primary mucosal melanomas are rare. Only a few cases have been described of patients presenting with acute abdominal pain due to a melanoma. In this report we present a young patient with no prior health problems. Due to silent progression of disease at first, and secondarily avoidance of medical consultation, she finally presented to our emergency department with signs of intestinal perforation. In the operating theater a massive metastasis in the intestines with perforation was seen, as well as many smaller intra-abdominal and cutaneous lesions. Approximately 35 cm of jejunum had to be resected. Furthermore, the primary melanoma on the left forearm was excised and turned out to be in almost complete regression. Although initial recovery after surgery was good, the patient died only one month after presentation due to the advanced nature of her disease, which points to the devastating effect of undiagnosed melanoma and gastrointestinal metastasis. Since the melanoma incidence is rising, similar cases may present in the near future. This emphasizes the importance of proper full physical examination in patients with atypical abdominal symptoms. PMID:25296605

den Uil, Sjoerd H; Thomassen, Irene; Vermeulen, Erik Gj; Vuylsteke, Ronald Jclm; Stockmann, Hein Bac; de Vries, Mattijs

2014-01-01

271

A new tubing-conveyed perforating method  

SciTech Connect

Two new innovations--an automatically released gun hanger, and a modular gun-deployment system--have recently been introduced to the oilfield to better support performing needs in wells in which the completion configurations differ from the older, traditionally accepted designs. The first design, an automatically-released gun hanger, was planned originally for monobore completions to allow a zone to be perforated and tested without imposing any downhole restrictions. This gun hanger can be used below a retrievable or permanent packer, a polished bore receptacle, or an electric submersible pump. A new modular gun system has also been designed to be run in conjunction with the gun hanger. This system allows operators to deploy long gun intervals, a section at a time, into a well. The guns are run into the wellbore individually and stacked on a gun hanger until the appropriate length is achieved. Since this method avoids any gun length restrictions that could be caused by a lubricator, it is ideal for rigless completions. In addition, the capability of the system to allow retrieval of any or all of the modules under pressure makes it ideal for use in wells with limited rathole. The combined technological advantages of these new completion tools increase production capability of the wellbore by allowing (1) maximum tubular ID usage and (2) perforating capabilities that include maximum gun size, optimum shot patterns and density, and maximum underbalance or overbalance. These enhancements are in keeping with the current operational and economic needs in today`s oilfield.

Mason, J.; George, F.; Pacheco, E.

1995-11-01

272

Pathogenesis of digitoxin-induced duodenal ulcers in pregnant rats. Roles of gastric acid and duodenal alkaline secretion.  

PubMed

Late-stage pregnant rats (day 17) had higher rates of gastric acid secretion (45-55 mu eq/15 min) as compared to nonpregnant and middle-stage pregnant (day 10) rats (20-25 mu eq/15 min). In contrast, basal rates of duodenal alkaline secretion were significantly lower (2-3 mu eq/15 min) in pregnant rats (day 10 and 17) than those in nonpregnant rats (approximately 5 mu eq/15 min), although the duodenal mucosa responded to acid with a significant rise in HCO3- output in these three groups of rats. In pregnant rats (day 17), a single injection of digitoxin, a Na+ K+-ATPase inhibitor (10 mg/kg, subcutaneously), had no effect on basal acid and alkaline secretions, but significantly blocked the acid-induced HCO3- secretion for more than 18 hr from 6 hr after administration. This drug, when given once daily for four days (10 mg/kg, subcutaneously), produced well-defined ulcers in the proximal duodenum with few lesions in the stomach of female rats, and the severity and incidence were significantly higher in late-stage pregnant rats than in the other two groups of rats. Following repeated administration of digitoxin (10 mg/kg) to late-stage pregnant rats (days 17-20), acid secretion significantly declined after two days of treatment, while the acid-induced HCO3- secretion was significantly attenuated after one day of treatment and remained inhibited during the whole period. These results suggest that an impairment of the mechanisms related to acid-induced HCO3- secretion may be associated with the induction of duodenal ulcers caused by digitoxin in female rats, and the high incidence of these ulcers in late-stage pregnant rats may be due to acid hypersecretion. PMID:3378483

Furukawa, O; Takeuchi, K; Nishiwaki, H; Okabe, S

1988-07-01

273

Aerodynamic resistance of perforated plates in natural convection  

Microsoft Academic Search

This paper describes some experimental results about aerodynamic resistance of perforated plates in natural convection, which are useful for designing casings of electronic equipment. Since velocity through a perforated plate and pressure loss are very small in the case of natural convection, the conventional method can not be used to measure the resistance of the plate with reasonable accuracy. Therefore,

M. Ishizuka; Y. Miyazaki; T. Sasaki

1985-01-01

274

About empirical models predicting the missile perforation of concrete barriers  

Microsoft Academic Search

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

J. Baroth; L. Daudeville; Y. Malecot

2012-01-01

275

Laparotomy versus Peritoneal Drainage for Necrotizing Enterocolitis and Perforation  

Microsoft Academic Search

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)

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

276

Mortality in Typhoid Intestinal Perforation-A Declining Trend  

PubMed Central

Background: Typhoid fever is an important public health problem in developing countries. Intestinal perforation is one of the leading fatal complications of typhoid fever. Typhoid perforation occurs more commonly in terminal ileum. Morbidity and Mortality associated with typhoid perforation are high (9-22%). However this study aims to know whether there are any changes of the same. Aim: To analyse the clinical presentation, management, complications, morbidity and mortality associated with typhoid intestinal perforation and assess changing trends in mortality in typhoid intestinal perforation. Material & Methods: This is a retrospective observational study. Cases regarding the study have been analyzed by reviewing the patient records. It includes 40 patients who were diagnosed with typhoid intestinal perforation, admitted and treated in the Department of General Surgery from February 2011 to January 2012. Results: A total of 40 patients were considered for the study and their mean age was 35.75 years. 80% of patients were male. Pain abdomen was their main symptom which lasted for an average of 2.95 days. Leukocytosis (11,000 cells/cumm) was present in 57.5% patients. Single perforation was present in 31(77.5%) patients and primary closure was done in 30 of them. Culture sensitivity showed E coli as the main organism. Complications were seen in 42.5% of patients in post–operative period. Conclusion: Early recognition, timely surgical intervention with appropriate surgery and antibiotics, and effective peri-operative care reduces the mortality in typhoid intestinal perforation. PMID:24179905

Pujar K., Anupama; A.C., Ashok; H.K., Rudresh; H.C., Srikantaiah; K.S, Girish; K.R., Suhas

2013-01-01

277

Palatal perforation secondary to tuberculosis: a case report.  

PubMed

Palatal perforation though rarely seen in adults but may have infectious, inflammatory, neoplastic, or traumatic cause. We present here a case of palatal perforation due to tuberculosis which was managed successfully using greater palatine artery pedicled flap closure at our centre. PMID:24431861

Sharma, Rohit; Sirohi, Deepika; Sinha, Ramen; Menon, P Suresh

2013-09-01

278

Acoustic Transmission Loss of Perforated Plates Vincent Phong1  

E-print Network

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

Papamoschou, Dimitri

279

Calcium transport by rat duodenal villus and crypt basolateral membranes  

SciTech Connect

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.

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

1987-02-01

280

Endoscopic Management of a Primary Duodenal Carcinoid Tumor  

PubMed Central

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

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

2012-01-01

281

Determinants of Hearing Loss in Perforations of the Tympanic Membrane  

PubMed Central

Background Although tympanic membrane perforations are common, there have been few systematic studies of the structural features determining the magnitude of the resulting conductive hearing loss. Our recent experimental and modeling studies predicted that the conductive hearing loss will increase with increasing perforation size, be independent of perforation location (contrary to popular otologic belief), and increase with decreasing size of the middle-ear and mastoid air space (an idea new to otology). Objective To test our predictions regarding determinants of conductive hearing loss in tympanic membrane perforations against clinical data gathered from patients. Study Design Prospective clinical study. Setting Tertiary referral center. Inclusion Criteria Patients with tympanic membrane perforations without other middle-ear disease. Main Outcome Measures Size and location of perforation; air-bone gap at 250, 500, 1,000, 2,000, and 4,000 Hz; and tympanometric estimate of volume of the middle-ear air spaces. Results Isolated tympanic membrane perforations in 62 ears from 56 patients met inclusion criteria. Air-bone gaps were largest at the lower frequencies and decreased as frequency increased. Air-bone gaps increased with perforation size at each frequency. Ears with small middle-ear volumes, ?4.3 ml (n = 23), had significantly larger air-bone gaps than ears with large middle-ear volumes, >4.3 ml (n = 39), except at 2,000 Hz. The mean air-bone gaps in ears with small volumes were 10 to 20 dB larger than in ears with large volumes. Perforations in anterior versus posterior quadrants showed no significant differences in air-bone gaps at any frequency, although anterior perforations had, on average, air-bone gaps that were smaller by 1 to 8 dB at lower frequencies. Conclusion The conductive hearing loss resulting from a tympanic membrane perforation is frequency-dependent, with the largest losses occurring at the lowest sound frequencies; increases as size of the perforation increases; varies inversely with volume of the middle-ear and mastoid air space (losses are larger in ears with small volumes); and does not vary appreciably with location of the perforation. Effects of location, if any, are small. PMID:16436981

Mehta, Ritvik P.; Rosowski, John J.; Voss, Susan E.; O'Neil, Ellen; Merchant, Saumil N.

2010-01-01

282

Inverse relationship of the anterolateral and anteromedial thigh flap perforator anatomy.  

PubMed

Background?When anterolateral thigh (ALT) perforators are inadequate, exploration of the contralateral thigh or a new flap may be required. If the anteromedial thigh (AMT) perforators were useable in these instances, harvest could proceed from a single donor site. The purposes of this study were to define the AMT perforator anatomy and examine the relationships between the AMT and ALT perforators. Methods?A total of 100 consecutive thighs were explored. The ALT and AMT perforator size and number were documented. The relationship between ALT and AMT size and number was examined using Fisher exact test, logistic regression, and linear regression. Results?The main blood supply to the AMT flap was the rectus femoris branch (RFB) off the descending branch of the lateral circumflex femoris artery. AMT perforators were only present in 51% of the thighs and most likely a single perforator near the midpoint and 3.2 cm medial to the line connecting the anterior superior iliac spine and the patella (perforator B location). Patients with one or fewer ALT perforators had fourfold increased chance of an AMT perforator. Patients with small or no ALT perforators usually had a large AMT perforator. After assigning numeric values to perforators based on size, lower ALT perforator scores were significantly related to higher AMT scores. Conclusion?The RFB is the main vascular pedicle of the AMT flap. There is an inverse relationship between size and number of ALT and AMT perforators: when ALT perforators are inadequate, AMT perforators are typically useable. PMID:24995393

Yu, Peirong

2014-09-01

283

Intrathoracic Caecal Perforation Presenting as Dyspnea  

PubMed Central

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

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

2010-01-01

284

Viscous damping of perforated planar micromechanical structures  

PubMed Central

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

Homentcovschi, D.; Miles, R.N.

2008-01-01

285

Dimensional scaling for impact cratering and perforation  

NASA Technical Reports Server (NTRS)

POD Associates have revisited the issue of generic scaling laws able to adequately predict (within better than 20 percent) cratering in semi-infinite targets and perforations through finite thickness targets. The approach used was to apply physical logic for hydrodynamics in a consistent manner able to account for chunky-body impacts such that the only variables needed are those directly related to known material properties for both the impactor and target. The analyses were compared and verified versus CTH hydrodynamic code calculations and existing data. Comparisons with previous scaling laws were also performed to identify which (if any) were good for generic purposes. This paper is a short synopsis of the full report available through the NASA Langley Research Center, LDEF Science Office.

Watts, Alan J.; Atkinson, Dale

1995-01-01

286

Metatarsal artery perforator-based propeller flap.  

PubMed

Soft-tissue defects of the distal foot that involve an exposed tendon and bone demonstrate a reconstructive challenge for plastic surgeons. This report investigates the feasibility and reliability of metatarsal artery perforator (MAP)-based propeller flap for reconstruction of the distal foot soft-tissue defects. Between July 2011 and June 2012, six patients underwent distal foot reconstruction with seven MAP-based propeller flaps. Five flaps were based on the third metatarsal artery and two flaps were based on the first metatarsal artery. The flap size ranged from 4 × 2 cm to 8 × 4 cm. All flaps completely survived. Two patients developed transient distal venous congestion, which subsided spontaneously without complications. There were no donor site complications. All patients were ambulating without difficulty within the first month of surgery. MAP-based propeller flaps can be used to repair the distal foot soft-tissue defects, providing sufficient skin territory and excellent esthetic and functional recovery. PMID:24822254

Cinpolat, Ani; Bektas, Gamze; Ozkan, Ozlenen; Rizvanovic, Zumreta; Seyhan, Tamer; Coskunfirat, O Koray; Ozkan, Omer

2014-05-01

287

Laser-mediated perforation of plant cells  

NASA Astrophysics Data System (ADS)

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

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

2007-07-01

288

Wall Interference in a Perforated Wind Tunnel  

NASA Technical Reports Server (NTRS)

The theory of cascades, made up of a series of flat plates placed one behind the other, is extended to the case where the impinging stream is not uniform, and the deduced properties of this cascade-flow are then applied to the study of the wall interference between such as cascade-like boundary and a vortex-source type of singularity. It is shown that the induced velocities, produced by the presence of such a wall, are equal to what is obtained by action of a suitably chosen 'reflected' singularity situated on one side of the wall, together with the action of another suitably chosen 'transmitted' singularity placed on the other side. The concepts of a reflection factor and a transmission factor are introduced to characterize various types of tunnel boundary, whether this is composed of solid wall, open and closed sequences, or just a free fluid surface. These ideas are then extended to cover the situation in which a pair of such walls are allowed to coalesce, especially in the event that one of the walls consists of open and closed portions and the other is a fluid surface. This latter particular combination of boundaries is called a perforated wall. Finally, the interference arising from an arbitrary general singularity placed symmetrically in between two such perforated walls is analyzed, and these results are then applied to the determination of the particular kinds of wall geometry that will produce no interference effects in the case of a slender lifting wing and also in the case of a symmetric profile having a finite thickness.

Brescia, Riccardo

1957-01-01

289

Esophageal perforation during or after conformal radiotherapy for esophageal carcinoma  

PubMed Central

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

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

2014-01-01

290

Evaluation of perforated and nonperforated appendicitis with CT.  

PubMed

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

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

2004-01-01

291

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

SciTech Connect

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

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

2013-06-15

292

Iatrogenic hypercortisolism complicating triamcinolone acetonide injections in patients with HIV on ritonavir-boosted protease inhibitors.  

PubMed

Epidural corticosteroid injection is a commonly used approach for managing back pain of several etiologies. The risk of clinical complications from systemic absorption is felt to be rare. Ritonavir is a protease inhibitor whose potent cytochrome P450 3A4 inhibition is exploited for pharmacologic boosting in human immunodeficiency virus (HIV) infection. It has been associated with systemic hypercortisolism when used in combination with nasal and inhaled corticosteroids. This is a case series describing 2 patients with HIV on ritonavir-containing regimens who developed iatrogenic hypercortisolism following epidural injection of triamcinolone acetonide. The 2 patients developed cushingoid symptoms, with detectable serum triamcinolone acetonide levels weeks after their epidural injections. Their symptoms took several weeks to resolve, in one case necessitating a change to an HIV regimen that did not contain ritonavir. Iatrogenic hypercortisolism is a rarely reported, but potentially devastating complication of injectable corticosteroids. Individuals receiving ritonavir-based therapy appear to be at increased risk for this process due to pharmacologic boosting of the corticosteroid. The preponderance of reported cases of iatrogenic hypercortisolism following injectable corticosteroids has involved triamcinolone acetonide, which may be due to the relatively rapid absorption characteristics and high serum levels of this compound compared with other preparations. For individuals on ritonavir-containing HIV therapy, we recommend close coordination with the involved HIV clinicians prior to use of injectable corticosteroids, and avoidance of injections with triamcinolone acetonide whenever possible. Choosing an alternative corticosteroid preparation to triamcinolone acetonide may reduce the risk of systemic absorption, though more research is needed to confirm this hypothesis. PMID:23159966

Fessler, David; Beach, Jennifer; Keel, John; Stead, Wendy

2012-01-01

293

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

PubMed

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

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

2014-08-01

294

Iatrogenic aortic dissection during left subclavian artery stenting: immediate detection by calcium sign under fluoroscope.  

PubMed

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. PMID:20532777

Wang, Yi-Chih; Hwang, Juey-Jen; Lai, Ling-Ping; Tseng, Chuen-Den

2011-02-01

295

Endovascular treatment of an innominate artery iatrogenic pseudoaneurysm following subclavian vein catheterization.  

PubMed

Central venous catheterization is routinely required in a wide range of clinical situations such as hemodynamic monitoring, delivery of blood products and drugs, hemodialysis, total parental nutrition, and management of perioperative fluids. Pseudoaneurysms account for 4% of all innominate artery aneurysms. Clinical presentation may include airway and neurological compression, chest pain, mediastinal syndrome, upper limb ischemia, and hemodynamic instability. We report what we believe is the first documented case of a successful endovascular stent-graft repair of an innominate artery iatrogenic pseudoaneurysm. PMID:21193466

de Troia, Alessandro; Tecchio, Tiziano; Azzarone, Matteo; Biasi, Lukla; Piazza, Paolo; Franco Salcuni, Pier

2011-01-01

296

Spontaneous bilateral pneumothorax resulting from iatrogenic buffalo chest after the nuss procedure.  

PubMed

We describe a case of iatrogenic buffalo chest resulting in spontaneous bilateral pneumothorax in a 14-year-old boy with pectus excavatum in the late postoperative period after the Nuss procedure. The patient presented with a sudden onset of dyspnea 2 months after the Nuss procedure, and a chest roentgenogram showed a bilateral pneumothorax. We performed an emergency operation and found a communication between the chest cavities and a ruptured bulla in the left lung. This case highlights the potential development of simultaneous bilateral pneumothorax caused by a communication between the chest cavities after the Nuss procedure. PMID:25282216

Sakamoto, Kazuhiro; Ando, Kohei; Noma, Daisuke

2014-10-01

297

Management of an Iatrogenic Injury in a Crossed Ectopic Kidney Without Fusion  

PubMed Central

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

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

2014-01-01

298

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

SciTech Connect

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.

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

299

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

PubMed Central

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

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

2000-01-01

300

A perforated microring resonator for optical sensing applications  

NASA Astrophysics Data System (ADS)

In this paper, we present numerical simulations of a refractive index sensor based on a perforated optical microring resonator. We show that the introduction of subwavelength perforations in the microring resonator increases the light-matter interaction and the sensitivity of the microring resonator. Here, the sensor performance is analyzed in two sensing schemes: bulk sensing and dielectric particle sensing. In both applications the perforated microring resonator sensor outperforms an ordinary microring resonator sensor and also maintains a high quality factor. The simulations were performed using finite-difference time domain and finite-element methods.

Gabalis, M.; Urbonas, D.; Petruskevicius, R.

2014-10-01

301

Coronary artery perforation treated with multiple bare metal stent implantation  

PubMed Central

Although coronary artery perforations are quite rare, when they occur, the consequences are devastating. Treatment options differ according to the type, location and severity of the perforation. As a general rule severe perforations are treated with covered stents. However, when implanting a covered stent is not an option as in our case due to various reasons, multiple bare metal stent implantation may be a good option. Besides that, management of the antiplatelet and the anticoagulant therapy remains controversial. We believe that therapy should be individualized. PMID:24570761

Baskurt, Murat; Fazl?ogullar?, Osman; Ayca, Burak; Kalyoncu, Muhsin

2013-01-01

302

Plasmablastic lasmablastic lymphoma of the duodenal and jejunum  

PubMed Central

Plasmablastic lymphoma (PBL) is a rare B-cell neoplasm with an aggressive clinical behavior that predominantly occurs in the oral cavity of human immunodeficiency virus (HIV)-positive patients. HIV-negative PBL has not been extensively reported. A 65-year-old female presented with anemia, who was HIV-negative. Gastrointestinal fiberscope (GIF), and colon fiberscope (CF) were performed. However, we could not detect the bleeding sites. We detected the tumor by capsule endoscopy, and obtained the tumor cells from the duodenal and jejunal sites. The neoplastic cells were diffusely positive for CD56, epithelial membrane (EMA), CD4, ?, and EBV-encoded RNA1 (EBER1) and partially positive for CD138 and CD79a. This patient was diagnosed as PBL. The small intestine is a rare extra-oral site of involvement in PBL patients, and only four cases in HIV-negative patients have been reported. PMID:25120837

Koike, Michiaki; Masuda, Azuchi; Ichikawa, Kunimoto; Shigemitu, Ayako; Komatus, Norio

2014-01-01

303

Somatostatin depletion by cysteamine: mechanism and implication for duodenal ulceration  

SciTech Connect

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

Szabo, S.; Reichlin, S.

1985-06-01

304

Gastric and duodenal squamous cell carcinoma: metastatic or primary?  

PubMed

Either metastatic or primary squamous cell carcinoma in the gastrointestinal tract is extremely rare, with very few cases reported in the literature. In this paper, we report a case in which the patient presented with dysphagia during the course of radiotherapy for recurrent lung cancer in a mediastinal lymph node. Although the dysphagia mimicked radiation esophagitis, the ultimate cause proved to be gastric and duodenal metastases from primary lung squamous cell carcinoma. Taking into account the value of identification of metastatic or primary SCC in the stomach and duodenum on the prognosis and treatment options, it is imperative that the correct diagnosis be established. This report is followed by a discussion of the differential diagnosis between metastatic and primary squamous cell carcinoma in the stomach and duodenum. PMID:23957943

Hu, Jian-Bin; Zhu, Yan-Hong; Jin, Mei; Sun, Xiao-Nan

2013-01-01

305

Duodenal-mucosal bacteria associated with celiac disease in children.  

PubMed

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

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

2013-09-01

306

Duodenal nutrient exclusion improves metabolic syndrome and stimulates villus hyperplasia  

PubMed Central

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

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

2014-01-01

307

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

PubMed Central

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

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

2012-01-01

308

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

NASA Astrophysics Data System (ADS)

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.

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

2013-12-01

309

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

PubMed

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

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

2014-11-01

310

Technical aspects of the laparoscopic management of a late presenting duodenal web.  

PubMed

The value of laparoscopy in repair of congenital duodenal webs is yet to be established and techniques are evolving. Described are technical details of a successful laparoscopic web ablation without duodenoplasty. PMID:19021465

Mahomed, Anies; D'hondt, Beelke; Khan, Khalid; Butt, Assad

2009-04-01

311

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

PubMed Central

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

Jiang, Pengbo; Christakos, Athena; Fam, Mina

2014-01-01

312

[Iatrogenic "metalloma" (titanoma) caused by implant failure in "metal-backed" patellar joint surface replacement].  

PubMed

Patellofemoral problems frequently provide the cause for revisions after total knee replacements (TKR). Problems with metal-backed patellae, in particular, have been reported on in the past, with a failure rate of 33%. As a result of implant failure, there is an increase of polyethylene and metallic wear, which eventually leads to a synovialitis and metallosis. We report a case of a iatrogenic induced metallosis of the knee joint resulting from failure of a metal-backed patella component with the formation of a substantial pseudotumor within the popliteal fossa. Intraoperatively, a browny-grey, knotted and hard structure was to be seen, which histologically imposed as a hyalinated scar tissue with black particular deposits. Energy dispersive X-ray microanalysis showed a high level of titanium within the intra- and extracellular deposits. In differential diagnosis these findings were postulated as "metalloma" (titanoma). In cases of periprosthetic pseudotumors, particular those with implant failure, a iatrogenic-induced metalloma should be considered. PMID:11995225

Büttner-Janz, Karin; Müller, M; Müller, K M; Friemann, J

2002-03-01

313

Iatrogenic Cushing Syndrome Secondary to Ritonavir-Epidural Triamcinolone Interaction: An Illustrative Case and Review  

PubMed Central

HIV positive patients on ritonavir-containing antiretroviral therapy (ART) can develop iatrogenic Cushing syndrome (IACS) and adrenal insufficiency as a result of drug-drug interactions with inhaled or intranasal glucocorticoid therapy. Reports related to epidural triamcinolone injections are relatively uncommon but increasingly reported. We describe a 48-year-old woman with immunologically and virologically well-controlled HIV on ritonavir-based ART, who developed headache, dizziness, and candida and herpes simplex virus (HSV) ulcerative esophagitis 7 days after receiving an epidural triamcinolone injection for cervical radicular pain. Iatrogenic Cushing syndrome and relative adrenal insufficiency were suspected and proven. The patient's ART was changed to a non-HIV protease inhibitor- (PI-) containing program, her symptoms improved, and she did not require hydrocortisone replacement. In this paper, we review the literature on IACS and relative secondary adrenal insufficiency from epidural triamcinolone injections in HIV patients on ritonavir-containing ART regimens. A high index of clinical suspicion is needed for diagnosis. Prevention of drug-drug interactions by taking a thorough medication history for patients on ritonavir-containing ART regimens before prescribing any form of corticosteroid is crucial and effective and sustained interdisciplinary communication in the care of such patients. PMID:24895495

Berg, Melody L.

2014-01-01

314

Evaluation of Perforated Carbonate Cores Under Acid Stimulation  

E-print Network

Although it has been shown that clean perforation tunnels facilitate the evolution of a single, deeper-penetrating wormhole, there are no reported applications of reactive shaped charges in carbonates prior to acid stimulation. The present study...

Diaz, Nerwing Jose

2011-10-21

315

Pulmonary Artery Perforation Repair During Thrombectomy Using Microcoil Embolization  

SciTech Connect

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

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

2006-02-15

316

[Perforator propeller flap for cutaneous coverage of the knee].  

PubMed

Previous pedicled techniques for coverage of the knee use muscular flaps and/or local fascio-cutaneous flaps limited to rotate until 90° on their cutaneous base. Freestyle perforator flaps match the patient's anatomy to fill a defect. Propeller perforator flaps have been used to treat three patients presenting with a skin loss over the knee. The surgery is based on the Echo-Doppler tracing the good perforator vessels around the wound. We performed two supero-medial flaps with a self-closing donor site and one supero-lateral flap where a graft was needed. All the patients healed in less than six weeks, with satisfying functional and esthetical results. We think freestyle perforator flaps are a reliable and predictable technique with a low morbidity rate and they are well adapted to cover skin defects over the knee. PMID:21719180

Gobel, F; Pélissier, P; Casoli, V

2011-08-01

317

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

SciTech Connect

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

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

2010-12-15

318

Prostaglandin E 1 (Misoprostol) overcomes the adverse effect of chronic cigarette smoking on duodenal ulcer healing  

Microsoft Academic Search

Chronic cigarette smoking adversely affects duodenal ulcer healing despite treatment by potent gastric acid-reducing agents. Prostaglandins of the E series possess antisecretory and cytoprotective properties and theoretically offer advantages over existing therapeutic agents. A double-blind randomized study was performed to compare complete duodenal ulcer healing as assessed by endoscopies every two weeks for up to 12 weeks. Two hundred twenty-nine

Shiu-Kum Lam; Wan-Yee Lau; Tat-Kuen Choi; Ching-Lung Lai; Anna S. F. Lok; Wai-Mo Hui; Matthew M. T. Ng; Samuel K. Y. Choi

1986-01-01

319

Influence of overall structural response on perforation of concrete targets  

Microsoft Academic Search

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

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

2007-01-01

320

Wave interaction with a new type perforated breakwater  

Microsoft Academic Search

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,

Yong Liu; Yucheng Li; Bin Teng

2007-01-01

321

Undetected oesophageal perforation and feeding-tube misplacement.  

PubMed

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

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

2014-10-23

322

Amyand’s Hernia with Perforated Appendix in a Neonate  

PubMed Central

When vermiform appendix is found in the inguinal hernial sac, the condition is called Amyand’s hernia (AH). Appendix in hernial sac can be normal, inflamed or perforated. It can present as complicated hernia or acute scrotum. We present a case of Amyand’s hernia in a 25-day-old male who presented with an obstructed hernia having perforated appendix in the hernial sac. PMID:25374801

Sandhu, Asif; Nayyar, Sajid Iqbal; Faryal, Rehman; Shafique, Shanze

2014-01-01

323

Perforated-Layer Implementation Of Radio-Frequency Lenses  

NASA Technical Reports Server (NTRS)

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.

Dolgin, Benjamin P.

1996-01-01

324

Cellular bicarbonate protects rat duodenal mucosa from acid-induced injury  

PubMed Central

Secretion of bicarbonate from epithelial cells is considered to be the primary mechanism by which the duodenal mucosa is protected from acid-related injury. Against this view is the finding that patients with cystic fibrosis, who have impaired duodenal bicarbonate secretion, are paradoxically protected from developing duodenal ulcers. Therefore, we hypothesized that epithelial cell intracellular pH regulation, rather than secreted extracellular bicarbonate, was the principal means by which duodenal epithelial cells are protected from acidification and injury. Using a novel in vivo microscopic method, we have measured bicarbonate secretion and epithelial cell intracellular pH (pHi), and we have followed cell injury in the presence of the anion transport inhibitor DIDS and the Cl– channel inhibitor, 5-nitro-2-(3-phenylpropylamino) benzoic acid (NPPB). DIDS and NPPB abolished the increase of duodenal bicarbonate secretion following luminal acid perfusion. DIDS decreased basal pHi, whereas NPPB increased pHi; DIDS further decreased pHi during acid challenge and abolished the pHi overshoot over baseline observed after acid challenge, whereas NPPB attenuated the fall of pHi and exaggerated the overshoot. Finally, acid-induced epithelial injury was enhanced by DIDS and decreased by NPPB. The results support the role of intracellular bicarbonate in the protection of duodenal epithelial cells from luminal gastric acid. PMID:11748264

Akiba, Yasutada; Furukawa, Osamu; Guth, Paul H.; Engel, Eli; Nastaskin, Igor; Sassani, Pejvak; Dukkipatis, Ramanath; Pushkin, Alexander; Kurtz, Ira; Kaunitz, Jonathan D.

2001-01-01

325

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

SciTech Connect

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

Oishi, T.; Szabo, S.

1987-03-01

326

Duodenal lipid sensing activates vagal afferents to regulate non-shivering brown fat thermogenesis in rats.  

PubMed

Previous evidence indicates that duodenal lipid sensing engages gut-brain neurocircuits to determine food intake and hepatic glucose production, but a potential role for gut-brain communication in the control of energy expenditure remains to be determined. Here, we tested the hypothesis that duodenal lipid sensing activates a gut-brain-brown adipose tissue neuraxis to regulate thermogenesis. We demonstrate that direct administration of lipids into the duodenum increases brown fat temperature. Co-infusion of the local anesthetic tetracaine with duodenal lipids abolished the lipid-induced increase in brown fat temperature. Systemic administration of the CCKA receptor antagonist devazepide blocked the ability of duodenal lipids to increase brown fat thermogenesis. Parenchymal administration of the N-methyl-d-aspartate receptor blocker MK-801 directly into the caudomedial nucleus of the solitary tract also abolished duodenal lipid-induced activation of brown fat thermogenesis. These findings establish that duodenal lipid sensing activates a gut-brain-brown fat axis to determine brown fat temperature, and thereby reveal a previously unappreciated pathway that regulates thermogenesis. PMID:23251649

Blouet, Clémence; Schwartz, Gary J

2012-01-01

327

Cigarette smoking, gastric acid secretion, and serum pepsinogen I concentrations in duodenal ulcer patients.  

PubMed Central

Cigarette smoking has been linked with duodenal ulcer disease although the mechanism of this association is unclear. This study assessed basal gastric secretory response to acute smoking of smokers with an active duodenal ulcer; in addition the possible effects of chronic smoking on gastric secretory capacity, as expressed by pentagastrin stimulated gastric acid secretion and fasting serum pepsinogen I (PG I) concentrations, were investigated in patients with active duodenal ulcer, or non-ulcer dyspepsia. In 10 smokers with duodenal ulcer smoking four cigarettes during 40 minutes did not influence basal gastric secretion of acid and pepsin, or serum PG I and gastrin concentrations. In 136 patients with duodenal ulcer and 90 controls with non-ulcer dyspepsia, pentagastrin stimulated acid secretion and fasting serum PG I concentrations were significantly higher among habitual heavy smokers than among non-smokers. These findings suggest that in heavy smokers with duodenal ulcer acid- and pepsin-secreting cell function is not affected by acute cigarette smoking. By contrast, chronic cigarette smoking seems to be associated either with an increase of parietal- and chief-cell mass, or with an enhancement of their secretory capacity. PMID:3936754

Parente, F; Lazzaroni, M; Sangaletti, O; Baroni, S; Bianchi Porro, G

1985-01-01

328

Cause rare d'une perforation de la cloison nasale  

PubMed Central

Les perforations de la cloison nasale constituent une pathologie fréquente en ORL. Leurs causes sont multiples et restent dominées par les traumatismes chirurgicaux. Les étiologies infectieuses et notamment la tuberculose sont rares. Nous présentons le cas d'une patiente ayant bénéficié d'une méatotomie bilatérale et chez laquelle une perforation de la cloison nasale a été découverte lors d'un examen systématique à un an de son intervention. D'abord considérée comme une complication de la chirurgie, la biopsie des berges de la perforation a permis de déterminer son origine tuberculeuse. La présentation clinique des perforations de la cloison nasale n'est pas spécifique. Elles sont souvent asymptomatiques et de découverte fortuite. Les traumatismes notamment chirurgicaux sont le plus siuvent en cause. L?orogine tuberculeuse resta très rare. Le diagnostic de certitude de tuberculose repose sur la biopsie des berges de cette perforation. Le but de ce travail est de mettre en avant l'intérêt de la biopsie dans le diagnostic de la tuberculose de la cloison nasale. Cette biopsie doit être systématique même en cas d'antécédents de chirurgie endonasale qui est le plus souvent en cause dans les perforations de la cloison nasale. PMID:24932334

Jahidi, Ali; Hemmaoui, Bouchaib; Itoua, Wulfran Rosaire; Errami, Noureddine; Benariba, Fouad

2014-01-01

329

Anatomical study of the perforating vessels of the lower leg.  

PubMed

Difficulty of soft tissue defects of the lower leg demands the development of new methods to treat such defects. The aim of this study is the examination of perforators and the various ways of blood supply to the skin in the lower leg. Provided with certain regularity, we would be able to cure soft-tissue defects also in the difficult zone of the distal segment and on the dorsum of the foot not harming vessels and not affecting mobility of muscles. Subcutaneous island-flaps supplied by perforating vessels could replace free flaps. By saving the crural fascia of 10 lower legs we flayed layers of skin and fat, marked the perforating vessels with pins, and photographed and documented them. Specimens were divided into a proximal, an intermediate and a distal segment, each of them subdivided into a medial, lateral and dorsal section. The perforators, which can be classified as septocutaneous and musculocutaneous vessels, followed a reproducible pattern all over the lower leg. All vessels were sufficient in number as well as in size. Additionally these perforators can easily be identified by colour-coded sonography. The knowledge that perforators in the lower leg occur regularly enables the development of a new operative approach in therapy of soft-tissue defects in this region with the advantage, that the vessels used can be selected preoperatively. PMID:10409809

Stadler, F; Brenner, E; Todoroff, B; Papp, C

1999-08-01

330

Perforator propeller flaps for sacral and ischial soft tissue reconstruction  

PubMed Central

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

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

2010-01-01

331

Inferior Flap Tympanoplasty: A Novel Technique for Anterior Perforation Closure  

PubMed Central

Objective. To report a novel tympanoplasty modification for anterior tympanic membrane perforation closure. Materials and Methods. A prospective study on 13 patients who underwent inferior tympanoplasty between December 2008 and May 2011 was carried out. In our technique, an inferior rather than a posterior flap is raised and the graft is laid from the inferior direction to obtain better access to the anterior part of the tympanic membrane perforation and provide better support. Results. A total of 13 patients underwent the novel inferior tympanoplasty technique with a mean age of 33 years. Six patients had undergone tympanoplasties and/or mastoidectomies in the past, 3 in the contralateral ear. A marginal perforation was observed in 3 cases, total perforation in 2 and subtotal in 1 case. The mean preoperative pure-tone average was 40.4?dB (10 to 90?dB), compared to 26.5?dB (10 to 55?dB) postoperatively. All perforations were found to be closed but one (92.3% success rate). Conclusions. The inferior tympanoplasty technique provides a favorable outcome in terms of tympanic membrane closure and hearing improvement for anterior perforations, even in difficult and complex cases. It is based on a well-known technique and is easy to implement. PMID:24000326

Gavriel, Haim

2013-01-01

332

A hypervelocity projectile launcher for well perforation  

SciTech Connect

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

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

1989-01-01

333

Spontaneous corneal perforation post cataract surgery.  

PubMed

A 69-year-old female was referred for bilateral cataracts. Best-corrected visual acuity was 6/12 oculus dexter (OD) and 6/18 oculus sinister (OS). On examination, tear film breakup time was 8 s, signifying mild dry eyes; otherwise was unremarkable. The patient underwent uneventful left cataract surgery. At a 1 month postoperative examination vision was 6/9. The left cornea was dry with extensive punctuate epithelial erosions. There was no lagophthalmos. Lubricants were started to both eyes. The authors proceeded with right cataract surgery. Postoperative preservative free drops were given. She failed to attend an earlier than routine 2 week postoperative examination. Four weeks postoperatively, the vision was 2/60. She was incompliant with the lubricant drops. Biomicroscopic examination showed a sterile painless paracentral corneal perforation with iris plugging, Seidel's negative. She was started on steroid drops and lubricants. A lower lid punctual plug was inserted. The best corrected vision at 4 months was 6/18 OD and 6/6 OS. PMID:22669966

Chaudhary, Rishika; Mushtaq, Bushra

2011-01-01

334

Large duodenal hematoma associated with transcatheter arterial embolization following endoscopic hemostasis in a cirrhosis patient: case report.  

PubMed

To date, there has been no report on duodenal intramural hematoma following transcatheter arterial embolization in bleeding duodenal ulcer refractory to endoscopic hemostasis. We experienced a case of obstructive cholangitis and pancreatitis secondary to duodenal intramural hematoma associated with transcatheter arterial embolization, following endoscopic hemostatic procedures for a bleeding duodenal ulcer in a patient with cirrhosis. The patient was successfully treated with percutaneous transhepatic biliary drainage. We suggest that transcatheter arterial embolization can be a cause of duodenal intramural hematoma, and that percutaneous transhepatic biliary drainage, rather than surgical intervention, can be useful in the treatment of biliary or pancreatic obstruction secondary to duodenal intramural hematoma, especially in patients with bleeding diathesis. PMID:22287407

Won, Moon; Jung, Park Mi; Ja, Park Seun; In, Park Moo; La, Jang Lee; Sik, Jung Gyoo

2011-12-01

335

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

PubMed Central

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

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

2014-01-01

336

Retention of small foreign objects in the stomach and duodenum. A sign of partial obstruction caused by duodenal anomalies.  

PubMed

Small round, oval, or cuboidal foreign objects nearly always pass through the gastrointestinal tract promptly, and stasis of such objects in the stomach or duodenum is extremely uncommon. The authors describe 3 cases of prolonged retention in children with no clinical or plain-film evidence of duodenal obstruction. In each case, a barium meal demonstrated a congenital anomaly of the duodenum producing partial obstruction: duodenal stenosis, prolapse of the duodenal diaphragm ("windsock duodenum"), and an annular pancreas. PMID:1118573

Kassner, E G; Rose, J S; Kottmeier, P K; Schneider, M; Gallow, G M

1975-03-01

337

Different effect of antiulcer agents on rat cysteamine-induced duodenal ulcer after sialoadenectomy, but not gastrectomy  

Microsoft Academic Search

The focus was on salivary glands in cysteamine-induced duodenal ulcer and the different effects of antiulcer agents on cysteamine-induced duodenal ulcer in sialoadenectomized but not gastrectomized rats. We tested antiulcer agents on cysteamine-induced duodenal ulcer in rats (agents\\/kg i.p.) simultaneously with cysteamine 400 mg\\/kg s.c., rat killed 24 h thereafter subjected to no surgery (normal), to gastrectomy (24 h before)

Vlado Bedekovic; Stjepan Mise; Tomislav Anic; Mario Staresinic; Miroslav Gjurasin; Mario Kopljar; Livije Kalogjera; Petar Drvis; Alenka Boban Blagaic; Lovorka Batelja; Sven Seiwerth; Predrag Sikiric

2003-01-01

338

Prevalence and Associated Periodontal Status of Teeth with Root Perforation: A Retrospective Study of 2,002 Patients' Medical Records  

Microsoft Academic Search

IntroductionVarious procedures along the course of an endodontic treatment may lead to perforations. The prognosis of perforated teeth depends on perforation location, perforation size, and time from occurrence. The aim of this study was to retrospectively evaluate the prevalence of root perforations and associated pathological changes in the adjacent periodontal tissues.

Igor Tsesis; Ester Rosenberg; Vadim Faivishevsky; Anda Kfir; Menahem Katz; Eyal Rosen

2010-01-01

339

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

PubMed

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

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

2013-07-01

340

Retroperitoneal lymphangioma with a duodenal lesion in an adult.  

PubMed

A multilocular-cystic and cavernous, retroperitoneal tumor was found in a 40-year-old man whose past medical history was unremarkable. On admission, he complained of a large and still growing intra-abdominal mass associated with dull pain and a low-grade fever. Laboratory findings revealed leukocytosis and C-reactive protein elevation, compatible with inflammation of the tumor. Percutaneous aspiration of the tumor was performed under transabdominal ultrasonographic guidance, and continuous drainage of fluid from within the tumor ameliorated his symptoms. From preoperative examinations, including radiological imaging, fluid aspiration, and endoscopy with biopsy, a diagnosis of retroperitoneal lymphangioma was made. Laparotomy revealed extensive adhesions between the tumor and both the duodenum and the pancreatic head. A pancreaticoduodenectomy was therefore performed. At 3-year follow-up, there was no sign of recurrence. Retroperitoneal lymphangioma is an uncommon disorder, and the cavernous type is extremely rare. The duodenal lesion was an important feature of the present case, and endoscopic biopsy of this lesion facilitated precise preoperative diagnosis of retroperitoneal lymphangioma. PMID:12051538

Fujishiro, Mitsuhiro; Kamoshida, Toshiro; Hotra, Soichi; Hirai, Shinji; Oka, Yuji; Sato, Munekatsu; Okumura, Minoru; Inadome, Yukinori; Takahashi, Atsushi

2002-01-01

341

Pseudo-iatrogenic hypospadias: the megameatus intact-prepuce hypospadias variant.  

PubMed

This article presents the authors' experience with 21 patients with the megameatus variant of hypospadias who were treated during an 8-year period. In nine of the cases, the parents were convinced that the defect was a complication of circumcision, and the patients were examined in consultations in preparation for litigation. Seven of those nine patients had been previously examined by either a plastic surgeon or a urologist, who failed to recognize this variant. The typical appearance of the defect and how to differentiate this congenital deformity from true iatrogenic hypospadias are described. The features of the megameatus intact-prepuce variant of hypospadias include a wide spatulated glans, a deep groove, a large wide patulous meatus at the subglanular groove, an intact prepuce before circumcision, no evidence of glanular scarring, and no history of bleeding at the time of circumcision. PMID:12621189

Peretz, Dora; Westreich, Melvyn

2003-03-01

342

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

PubMed

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

De Pouvourville, G

1995-04-01

343

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

PubMed

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

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

1982-06-01

344

[Surgical treatment of iatrogenic lesions of the urinary tracts and their complications].  

PubMed

The article presents results of surgical treatment of 167 patients with iatrogenic urinary tract lesions made in the course of various surgical interventions. Ureteral trauma was detected in 106 (63.5%), urinary bladder trauma--in 44 (26.3%), urethral trauma--in 5 (3.0%) and trauma of the bladder and ureters--in 12 (7.2%) patients. Endoureterotomy was made in 7 (4.0%) patients with short ureteral stricture, intraoperative correction of ureteral injuries was made in 8 (4.6%) cases. Ureteroplasty according to the technique designed by the authors was conducted in one female patient. A variant of ureterocystoanastomosis (UCA) was created in 67 (38.8%) patients. Reconstruction of the urinary tract with an ileal graft was performed in 16 (9.3%) patients, with the appendix--in 4 (2.3%) patients. Intestinal plastic correction of the ureters and urinary bladder was made in 2 (1.2%) patients. In trauma of the urinary bladder in 3 (1.7%) patients it was sutured, 41 (23.7%) patients underwent transvaginal vesicofistuloraphy. Electrocoagulation of the vesicovaginal fistula and colpocleisis were performed in 8 (4.6%) patients. Plastic surgery of vesicorectal and urethrovaginal fistula was conducted in 3 (1.7%) and 5 (2.9%) patients, respectively. In postoperative period after reconstructive operations complications developed in 17 (10.2%) patients. Conservative treatment of the complications was carried out in 11 (6.6%) patients, reoperations were made in 6 (3.6%) patients: resection of the stricture of appendicocystoanastomosis with reanastomosis (n = 1), repeat UCA (n = 1), revesicofistuloraphy (n = 1) and electrocoagulation of recurrent fistula (n = 3). Rehabilitation was achieved in 98.8% patients. Obstruction of the ureters and urogenital fistulas are prevailing complications (93.4%) of iatrogenic injury of the urinary tract. Operations of choice in such complications are UCA and transvaginal fistuloraphy, respectively. PMID:17722613

Komiakov, B K; Guliev, B G; Rodygin, L M

2007-01-01

345

Classical Hodgkin lymphoma arising in the setting of iatrogenic immunodeficiency: a clinicopathologic study of 10 cases.  

PubMed

Iatrogenic immunodeficiency-associated lymphoproliferative disorders are rare. A small subset of these lesions resembles classical Hodgkin lymphoma (CHL), but there are few data in the literature about these lesions. We describe 10 patients with autoimmune diseases treated with immunomodulator therapeutic agents who developed CHL. The autoimmune diseases included rheumatoid arthritis (n=5), systemic lupus erythematosus (n=2), dermatomyositis (n=1), autoimmune hepatitis (n=1), and Crohn disease (n=1), and the immunomodulatory therapies were methotrexate, azathioprine, tumor necrosis factor-? inhibitors, and thalidomide alone or in various combinations. The study group included 9 women and 1 man with a median age of 50 years (range, 25 to 77 y). The histologic features supported CHL in all cases with Reed-Sternberg (RS) and Hodgkin (H) cells in an inflammatory cell background, although the neoplasm could only be subclassified in 3 patients: 2 nodular sclerosis and 1 mixed cellularity. Immunohistochemical analysis supported the diagnosis of CHL. In all cases the RS-H cells were CD30. Nine of 10 cases were CD15, whereas CD20 was expressed variably in 4/10 cases. CD45/LCA was negative in 8 cases assessed. In situ hybridization for Epstein-Barr virus-encoded RNA was positive in the RS-H cells in 8/10 cases. The microenvironment of these lesions depicted a predominance of T-regulatory cells and M2 histiocytes. Clinical follow-up data were available for 7 patients, with a median posttreatment period of 27 months (range, 12 mo to 7 y). In all 7 patients immunomodulatory drug therapy was discontinued, and chemotherapy for CHL was administered; 2 patients also received local radiation. All 7 patients achieved complete remission and are alive. We conclude that iatrogenic immunodeficiency-associated CHL is highly associated with Epstein-Barr virus infection, and patients usually have a good outcome after discontinuation of immunomodulatory agents and chemotherapy for CHL. PMID:23774171

Loo, Eric Y; Medeiros, L Jeffrey; Aladily, Tariq N; Hoehn, Daniela; Kanagal-Shamanna, Rashmi; Young, Ken H; Lin, Pei; Bueso-Ramos, Carlos E; Manning, John T; Patel, Keyur; Thomazy, Vilmos; Brynes, Russell K; Goswami, Maitrayee; Fayad, Luis E; Miranda, Roberto N

2013-08-01

346

Treatment of tympanic membrane perforations with hyaluronan in an open pilot study of unselected patients.  

PubMed

Twenty-five unselected tympanic membrane (TM) perforations of varying size and duration, from one day to 10 years, were treated by local application of the glycosaminoglycan, hyaluronan, 1%. The treatment was well tolerated without any side-effects. Seventeen of the perforations were closed, though two drums were re-perforated. Four perforations not completely covered were markedly reduced in size. No effect of hyaluronan could be observed on moist perforations. The scar formed after treatment with hyaluronan 'normal' appearance. Hyaluronan treatment seems to be an alternative to myringoplasty when treating small and medium-sized dry perforations. PMID:3324631

Stenfors, L E

1987-01-01

347

Complex heel reconstruction with a sural fasciomyocutaneous perforator flap.  

PubMed

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

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

2014-02-01

348

Reconstruction of pressure sores with perforator-based propeller flaps.  

PubMed

Perforator flaps have been successfully used for reconstruction of pressure sores. Although V-Y advancement flaps approximate debrided wound edges, perforator-based propeller flaps allow rotation of healthy tissue into the defect. Perforator-based propeller flaps were planned in 13 patients. Seven pressure sores were over the sacrum, five over the ischial tuberosity, and one on the tip of the scapula. Three patients were paraplegic, six were bedridden, and five were ambulatory. In three patients, no perforators were found. In 10 patients, propeller flaps were transferred. In two patients, total flap necrosis occurred, which was reconstructed with local advancement flaps. In two cases, a wound dehiscence occurred and had to be revised. One hematoma required evacuation. No further complications were noted. No recurrence at the flap site occurred. Local perforator flaps allow closure of pressure sores without harvesting muscle. The propeller version has the added benefit of transferring tissue from a distant site, avoiding reapproximation of original wound edges. Twisting of the pedicle may cause torsion and venous obstruction. This can be avoided by dissecting a pedicle of at least 3 cm. Propeller flaps are a safe option for soft tissue reconstruction of pressure sores. PMID:21184385

Jakubietz, Rafael G; Jakubietz, Danni F; Zahn, Robert; Schmidt, Karsten; Meffert, Rainer H; Jakubietz, Michael G

2011-03-01

349

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

PubMed

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

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

2008-10-01

350

Position paper: management of perforated sigmoid diverticulitis.  

PubMed

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

Moore, Frederick A; Catena, Fausto; Moore, Ernest E; Leppaniemi, Ari; Peitzmann, Andrew B

2013-01-01

351

Pars flaccida perforation in tissue culture: morphological study.  

PubMed

Subtotal pars flaccida perforation was effected in vitro in rat tympanic membranes. The drums were subsequently kept in tissue culture and after various intervals studied by means of light and scanning electron microscopy. No complete covering of the perforation was seen, though a marked thickening and hyperplasia of the outer, keratinizing, squamous epithelium (OE) was evident. The inner, tympanal epithelium (IE) appeared swollen, containing rounded structures in the cytoplasm especially close to the contact area with the OE. Ingrowth of OE onto the tympanal side of the drum was seen particularly in the areas where the IE was sparse and completely lacking. Complete covering of a drum perforation seems to be dependent on the formation of supporting granulation tissue, probably resulting from an inflammatory reaction in the healing area. PMID:2324630

Stenfors, L E; Olsen, E G; Henriksen, A O

1990-02-01

352

Typhoid glomerulonephritis and intestinal perforation in a Nigerian child.  

PubMed

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

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

2014-01-01

353

Symptomatic bilateral isolated perforator infarction following aneurysmal subarachnoid hemorrhage  

PubMed Central

Vasospasm following aneurysmal subarachnoid hemorrhage (SAH) occurs in the extraparenchymal vessels in the subarachnoid space at the base of the brain. Ischemia/ Infarction affecting primarily the perforator vessels in isolation, following aneurysmal SAH is uncommon. A 28-year-old man with a ruptured middle cerebral artery aneurysm underwent clipping of the aneurysm. He developed delayed bilateral deep seated infarcts involving both internal capsular regions, the thalamus and basal ganglia without any major vessel infarct. The patient was managed with triple H (hypertensive hypervolemic hemodilutional) therapy and calcium channel antagonists but did not show any improvement and remained in poor neurological status. Perforator vasospasm occurring secondary to aneurysmal SAH, though documented in experimental animal studies, has rarely been reported in humans in a clinical setting. The present case provides evidence, albeit indirect, of isolated perforator vasospasm, which possibly should be the target of future therapeutic strategies. PMID:23546349

Salunke, Pravin; Gupta, Sunil K

2013-01-01

354

Perforation of the bladder by the intrauterine device.  

PubMed

Probably because of its rarity, the IUD complication of bladder perforation has seldom been diagnosed prior to intervention. This article presents in tabular form data on 8 cases of bladder perforation by IUDs in an effort to develop appropriate methods of preoperative diagnosis. Several types of bladder perforation were found in the 8 cases. The main symptom was recurrent and persistent cystitis which usually responded only temporarily to therapy. Symptoms included dysuria, burning on urination, frequency, nocturia, occasional hematuria, lower abdominal and suprapubic pain, and bladder pressure. Objective evidence was provided by microscopic pyuria and hematuria, as well as positive urine cultures. In most cases, symptoms appeared soon after insertion or within a few months. Attacks of cystitis starting shortly after insertion of the IUD and continuing repetitively should arouse suspicion of bladder perforation, and concomitant absence of the IUD string or unanticipated pregnancy should heighten the suspicion. Preliminary investigation prior to cystoscopy is preferrable beginning with a plain X-ray film in anteroposterior (AP) and lateral projections. If a bladder calculus has not formed or is insufficiently radiopaque, the AP film can be misleading unless a lateral film is also taken. Although it was used in only 2 cases, sonography will probably prove increasingly valuable in the diagnosis of bladder perforations by IUDs. If sonography does not demonstrate the intravesical IUD, opacification of the bladder by intravenous pyelography or retrograde cystography, using AP and lateral films, may show it. Hysterography may be helpful when sonography or intravenous pyelography or retrograde cystography give a hint of concomitant partial uterine location of the IUD. Cystography after preliminary tests can help in planning the optimal approach for removing the IUD. In the 8 cases the free-floating IUD was removed by cystoscopy in 3 cases, the adherent IUD by suprapubic cystotomy in 4 cases, and by vaginal cystotomy in 1 case. In general, suprapubic cystotomy is the procedure of choice for removing an IUD perforating into and adherent to the bladder wall. PMID:6229704

Zakin, D

1984-02-01

355

Practical Considerations for Perforator Flap Thinning Procedures Revisited  

PubMed Central

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

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

2014-01-01

356

High-energy gas fracturing in cased and perforated wellbores  

SciTech Connect

A propellant-based technology, High-Energy Gas Fracturing (HEGF), has been applied to fracturing through perforations in cased boreholes. HEGF is a tailored-pulse fracturing technique originally developed by Sandia National Laboratories for application in uncased, liquid-free gas wells in Appalachian Devonian shales. Because most oil and gas wells are liquid filled as well as cased and perforated, the potential impact of present research is significantly broader. A number of commercial tailored-pulse fracturing services, using a variety of explosives or propellants, are currently available. Present research provides valuable insight into phenomena that occur in those stimulations. The use of propellants that deflagrate or burn rather than detonate, as do high-order explosives, permits controlled buildup of pressure in the wellbore. The key to successful stimulation in cased and perforated wellbores is to control the pressure buildup of the combustion gases to maximize fracturing without destroying the casing. Eight experiments using cased and perforated wellbore were conducted in a tunnel complex at the Department of Energy's Nevada Test Site, which provides a realistic in situ stress environment (4 to 10 MPa (600 to 1500 psi)) and provides access for mineback to directly observe fracturing obtained. Primary variables in the experiments include propellant burn rate and amount of propellant used, presence or absence of liquid in the wellbore, in situ stress orientation, and perforation diameter, density, and phasing. In general, the presence of liquid in the borehole results in a much faster pressure risetime and a lower peak pressure for the same propellant charge. Fracture surfaces proceed outward along lines of perforations as determined by phasing, then gradually turn toward the hydraulic fracture direction. 8 refs., 23 figs., 3 tabs.

Cuderman, J.F.

1986-06-01

357

Esophageal perforation after radiofrequency ablation for atrial fibrillation.  

PubMed

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

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

2014-11-01

358

Perforator flap breast reconstruction after unsatisfactory implant reconstruction.  

PubMed

In 2009, 86,424 breast reconstructions were performed in the United States, with 76% being implant-based procedures. Capsular contracture and infection are the 2 most cited indications for implant explantation, resulting in a reconstruction failure. However, several patients are dissatisfied with implant reconstruction even without the aforementioned complications. We hypothesize that microvascular autologous tissue transfer with perforator free-flap breast reconstruction provides an excellent salvage modality in the face of an unsatisfactory implant reconstruction, resulting in an improved cosmetic and functional outcome, with low risk of complications. We retrospectively reviewed the charts of patients in the senior author's practice who underwent perforator flap breast reconstruction between the years 1998 through 2008, and identified all patients who had prior implant reconstruction. Indications for implant explantation, medical history, operative procedure, and postoperative complications were reviewed. During the study period, 1846 perforator flaps were performed. We found 191 patients who underwent autologous breast reconstruction after implant reconstruction with a total of 284 flaps (15.4%). The most frequent patient complaint was unnatural appearance and feel of the implants (Baker I or Baker II), and the majority of patients had not undergone radiation. Most patients were reconstructed using abdominal flaps with 164 deep inferior epigastric perforators, 50 superior gluteal artery perforators, 30 superficial inferior epigastric arteries, 35 inferior gluteal artery perforators, and 5 transverse upper gracilis. The total complication rate was 7.4%, with most complications related to wound healing at the donor site. There were 3 flap losses (1%), all of which were later successfully reconstructed with another perforator flap. Implant failures are traditionally thought to be in patients with Baker grade III/IV capsular contractures and in patients status post radiation therapy. However, in our study, the majority of patients seeking perforator flap reconstruction after implant reconstruction complained of an unnatural feel and appearance of their breasts, and did not have a severe capsular contracture deformity (Baker III/IV), nor had they undergone radiation. This suggests that implant reconstruction can lead to patient dissatisfaction severe enough to warrant removal even with Baker I/II results, and not in the setting of postradiation changes. PMID:21301299

Levine, Steven M; Lester, Mary E; Fontenot, Benjamin; Allen, Robert J

2011-05-01

359

Open vs laparoscopic repair of perforated peptic ulcer  

Microsoft Academic Search

Background: Most studies have found that the only advantage to the laparoscopic treatment of perforated peptic ulcer is a reduced need\\u000a for postoperative analgesia. Therefore, we set out to assess the short-term outcome of open (OR) versus laparoscopic (LR)\\u000a repair of perforated peptic ulcer.\\u000a \\u000a \\u000a \\u000a \\u000a Methods: A total of 62 consecutive OR patients were compared with a concurrent cohort of 17

R. Bergamaschi; R. Mårvik; G. Johnsen; J. E. K. Thoresen; B. Ystgaard; H. E. Myrvold

1999-01-01

360

A Rare Complication of an Ingested Foreign Body: Gallbladder Perforation  

PubMed Central

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

Karacay, Safak; Topcu, Koray; Sozubir, Selami

2013-01-01

361

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

SciTech Connect

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

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

2009-03-15

362

Duodenal Tube Feeding: An Alternative Approach for Effectively Promoting Weight Gain in Children with Gastroesophageal Reflux and Congenital Heart Disease  

PubMed Central

We tested whether duodenal tube feeding effectively improves the clinical symptoms and body weight gain in children with congenital heart disease (CHD) and gastroesophageal reflux (GER). In the retrospective analysis of 17 consecutive children with CHD who were treated with duodenal tube feeding for symptomatic GER, we found that clinical symptoms of persistent emesis or respiratory wheezing after feeding disappeared with duodenal tube feeding in all patients. Duodenal tube feeding facilitated a stable nutritional supply, resulting in marked improvement of weight gain from 6 to 21?g/day (P < .0001). In a patient with trisomy 21 and persistent pulmonary hypertension after the closure of a ventricular septal defect, duodenal tube feeding ameliorated pulmonary hypertension, as evidenced by the improvement of the pressure gradient of tricuspid regurgitation from 77 to 41?mm?Hg. In 14 of the 17 patients, the duodenal tube was successfully removed, with the spontaneous improvement of GER (median duration of duodenal tube feeding: 7 months). In conclusion, duodenal tube feeding improves the weight gain of infants with GER who need treatment for CHD-associated heart failure. It also allows for the improvement of pulmonary hypertension. PMID:23653635

Kuwata, Seiko; Iwamoto, Yoichi; Ishido, Hirotaka; Taketadu, Mio; Tamura, Masanori; Senzaki, Hideaki

2013-01-01

363

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

Microsoft Academic Search

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

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

2000-01-01

364

Vagal reflex inhibition of motility in the abomasal body of sheep by antral and duodenal tension receptors  

Microsoft Academic Search

Vagally-mediated regulation of motility in the abomasal body by duodenal and abomasal antral motility was demonstrated in acutely prepared anaesthetized sheep. The enteric plexuses between the abomasal body, antrum and duodenum were interrupted by transection. Antral contractions were more effective than duodenal contractions at causing inhibition of the abomasal body, and antral isometric conditions were more effective than antral isotonic

D. F. Cottrell

1994-01-01

365

Polypoid tumors of the major duodenal papilla: preoperative staging with intraductal US, EUS, and CT — a prospective, histopathologically controlled study  

Microsoft Academic Search

Background: An adenoma-carcinoma sequence also applies to adenomas of the major duodenal papilla. Therefore accurate preoperative diagnosis and tumor staging are essential to select the appropriate patients for adequate treatment. In a prospective, histopathologically controlled study of tumors of the main duodenal papilla, the preoperative diagnostic value of ultrasound (US) catheter probes applied during endoscopic retrograde cholangiopancreatography (ERCP) was investigated.

Josef Menzel; Nicolas Hoepffner; Udo Sulkowski; Peter Reimer; Axel Heinecke; Christopher Poremba; Wolfram Domschke

1999-01-01

366

Characterization of cardiac lead perforation risk via a dynamic simulated environment  

E-print Network

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

Rosario, Matthew J

2012-01-01

367

Study of the Velocities of Longitudinal Elastic Waves on Perforated Models, Saturated with Liquids.  

National Technical Information Service (NTIS)

The possibility is shown of utilizing perforated materials for two dimensional seismic modeling and the development of a method for studying the rates of elastic waves in perforated plates with network of holes of various structure.

G. I. Petkovich, T. Z. Verbitskii

1964-01-01

368

Combined duodenal and pancreatic major trauma in high risk patients: can a partial reconstruction be safe?  

PubMed

Pancreatic trauma is an uncommon injury, occurring in only about 0.2% of blunt abdominal injuries, while duodenal injuries represent approximately 4% of all blunt abdominal injuries. When trauma of the pancreas and duodenum do not permit reparation, pancreatoduodenectomy (PD) is mandatory. In the reconstructive phase, the use of ductal ligation as an alternative to standard pancreaticojejunostomy has been reported by some authors. We report a case of polytrauma with pancreatic and duodenal injury in which the initial diagnosis failed to recognize the catastrophic duodenal and pancreatic situation. The patient was submitted for PD and the pancreatic stump was abandoned in the abdominal cavity after main pancreatic ductal ligation. This technique can minimize the morbidity and mortality of PD in patients with other organs or apparatus involved severely and extensively in trauma. PMID:24847897

Toro, A; Li Destri, G; Mannino, M; Arcerito, M C; Ardiri, A; Politi, A; Bertino, G; Di Carlo, I

2014-04-01

369

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

SciTech Connect

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

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

1983-07-01

370

Changes in gastric mucosa after vagotomy and gastrojejunostomy for duodenal ulcer.  

PubMed Central

Gastric mucosa was studied histologically in 141 patients. Eighty two had undergone vagotomy and gastrojejunostomy between 15 and 25 years previously for duodenal ulcer, and 59 control patients had a long history (minimum 15 years) of duodenal ulcer treated medically. No carcinoma was found in either group. Two patients with severe dysplasia and 13 patients with moderate dysplasia were found in the study group, compared with none in the control group (p less than 0.01). Intestinal metaplasia was seen in 44 (53%) of the study group and 16 (27%) of the control group (p less than 0.01). Atrophy and gastritis were more severe (p less than 0.01 for atrophy; p = 0.05 for gastritis) in the study group. Gastric mucosal changes were more severe after surgical treatment for duodenal ulcer than after medical treatment, and possibly a high incidence of gastric carcinoma may occur 25 years after vagotomy and gastrojejunostomy. PMID:6416435

Watt, P C; Sloan, J M; Kennedy, T L

1983-01-01

371

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

PubMed

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

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

2014-08-01

372

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

PubMed Central

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

Okaly, Geetha V Patil; HM, Sudha; Pai, Sreekar Agumbe; Sridher, H.

2014-01-01

373

Values of endoscopic ultrasonography for diagnosis and treatment of duodenal protruding lesions*  

PubMed Central

Objective: The diagnoses of patients with duodenal protruding lesions are difficult when using conventional examinations such as computed tomography (CT) and conventional endoscope etc. Thus, we investigated the clinical value of endoscopic ultrasonography (EUS) with miniature ultrasonic probes on the diagnosis and treatment of duodenal protruding lesions. Methods: Patients with duodenal protruding lesions who were indicated for EUS were examined by EUS with 12~15 MHz miniature ultrasonic probes and double-cavity electronic endoscope. According to diagnosis of EUS, those patients were indicated for biopsy and treatment received biopsy, endoscopic resection or surgical excision. The postoperative histological results were compared with the preoperative diagnosis of EUS. Those patients without endoscopic resection or surgical excision were periodically followed up with EUS. Results: A total of 169 patients with duodenal protruding lesions were examined by EUS, of which 40 were diagnosed with cysts, 36 with inflammatory protruding or polyp, 25 with Brunner’s gland adenoma, 19 with ectopic pancreas, 17 with gastrointestinal stromal tumor, 12 with extrinsic compression, 12 with minor papilla, 6 with lipoma, 1 with adenocarcinoma and 1 with lymphoma. After EUS examinations, 75 patients received biopsy, endoscopic resection or surgical excision respectively. The postoperative histological results of 70 patients were completely consistent with the preoperative diagnosis of EUS, with 93.33% diagnostic accuracy. The results of follow-up with EUS indicated that duodenal cyst, Brunner’s gland adenoma, ectopic pancreas, gastrointestinal stromal tumor and lipoma remained unchanged within 1~3 years. No related complications occurred among all patients that received EUS examinations. Conclusion: EUS is an effective and reliable diagnostic method for duodenal protruding lesions. PMID:18381809

Xu, Guo-qiang; Wu, Yi-qun; Wang, Li-jun; Chen, Hong-tan

2008-01-01

374

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

PubMed Central

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

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

2012-01-01

375

Simultaneous Gastric and Duodenal Erosions due to Adjustable Gastric Banding for Morbid Obesity  

PubMed Central

Erosion is an uncommon but feared late complication of adjustable gastric banding for morbid obesity. A high index of clinical suspicion is required, since symptoms are usually vague and nonspecific. Diagnosis is confirmed on upper gastrointestinal endoscopy and band removal is the mainstay of treatment, with band revision or conversion to other bariatric modalities at a later stage. Duodenal erosion is a much rarer complication, caused by the connection tubing of the band. We present our experience with a case of simultaneous gastric and duodenal erosions, managed by laparoscopic explantation of the band, primary suture repair of the duodenum, and omentopexy. PMID:24883218

Manatakis, Dimitrios K.; Terzis, Ioannis; Kyriazanos, Ioannis D.; Dontas, Ioannis D.; Stoidis, Christos N.; Stamos, Nikolaos; Davides, Demetrios

2014-01-01

376

Iatrogenic glenoid fracture after brisement manipulation for the stiffness of shoulder in patients with rotator cuff tear.  

PubMed

In combined stiffness with rotator cuff tear, the brisement manipulation with or without capsular release has been more common procedure prior to the rotator cuff repair. It is known to be relatively safe and easy procedure with rare complications. However, the present authors found the iatrogenic fracture of anteroinferior portion of glenoid after brisement manipulation during the arthroscopic rotator cuff repair. The patient was followed up with the routine postoperative protocol for rotator cuff repair, which was composed of 4 weeks of protection with abduction brace, passive and active assisted range of motion exercise afterward, and progressive strengthening exercise. Two years after surgery, the patient showed improved clinical score and healing of fracture fragment. However, iatrogenic glenoid fracture should be kept in mind when the brisement manipulation is performed during arthroscopic surgery. PMID:23412222

Koh, Kyoung Hwan; Kim, Jong Ho; Yoo, Jae Chul

2013-11-01

377

Migration of Retinal Cells through a Perforated Membrane: Implications for a  

E-print Network

Migration of Retinal Cells through a Perforated Membrane: Implications for a High cells. This is a report of a phenomenon of retinal cellular migration into a perforated membrane the migration. RESULTS. Retinal tissue in vitro grew within 3 days through perforations of greater than 5 m

Palanker, Daniel

378

Method and apparatus for perforating at cutting with a solid fueled gas mixture  

Microsoft Academic Search

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

A. J. Woytek; J. T. Lileck; E. J. Steigerwalt

1984-01-01

379

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

PubMed

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

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

2014-07-01

380

An experimental investigation of techniques to suppress edgetones from perforated wind tunnel walls  

Microsoft Academic Search

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

N. S. Dougherty Jr.; C. F. Anderson; R. L. Parker Jr.

1975-01-01

381

Perforation of the Esophagus Secondary to Insertion of Covered Wallstent Endoprostheses  

SciTech Connect

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.

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

382

Prognosis and Outcome of the Tympanic Membrane Flap at Traumatic Tympanic Membrane Perforation Edge  

Microsoft Academic Search

This study aimed to retrospectively evaluate the prognosis and outcome of tympanic membrane perforations with a particular focus on the fate of the perforation edge flaps.Chart records of 329 patients with a single ear traumatic tympanic membrane perforation were retrieved and analyzed. Of these patients, 70 were left to heal spontaneously, 93 received gelatin sponge patching treatment and 114 were

Zheng-Cai Lou; Yun-Xing Hu; Yong-Mei Tang

2011-01-01

383

Chest wall reconstruction with perforator flaps after wide full-thickness resection  

Microsoft Academic Search

ioneering work by Koshima and colleagues1 and Kroll and Rosenfield2 in the late 1980s introduced perforator flaps, a new type of surgical flap based on musculocu- taneous perforator arteries with exclusion of the passive muscle carrier. Perforator flaps combine the reliable blood supply of musculocutaneous flaps with the reduced donor site morbidity of a skin flap. We report the successful

Hideki Itano; Akio Andou; Isao Koshima; Nobuyoshi Shimizu

384

[The perforating system of the area of the vena saphena magna].  

PubMed

An anatomical study of perforating veins system in relation to saphena magna vein had been performed. We had found a great variability of the perforating veins on the lateral aspect of the leg, whereas on the medial side there are 3 perforating veins presents in 100% of the subjects. PMID:1567058

Ortega Santana, F; Centol Ramírez, A; Guijarro de Pablos, J; Anitúa, M

1992-01-01

385

Augmentation of convective heat transfer from high-porosity perforated surfaces  

Microsoft Academic Search

The study aims at developing perforated surfaces of high performance in a heat exchanger, that are free from flow-induced noise and vibration. This goal is accomplished by employing perforated surfaces of high porosity, resulting in the generation of a second laminar flow regime. Empirical equations are derived for predicting the laminar heat transfer and friction loss performance of perforated heat

C. P. Lee; W.-J. Yang

1978-01-01

386

Perforated heat exchanger surfaces. I - Flow phenomena, noise and vibration characteristics  

Microsoft Academic Search

This paper is a first part of two part series review on perforated heat exchanger surfaces. Flow phenomena, noise and vibration characteristics associated with perforated surfaces are reviewed and discussed. It is shown that beyond a certain Reynolds number, flow over a perforation becomes unstable accompanied by oscillations and vortex shedding. Flow oscillations and vortex shedding make the boundary layer

R. K. Shah

1975-01-01

387

A Novel Type of Ureteral Stents in the Treatment of a Bilateral Iatrogenic Transaction of the Ureters  

PubMed Central

This report illustrates the case of a patient who suffered an iatrogenic complete injury of both ureters after a complex surgical procedure to remove a large sacral chordoma. Ureteral recanalization was achieved with two removable, autoexpandable, and polytetrafluoroethylene covered nitinol stents. To our knowledge, we describe the first application of this type of stents to treat a bilateral ureteral transection. Despite the bad general conditions of the patient, the ureteral stents successfully restored and maintained the bilateral ureteral continuity. PMID:23984172

Mazza, Ernesto; Mondaini, Francesco; Abdulcadir, Dalmar; Raspanti, Claudio; Citone, Michele; Lapini, Alberto

2013-01-01

388

A novel type of ureteral stents in the treatment of a bilateral iatrogenic transaction of the ureters.  

PubMed

This report illustrates the case of a patient who suffered an iatrogenic complete injury of both ureters after a complex surgical procedure to remove a large sacral chordoma. Ureteral recanalization was achieved with two removable, autoexpandable, and polytetrafluoroethylene covered nitinol stents. To our knowledge, we describe the first application of this type of stents to treat a bilateral ureteral transection. Despite the bad general conditions of the patient, the ureteral stents successfully restored and maintained the bilateral ureteral continuity. PMID:23984172

Mazza, Ernesto; Mondaini, Francesco; Abdulcadir, Dalmar; Raspanti, Claudio; Citone, Michele; Lapini, Alberto

2013-01-01

389

Review of active compression-decompression cardiopulmonary resuscitation (ACD-CPR) analysis of iatrogenic complications and their biomechanical explanation  

Microsoft Academic Search

Our review takes a critical look at the active compression-decompression technique (ACD) for cardiopulmonary resuscitation (CPR). ACD-CPR was developed following a report of successful resuscitation performed by a medical amateur using a household plunger. The efficacy of the principle of active decompression has been demonstrated by animal and human studies. Potential iatrogenic complications from the CardioPump were evaluated only when

Walter Rabl; Michael Baubin; Christian Haid; Karl P. Pfeiffer; Richard Scheithauer

1997-01-01

390

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

PubMed

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

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

2014-07-01

391

Iatrogenic Consequences of Early Magnetic Resonance Imaging in Acute, Work-Related, Disabling Low Back Pain  

PubMed Central

Study Design. Retrospective cohort study. Objective. To determine the effect of early (receipt ?30 d postonset) magnetic resonance imaging (MRI) on disability and medical cost outcomes in patients with acute, disabling, work-related low back pain (LBP) with and without radiculopathy. Summary of Background Data. Evidence-based guidelines suggest that, except for “red flags,” MRI is indicated to evaluate patients with persistent radicular pain, after 1 month of conservative management, who are candidates for surgery or epidural steroid injections. Prior research has suggested an independent iatrogenic effect of nonindicated early MRI, but it had limited clinical information and/or patient populations. Methods. A nationally representative sample of workers with acute, disabling, occupational LBP was randomly selected, oversampling those with radiculopathy diagnoses (N = 1000). Clinical information from medical reports was used to exclude cases for which early MRI might have been indicated, or MRI occurred more than 30 days postonset (final cohort = 555). Clinical information was also used to categorize cases into “nonspecific LBP” and “radiculopathy” groups and further divided into “early-MRI” and “no-MRI” subgroups. The Cox proportional hazards model examined the association of early MRI with duration of the first episode of disability. Multivariate linear regression models examined the association with medical costs. All models adjusted for demographic and medical severity measures. Results. In our sample, 37% of the nonspecific LBP and 79.9% of the radiculopathy cases received early MRI. The early-MRI groups had similar outcomes regardless of radiculopathy status: much lower rates of going off disability and, on average, $12,948 to $13,816 higher medical costs than the no-MRI groups. Even in a subgroup with relatively minimal disability impact (?30 d of total lost time post-MRI), medical costs were, on average, $7643 to $8584 higher in the early-MRI groups. Conclusion. Early MRI without indication has a strong iatrogenic effect in acute LBP, regardless of radiculopathy status. Providers and patients should be made aware that when early MRI is not indicated, it provides no benefits, and worse outcomes are likely. Level of Evidence: 3 PMID:23883826

Webster, Barbara S.; Bauer, Ann Z.; Choi, YoonSun; Cifuentes, Manuel; Pransky, Glenn S.

2013-01-01

392

Efficiency of perforated breakwater and associated energy dissipation  

E-print Network

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

Ariyarathne, Hanchapola Appuhamilage

2008-10-10

393

Efficiency of perforated breakwater and associated energy dissipation  

E-print Network

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

Ariyarathne, Hanchapola Appuhamilage

2009-05-15

394

Parameter Estimation for the Heat Equation on Perforated Domains.  

National Technical Information Service (NTIS)

In this effort, we investigate the behavior of a model derived from homogenization theory as the model solution in parameter estimation procedures for simulated data for heat flow in a porous medium. We consider data simulated from a model on a perforated...

A. K. Criner, D. Cioranescu, H. T. Banks, W. P. Winfree

2011-01-01

395

Is operative management effective in treatment of perforated typhoid?  

Microsoft Academic Search

BackgroundSalmonella typhi infection continues to be a significant problem worldwide. Patients suffering from “typhoid” in endemic regions such as West Africa often present late in the course of the disease with symptoms of malnutrition and peritonitis. Clinical peritonitis in these patients is invariably associated with perforation of the terminal ileum and purulent peritonitis. Operative intervention and its success have not

Jonathan M. Saxe; Robert Cropsey

2005-01-01

396

Normal perforation of reinforced concrete target by rigid projectile  

Microsoft Academic Search

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

X. W. Chen; X. L. Li; F. L. Huang; H. J. Wu; Y. Z. Chen

2008-01-01

397

Penetration and perforation of reinforced-concrete targets  

SciTech Connect

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.

Forrestal, M.J.; Hightower, M.M.; Luk, V.K.; Christensen, B.K.

1988-01-01

398

Mechanisms of gold nanoparticle mediated ultrashort laser cell membrane perforation  

NASA Astrophysics Data System (ADS)

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.

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

399

Pool boiling heat transfer enhancement by perforated plates  

SciTech Connect

Several recent studies have revealed that the boiling heat transfer may be considerably enhanced in a narrow restricted region. Thin liquid film underneath the elongated bubble quickly evaporates, and enhances the heat transfer. In this study, the narrow restricted region was formed by attaching a perforated plate on top of a boiling surface. Through systematic experiments, effects of the hole size, hole pattern, gap width between the perforated plate and the boiling surface were investigated using water or R-113. Results show that perforated plates considerably enhance the boiling of water or R-113. For water, especially, they have outperformed commercial enhanced tubes, which confirms that the possible boiling enhancement mechanism of the perforated plate (thin film evaporation underneath the elongated bubble) is very effective to the boiling of high surface tension liquids such as water. Optimum configuration was found -- 3.0 mm hole diameter, 15 mm x 15 mm hole pattern, 0.3--0.5 mm gap width for water, and 2.0 mm hole diameter, 3.5 mm x 3.5 mm hole pattern, 0.5 mm gap width for R-113. A correlation which correlates most of the data within {+-}30% was also developed.

Kim, N.H. [Univ. of Inchon (Korea, Republic of). Dept. of Mechanical Engineering

1996-12-31

400

Colonic lymphoma presenting acutely with perforated colo-splenic fistula  

PubMed Central

INTRODUCTION Primary colonic lymphoma is rare. It comprises less than 1% of large bowel malignancies. Affected patients often present with non-specific vague symptoms with subsequent delays in diagnosis and management. PRESENTATION OF CASE An immuno-competent 35-year-old male presented with left iliac fossa pain, fever and constipation. Clinical examination revealed left-sided abdominal peritonism. After the initial radiological and endoscopic investigations, a provisional diagnosis of a localized perforation of a splenic flexure diverticulum was made and ultrasound-guided percutaneous drainage of the abscess was performed. The patient failed to settle on conservative treatment and therefore exploratory laparotomy was carried out. An inflammatory phlegmon consisting of a left paracolic gutter abscess, the spleen and the splenic flexure of the colon was resected en-bloc and a primary colo-colic anastomosis was performed. His operative recovery was complicated by wound infection which was treated conservatively. The histopathology revealed colo-splenic fistula secondary to a perforated colonic non-Hodgkin's lymphoma. The spleen contained multiple metastatic lymphomatous deposits. He was started on chemotherapy and remained well at 5-year follow up. DISCUSSION Colon non-Hodgkin's lymphoma may present initially with an acute abdomen due to perforation. It mimics any acute surgical condition. Perforation and fistulaization into the spleen is very rare. CONCLUSION This case highlights the delay and difficulty in diagnosing primary colonic lymphoma without resorting to surgical resection. PMID:22609704

Al-Zahir, Ali Ahmed; Meshikhes, Abdul-Wahed Nasir

2012-01-01

401

Body Force Model for the Aerodynamics of Inclined Perforated Surfaces  

E-print Network

Body Force Model for the Aerodynamics of Inclined Perforated Surfaces Juntao Xiong, Andrew Johnson.2514/1.J051699 This is a joint experimental and computational research effort on the aerodynamics aspects of the aerodynamics of wedge FFDs. The following sections present the experimental

Papamoschou, Dimitri

402

Scour around a perforated disk modeling a marine hydrokinetic device  

NASA Astrophysics Data System (ADS)

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.

Beninati, M. L.; Soliani, G.; Zhou, C. C.; Krane, M.; Fontaine, A.

2013-12-01

403

Finite element modeling of perforated PZT-polymer compositest  

Microsoft Academic Search

Perforated PZT-polymer composites with 3–1 connectivity patterns have been fabricated by drilling square holes perpendicular to the poling direction in prepoled PZT blocks and filling the holes with epoxy polymer. The influence of the separation between the holes on the dielectric and piezoelectric properties of the composite was studied. The finite element method has been used to calculate the stress

S. Davanzo; A. Safari; R. E. Newnham

1985-01-01

404

Homogenization of the demagnetization field operator in periodically perforated domains  

E-print Network

Homogenization of the demagnetization field operator in periodically perforated domains Kévin Santugini-Repiquet July 25, 2006 Abstract In this paper, we study the homogenization of the demagnetization. As an application, we homogenize the Landau- Lifshitz equation in such domains. We consider regular homothetic holes

Paris-Sud XI, Université de

405

[Perforation of the nasal septum of occupational origin].  

PubMed

Perforations of nasal septum as typical effects of exposure to certain hazards are a particular health problem among the diseases of upper respiratory tract mucous membranes (entry 10 on the list of occupational diseases). To obtain more data on etiopathogenetic factors and correlations between the clinical picture and exposure duration, the documentation of the patients in whom perforation was diagnosed during 1972-1979 was analysed epidemiologically. The examinations covered 185 workers of various industrial branches-salina, chemical plants, leather plants, tanneries, electroplating plants-who developed nasal septum perforation due to local effects of working environment irritants. In the test group the nasal septum was defected mostly in those exposed to chromium compounds (46.5%) and in salina workers (44.3%). In the remaining 9.2% of subjects the septum perforation resulted from exposure to arsenic, nickel, silicone compounds, cadmium, fluorine, soda and ammonia. The clinical course of the disease was presented as classified by industrial branch, occupational exposure, age and length of employment. In addition, procedures of diagnostics, certification and prevention were considered. PMID:6888263

Kowalska, S; Su?kowski, W

1983-01-01

406

Jejunal perforation due to porcupine quill ingestion in a horse  

PubMed Central

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

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

2014-01-01

407

Perforated peptic ulcer associated with abdominal compartment syndrome.  

PubMed

Abdominal compartment syndrome (ACS) is defined as an increased intra-abdominal pressure with adverse physiologic consequences. Abdominal compartment syndrome caused by perforated peptic ulcer is rare owing to early diagnosis and management. Delayed recognition of perforated peptic ulcer with pneumoperitoneum, bowel distension, and decreased abdominal wall compliance can make up a vicious circle and lead to ACS. We report a case of perforated peptic ulcer associated with ACS. A 74-year-old man with old stroke and dementia history was found to have distended abdomen, edema of bilateral legs, and cyanosis. Laboratory tests revealed deterioration of liver and kidney function. Abdominal compartment syndrome was suspected, and image study was arranged to find the cause. The study showed pneumoperitoneum, contrast stasis in heart with decreased caliber of vessels below the abdominal aortic level, and diffuse lymphedema at the abdominal walls. Emergent laparotomy was performed. Perforated peptic ulcer was noted and the gastrorrhaphy was done. The symptoms, and liver and kidney function improved right after emergent operation. PMID:19091294

Lynn, Jiun-Jen; Weng, Yi-Ming; Weng, Chia-Sui

2008-11-01

408

Sound radiation from a line forced perforated elastic sandwich panel  

E-print Network

Sound radiation from a line forced perforated elastic sandwich panel I. David Abrahams Department INTRODUCTION Sound transmission through panels has long been a sub- ject of importance in a variety- plates separated by stiffeners or ribs in between.2 The trans- mission and reflection of sound waves

Abrahams, I. David

409

Corneal topography of spontaneous perforation of acute hydrops in keratoconus  

Microsoft Academic Search

An unusual case of spontaneous corneal perforation of acute hydrops in the left eye of a 21-year-old man is presented. The patient had a history of atopic diseases. To evaluate the status of the other eye, corneal topographic analysis was performed. This confirmed a subclinical keratoconus in the fellow eye and the association with atopy, eye rubbing, and rapid progression

Carlos Nicoli; Ricardo D Wainsztein; Luis P Trotta

1999-01-01

410

CHARACTERIZATION OF CLEAN AND FOULED PERFORATED MEMBRANE DIFFUSERS  

EPA Science Inventory

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

411

CHARACTERIZATION OF CLEAN AND FOULED PERFORATED MEMBRANE DIFFUSERS  

EPA Science Inventory

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

412

Reconstruction of Pretibial Defect Using Pedicled Perforator Flaps  

PubMed Central

Background Coverage of defects of the pretibial area remains a challenge for surgeons. The difficulty comes from the limited mobility and availability of the overlying skin and soft tissue. We applied variable pedicled perforator flaps to overcome the disadvantages of local flaps and free flaps on the pretibial area. Methods Eight patients who had the defects in the anterior tibial area were enrolled. Retrospective data were obtained on patient demographics, cause, defect location, defect size, flap dimension, originating artery, pedicle length, pedicle rotation, complication, and postoperative result. The raw surface created following the flap elevation was covered with a split thickness skin graft. Results Posterior tibial artery-based perforator flaps were used in five cases and peroneal artery-based perforator flaps in three cases. The mean age was 54.3 and the mean period of follow-up was 6 months. The average size of the flaps was 63.8 cm2, with a range of 18 to 135 cm2. There were no major complications. No patients had any newly developed functional deficit of the lower leg. Conclusions We suggest that pedicled perforator flaps can be an alternative treatment modality for covering pretibial defects as a simple, safe and versatile procedure. PMID:22872840

Shin, In Soo; Lee, Dong Won; Rah, Dong Kyun

2012-01-01

413

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

E-print Network

to thermal neutrons. The prototype devices deliver 4.7% thermal neutron detection efficiency while operatingAuthor's personal copy Perforated diode neutron detector modules fabricated from high 66506-2503, USA a r t i c l e i n f o PACS: 29.40.Wk Keywords: Semiconductor neutron detectors

Shultis, J. Kenneth

414

Leaky properties of microstrip above a perforated ground plane  

Microsoft Academic Search

A leaky line is proposed. The leaky line emits leaky wave by feeding the bound mode that is not supposed to leak. The proposed guiding structure consists of a microstrip above a perforated ground plane with etched holes positioned anti-symmetrically. A prototype is built and tested to verify the concept. The two-port scattering parameters of the leaky line employing the

Kuo-Cheng Chen; Ching-Kuang C. TZUANG; Yongxi Qian; Tatsuo ITOH

1999-01-01

415

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

SciTech Connect

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

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

2013-02-15

416

Perforator plus flaps: Optimizing results while preserving function and esthesis  

PubMed Central

Background: The tenuous blood supply of traditional flaps for wound cover combined with collateral damage by sacrifice of functional muscle, truncal vessels, or nerves has been the bane of reconstructive procedures. The concept of perforator plus flaps employs dual vascular supply to flaps. By safeguarding perforators along with supply from its base, robust flaps can be raised in diverse situations. This is achieved while limiting collateral damage and preserving nerves, vessels, and functioning muscle with better function and aesthesis. Materials and Methods: The perforator plus concept was applied in seven different clinical situations. Functional muscle and fasciocutaneous flaps were employed in five and adipofascial flaps in two cases, primarily involving lower extremity defects and back. Adipofascial perforator plus flaps were employed to provide cover for tibial fracture in one patients and chronic venous ulcer in another. Results: All flaps survived without any loss and provided long-term stable cover, both over soft tissue and bone. Functional preservation was achieved in all cases where muscle flaps were employed with no clinical evidence of loss of power. There was no sensory loss or significant oedema in or distal to the flap in both cases where neurovascular continuity was preserved during flap elevation. Fracture union and consolidation were satisfactory. One patient had minimal graft loss over fascia which required application of stored grafts with subsequent take. No patient required re-operation. Conclusions: Perforator plus concept is holistic and applicable to most flap types in varied situations. It permits the exercise of many locoregional flap options while limiting collateral functional damage. Aesthetic considerations are also addressed while raising adipofascial flaps because of no appreciable donor defects. With quick operating times and low failure risk, these flaps can be a better substitute to traditional flaps and at times even free tissue transfers. PMID:21217970

Mehrotra, Sandeep

2010-01-01

417

Incidence of perforation with Goode T-tube.  

PubMed

Two groups of patients from the same era were retrospectively studied in Cincinnati and Chicago. In Cincinnati two subgroups were studied. The first group received myringotomy with insertion of a 'T'-shaped ventilating tube (75 patients, 140 ears, 147 insertions). Fifty-eight ears still had the tube in place, 31 had healed after spontaneous extrusion, 17 had healed after removal of the tube, 20 had persistent perforation after the tube was gone, 2 had a cholesteatoma, and 4 patients (7 ears) were lost to follow-up. The second set received myringotomy and insertion of a small grommet (Donaldson tube, 71 patients, 140 ears, 164 insertions) tympanostomy tube. None could be documented to still have the tube in place, 156 ears healed after spontaneous extrusion, none required removal, 3 ears had a persistent perforation after the tube was gone, none had cholesteatoma, and 5 patients (5 ears) were lost to follow-up. The perforation rate for the T-tube is 13.6% and for the grommet is 1.8% (P = 0.0005). In Chicago, 93 patients who received the Goode T style tube (175 ears, 175 insertions) prior to March, 1986 were evaluated. The degree of retraction of the tympanic membrane preoperatively was recorded. No ears still had the tube in place, 145 had healed after spontaneous extrusion or removal of the tube, 30 had persistent perforation 12 months after the tube was gone, 4 had a cholesteatoma, and 8 patients (15 ears) were lost to follow-up. The rate of perforation is 18.8% which is not statistically different from the Cincinnati rate.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:2037413

Matt, B H; Miller, R P; Meyers, R M; Campbell, J M; Cotton, R T

1991-02-01

418

Recycling delayed perforator flap: deep inferior epigastric artery perforator-based propeller flap from a prior vertical rectus abdominis musculocutaneous flap.  

PubMed

This article reports a case of re-elevating a prior vertical rectus abdominis musculocutaneous flap as a deep inferior epigastric artery perforator-based propeller flap to cover a recurrent chest wall defect. This case demonstrates that a conventional musculocutaneous flap tissue with a preserved perforator can be recycled as a perforator flap. Furthermore, this technique can be a promising new surgical option for recurring abdominal and chest defects. PMID:21354884

Go, Ju Young; Lim, So Young; Mun, Goo Hyun; Bang, Sa Ik; Oh, Kap Sung; Pyon, Jai Kyong

2011-09-01

419

A case report of esophageal perforation: Complication of nasogastric tube placement  

PubMed Central

Patient: Male, 70 Final Diagnosis: Esophageal perforation Symptoms: Abdominal pain • nausea • vomiting Medication: — Clinical Procedure: — Specialty: Surgery Objective: Unusual clinical course Background: Esophageal perforation is a well-defined and severe clinical condition. There are several etiologies of esophagus perforation. Case Report: We report the case of a 70-year-old Caucasian man who underwent an emergency cholecystectomy due to acute cholecystitis. Two days after surgery, his condition deteriorated. Thorax computerized tomography revealed an esophageal perforation. Conclusions: Esophageal perforation due to nasogastric application is relatively rare but the consequences are potentially serious. The anatomy of the upper gastrointestinal system should be understood by all healthcare professionals involved in the treatment. PMID:24803977

Isik, Arda; Firat, Deniz; Peker, Kemal; Sayar, Ilyas; Idiz, Oguz; Soytürk, Mehmet

2014-01-01

420

Value of temporary stents for the management of perivaterian perforation during endoscopic retrograde cholangiopancreatography  

PubMed Central

Endoscopic retrograde cholangiopancreatography (ERCP) has become the mainstay of treatment in hepato-pancreato-biliary disease. However, ERCP requires a high level of technical skills and experience in therapeutic endoscopy, there is always a risk of complications. Especially, the perforation per se affects the patient adversely, and the clinical course may lead to a poor prognosis, even with appropriate management. The treatments for ERCP-related perforation are diverse, depending on the location and mechanism of the bowel perforation and the time of diagnosis. Thus, we reviewed the appropriate surgical and non-surgical management options for therapeutic ERCP-related perforations, especially, evaluating metallic stenting as a treatment modality in perivaterian perforation.

Lee, Sang Min; Cho, Kwang Bum

2014-01-01

421

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

PubMed Central

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

2014-01-01

422

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

PubMed

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

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

2013-01-01

423

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

PubMed Central

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

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

2013-01-01

424

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

PubMed Central

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

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

2014-01-01

425

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

PubMed Central

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

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

426

Peripheral Tissue Involvement in Sporadic, Iatrogenic, and Variant Creutzfeldt-Jakob Disease  

PubMed Central

Human prion diseases are rare fatal neurodegenerative conditions that occur as acquired, familial, or idiopathic disorders. A key event in their pathogenesis is the accumulation of an altered form of the prion protein, termed PrPSc, in the central nervous system. A novel acquired human prion disease, variant Creutzfeldt-Jakob disease, is thought to result from oral exposure to the bovine spongiform encephalopathy agent. This disease differs from other human prion diseases in its neurological, neuropathological, and biochemical phenotype. We have used immunohistochemistry and Western blot techniques to analyze the tissue distribution and biochemical properties of PrPSc in peripheral tissues in a unique series of nine cases of variant Creutzfeldt-Jakob disease. We have compared this with the distribution and biochemical forms found in all of the major subtypes of sporadic Creutzfeldt-Jakob disease and in a case of iatrogenic Creutzfeldt-Jakob disease associated with growth hormone therapy. The results show that involvement of the lymphoreticular system is a defining feature of variant Creutzfeldt-Jakob disease, but that the biochemical isoform of PrPSc found is influenced by the cell type in which it accumulates. PMID:14695328

Head, Mark W.; Ritchie, Diane; Smith, Nadine; McLoughlin, Victoria; Nailon, William; Samad, Sazia; Masson, Stephen; Bishop, Matthew; McCardle, Linda; Ironside, James W.

2004-01-01

427

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

PubMed Central

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

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

2014-01-01

428

Development of a duodenal gallstone ileus with gastric outlet obstruction (Bouveret syndrome) four months after successful treatment of symptomatic gallstone disease with cholecystitis and cholangitis: a case report  

PubMed Central

Introduction Cases of gallstone ileus account for 1% to 4% of all instances of mechanical bowel obstruction. The majority of obstructing gallstones are located in the terminal ileum. Less than 10% of impacted gallstones are located in the duodenum. A gastric outlet obstruction secondary to a gallstone ileus is known as Bouveret syndrome. Gallstones usually enter the bowel through a biliary enteral fistula. Little is known about the formation of such fistulae in the course of gallstone disease. Case presentation We report the case of a 72-year-old Caucasian woman born in Germany with a gastric outlet obstruction due to a gallstone ileus (Bouveret syndrome), with a large gallstone impacted in the third part of the duodenum. Diagnostic investigations of our patient included plain abdominal films, gastroscopy and abdominal computed tomography, which showed a biliary enteric fistula between the gallbladder and the duodenal bulb. Our patient was successfully treated by laparotomy, duodenotomy, extraction of the stone, cholecystectomy, and resection of the fistula in a one-stage surgical approach. Histopathological examination showed chronic and acute cholecystitis, with perforated ulceration of the duodenal wall and acute purulent inflammation of the surrounding fatty tissue. Four months prior to developing a gallstone ileus our patient had been hospitalized for cholecystitis, a large gallstone in the gallbladder, cholangitis and a small obstructing gallstone in the common biliary duct. She had been treated with endoscopic retrograde cholangiopancreatography, endoscopic biliary sphincterotomy, balloon extraction of the common biliary duct gallstone, and intravenous antibiotics. At the time of her first presentation, abdominal ultrasound and endoscopic examination (including esophagogastroduodenoscopy and endoscopic retrograde cholangiopancreatography) had not shown any evidence of a biliary enteral fistula. In the four months preceding the gallstone ileus our patient had been asymptomatic. Conclusion In patients known to have gallstone disease presenting with symptoms of ileus, the differential diagnosis of a gallstone ileus should be considered even in the absence of preceding symptoms related to the gallbladder disease. Gallstones large enough to cause intestinal obstruction usually enter the bowel by a biliary enteral fistula. During the formation of such a fistula, patients can be asymptomatic. PMID:21092262

2010-01-01

429

Spontaneous healing of pancreatic abscess after fistulization to the duodenal bulb.  

PubMed

A 70-year-old man was admitted to the hospital because of sudden, upper abdominal and back pain. Laboratory and image data indicated acute pancreatitis. Shortly after the admission, pancreatic and liver abscess with bacteremia developed. Antibiotic therapy seemed effective. A month later, spontaneous fistulization of the pancreatic abscess to the duodenal bulb was found by gastroduodenal fiberscopy. Injection of contrast medium into the duodenal orifice showed that the fistula was draining the abscess and that no other fistula formed from the abscess. Endoscopic retrograde cholangiopancreatogram indicated no fistula formation to the pancreatic duct. The pancreatic abscess became smaller and was not visible using computerized tomography and ultrasonography 3 months later and thereafter. Closure of the duodenal orifice was ascertained by the endoscopy. It is suggested that retrograde infection from the fistula was prevented by the single fistulization to the acidic duodenal bulb, which is not supposed to allow most bacterial growth. Pancreatic abscess usually necessitates operative treatment, even with fistulization to the alimentary tract. It seems likely that the single, small fistulization to the bulb, in addition to the lack of underlying disease and medical and nutritional support, facilitated the spontaneous healing process. PMID:9216441

Kawachi, S; Ogawa, T; Ukita, M; Shiroko, J; Kawase, Y; Adachi, S; Kametani, M; Kamikubo, K

1997-07-01

430

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

PubMed

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

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

2014-09-01

431

Curing Helicobacter pylori infection in patients with duodenal ulcer may provoke reflux esophagitis  

Microsoft Academic Search

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

J Labenz; AL Blum; E Bayerdorffer; A Meining; M Stolte; G Borsch

1997-01-01

432

Helicobacter pylori infection and abnormalities of acid secretion in patients with duodenal ulcer disease  

Microsoft Academic Search

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

Emad M. El-Omar; Ian D. Penman; Joy E. S. Ardill; Ravi S. Chittajallu; Catherine Howie; Kenneth E. L. McColl

1995-01-01

433

Malignant Gastric and Duodenal Stenosis: Palliation by Peroral Implantation of a Self-Expanding Metallic Stent  

SciTech Connect

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.

Pinto, Isabel T. [Department of Radiology, Hospital Universitario de Getafe, Ctra. de Toledo, Km. 12.5, E-28905 Getafe, Madrid (Spain)

1997-11-15

434

Foveolar gastric metaplasia of the duodenum: a frequent, so far neglected type of duodenal polyp.  

PubMed

Foveolar gastric metaplasia of the duodenum (FGM) is considered as imperfect mucosal healing in the context of H. pylori gastritis and intake of NSAIDs or ASS.? Typical endoscopic findings are redness of the mucosa, erosion/ulcer and loss of mucosal folds. During diagnostic histological examinations we observed a frequent so far not described association of FGM with endoscopically observed duodenal polyps. The archives of two institutes of pathology with high gastroenterological workload (approximately 100?000 patients per year) were investigated for an association between "duodenal polyp" and "foveolar gastric metaplasia". In Institute 1, of 481 duodenal polyps 41?% were classified as FGM, 9?% as adenoma and 2?% as heterotopic gastric mucosa. In 48?% no histological correlate was present. In Institute 2, 217 cases of FGM were diagnosed. Of these, in 69 cases the endoscopic finding was "polyp" (32?%). In the other cases, the endoscopic findings were mucosal defect (18?%), redness/inflammation (16?%), suspicion for gastric heterotopia (5?%) and scar (3?%). In 26?% of cases no pathologic endoscopic finding was reported. Both groups of patients with FGM showed a similar distribution of age ranges (24?-?83 years and 16?-?88 years), median age (62 years and 61 years, respectively) and a dominance of male sex (both 1.5:1). In conclusion, foveolar gastric metaplasia is a frequent, so far neglected correlate of endoscopically detected duodenal polyps. PMID:24718939

Sarbia, M; Sauer, G; Karimi, D; Berndt, R

2014-04-01

435

Gastric and duodenal mucosa in 'healthy' individuals. An endoscopic and histopathological study of 50 volunteers  

Microsoft Academic Search

The results of histological and immunohistochemical examination of gastric and duodenal biopsy specimens from 50 volunteers without a clinical history of gastrointestinal disease are reported. Multiple specimens of tissue from standard sites in the stomach and duodenum were carefully orientated, and serially sectioned for examination by light microscopy and for immunohistochemical characterisation of plasma cells within the lamina propria. The

J Kreuning; F T Bosman; G Kuiper; A M Wal; J Lindeman

1978-01-01

436

Duodenal stenosis resulting from a preduodenal portal vein and an operation for scoliosis.  

PubMed

A preduodenal portal vein (PDPV) is known to be a rare cause of duodenal stenosis. We treated a 22-year-old male patient with malnutrition as a result of PDPV and a previously performed operation for scoliosis, who showed an improvement in quality of life after being treated with a combination of nutritional support and surgery. The patient with PDPV had been admitted to our department with duodenal stenosis, ranging from the first to third portions. He had suffered from vomiting since 1 year of age, and he developed malnutrition during the last 6-mo period after orthopedic surgery for scoliosis. The stenosis was related to both the PDPV and the previously performed operation for scoliosis. After receiving nutritional support for 6 mo, a gastrojejunostomy with Braun's anastomosis for the first portion and a duodenojejunostomy for the second and third portions were performed. The postoperative course was almost uneventful. Three months later, he was discharged and able to attend university. In patients with widespread duodenal stenosis, there may be a complicated cause, such as PDPV and duodenal stretching induced by previous spinal surgery. PMID:19701980

Masumoto, Kouji; Teshiba, Risa; Esumi, Genshiro; Nagata, Kouji; Nakatsuji, Takanori; Nishimoto, Yuko; Yamaguchi, Sadako; Sumitomo, Kenzo; Taguchi, Tomoaki

2009-08-21

437

Duodenal stenosis resulting from a preduodenal portal vein and an operation for scoliosis  

Microsoft Academic Search

A preduodenal portal vein (PDPV) is known to be a rare cause of duodenal stenosis. We treated a 22-year- old male patient with malnutrition as a result of PDPV and a previously performed operation for scoliosis, who showed an improvement in quality of life after being treated with a combination of nutritional support and surgery. The patient with PDPV had

Kouji Masumoto; Risa Teshiba; Genshiro Esumi; Kouji Nagata; Takanori Nakatsuji; Yuko Nishimoto; Sadako Yamaguchi; Kenzo Sumitomo; Tomoaki Taguchi

2009-01-01

438

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

E-print Network

Effects of rapeseed oil duodenal infusion on dairy cow performances and blood metabolites during. Milk fat and protein contents were non- significantly increased (+ 1.3 gA) and de- creased (-1.0 g/1 (but not postprandi- al) plasma glucose was decreased (0.46 vs 0.55 g/l, P

Boyer, Edmond

439

Spontaneous intramural duodenal hematoma in type 2B von Willebrand disease  

PubMed Central

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

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

2013-01-01

440

Laparoscopic drainage of an intramural duodenal haematoma: a novel technique and review of the literature.  

PubMed

Intramural Duodenal Haematoma (IDH) is an uncommon complication of blunt abdominal trauma. IDH's are most often treated non-operatively. We describe laparoscopic treatment of an IDH after failed conservative management. To our knowledge, successful laparoscopic drainage of an IDH in an adult has not been described previously in the literature. PMID:22185364

Nolan, Gregory J; Bendinelli, Cino; Gani, Jon

2011-01-01