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1

Triple-Tube-Ostomy: A Novel Technique for the Surgical Treatment of Iatrogenic Duodenal Perforation  

PubMed Central

Although duodenal perforation is currently an infrequent complication of medical procedures, its incidence in the future predictably will increase as endoscopic treatment of duodenal neoplasms becomes more frequently used. In some cases, duodenal perforation is difficult to treat even surgically. We report here a novel technique called ‘triple-tube-ostomy’ for the treatment of iatrogenic duodenal perforation. Since November 2009, there have been three cases of iatrogenic perforation of the duodenum, due to various causes, which we have treated with our novel technique. The main principles of the technique are biliary diversion, decompression of the duodenum, and early enteral nutrition. All patients who underwent the triple-tube-ostomy procedure had good postoperative courses, with few complications. The novel surgical technique we describe in this report is safe, reliable, easy to learn and perform, and led to a good postoperative course in all cases where we performed it.

Fujikuni, Nobuaki; Tanabe, Kazuaki; Yamamoto, Hideki; Suzuki, Takahisa; Tokumoto, Noriaki; Ohdan, Hideki

2011-01-01

2

Iatrogenic Duodenal Perforation Treated with Endoscopic Placement of Metallic Clips: A Case Report  

PubMed Central

Perforation is one of the major complications encountered during endoscopic procedures. The standard of care for these complications is either surgical intervention or nonoperative medical approach with antibiotics and bowel rest with or without parenteral alimentation. Metallic clips, initially developed to secure hemostasis in bleeding, have been successfully used to close perforations in the gastrointestinal tract (GI) including the duodenum. This avoids perioperative morbidities associated with surgical intervention while limiting the leakage of intestinal contents and peritoneal contamination that is possible with medical management. We present a case of a patient with a lateral duodenal perforation during an endoscopic retrograde cholangiopancreatography (ERCP) which was successfully treated with immediate placement of metallic endoclips.

Solomon, Missale; Schlachterman, Alexander; Morgenstern, Ricardo

2012-01-01

3

Iatrogenic duodenal perforation treated with endoscopic placement of metallic clips: a case report.  

PubMed

Perforation is one of the major complications encountered during endoscopic procedures. The standard of care for these complications is either surgical intervention or nonoperative medical approach with antibiotics and bowel rest with or without parenteral alimentation. Metallic clips, initially developed to secure hemostasis in bleeding, have been successfully used to close perforations in the gastrointestinal tract (GI) including the duodenum. This avoids perioperative morbidities associated with surgical intervention while limiting the leakage of intestinal contents and peritoneal contamination that is possible with medical management. We present a case of a patient with a lateral duodenal perforation during an endoscopic retrograde cholangiopancreatography (ERCP) which was successfully treated with immediate placement of metallic endoclips. PMID:22431936

Solomon, Missale; Schlachterman, Alexander; Morgenstern, Ricardo

2012-01-01

4

Endoscopic Treatments of Endoscopic Retrograde Cholangiopancreatography-Related Duodenal Perforations  

PubMed Central

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

Han, Joung-Ho; Park, Sang-Heum

2013-01-01

5

Endoscopic treatments of endoscopic retrograde cholangiopancreatography-related duodenal perforations.  

PubMed

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

Lee, Tae Hoon; Han, Joung-Ho; Park, Sang-Heum

2013-09-01

6

Duodenal perforations after laparoscopic cholecystectomy.  

PubMed

Duodenal perforations after laparoscopic cholecystectomies are rarely reported. The aim of this study is to focus on this complication and to suggest ways to reduce its occurrence and avoid diagnostic mistakes and therapeutical delays that could be fatal. We reviewed four personal cases and a number of others reported in the literature. Duodenal perforations are caused by improper use of the irrigator-aspirator device when retracting the duodenum, or by electrosurgical and laser burns. A duodenal perforation should be suspected in cases of bile leakage, peritonitis, intraabdominal or retroperitoneal collections, high serum or drainage amylase concentration, absence of bile leakage from the biliary tree, and the existence of a retroduodenal mass. Diagnosis requires a gastrografin upper GI series. Differential diagnosis is mainly with biliary lesions and other causes of peritonitis. Relaparoscopy may require intraoperative upper GI endoscopy or Kocher's duodenal mobilization to detect the perforation. Early diagnosis allows primary repair, usually by laparoscopy. Perforations of the duodenal cap are easier to diagnose and have a better prognosis than those of the descending duodenum. A lumbar abscess is a frequent complication. PMID:10227957

Croce, E; Golia, M; Russo, R; Azzola, M; Olmi, S; De Murtas, G

1999-05-01

7

Traumatic perforation of duodenal diverticulum.  

PubMed

A fragile 72-year-old female with previous coronary artery disease sustained blunt abdominal trauma in a motor vehicle crash. A ruptured duodenum was identified by computed tomography scanning. Exploratory laparotomy revealed that the duodenal rupture was caused by perforation of a diverticulum in the second portion of the duodenum. The surgical management of the injury to the duodenum is described in detail. PMID:9291392

Poostizadeh, A; Gow, K W; Al-Mahmeed, T; Allardyce, D B

1997-08-01

8

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.

2014-01-01

9

Iatrogenic oesophageal perforations: a clinical review.  

PubMed Central

Thirty patients with iatrogenically induced perforation of the oesophagus were managed in our unit between January 1986 and December 1996. Thirteen (43%) of these injuries were referred after upper gastrointestinal endoscopy performed by physicians. Ten (33%) cases were referred by ENT surgeons and general surgeons referred 7 (23%) cases. Of these patients, 15 (50%) had no abnormality of the oesophagus found before perforation. Only 18 (60%) of patients were referred within 24 h of injury. The mean duration of care required in the intensive care unit was 1.5 days +/- 2.5 days and the mean inpatient hospital stay 26.5 days +/- 22.1 days. The mortality was 10% (three cases). Oesophageal perforation remains a serious life-threatening injury. The early diagnosis of this uncommon condition requires a high index of suspicion as the symptoms are often non-specific. Identification of the site of perforation is necessary as the management of cervical and thoracic perforations differs considerably. Early referral combined with appropriate therapy would appear to result in a better outcome than previously published data. It is therefore suggested that patients with this relatively rare condition should be referred as soon as possible to a centre with expertise in its management.

Lawrence, D. R.; Moxon, R. E.; Fountain, S. W.; Ohri, S. K.; Townsend, E. R.

1998-01-01

10

Primary endoscopic approximation suture under cap-assisted endoscopy of an ERCP-induced duodenal perforation  

PubMed Central

Duodenal perforation during endoscopic retrograde cholangiopancreatography (ERCP) is a rare complication, but it has a relatively high mortality risk. Early diagnosis and prompt management are key factors for the successful treatment of ERCP-related perforation. The management of perforation can initially be conservative in cases resulting from sphincterotomy or guide wire trauma. However, the current standard treatment for duodenal free wall perforation is surgical repair. Recently, several case reports of endoscopic closure techniques using endoclips, endoloops, or fully covered metal stents have been described. We describe four cases of iatrogenic duodenal bulb or lateral wall perforation caused by the scope tip that occurred during ERCP in tertiary referral centers. All the cases were simply managed by endoclips under transparent cap-assisted endoscopy. Based on the available evidence and our experience, endoscopic closure was a safe and feasible method even for duodenoscope-induced perforations. Our results suggest that endoscopists may be more willing to use this treatment.

Lee, Tae Hoon; Bang, Byoung Wook; Jeong, Jee In; Kim, Hyung Gil; Jeong, Seok; Park, Seon Mee; Lee, Don Haeng; Park, Sang-Heum; Kim, Sun-Joo

2010-01-01

11

Primary endoscopic approximation suture under cap-assisted endoscopy of an ERCP-induced duodenal perforation.  

PubMed

Duodenal perforation during endoscopic retrograde cholangiopancreatography (ERCP) is a rare complication, but it has a relatively high mortality risk. Early diagnosis and prompt management are key factors for the successful treatment of ERCP-related perforation. The management of perforation can initially be conservative in cases resulting from sphincterotomy or guide wire trauma. However, the current standard treatment for duodenal free wall perforation is surgical repair. Recently, several case reports of endoscopic closure techniques using endoclips, endoloops, or fully covered metal stents have been described. We describe four cases of iatrogenic duodenal bulb or lateral wall perforation caused by the scope tip that occurred during ERCP in tertiary referral centers. All the cases were simply managed by endoclips under transparent cap-assisted endoscopy. Based on the available evidence and our experience, endoscopic closure was a safe and feasible method even for duodenoscope-induced perforations. Our results suggest that endoscopists may be more willing to use this treatment. PMID:20458771

Lee, Tae Hoon; Bang, Byoung Wook; Jeong, Jee In; Kim, Hyung Gil; Jeong, Seok; Park, Seon Mee; Lee, Don Haeng; Park, Sang-Heum; Kim, Sun-Joo

2010-05-14

12

[Applications of laparoscopy for duodenal ulcer perforation].  

PubMed

Experience of treatment of 142 patients, operated on in clinic in 2001 yr for duodenal perforative ulcer was summarized. In 130 patients operation was performed by an open access method and in 12--by laparoscopic one. Laparoscopy was applied for the perforative aperture closure (in 5 patients) and for excision of ulcer with duodenoplasty (in 7). The operation duration have constituted (78 +/- 4.2) min at average. Postoperative complications were absent, all the patients survived. Duration of the patient treatment conducted in stationary after performance of laparoscopic operation have constituted (6.4 +/- 0.6) days at average and after application of open method--(9.6 +/- 5) days. PMID:12145856

Tutchenko, N I; Svetlichny?, E V; Slonetski?, B I; Shchur, I V; Lysenko, V I

2002-04-01

13

[Duodenal perforation after blunt abdominal trauma].  

PubMed

Duodenal perforation after a blunt abdominal trauma is a rare emergency situation that can result in life-threatening complications. We report on a woman who had a perforation of the duodenum after a supposed mild blunt abdominal trauma. Unremarkable at the initial presentation, the patient presented with acute abdominal pain and a retroperitoneal abscess five days after the initial trauma. The duodenal repair was performed with a Roux-Y anastomosis. Difficulties in diagnosis are very common, but the early recognition of the rupture is essential. The contrast-enhanced CT scan is the gold standard for diagnosis. Surgical management depends on the severity of the trauma and must be chosen on an individual basis. PMID:20020392

Schneider, R; Moebius, C; Thelen, A; Jonas, S

2009-12-01

14

Iatrogenic Rectal Perforation During Operative Colonoscopy: Closure With Endoluminal Clips  

PubMed Central

The risk of perforation during diagnostic or operative colonoscopy can be as high as 2%. Despite conservative treatment being acceptable, the closure of the perforation is usually mandatory, and surgery (either open or laparoscopic) is commonly advocated as rescue therapy. Currently, with the availability of the Endoclip, endoscopists are able to manage iatrogenic perforations avoiding surgery. Clip placement, if necessary, will not delay surgery and might help the surgeon find the site of perforation. However, data in the literature are scant, especially for the closure of large colonic defects. Endoscopic repair using Endoclip devices for a large high rectal perforation following polypectomy is described herein.

Vecchio Blanco, Giovanna Del; Benavoli, Domenico; Gaspari, Achille L.

2009-01-01

15

Endoscopic treatment of duodenal fistula after incomplete closure of ERCP-related duodenal perforation.  

PubMed

Endoscopic retrograde cholangiopancreatography (ERCP) is an important diagnostic and therapeutic modality for various pancreatic and biliary diseases. The most common ERCP-induced complication is pancreatitis, whereas hemorrhage, cholangitis, and perforation occur less frequently. Early recognition and prompt treatment of these complications may minimize the morbidity and mortality. One of the most serious complications is perforation. Although the incidence of duodenal perforation after ERCP has decreased to < 1.0%, severe cases still require prolonged hospitalization and urgent surgical intervention, potentially leading to permanent disability or mortality. Surgery remains the mainstay treatment for perforations of the luminal organs of the gastrointestinal tract. However, evidence from case reports and case series support a beneficial role of endoscopic clipping in the closure of these defects. Duodenal fistulas are usually a result of sphincterotomies, perforated duodenal ulcers, or gastrectomy. Other causative factors include Crohn's disease, trauma, pancreatitis, and cancer. The majority of duodenal fistulas heal with nonoperative management. Those that fail to heal are best treated with gastrojejunostomy. Recently proposed endoscopic approaches for managing gastrointestinal leaks caused by fistulas include fibrin glue injection and positioning of endoclips. Our patient developed a secondary persistent duodenal fistula as a result of previous incomplete closure of duodenal perforation with hemoclips and an endoloop. The fistula was successfully repaired by additional clipping and fibrin glue injection. PMID:24932379

Yu, Dong Wook; Hong, Man Yong; Hong, Seung Goun

2014-06-16

16

Endoscopic treatment of duodenal fistula after incomplete closure of ERCP-related duodenal perforation  

PubMed Central

Endoscopic retrograde cholangiopancreatography (ERCP) is an important diagnostic and therapeutic modality for various pancreatic and biliary diseases. The most common ERCP-induced complication is pancreatitis, whereas hemorrhage, cholangitis, and perforation occur less frequently. Early recognition and prompt treatment of these complications may minimize the morbidity and mortality. One of the most serious complications is perforation. Although the incidence of duodenal perforation after ERCP has decreased to < 1.0%, severe cases still require prolonged hospitalization and urgent surgical intervention, potentially leading to permanent disability or mortality. Surgery remains the mainstay treatment for perforations of the luminal organs of the gastrointestinal tract. However, evidence from case reports and case series support a beneficial role of endoscopic clipping in the closure of these defects. Duodenal fistulas are usually a result of sphincterotomies, perforated duodenal ulcers, or gastrectomy. Other causative factors include Crohn’s disease, trauma, pancreatitis, and cancer. The majority of duodenal fistulas heal with nonoperative management. Those that fail to heal are best treated with gastrojejunostomy. Recently proposed endoscopic approaches for managing gastrointestinal leaks caused by fistulas include fibrin glue injection and positioning of endoclips. Our patient developed a secondary persistent duodenal fistula as a result of previous incomplete closure of duodenal perforation with hemoclips and an endoloop. The fistula was successfully repaired by additional clipping and fibrin glue injection.

Yu, Dong Wook; Hong, Man Yong; Hong, Seung Goun

2014-01-01

17

Duodenal perforation caused by an inferior vena cava filter.  

PubMed

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

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

2012-02-01

18

Testicular seminoma presenting with duodenal perforation: a case report  

Microsoft Academic Search

INTRODUCTION: Testicular neoplasms metastasizing to the retroperitoneum rarely involve the upper gastrointestinal tract. Gastrointestinal tract metastases usually present with complications including intestinal obstruction, gastrointestinal hemorrhage, and rarely ulceration of the bowel mucosa. CASE PRESENTATION: We describe an unusual case of duodenal perforation as the presenting manifestation of metastatic classic type seminoma in a 45-year-old man. CONCLUSION: Germ cell tumor diagnosis

Ranko Miocinovic; Ronney Abaza

2008-01-01

19

Proximal duodenal perforation in three dogs following deracoxib administration.  

PubMed

The purpose of this study was to describe the clinical and gross pathological findings, treatment, and outcome in three dogs receiving deracoxib that developed proximal duodenal perforation and subsequent septic peritonitis. Clinical findings were acute vomiting and anorexia following initiation of deracoxib therapy. Deracoxib dosages ranged from 2 to 3 mg/kg per os q 24 hours. In each dog, exploratory laparotomy revealed duodenal perforations approximately 1 cm orad to the major duodenal papilla. Two out of three dogs survived following exploratory laparotomy. Two of three dogs in the present case series received the approved deracoxib dosage. Dogs receiving deracoxib, even at labeled dosages, should be monitored judiciously for signs of gastrointestinal disease. PMID:20610698

Case, J Brad; Fick, Jennifer L; Rooney, Matthew B

2010-01-01

20

The Sixth Decision Regarding Perforated Duodenal Ulcer  

PubMed Central

This presentation reviews the literature regarding the current surgical treatment of perforated ulcers, describes the surgical techniques for laparoscopic repair, and reviews the clinical algorithm used by laparoscopic surgeons at Duke University Medical Center.

McMahon, Ross L.; Kakihara, Minoru; Pappas, Theodore N.; Eubanks, Steve

2002-01-01

21

Laparoscopic omental patch repair for perforated duodenal ulcer.  

PubMed

A retrospective review was carried out on 33 consecutive patients with omental patch repair for perforated duodenal ulcer; 13 had laparoscopic repair, and 20 had open repair. Laparoscopic repair was successful in 12 patients, with only one postoperative complication (8%). The morbidity rate for open repair was 15 per cent (3 of 20), and there was one postoperative death in the open group (5%). Overall, it did not take longer to perform the operation laparoscopically than the open method. Patients in the laparoscopic group required less postoperative analgesia (mean doses, 0.2 vs 0.9; P = 0.02). There was no difference in terms of hospital stay and resumption of diet after operation between the two groups. Laparoscopic omental patch repair offers a safe alternative to the open method in the treatment of perforated duodenal ulcer. PMID:9915527

Kok, K Y; Mathew, V V; Yapp, S K

1999-01-01

22

[Minimal resections in surgical treatment of perforative duodenal ulcers].  

PubMed

289 patients were operated on the reason of perforative duodenal ulcer. Omental tamponade of the ulcer after Oppel-Policarpov was performed in 260 (90%) cases; traditional ulcer closure with omental support - in 13 (4,5%); excision of the ulcer - in 4 (1,4%); truncal vagotomy and pyloroplasty - in 9 (3,1%) and gastric resection was performed in 3 (1%) patients. After 277 operations "of minimal volume" major complications were registered in 21 (7,6%) patients with lethal outcomes in 9 cases. All patients received adequate antiulcer drug treatment. Follow-up results, obtained in 153 patients, demonstrated good results of the operation and nonrecurrent course in 133 (86,9%) cases. The omental tamponade of the ulcer after Oppel-Policarpov proved to be the method of choice in treatment of the perforative duodenal ulcer. Early beginning of antiulcer conservative treatment after the operation provide excellent results and stable recovery. PMID:21423108

Kurbanov, F S; Baloglanov, D A; Sushko, A N; Asadov, S A

2011-01-01

23

Duodenal Perforation: Unusual Complication of Gastrostomy Tube Replacement  

PubMed Central

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

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

2014-01-01

24

Testicular seminoma presenting with duodenal perforation: a case report  

PubMed Central

Introduction Testicular neoplasms metastasizing to the retroperitoneum rarely involve the upper gastrointestinal tract. Gastrointestinal tract metastases usually present with complications including intestinal obstruction, gastrointestinal hemorrhage, and rarely ulceration of the bowel mucosa. Case presentation We describe an unusual case of duodenal perforation as the presenting manifestation of metastatic classic type seminoma in a 45-year-old man. Conclusion Germ cell tumor diagnosis should be considered when an ulcerating small bowel mass is identified in a young man.

Miocinovic, Ranko; Abaza, Ronney

2008-01-01

25

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

26

Novel deployment of a covered duodenal stent in open surgery to facilitate closure of a malignant duodenal perforation  

PubMed Central

Background Its a dilemma to attempt a palliative procedure to debulk the tumour and/or prevent future obstructive complications in a locally advanced intra abdominal malignancy. Case presentation A 38 year old Vietnamese man presented with a carcinoma of the colon which had invaded the gallbladder and duodenum with a sealed perforation of the second part of the duodenum. Following surgical exploration, it was evident that primary closure of the perforated duodenum was not possible due to the presence of unresectable residual tumour. Conclusion We describe a novel technique using a covered duodenal stent deployed at open surgery to aid closure of a malignant duodenal perforation.

Lung, Philip F; Cresswell, Adrian B; Psaila, Josephine; Patel, Ameet G

2009-01-01

27

Cardiac Gated Computed Tomography Used to Confirm Iatrogenic Aortic Valve Leaflet Perforation after Mitral Valve Replacement  

PubMed Central

Aortic insufficiency from iatrogenic valve perforation from nonaortic valve operations is rarely reported despite the prevalence of these procedures. Rapid diagnosis of these defects is essential to prevent deterioration of cardiac function. In this paper, we describe a young man who reported to our institution after two open cardiac surgeries with new aortic regurgitation found to be due to an iatrogenic perforation of his noncoronary aortic valve cusp. This defect was not appreciated by previous intraoperative transesophageal echocardiography and was inadequately visualized on follow-up transthoracic and transesophageal echocardiograms. In contrast, cardiac gated computed tomography clearly visualized the defect and its surrounding structures. This case highlights the utility of cardiac gated computed tomography for cases of suspected valvular perforation when echocardiography is not readily available or inadequate imaging is obtained.

Love, Kathleen; Ramirez, Alfredo; Boswell, Gilbert; Nayak, Keshav

2013-01-01

28

Veiled right kidney sign in retroperitoneal duodenal perforation after endoscopic retrograde cholangiopancreatography.  

PubMed

Retropneumoperitoneum due to duodenal perforation after endoscopic retrograde cholangiopancreatography is rare. Recognizing the presence of free air, which outlines the right kidney, is essential for its early diagnosis and appropriate management. PMID:21256547

Banerji, John Samuel

2011-08-01

29

Migration of a biliary stent causing duodenal perforation and biliary peritonitis  

PubMed Central

Migration of endoscopically placed biliary stents is a well-recognized complication of endoscopic retrograde cholangiopancreatography. Less than 1% of migrated stents however cause intestinal perforation. We present a case of a migrated biliary stent that resulted in duodenal perforation and biliary peritonitis.

Issa, Hussain; Nahawi, Mamdouh; Bseiso, Bahaa; Al-Salem, Ahmed

2013-01-01

30

[A case of successful endoscopic clipping for iatrogenic colon perforation induced by peritoneal catheter insertion].  

PubMed

Advanced cancer patients with refractory ascites often do not respond to conventional treatments including dietary sodium restriction, diuretics, and repeated large volume paracentesis. In these patients, continuous peritoneal drainage by an indwelling catheter may be an effective option for managing refractory ascites with a relative low complication rate. Peritoneal catheter-induced complications include hypotension, hematoma, leakage, cellulitis, peritonitis, and bowel perforation. Although bowel perforation is a very rare complication, it can become disastrous and necessitates emergency surgical treatment. Herein, we report a case of a 57-year-old male with refractory ascites due to advanced liver cancer who experienced iatrogenic colonic perforation after peritoneal drainage catheter insertion and was treated successfully with endoscopic clipping. (Korean J Gastroenterol 2014;63:373-377). PMID:24953616

Hahn, Kyu Yeon; Kim, Hyun Ju; Park, Hye Jung; Kim, Sun Wook; Chang, Soo Yun; Kim, Beom Kyung; Han, Kwang Hyub; Hong, Sung Pil

2014-06-25

31

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.

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

2013-01-01

32

Duodenal Perforation and Right Hydronephrosis Due to Toothpick Ingestion  

Microsoft Academic Search

We report a case of a 36-year-old man who was admitted to the Emergency Department with right flank pain. The clinical presentation was suggestive of renal colic. However, a computed tomography scan showed the presence of a foreign body in the inferior duodenal flexure. Upper gastrointestinal endoscopy demonstrated a 6.5-cm wooden toothpick deeply embedded in the duodenal wall; this was

Giuseppe R. Nigri; Emilio Di Giulio; Raffaella Di Nardo; Francesca Pezzoli; Francesco D’Angelo; Paolo Aurello; Matteo Ravaioli; Giovanni Ramacciato

2008-01-01

33

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

PubMed Central

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

Akdemir, Ali; Cirpan, Teksin

2014-01-01

34

Self-expandable metal stents as a new treatment option for perforated duodenal ulcer.  

PubMed

Primary stenting and drainage has been shown to be an effective and safe way to treat esophageal perforations and anastomotic leaks after gastric bypass surgery. We present a case series of eight patients with perforated duodenal ulcers treated with covered self-expandable metal stents (SEMS). The first two patients received their stents because of postoperative leakage after initial traditional surgical closure. The following six patients had SEMS placed as primary treatment due to co-morbidities or technical surgical difficulties. Endoscopy and stent treatment in these six patients was performed at a median of 3 days (range, 0 - 7 days) after initial symptoms. Six patients had percutaneous abdominal drainage. Early oral intake, 0 - 7 days after stent placement, was possible. All patients except one recovered without complications and were discharged 9 - 36 days after stent placement. This series indicates that primary treatment with SEMS and drainage might be an alternative to surgery in patients with perforated ulcer disease. PMID:23208777

Bergström, M; Arroyo Vázquez, J A; Park, P-O

2013-01-01

35

Endoscopic closure of an endoscope-related duodenal perforation using the over-the-scope clip.  

PubMed

Perforations of the duodenum are a significant source of morbidity in clinical practice. Surgical repair is usually mandated, but it is associated with significant morbidity and mortality. Until recently, there has been no technique available which reproducibly and safely allowed endoscopic closures of penetrating defects within the digestive tract. With the new over-the-scope clipping system", which regarding design and function is similar to a bear-trap, the endoscopic closure of perforations has become possible. Here, we report our first experience with the over-the-scope clipping system for the closure of duodenal perforation developed during endoscopic retrograde cholangiopancreatography. A 79-year-old woman with jaundice resulting from obstruction of the common bile duct caused by choledocholithiasis underwent endoscopic retrograde cholangiopancreatography. At the time of the procedure, an endoscope-related perforation measuring about 15 mm was visualized proximal to the papilla. Endoscopic repair was performed by using the over-the-scope clipping according to a standardized operating procedure. Amsterdam type plastic stent was placed into the common bile duct. An abdominal computed tomography with gastrographin showed a pneumoretroperitoneum in the peripancreatic-perirenal area and complete closure of the perforation. The patient remained symptom free, no signs of sepsis developed, and the obstructive jaundice was relieved by endoscopic biliary drainage. The patient was allowed to have a full diet one week later and was discharged from the hospital 2 weeks later. It seems that, the over-the-scope clipping is effective for endoluminal closure of endoscope-related duodenal perforations. PMID:24557968

Do?an, Ümit Bilge; Kesk?n, Mahmut Birol; Söker, Gökhan; Ak?n, Mustafa Salih; Yalaki, Serkan

2013-01-01

36

Inflammation of ectopic pancreatic tissue as unusual cause of duodenal perforation--a case report.  

PubMed

Ectopic pancreatic tissue, also known as a pancreatic rest, is an uncommon congenital anomaly defined as extrapancreatic tissue located far from the pancreas and without any connection via vascular or anatomical means to it. Such tissue may occur throughout the GI tract but has a propensity to affect the stomach and the proximal small intestine. The majority of patients with pancreatic ectopia are asymptomatic, but when symptoms occur, they can be presented in a variety of ways. We report a patient with acute surgical abdomen due to a duodenal perforation caused by inflammation of ectopic pancreatic tissue in duodenum and stomach. Histology of the resected duodenum and stomach demonstrated heterotopic pancreatic tissue acute inflammation without atypia, suggesting "pancreatitis of the duodenum and stomach". To date, there have been a few reports describing perforation of the stomach due to heterotopic pancreas. Therefore, the present case was considered to be a very rare case of this disorder. To conclude, heterotopic pancreas should always be considered in the differential diagnosis of acute abdomen. PMID:20977114

Gunjaca, I; Mlinac-Lucijani?, M; Pavlovi?, A; Gunjaca, M

2010-09-01

37

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

PubMed Central

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

2013-01-01

38

Iatrogenic Perforation of the Left Ventricle during Insertion of a Chest Drain  

PubMed Central

Chest draining is a common procedure for treating pleural effusion. Perforation of the heart is a rare often fatal complication of chest drain insertion. We report a case of a 76-year-old female patient suffering from congestive heart failure. At presentation, unilateral opacity of the left chest observed on a chest X-ray was interpreted as massive pleural effusion, so an attempt was made to drain the left pleural space. Malposition of the chest drain was suspected because blood was draining in a pulsatile way from the catheter. Computed tomography revealed perforation of the left ventricle. Mini-thoracotomy was performed and the drain extracted successfully.

Kim, Dongmin; Lim, Seong-Hoon

2013-01-01

39

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

PubMed Central

Although complications including graft thrombosis, graft pancreatitis, and rejection have been well documented after pancreas transplantation, the occurrence of graft duodenal perforation is uncommon. In this article, we report a case of graft duodenal perforation due to internal hernia after simultaneous pancreas-kidney transplantation (SPK). A patient with type I diabetes mellitus and diabetic nephropathy had undergone SPK from a cadaveric donor. One year later, she was admitted to our hospital for severe lower abdominal pain with preshock status. She was immediately examined by abdominal computed tomography and both peripancreas graft fluid accumulation and severe dilatation of the ileum were detected. On emergency operation, two punched holes located at the graft duodenal side near the suture line and an obstruction of herniated bowel behind the graft pancreas were detected. These holes were repaired and the internal hernia was reduced. However, a control of the intraabdominal infection was very difficult despite intensive treatment with antibiotics and additional abdominal drainage. Finally, a graft pancreatectomy was unavoidably required. When complications, including symptomatic intraabdominal infection, require re-laparotomy after pancreas transplantation, the therapeutic focus should be switched from salvaging the graft to the preservation of life.

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

2008-01-01

40

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

PubMed Central

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

Lee, Sun Joo; Shin, Hee Sup; Lee, Seung Hwan

2012-01-01

41

Perforated Duodenal Ulcer; Management in a Resource Poor, Semi-Urban Nigerian Hospital  

PubMed Central

Introduction: Perforated duodenal ulcer (PDU) is still seen frequently in the study center inspite of the free use of effective medical curative therapy. We then set out to ascertain the pattern of presentation, peculiar risk factors in the study environment, re-evaluate our method of management, and to see if it is adequate for patients in a developing country. Materials and Methods: This is a retrospective study of patients admitted and managed for PDUs, between January 2004 and December 2011 at the Federal Medical Centre, IdoEkiti, Southwest Nigeria. The records of patients were retrieved and demographic data relating to age, sex, symptoms, duration, diagnosis, intra-operative findings, and management outcome were extracted. The results were analyzed. Results: A total of 30 patients were admitted and operated during this period. Twenty-eight of them were males and two were females. The mean age was 47 years and the male: female ratio was 14:1. The duration of symptoms before presentation ranged from 2 to 7 days. None of the patients had a prior diagnosis of their ulcers, by an upper gastro intestinal endoscopy before presentation; although most had dyspeptic symptoms, with inadequate or no medical treatment. The notable peculiar risk factor was the abuse of local herbal concoction for body pains by all the patients. Seven patients smokes, 15 consumes alcohol, and only two take non-steroidal anti-inflammatory drugs for body pains. Most of the managed patients; 26 were satisfactorily discharged home and later followed-up at the surgical out-patient department. Four mortality was recorded during the period of study. Conclusion: PDU is still a major complication of chronic peptic ulcer disease. Simple omental patch and H. pylori eradication is no longer appropriate as a mode of treatment for the youths who are mostly affected in the center. We therefore, suggest a more wide spread use of definitive ulcer surgery for most of our patients with no pre-operative risk factors.

Oribabor, Felix O; Adebayo, Bamidele O; Aladesanmi, Tunde; Akinola, David O

2013-01-01

42

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.

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

2014-01-01

43

Perforated duodenal ulcer presenting with a subphrenic abscess revealed by plain abdominal X-ray films and confirmed by multi-detector computed tomography: a case report  

PubMed Central

Introduction Peptic ulcer disease is still the major cause of gastrointestinal perforation despite major improvements in both diagnostic and therapeutic strategies. While the diagnosis of a perforated ulcer is straightforward in typical cases, its clinical onset may be subtle because of comorbidities and/or concurrent therapies. Case presentation We report the case of a 53-year-old Caucasian man with a history of chronic myeloid leukemia on maintenance therapy (100mg/day) with imatinib who was found to have a subphrenic abscess resulting from a perforated duodenal ulcer that had been clinically overlooked. Our patient was febrile (38.5°C) with abdominal tenderness and hypoactive bowel sounds. On the abdominal plain X-ray films, a right subphrenic abscess could be seen. On contrast-enhanced multi-detector computed tomography, a huge air-fluid collection extending from the subphrenic to the subhepatic anterior space was observed. After oral administration of 500cm3 of 3 percent diluted diatrizoate meglumine, an extraluminal leakage of the water-soluble iodinated contrast media could then be appreciated as a result of a perforated duodenal ulcer. During surgery, the abscess was drained and extensive adhesiolysis had to be performed to expose the duodenal bulb where the ulcer was first identified by methylene blue administration and then sutured. Conclusions While subphrenic abscesses are well known complications of perforated gastric or duodenal ulcers, they have nowadays become rare thanks to advances in both diagnostic and therapeutic strategies for peptic ulcer disease. However, when peptic ulcer disease is not clinically suspected, the contribution of imaging may be substantial.

2013-01-01

44

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

PubMed Central

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

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

2010-01-01

45

Perforated Duodenal Ulcer in Pregnancy--A Rare Cause of Acute Abdominal Pain in Pregnancy: A Case Report and Literature Review  

PubMed Central

Medical and surgical disorders in pregnancy can be can be quite challenging for the obstetrician gynaecologist even in resource rich countries. Reaching an accurate diagnosis and admininstering appropriate management can be difficult in the presence of an on-going pregnancy. The importance of involving specialist from other disciplines (multidisciplinary care) cannot be overemphasized. We present an interesting case of perforated duodenal ulcer in a pregnant patient, review the literature ,discuss the differential diagnosis and evaluate the management principles for this rare condition.

Essilfie, Papa; Hussain, M.; Bolaji, I.

2011-01-01

46

Ingested Fish Bone: An Unusual Mechanism of Duodenal Perforation and Pancreatic Trauma  

PubMed Central

Ingestion of gastrointestinal foreign bodies represents a challenging clinical scenario. Increased morbidity is the price for the delayed diagnosis of complications and timely treatment. We present a case of 57-year-old female patient which was admitted in the emergency room department complaining of a mid-epigastric pain over the last twenty-four hours. Based on the patient's history, physical examination and elevated serum amylase levels, a false diagnosis of pancreatitis, was initially adopted. However, a CT scan confirmed the presence of a radiopaque foreign body in the pancreatic head and the presence of air bubbles outside the intestinal lumen. The patient was unaware of the ingestion of the foreign body. At laparotomy, after an oblique duodenotomy, a fish bone pinned in the pancreatic head after the penetration of the medial aspect of the second portion of the duodenal wall was identified and successfully removed. The patient had an uneventful postoperative recovery. Wide variation in clinical presentation characterizes the complicated fish bone ingestions. The strategically located site of penetration in the visceral wall is responsible for the often extraordinary gastrointestinal tract injury patterns. Increased level of suspicion is of paramount importance for the timely diagnosis and treatment.

Symeonidis, Dimitrios; Koukoulis, Georgios; Baloyiannis, Ioannis; Rizos, Apostolos; Mamaloudis, Ioannis; Tepetes, Konstantinos

2012-01-01

47

Repair of Furcal Iatrogenic Perforation with Mineral Trioxide Aggregate: Two Years Follow-up of Two Cases  

PubMed Central

Furcal perforation is usually an undesired complication that can occur during preparation of endodontic access cavities or exploring canal orifice of multirooted teeth. Inadequacy of the repair materials has been a contributing factor to the poor outcome of repair procedures. On the basis of the recent physical and biologic property studies of the relatively new introduced mineral trioxide aggregate, this material may be suitable for closing the communication between the pulp chamber and the underlying periodontal tissues. There are few reports on repair of furcal perforation with MTA in molar teeth. The purpose of this case report was to describe the treatment of two furcal perforation using MTA in molar teeth. The perforations were cleaned with NaOCl and saline solution and sealed with MTA without internal matrix. Finally, the teeth were endodontically treated and coronally restored with composite resin and ceramic veneer crown and bridge. After 2 years, the absence of periradicular radiolucent lesions, pain, and swelling along with functional tooth stability indicated a successful outcome of sealing perforations in two cases.

Unal, Gul Celik; Maden, Murat; Isidan, Tugba

2010-01-01

48

Perforated duodenal ulcer in pregnancy-a rare cause of acute abdominal pain in pregnancy: a case report and literature review.  

PubMed

Medical and surgical disorders in pregnancy can be can be quite challenging for the obstetrician gynaecologist even in resource rich countries. Reaching an accurate diagnosis and admininstering appropriate management can be difficult in the presence of an on-going pregnancy. The importance of involving specialist from other disciplines (multidisciplinary care) cannot be overemphasized. We present an interesting case of perforated duodenal ulcer in a pregnant patient, review the literature ,discuss the differential diagnosis and evaluate the management principles for this rare condition. PMID:22567500

Essilfie, Papa; Hussain, M; Bolaji, I

2011-01-01

49

Duodenal perforation due to a kink in a nasojejunal feeding tube in a patient with severe acute pancreatitis: a case report  

PubMed Central

Introduction Nasojejunal feeding tube placement can be achieved by fluoroscopic or endoscopic techniques. Significant complications due to nasojejunal feeding tube placement, such as hydrothorax, duodenal perforation and retroperitoneal emphysema, are very rare. We present a case of massive retroperitoneal emphysema and abscess because of duodenal perforation caused by a kink in a nasojejunal feeding tube. Case presentation A 34-year-old Chinese woman was admitted to our intensive care unit due to hypertriglyceridemia and severe acute pancreatitis. As she suffered from acute respiratory distress syndrome and required mechanical ventilation, a nasojejunal feeding tube was placed by transnasal endoscopic technique. The procedure took place at her bedside. Half a month later, she had a high fever and abdominal distension. An abdominal radiography was performed and showed that the nasojejunal feeding tube was kinking on the third portion of the duodenum and the tip of the nasojejunal feeding tube was inserted into the right retroperitoneum on the second portion of the duodenum. Conclusion When a nasojejunal feeding tube is placed through the transnasal endoscopic technique, an abdominal radiography should be used to confirm the tube's position and indicate if it is kinking or beyond the ligament of Treitz.

2010-01-01

50

Duodenal ESD: conquering difficulties.  

PubMed

Duodenal endoscopic submucosal dissection (ESD) is technically difficult due to the unique anatomic features. The risks include intraprocedural complications, delayed bleeding, and perforation. A small-caliber-tip transparent hood is useful. Mechanical stretching of the submucosal tissue allows safe dissection and effective prevention of bleeding with minimum muscle injury under direct visualization of the submucosal tissue and blood vessels. A short double-balloon endoscope is useful to stabilize control of the endoscope tip in distal duodenal ESD. Selection of ESD in the duodenum should be made cautiously considering both benefits and risks of the procedure. PMID:24679234

Yamamoto, Hironori; Miura, Yoshimasa

2014-04-01

51

Palliative cardia resection with gastroesophageal reconstruction for perforated carcinoma of the gastroesophageal junction  

PubMed Central

Iatrogenic perforation of esophageal cancer or cancer of the gastroesophageal (GE) junction is a serious complication that, in addition to short term morbidity and mortality, significantly compromises the success of any subsequent oncological therapy. Here, we present an 82-year-old man with iatrogenic perforation of adenocarcinoma of the GE junction. Immediate surgical intervention included palliative resection and GE reconstruction. In the case of iatrogenic tumor perforation, the primary goal should be adequate palliative (and not oncological) therapy. The different approaches for iatrogenic perforation, i.e. surgical versus endoscopic therapy are discussed.

Gillen, Sonja; Friess, Helmut; Kleeff, Jorg

2009-01-01

52

Esophageal Perforation in Adults  

PubMed Central

Objective: To evaluate the outcome of aggressive conservative therapy in patients with esophageal perforation. Summary Background Data: The treatment of esophageal perforation remains controversial with a bias toward early primary repair, resection, and/or proximal diversion. This review evaluates an alternate approach with a bias toward aggressive drainage of fluid collections and frequent CT and gastographin UGI examinations to evaluate progress. Methods: From 1992 to 2004, 47 patients with esophageal perforation (10 proximal, 37 thoracic) were treated (18 patients early [<24 hours], 29 late). There were 31 male and 16 females (ages 18–90 years). The etiology was iatrogenic (25), spontaneous (14), trauma (3), dissecting thoracic aneurysm (3), and 1 each following a Stretta procedure and Blakemore tube placement. Results: Six of 10 cervical perforations underwent surgery (3 primary repair, 3 abscess drainage). Nine of 10 perforations healed at discharge. In 37 thoracic perforations, 2 underwent primary repair (1 iatrogenic, 1 spontaneous) and 4 underwent limited thoracotomy. Thirty-4 patients (4 cervical, 28 thoracic) underwent nonoperative treatment. Thirteen of the 14 patients with spontaneous perforation (thoracic) underwent initial nonoperative care. Overall mortality was 4.2% (2 of 47 patients). These deaths represent 2 of 37 thoracic perforations (5.4%). There were no deaths in the 34 patients treated nonoperatively. Esophageal healing occurred in 43 of 45 surviving patients (96%). Subsequent operations included colon interposition in 2, esophagectomy for malignancy in 3, and esophagectomy for benign stricture in 2. Conclusions: Aggressive treatment of sepsis and control of esophageal leaks leak lowers mortality and morbidity, allow esophageal healing, and avoid major surgery in most patients.

Vogel, Stephen B.; Rout, W Robert; Martin, Tomas D.; Abbitt, Patricia L.

2005-01-01

53

Esophagocutaneous drainage to treat late and complicated esophageal perforation  

Microsoft Academic Search

Five patients with complicated esophageal perforation - three with spontaneous rupture, one with dehiscence after resection of a diverticulum, and one with an iatrogenic lesion - were successfully treated by esophagocutaneous drainage of the esophageal perforation. At thoracotomy, after careful debridement and cleaning of the mediastinum and pleura, a T-tube drain was placed in the esophagus through the perforation in

S. Larsson; G. Pettersson; V. Lepore

2009-01-01

54

Iatrogenic Sinistral Hypertension Complicating Screening Colonoscopy  

PubMed Central

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

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

2013-01-01

55

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.

Scott, B; Holmes, G

1993-01-01

56

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

SciTech Connect

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

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

2005-01-15

57

Gastric and Duodenal Safety of Daily Alendronate  

Microsoft Academic Search

Background: Isolated case reports of gastric ulcers af- ter alendronate sodium use raised concern about the gas- troduodenal safety of daily alendronate. This study was conducted to estimate the excess risk of hospitaliza- tions for gastric or duodenal perforations, ulcers, and bleeding associated with alendronate use. Participants and Methods: Study subjects were 6432 men and women, 35 years or older.

James G. Donahue; K. Arnold Chan; Susan E. Andrade; Arne Beck; Myde Boles; Diana S. M. Buist; Vincent J. Carey; Julie M. Chandler; Gary A. Chase; Bruce Ettinger; Paul Fishman; Michael Goodman; Harry A. Guess; Jerry H. Gurwitz; Andrea Z. LaCroix; T. R. Levin; Richard Platt

2002-01-01

58

Duodenal Ulcer in Children  

PubMed Central

Forty-nine cases of duodenal ulcer in children are presented. Strict radiological and clinical criteria were observed in making this diagnosis. The children came from a population of approximately 100,000 children over a 10-year period. Upper abdominal pain was the commonest presenting symptom, and exacerbations and remissions of the disease were observed to be shorter than is expected in the adult. Haemorrhage occurred as a complication in 24% and there were no cases of perforation or stenosis. A family history of duodenal ulcer was found to be highly significant, and it was found that in 55% of patients there was an important element of stress. Treatment was conservative in all but 2 cases, in both of which a vagotomy and pyloroplasty were performed. These operations were judged to have been successful. 6 cases had appendicectomy in the hope of relieving undiagnosed abdominal pain, in which it was unsuccessful. A plea is made for keeping this diagnosis in mind when dealing with abdominal pain in children.

Robb, J. D. A.; Thomas, P. S.; Orszulok, J.; Odling-Smee, G. W.

1972-01-01

59

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.

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

60

Spectrum of perforation peritonitis.  

PubMed

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

2013-11-01

61

Gastrointestinal perforation  

MedlinePLUS

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

62

Gastrointestinal perforation: ultrasonographic diagnosis  

PubMed Central

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.

2013-01-01

63

Iatrogenic vascular trauma.  

PubMed

With the increasing performance of percutaneous transluminal angioplasty and insertion of an increasing number of intravascular devices, the size of arterial punctures has been increasing. A consistent minority of these procedures will result in vascular injuries requiring treatment. At the same time, the regionalized nature of trauma care in the United States has resulted in a large number of vascular surgeons who are exposed to vascular trauma only when iatrogenic. The most common injuries observed are caused by percutaneous vascular instrumentation and include hemorrhage and pseudoaneurysm that may compress adjacent structures, fistula, acute occlusion, and embolization. Injuries unique to balloon angioplasty/stenting include arterial rupture and dissection. Indwelling intravascular devices are another common source of iatrogenic vascular injury ranging from arterial rupture to thrombosis and embolization. Much less common injuries are observed in orthopedic and abdominal/laparoscopic operations but show reproducible causes/patterns. Finally, pediatric iatrogenic vascular trauma is relatively common because of the small size of the vasculature, but the natural history and management is markedly different from that in adults. PMID:9876035

Nehler, M R; Taylor, L M; Porter, J M

1998-12-01

64

Operative and nonoperative management of esophageal perforations.  

PubMed Central

During a 21-year period, 72 patients were treated for esophageal perforations; the diagnosis was made only at postmortem examination in 13 other patients. Fifty-eight of 85 patients (68%) sustained iatrogenic perforations, 11 patients (13%) had "spontaneous" perforation, nine patients (11%) had foreign body related perforation, and seven patients (8%) had perforation caused by external trauma. Eleven cervical perforations, contained between the cervical paravertebral structures, plus eight thoracic perforations, contained in the mediastinum, were treated with antibiotics, intravenous hydration, and nasogastric drainage. The mortality rate after this nonoperative approach was 16% (3/19 patients). Indications for operative treatment in 53 patients were hydropneumothorax with mediastinal emphysema, sepsis, shock and respiratory failure. The operative mortality rate in these instances was 17% (9/53 patients). Six of the nine patients who died had been operated on more than 24 hours after the onset of symptoms. For cervical perforations the best results were obtained by drainage plus repair of the perforation (mortality rate: 0%; 0/10 patients) and for thoracic perforations by suturing supported by a pedicled pleural flap (mortality rate: 11%; 1/9 patients). Simple drainage of thoracic perforation was followed by a mortality rate of 43% (3/7 patients).

Michel, L; Grillo, H C; Malt, R A

1981-01-01

65

Therapeutic angiography for giant bleeding gastro-duodenal artery pseudoaneurysm  

PubMed Central

We present the case of an 18-year-old female transferred to our center from an outside hospital due to persistent gastrointestinal bleeding. Two weeks prior to her transfer she underwent duodenal omentopexy for a perforated duodenal peptic ulcer. The patient underwent a computed tomography angiogram which identified the source of bleeding as a giant gastro-duodenal artery (GDA) pseudoaneurysm. The patient was taken to interventional radiology where successful microcoil embolization was performed. We present this rare case of a giant GDA pseudoaneurysm together with imaging and a review of the medical literature regarding prevalence, etiology and treatment options for visceral arterial aneurysms.

Elazary, Ram; Abu-Gazala, Mahmoud; Schlager, Avraham; Shussman, Noam; Rivkind, Avraham I; Bloom, Allan I

2010-01-01

66

Perforation Peritonitis and the Developing World  

PubMed Central

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.

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

2014-01-01

67

An overview of history, pathogenesis and treatment of perforated peptic ulcer disease with evaluation of prognostic scoring in adults.  

PubMed

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

Prabhu, V; Shivani, A

2014-01-01

68

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

PubMed Central

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

Prabhu, V; Shivani, A

2014-01-01

69

Treatment results of gastrointestinal perforation after endoscopic retrograde cholangiopancreatography  

PubMed Central

Introduction Duodenal perforation, damage to common bile duct or ampulla of Vater complicates from 0.7% to 10% of endoscopic retrograde cholangiopancreatography (ERCP) procedures. This complication is associated with high risk of contracting fatal diseases and death. As the endoscopic and minimally invasive treatment methods develop and gain popularity, it becomes increasingly important to determine the correct procedure in the event of gastrointestinal perforation after ERCP. Aim To present the results of treatment of gastrointestinal perforation after ERCP and indicate the correct procedure for such cases. Material and methods The material includes 19 patients who underwent ERCP in the years 2008–2011 and were subsequently diagnosed with duodenal perforation (except for duodenal bulb) and common bile duct (CBD). Women accounted for 68% of patients (13/19), while men constituted 32% (6/19). The mean age of patients was 66.6 years old. Indications for ERCP included cholelithiasis in 95% of cases and bile duct strictures in the remaining 5%. Treatment was conditional on the result of X-ray examination of the abdominal cavity, followed by computed tomography with aqueous contrast medium administered orally. Results Four patients were diagnosed with intraperitoneal perforation and 15 patients with retroperitoneal perforation. In the patient group with retroperitoneal perforation the contrast media leakage (10 patients) required surgical intervention – the perforation site was located in 5 cases; in the other 5 the site could not be found. With the absence of active contrast media leakage in computed tomography (CT) (5 patients) conservative treatment was applied. Four patients with intraperitoneal perforation were referred for operative treatment. In patients under conservative treatment no complications were observed and the average hospitalization time was 9 days. Among patients with retroperitoneal perforation, who had undergone surgical treatment, complications occurred in 3 cases. The average hospitalization time in the group in which the perforation site was located was 16 days, while in the group with an unidentified perforation site it was 17 days. Patients with intraperitoneal perforation were given operative treatment, with the average hospitalization time of 12 days. Conclusions Each patient with suspected post-ERCP perforation should undergo CT of the abdominal cavity with aqueous contrast medium administered orally. In the event of no contrast leak in patients with retroperitoneal duodenal perforation, conservative treatment should be applied. In the case of retroperitoneal perforation with active contrast media leakage outside the gastrointestinal tract, and in the case of intraperitoneal perforation, an immediate surgical intervention is recommended.

Ciostek, Piotr; Porzycki, Piotr; Kwiatkowska, Magdalena

2013-01-01

70

[Perforation of the colon during colonoscopy].  

PubMed

Perforation of the colon during colonoscopy for diagnostic or therapeutic purposes is an important but not a frequent complication. Bibliographic controversies exist upon the type of treatment either conservative or surgical. In the late years reported cases favorise a trial for conservative treatment under optimal clinical conditions. We report our late experience with 3 cases of iatrogenic colonic perforation treated laparoscopically. Direct visualisation of the local status, the possibility of simple colonic oversew, abdominal toilette and drainage are the advantages of the method on which it should be added the psychological comfort for the surgeon and his gastroenterologist. PMID:10073123

Nassiopoulos, K; Chanson, C; Petropoulos, P

1999-01-01

71

Management of Isolated Blunt Duodenal Injury  

PubMed Central

Five cases of duodenal injuries were treated in our hospital between January 1, 1975 and June 18, 1979. They belonged to the Class II and early Class III of duodenal injuries. They were treated with simple closure of the perforation in a single or double layer with external drainage. Only in one case were gastrojejunostomy and bilateral vagotomy added because the patient had a history of ulcer disease. The delay in operative treatment ranged between five and 48 hours. All responded well to the surgical treatment. In the instance of the longest operative delay, a purulent drainage occurred and it responded promptly to a selective antibiotic therapy. The average hospitalization stay was nine days for the patients operated upon early, whereas it was 15 days for the two delayed cases. No mortality was recorded. ImagesFigure 1Figure 2Figure 3

Nasr, Elias N.; Bhatti, Muhammad A. K.; Warner, Errol

1981-01-01

72

Successful management of colonic perforation with a covered metal stent  

PubMed Central

Self-expandable stents are widely available for the treatment of perforation of the gastrointestinal tract. Because of the risk of migration, there has been no report of the use of self-expandable stents for the treatment of perforation of the colon or rectum. This is a report of successful treatment of iatrogenic colonic perforation during balloon dilatation of anastomotic stricture with a fully covered stent. Fully covered, self-expandable metallic stents can be considered useful tools for management of this condition.

Lee, Wook Hyun; Kim, Jin Soo; Lee, Ha Nee; Kim, Soo Jung; Lee, Seok Jong

2013-01-01

73

Iatrogenic Disease: An Annotated Bibliography.  

National Technical Information Service (NTIS)

This bibliography was compiled in conjunction with the one-day conference, May 16, 1984, on Iatrogenic Disease which was held in association with the joint annual meeting of the American Geriatric Society and the American Federation for Aging Research. Re...

K. Steel C. Crescenzi

1984-01-01

74

Technology dependency and iatrogenic injuries.  

PubMed

Research on iatrogenic injuries and technology dependency is sparse in light of the expansive use of technology in health care today. Many of the publications are single case reports of an iatrogenic injury related to a specific type of device. Little has been done to analyze these reports in a collective fashion. Nursing research is especially limited, and most studies were located in the medical literature. The majority of research has been done in pediatric populations with major emphasis on respiratory and nutritional technology. In contrast, little research has been done with adults who are ventilator dependent. Perhaps the paucity of research in this area is related to the Food and Drug Administration (FDA) requirements for technology safety before placement of a device on the health care market with the subsequent assumption by health care personnel that the technology is safe and effective. The challenge for the future is to build programs of nursing research that (1) describe the incidence and nature of iatrogenic injuries associated with technologies that are of high volume and for which many patients are dependent and (2) to tests ways to prevent iatrogenic injuries associated with technologies often used in nursing practice. PMID:8516185

Titler, M G

1993-06-01

75

Duodenal epithelial thymidine uptake in patients with duodenal ulcer or endoscopic duodenitis  

Microsoft Academic Search

To evaluate the relationship between duodenal ulcer disease and duodenitis, duodenal epithelial cell renewal was measured\\u000a in mucosal biopsies by the incorporation of [3H]thymidine. When 14 patients with duodenal ulcer were compared to 13 control subjects or 7 with endoscopic duodenitis alone,\\u000a the crypt size was the same in all groups. Similar to other inflammatory processes of the gastrointestinal tract,

Fred S. Gorelick; Vincent A. Deluca; Daniel G. Sheahan; Pierluigi Marignani; Robert S. Goldblatt; Jerry Winnan; Elliot M. Livstone

1983-01-01

76

Management of perforation after endoscopic retrograde cholangiopancreatography (ERCP): a population-based review  

PubMed Central

Background. Perforation related to endoscopic retrograde cholangiopancreatography (ERCP) is a rare complication associated with significant morbidity and mortality. This study evaluated the management and outcomes of these perforations. Patients and methods. Between July 1996 and December 2002, a total of 6620 ERCPs were performed at our regional endoscopy unit serving the 1.5 million population of Southern Alberta. Thirty perforations (0.45%) were identified and retrospectively reviewed. Results. Seven of these 30 patients were found to have guidewire perforations of the bile duct, 11 perforations were peri-ampullary, 3 duodenal, 1 esophageal, and 1 patient had a perforation of an afferent limb of a Billroth II anastomosis. In seven patients the location of the perforation could not be determined (unknown). All patients with guidewire perforations were recognized during ERCP, and all were managed medically. Of the 11 peri-ampullary perforations, 7 of these patients had a pre-cut sphincterotomy, 5 underwent surgery and 4 patients died. Delay in diagnosis occurred in all patients that died. Of the three duodenal perforations, all required operation and one patient died. Of the seven ‘unknown’ retroperitoneal perforations, two patients required surgery and there was no mortality. The patients with esophageal and afferent limb perforations both recovered uneventfully after surgery. Most patients who required surgery had retroperitoneal fluid seen on CT scanning. Conclusions. We found that most guidewire perforations can be managed medically with little morbidity. Pre-cut sphincterotomy is a risk factor for perforation. Peri-ampullary and duodenal perforations have a high morbidity and mortality rate. In particular, retroperitoneal fluid collections on CT scans, delay in diagnosis and failure of medical therapy requiring salvage surgery are associated with poor outcomes. Early aggressive surgery may improve patient care.

Wu, Hao M.; Dixon, Elijah; May, Gary R.

2006-01-01

77

Endovascular Stent-Graft Applications in Iatrogenic Vascular Injuries  

SciTech Connect

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

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

2003-09-15

78

[Dysphonia as early presentation symptom in colonic perforation].  

PubMed

We report two cases with similar main complaints: dysphonia and subcutaneous cervical emphysema. After diagnosis procedures we identified pneumomediastinum, pneumoperitoneum and pneumoretroperitoneum caused by colonic perforation. Both patients underwent surgical treatment at Hospital Campo Arañuelo, Navalmoral de la Mata. Dysphonia and subcutaneous cervical emphysema are infrequent symptoms of presentation for occult gastrointestinal tract perforation or any retroperitoneal condition. Subcutaneous emphysema due to colonic perforation is extremely uncommon but it must to be considerate as a cause when its etiology remains unknown. Non iatrogenic subcutaneous emphysema is very rare in publications and is mostly associated with perforated sigmoid diverticulitis or carcinoma and the prognosis is poor Both patients underwent surgical treatment and also a wide spectrum antibiotic course. One of them needed respiratory support in the intensive care unit, and, in the outcome, he required a second surgical procedure to evacuate a residual abscess before discharge. PMID:22476128

Barrera Melgarejo, Elizabeth; Joya Vázquez, Rebeca; Sánchez Antonio, Molina; López López, Angeles; Gómez García, Olga; Bengochea Cantos, José

2011-01-01

79

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.

Burks, Frank N.

2014-01-01

80

A Case of Duodenal Duplication Cyst Manifested by Duodenal Polyp  

PubMed Central

Duodenal duplication cyst is a rare anomaly, totaling only 4% to 12% of gastrointestinal duplications, and is usually encountered during infancy or in early childhood. Most are commonly located posterior to the first or second portion of the duodenum. Presenting signs and symptoms include vomiting, decreased oral intake, periumbilical tenderness, abdominal distention, obstructive jaundice, acute pancreatitis, and gastrointestinal bleeding. The traditional treatment of a duodenal duplication cyst has been complete surgical resection, but very few cases of endoscopic treatment have been reported in the literature. Here, we report a case of duodenal duplication cyst that was manifested by a duodenal polyp.

Park, Su Bin; Kim, Jin Hee; Lee, Hyun Jeong; Jang, Seong Pil; Kim, Gwang Ha; Song, Geun Am

2012-01-01

81

Gastrinoma (Duodenal and Pancreatic)  

Microsoft Academic Search

Gastrinomas are neuroendocrine tumors (NETs), usually located in the duodenum or pancreas, that secrete gastrin and cause a clinical syndrome known as Zollinger-Ellison syndrome (ZES). ZES is characterized by gastric acid hypersecretion resulting in severe acid-related peptic disease (peptic ulcer disease, PUD; gastro-esophageal reflux disease, GERD) [1–3] and diarrhea. In this section ZES, due to both duodenal and pancreatic gastrinomas,

Robert T. Jensen; Bruno Niederle; Emmanuel Mitry; John K. Ramage; Thomas Steinmüller; V. Lewington; Aldo Scarpa; Anders Sundin; Aurel Perren; David Gross; Juan M. O’Connor; Stanislas Pauwels; Günter Klöppel

2006-01-01

82

Multiple Adenomatous Duodenal Polyposis  

PubMed Central

Multiple duodenal polyps are a relatively rare finding, usually co-occurrent with familial adenomatous polyposis (FAP).We report a patient with multiple duodenal adenomas and a negative examination for FAP: multiple flat polyps were detected endoscopically in a 37-year-old male patient, extending from the apex of the bulb to the end of the descending part of the duodenum. In terms of histology, they were tubular adenomas with moderate dysplasia. Colonoscopy and enteroclysis were normal. Both push and capsule enteroscopy only showed multiple polyps in the area of the descending duodenum. DNA analysis of the APC gene was as follows: DGGE, exon 1–15, deletion at codons 1309 and 1061 by means of PCR for attenuated APC were negative. Afterwards we screened the patient for germline MYH mutations using the denaturing high-performance liquid chromatography (DHPLC) in combination with sequencing. No novel pathogenic mutation has been identified. Large polyps were removed by means of endoscopic polypectomy and mucosectomy, while small polyps were removed by means of argon plasma coagulation.We conduct yearly checkups, removing only sporadic polyps. The rare finding of duodenal polyposis not co-occurrent with FAP proves that multiple adenomas in the digestive tube need not necessarily co-occur with FAP.

Zadorova, Zdena; Mandys, Vaclav

2013-01-01

83

Corneal perforation: another side effect of nicorandil.  

PubMed

Abstract Context: Nicorandil is an antianginal drug used for 20 years in Japan and introduced in France in 1994. Since 1997, side effects such as mucocutaneous ulcerations have regularly been reported. Objective: To describe the first case of a patient with a spontaneous corneal perforation associated with mucocutaneous ulcerations while taking Nicorandil. Materials and methods: A 81-year-old patient, with no past history of ocular disease but a long past history of cardiovascular disease, presented with a spontaneous paracentral corneal perforation. This was consecutive to 5 months of recurrent keratoconjunctivitis and mucocutaneous ulcerations resistant to conventional therapy. (He was taking nicorandil for 5 years.) A penetrating keratoplasty was performed in emergency. Results: Inflammatory and infectious causes of spontaneous corneal perforation were ruled out. After initial uneventful post-operative wound healing, an epithelial ulcer appeared on the graft. Dermatologists suggested the iatrogenic role of nicorandil and the drug was discontinued. Both mucocutaneous and corneal ulcerations resolved rapidly. Discussion: Although mucocutaneous ulcerations have been attributed several times to nicorandil, this is, to our knowledge, the first major corneal damage due to this antianginal drug. Timing, pattern of illness, absence of other aetiology, recurrence of epithelial ulceration on the corneal graft and its spontaneous healing after nicorandil discontinuation make it highly apparent probable that nicorandil was directly involved in this corneal perforation. Conclusion: Ophthalmologists and dermatologists should be aware of the risk of severe but reversible corneal ulcerations in patients treated with nicorandil. A pharmacovigilance warning statement should be compulsory. PMID:23845070

Campolmi, Nelly; Guy, Claire; Cinotti, Elisa; Forest, Fabien; Gain, Philippe; Philippe-Zech, Camille; Gauthier, Anne Sophie; Thuret, Gilles

2014-06-01

84

Iatrogenic Cushing's Syndrome Induced by Posaconazole  

PubMed Central

Iatrogenic Cushing's syndrome is an undesirable outcome of glucocorticoids treatment. It can be increased by pharmacologic interactions. Glucocorticoid therapy, given in association with ritonavir, and some azole treatments are causes of iatrogenic Cushing's syndrome. We present a patient with common-variable immunodeficiency who received 7 years of itraconazole therapy for bronchial colonization with Aspergillus in combination with inhaled fluticasone without any Cushingoid symptoms. After a switch to posaconazole, the patient developed Cushingoid symptoms.

Pilmis, Benoit; Jullien, Vincent; Hermine, Olivier; Touraine, Philippe; Lecuit, Marc; Lortholary, Olivier

2013-01-01

85

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

PubMed

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

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

2014-01-01

86

[Our experience with duodenal tumors].  

PubMed

The authors report 3 cases of benign duodenal tumors and one case of duodenal cancer. In two cases the benign tumors were adenomatous polyps, in one case with signs of dysplasia. One case of benign tumor was a lipoma. All the three benign tumors were removed through a duodenotomy, in one case associated with a sphincteroplasty. The case of duodenal cancer, arisen in a patient operated since 24 years with a gastric resection, was treated with a Whipple technique but for the very old age and the bad health conditions, the patient died in 11th post-operative day for myocardium infarct. PMID:11014015

Napolitano, L; D'Aulerio, A; Gargano, E; Angelucci, D

2000-01-01

87

Trends in the incidence of intestinal perforation in US dialysis patients (1992-2005)  

PubMed Central

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

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

2014-01-01

88

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.

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

2013-01-01

89

Iatrogenic’ Wernicke’s Encephalopathy in Japan  

Microsoft Academic Search

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

Elisa Shikata; Tomohiko Mizutani; Yuji Kokubun; Toshiaki Takasu

2000-01-01

90

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.

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

2014-01-01

91

Percutaneous Transhepatic Duodenal Diversion for the Management of Duodenal Fistulae  

Microsoft Academic Search

Purpose  The aim of this study was to determine the success of the nonoperative management of persistent duodenal fistulae (DF) with\\u000a percutaneous transhepatic duodenal diversion (PTDD).\\u000a \\u000a \\u000a \\u000a Methods  Retrospective chart review identified six patients with DF managed by PTDD from 2006 to 2007. Patient outcomes and complications\\u000a were assessed.\\u000a \\u000a \\u000a \\u000a Results  The etiology of DF included pancreatic surgery (three patients), gastrectomy (two patients), and Crohn’s

Jessica G. Zarzour; John D. Christein; Ernesto R. Drelichman; Rachel F. Oser; Mary T. Hawn

2008-01-01

92

Diagnosis of periampullary duodenal diverticula: the value of new imaging techniques  

PubMed Central

Objective The purpose of this study was to evaluate and demonstrate the clinical and imaging features of symptomatic duodenal diverticula presenting as or mimicking acute abdomen. Methods The imaging studies of 10 patients, all presenting with acute abdomen and diagnosed with duodenal diverticula as the possible underlying cause, over a time period of 20 months were retrospectively analyzed. Results Eleven duodenal diverticula were depicted in 8 Multidetector Computed Tomography (MDCT) exams, 2 MRI-MRCP exams and in one intraoperative cholangiography. Acute abdominal symptomatology resulting from duodenal diverticula was as follows: one patient presented with perforation-diverticulitis, two patients with pancreatitis, one patient with acute acalculous cholecystitis, four patients with biliary dilation and two patients with acute postprandial discomfort-pain. The mean maximal diameter of the diverticula examined was 2.67 cm (range 0.96-4.98 cm). Further image analysis of the MDCT exams revealed that both the axial and the coronal plane demonstrated the presence of the diverticula but the depiction of the diverticular neck was demonstrated in five cases in the axial plane and in all cases in the coronal plane. Conclusion Although duodenal diverticula constitute a rare cause of acute abdomen, careful analysis of imaging studies can aid to the identification of this uncommon factor of abdominal symptomatology.

Perdikakis, Evangelos; Chryssou, Evangelia G.; Karantanas, Apostolos

2011-01-01

93

Gastroplasty for Esophageal Perforation after Endoscopic Balloon Dilatation for Achalasia: Two Cases  

PubMed Central

Esophageal perforation after endoscopic forceful pneumatic dilatation for achalasia is a devastating complication and surgical treatment is necessary. A 65-yr-old man and a 54-yr-old woman referred for esophageal perforation two hours after pneumatic dilatation and during the procedure, respectively. Gastroplasties through thoracotomy were performed in both cases and their recoveries were uneventful. The esophagogram with gastrografin on the post-operative 8th day did not show any passage disturbance or leakage at the anastomosis site. On the follow-up endoscopy 4 to 6 months after operation revealed that reflux esophagitis of LA classification A were noted in the both patients. They did not complain any reflux symptom or dysphagia for 9 to 13 months after operation. Instead of the most widely used procedure; primary repair of perforation site, wrapping with intercostal muscle flap and esophagomyotomy, gastroplasty was performed in two cases of iatrogenic esophageal perforation in achalasia and experienced good results.

2014-01-01

94

Gastroplasty for esophageal perforation after endoscopic balloon dilatation for achalasia: two cases.  

PubMed

Esophageal perforation after endoscopic forceful pneumatic dilatation for achalasia is a devastating complication and surgical treatment is necessary. A 65-yr-old man and a 54-yr-old woman referred for esophageal perforation two hours after pneumatic dilatation and during the procedure, respectively. Gastroplasties through thoracotomy were performed in both cases and their recoveries were uneventful. The esophagogram with gastrografin on the post-operative 8th day did not show any passage disturbance or leakage at the anastomosis site. On the follow-up endoscopy 4 to 6 months after operation revealed that reflux esophagitis of LA classification A were noted in the both patients. They did not complain any reflux symptom or dysphagia for 9 to 13 months after operation. Instead of the most widely used procedure; primary repair of perforation site, wrapping with intercostal muscle flap and esophagomyotomy, gastroplasty was performed in two cases of iatrogenic esophageal perforation in achalasia and experienced good results. PMID:24851034

Kim, Hyunjo

2014-05-01

95

Iatrogenic oesophageal transection during laparoscopic sleeve gastrectomy.  

PubMed

Laparoscopic sleeve gastrectomy has been hailed as an easy and safe procedure when compared with other bariatric operations. However, it may be associated with well-recognised early complications such as leaks and bleeding, as well as late ones such as stenosis and weight regain. Iatrogenic complete oesophageal transection has never been reported before as a complication. We report a case of complete oesophageal transection during laparoscopic sleeve gastrectomy that was not recognised intraoperatively. The repair of this iatrogenic injury was staged, with the final stage carried out some 3 months after the initial procedure. This case report highlights the possible occurrence of complete oesophageal transection during laparoscopic sleeve gastrectomy, and suggests steps to avoid and correct such complications. PMID:24591379

Meshikhes, Abdul-Wahed Nasir; Al-Saif, Osama Habib

2014-01-01

96

Cryoballoon ablation for iatrogenic left atrial tachycardia  

PubMed Central

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

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

2012-01-01

97

Spontaneous bladder perforation unrelated to trauma or surgery.  

PubMed

Urinary bladder ruptures (UBR) typically result from either blunt or penetrating trauma, or from iatrogenic surgical injuries. Patients typically present with symptoms including lower abdominal pain, haematuria, dysuria and anuria. Here, we report on a rare case of spontaneous bladder perforation. A 60-year-old, Caucasian woman initially presented with lower abdominal pain and diarrhoea, and was subsequently found to have an elevated serum creatinine level. A CT cystogram revealed a leak from the bladder. The patient consented to exploratory laparotomy and repair of the non-traumatic bladder perforation. At the time of the last follow-up, given the fact that the patient's urodynamics were unremarkable and that she was emptying her bladder well (repeat postvoid residual was zero), the patient was informed that she did not require future urological follow-up unless difficulties arise. PMID:24925535

Cusano, Antonio; Abarzua-Cabezas, Fernando; Meraney, Anoop

2014-01-01

98

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

99

Small bowel and colon perforation.  

PubMed

For patients with small bowel and colonic perforations, a definitive diagnosis of the cause of perforation is not necessary before operation. Bowel obstruction and inflammatory bowel disease are the most common causes of nontraumatic intestinal perforations in industrialized countries, whereas infectious causes of intestinal perforations are more common in developing countries. Treatment of small bowel and colonic perforations generally includes intravenous antibiotics and fluid resuscitation, but the specific management of the bowel depends on the underlying cause of the perforation. PMID:24679432

Brown, Carlos V R

2014-04-01

100

Repair of furcal perforation treated with mineral trioxide aggregate in a primary molar tooth: 20-month follow-up.  

PubMed

Furcal perforations may occur during access opening of the pulp chamber or cavity preparation. The perforation can cause an inflammatory reaction in the periodontal ligament. Management of these iatrogenic accidents can pose a significant clinical challenge, mainly when they occur in primary teeth. Current developments in the techniques and materials utilized for root perforation repair have enhanced this procedure's prognosis. Recently, mineral trioxide aggregate (MTA) has been used for several dental purposes. This biocompatible material promotes bone healing and elimination of clinical symptoms. The purpose of this case report was to describe the treatment of a furcal perforation using mineral trioxide aggregate (MTA) in a primary molar tooth. After 20 months, the tooth was asymptomatic. The radiolucent image had disappeared and bone formation at the furcation area had been observed, suggesting healing of the underlying periodontal tissues. Therefore, MTA may be considered an alternative option for the repair of furcal perforation in primary teeth, prolonging the longevity of these dental elements. PMID:18647517

Oliveira, Thais M; Sakai, Vivien T; Silva, Thiago C; Santos, Carlos F; Machado, Maria Aparecida A M; Abdo, Ruy C C

2008-01-01

101

Simple patch closure for perforated peptic ulcer in children followed by helicobacter pylori eradication.  

PubMed

Objective: Peptic ulcer disease in children is rare. Therefore, the diagnosis can be missed until complications such as perforation or hemorrhage occur. Few reports have investigated the procedures and outcomes of children who have undergone operations for perforated duodenal ulcers. We report our experience with the modified Graham technique for perforated duodenal ulcers in nine children and review the literature. Methods : The records of patients operated on for a perforated duodenal ulcer in the last 8 years in two pediatric surgery centers were evaluated retrospectively. Patient demographics, symptoms, time to admission to hospital, operative findings, and postoperative clinical course were evaluated. Results : Nine children (mean age 13.2 years, range 6-170 years) were included. All patients were admitted in the first six hours after their abdominal pain started. In three patients, there was free air on plain x-rays, while the x-rays were normal in six. All perforations were located on the anterior surface of the first part of the duodenum and repaired with primary suturing and Graham patch omentoplasty. The recovery was uneventful in all patients. In five patients, urea breath tests were performed postoperatively for Helicobacter Pylori, and the results were positive. All patients underwent triple therapy with lansoprazole, amoxicillin, and clarithromycin. The mean follow-up time was 58 (range 3-94) months. Conclusions : Peptic ulcer perforation should be suspected in children who have acute abdominal pain and peritoneal signs, especially when their suffering is intense. The simple patch repair and postoperative triple therapy for Helicobacter Pylori are safe and satisfactory for treating peptic ulcer perforation in children. PMID:24948965

Yildiz, Turan; Ilce, Huri Tilla; Ceran, Canan; Ilce, Zekeriya

2014-05-01

102

Simple Patch Closure for Perforated Peptic Ulcer in Children Followed by Helicobacter Pylori Eradication  

PubMed Central

Objective: Peptic ulcer disease in children is rare. Therefore, the diagnosis can be missed until complications such as perforation or hemorrhage occur. Few reports have investigated the procedures and outcomes of children who have undergone operations for perforated duodenal ulcers. We report our experience with the modified Graham technique for perforated duodenal ulcers in nine children and review the literature. Methods : The records of patients operated on for a perforated duodenal ulcer in the last 8 years in two pediatric surgery centers were evaluated retrospectively. Patient demographics, symptoms, time to admission to hospital, operative findings, and postoperative clinical course were evaluated. Results : Nine children (mean age 13.2 years, range 6–170 years) were included. All patients were admitted in the first six hours after their abdominal pain started. In three patients, there was free air on plain x-rays, while the x-rays were normal in six. All perforations were located on the anterior surface of the first part of the duodenum and repaired with primary suturing and Graham patch omentoplasty. The recovery was uneventful in all patients. In five patients, urea breath tests were performed postoperatively for Helicobacter Pylori, and the results were positive. All patients underwent triple therapy with lansoprazole, amoxicillin, and clarithromycin. The mean follow-up time was 58 (range 3–94) months. Conclusions : Peptic ulcer perforation should be suspected in children who have acute abdominal pain and peritoneal signs, especially when their suffering is intense. The simple patch repair and postoperative triple therapy for Helicobacter Pylori are safe and satisfactory for treating peptic ulcer perforation in children.

Yildiz, Turan; Ilce, Huri Tilla; Ceran, Canan; Ilce, Zekeriya

2014-01-01

103

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.

Secil, Mustafa

2014-01-01

104

Duodenal atresia in dizygotic twins  

Microsoft Academic Search

The authors report duodenal atresia occurring in both members of dizygotic twins who showed no signs of Down's syndrome, and both had normal chromosomal constitutions. They both had the two unlinked end type of atresia in the second portion of the duodenum, and direct end-to-end duodenoduodenostomy was carried out. Their postoperative courses were smooth, and both babies were discharged 32

Takahide Yokoyama; Shinpachi Ishizone; Yoshitaka Momose; Masaru Terada; Shuuichirou Kitahara; Seiji Kawasaki

1997-01-01

105

Perforation Following Colorectal Endoscopy: What Happens Beyond the Endoscopy Suite?  

PubMed Central

Background: The risk factors for perforation from colorectal endoscopy have been well studied, but little is known about clinical outcomes beyond the immediate event. Objective: To evaluate short- and long-term outcomes of iatrogenic colorectal perforation following colorectal endoscopy. Design: Retrospective review over 16 years at a single tertiary care institution. Main Outcome Measures: Treatment interventions, morbidity and mortality rates, hospital length of stay, stoma closure rate, and long-term complications. Results: Of 132,259 colorectal endoscopies, 26 patients (0.02%) had a perforation (54% males; mean age, 67 years). The rectosigmoid colon was the most common site of perforation (65%). Thirty-eight percent of the perforations were recognized at the time of procedure, 31% presented within 24 hours, and 31% presented beyond 24 hours. Operative repair was undertaken in 85% of the patients, and 15% were managed with inpatient hospital observation. Primary repair was performed in 68% (defunctioning stoma in 18%). Mean hospital length of stay was 10.1 days. The overall postoperative complications rate was 55%, and wound complications were noted in 45%. The 30-day mortality rate was 19%. No death was observed beyond the first month. American Society of Anesthesiologists physical status Classes 3 and 4 were associated with mortality (p = 0.004). Of 7 patients who received a stoma, only 2 patients (29%) had stoma reversal. Long-term complications included incisional hernia (10%) and small-bowel obstruction (5%). Conclusions: Perforation following colorectal endoscopy was uncommon in this study but was associated with significant morbidity and mortality. An increased risk of death was noted with higher American Society of Anesthesiologists physical status class.

Tam, Michael S; Abbas, Maher A

2013-01-01

106

Delayed presentation of blunt duodenal injuries in children. Case report and review of literature  

PubMed Central

Summary: Background Duodenal injuries are rare in children and classically present following a fall over the handle bar. Retroperitoneal location of the duodenum may lead to delay in diagnosis, and missed injuries are associated with increased morbidity and mortality. Case report. A 5-year-old child was admitted to the National Trauma Center, in Tirana (Albania), 28 hours after a Motor Vehicle Crash (MVC), complaining of mild abdominal pain. He was febrile (39°C) and had a white blood cells count of 18,000 mm3. On physical exam he had mild tenderness. Plain abdominal X-rays and Focused Abdominal Sonography for Trauma (FAST) were negative for free air or free fluid. The CT scan of the abdomen demonstrated free air and fluid in the retroperitoneal space. At laparatomy, a perforation of the second portion of the duodenum was found. A single layer suture repair of the duodenum with wide drainage was performed. The patient was discharged from the hospital tolerating oral feeding 8 days later. Conclusion Duodenal injuries in children are rare. Most duodenal hematomas are managed non-operatively. This is a case of MCV with delayed presentation that was treated surgically for perforation successfully.

TORBA, M.; GJATA, A.; BUCI, S.; TROCI, A.; SUBASHI, K.

2013-01-01

107

Iatrogenic injuries leading to suspicion of homicide.  

PubMed

Injuries produced as a result of medical intervention may lead to confusion in certain cases during investigation and postmortem examination. Proper documentation of all interventions with the injuries, if produced, is of vital importance. The present case is a rare case where the iatrogenic injuries produced by a medical practitioner during the course of treatment of a case of suicidal hanging resulted in a suspicion being raised as to the nature of death. The suspicion was further strengthened by the lack of proper documentation and inappropriate/improper use of terminology of medicolegal significance. PMID:18761312

Chattopadhyay, Saurabh; Pal, Indranil

2008-10-01

108

Changing patterns in iatrogenic ureteral injuries.  

PubMed

Advances in laparoscopic and endoscopic surgery over the past 25 years have changed the preferred methods for performing many operations. We previously reported an increase in the number of patients treated for ureteral injury at our institution that paralleled the introduction of minimally invasive techniques. Since that report, more advanced endoscopic procedures have been introduced. We sought to determine whether the latter influenced the number of ureteral injuries managed at our institution. Reported here are the results of our retrospective study, which sought to determine if the rate of treatment of major iatrogenic ureteral injuries has changed. PMID:22232566

Romero, Victoriano; Akpinar, Haluk; Smith, John J; Assimos, Dean G

2011-01-01

109

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.

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

110

[Radical operative treatment of perforative gastroduodenal ulcer disease].  

PubMed

Data of 363 patients operated on for perforated gastric or duodenal ulcers were analyzed. Immediate and follow-up results were obtained after simple suture plication, Jadd's ulcer excision combined with stem vagotomy and after distal gastric resection. Predictors of the unfavourable outcome were determined. These are: Mannheim peritonitis index >20, surgical risk of IV-V grade, signs of multiple organ failure and symptomatic character of the ulcer. The comparison of long-term results revealed that patients after suture plication experienced the ulcer recurrence in 78,4% and necessity of further operation occurred in 21,5%. Every third patient after stem vagotomy experienced postvagotomic disorders and ulcer recurrence. Primary gastric resection demonstrated the best long-term results concerning ulcer disease. The algorithm of treatment modalities of the perforative ulcer desease was worked. The algorithm is based on stage-by stage determination of indications and contraindications to gastric resection. PMID:19365375

Gostishchev, V K; Evseev, M A; Golovin, R A

2009-01-01

111

Respiratory distress and chest pain: a perforated peptic ulcer with an unusual presentation  

PubMed Central

Background Dyspnea and chest pain are common presenting complaints to the ED, and coupled together can present a challenging diagnostic dilemma in patients in extremis. A thoughtful evaluation is required, giving due diligence to the immediate life threats as well as multiple etiologies which can cause serious morbidity. A perforated peptic ulcer is one such possibility and requires rapid diagnosis and prompt intervention to avoid the associated high risk of morbidity and mortality. Method We present a case report of a 54 year old man with respiratory distress and chest pain as the initial Emergency Department presentation of a perforated duodenal ulcer. Results We discuss an unusual presentation of a perforated duodenal ulcer that was recognized in the emergency department and treated promptly. The patient was surgically treated immediately, had a prolonged and complicated post-operative course, but is ultimately doing well. We also provide a brief literature review of the risk factors, imaging choices, and management decision required to treat a perforated ulcer. Conclusions Perforated ulcers can have highly varied presentations and are occasionally difficult to diagnose in a complicated patient. Knowledge of the risk factors and a thorough history and physical can point to the diagnosis, but timely and appropriate imaging is often required because delays in diagnosis and treatment lead to poor outcomes. Early administration of antibiotics and immediate surgical repair are necessary to limit morbidity and mortality.

2011-01-01

112

A 4-week, multicenter, duodenal ulcer healing trial comparing four escalating doses of ranitidine.  

PubMed

In a randomized double-blind 4-wk trial, ranitidine doses of 300 mg at bedtime (hs), twice daily (bid), three times daily (tid), and four times daily (qid) were compared in 629 patients with endoscopically confirmed duodenal ulcer(s). Endoscopies were performed at baseline and after 4 wk of therapy. Per protocol analysis revealed wk 4 healing rates that were significantly increased (p < or = 0.001) for the bid, tid, and qid groups, compared with the hs group. All treatments provided early symptomatic (ulcer pain) relief. No significant differences in adverse events or laboratory abnormalities were observed between groups. Ranitidine 300 mg bid provides an alternative therapeutic approach for patient populations at risk for ulcer complications. These patients include those with the following: a past history of an upper gastrointestinal hemorrhage, perforation, obstruction, penetration, or giant (> 2.0 cm) duodenal ulcer. The elderly and those with chronic unresponsive ulcerations may also be included in this population. PMID:8424425

Euler, A R; Wood, D R; Sykes, R S

1993-02-01

113

Left pneumothorax secondary to colonoscopic perforation of the sigmoid colon: a case report.  

PubMed

We present here the case of a 75-year-old woman who complained of acute abdominal pain after a diagnostic colonoscopy. Abdominal x-rays demonstrated pneumoperitoneum, whereas chest x-rays showed pneumomediastinum and left pneumothorax. A chest drain was placed and subsequently an exploratory laparoscopy was performed, during which air was found in the subserosa of the sigmoid colon and in the mesosigmoid secondary to perforation of a sigmoid diverticulum. The perforation was repaired and a protective loop colostomy was fashioned. The patient was discharged 8 days postoperatively in a good general condition. Although numerous cases of pneumoretroperitoneum and pneumomediastinum secondary to iatrogenic perforation of the colon have been described, reports of pneumothorax are much rarer. We, therefore, discuss the anatomic bases and the possible physiopathologic mechanisms responsible for this clinical complication. PMID:17318062

Lovisetto, Federico; Zonta, Sandro; Rota, Emanuela; Mazzilli, Massimiliano; Faillace, Giuseppe; Bianca, Alessandro; Fantini, Alessio; Longoni, Mauro

2007-02-01

114

Duodenal ferritin synthesis in genetic hemochromatosis  

Microsoft Academic Search

Background\\/Aims: The molecular defect of genetic hemochromatosis (GH) is unknown. It is believed that low expression of duodenal ferritin in GH is caused by tissue or cell specific defect of ferritin synthesis. Our study was designed to ascertain whether the control of duodenal ferritin synthesis in GH was defective. Methods: Expression at the single cell level of H and L

Antonello Pietrangelo; Giovanna Casalgrandi; Daniela Quaglino; Rossana Gualdi; Dario Conte; Stefano Milani; Giuliana Montosi; Lucia Cesarini; Ezio Ventura; Gaetano Cairo

1995-01-01

115

Continuous duodenal infusions of levodopa.  

PubMed

Infusion of carbidopa/levodopa or levodopa through a duodenal tube can facilitate increased mobility and functional ability in individuals with Parkinson's disease when conventional drug therapy is unsuccessful in achieving desired outcomes. Therapy requires appropriate patient selection, ongoing assessment of the patient's physical and emotional needs and collaboration between the patient, nurses and physicians. Determining the amount of medication required to achieve the desired outcomes takes time. Implantable pumps may be a future strategy. Future research should focus on patient and family coping throughout hospitalization and at home so the emotional needs of this specific population can be met. PMID:8270813

Fowler, S B; Bergen, M

1993-10-01

116

A conservative surgical approach for management of iatrogenic pulmonary artery perforation.  

PubMed

Accidental malposition of a chest tube in the pulmonary artery is a potentially fatal complication. Here we describe a 66 year-old obese woman with prior cardiac transplantation, intubated for respiratory failure and felt to have a large left pleural effusion. A chest tube was inserted using a trocar tube, and resulted in near-exsanguinating hemorrhage immediately, with development of hypovolemic shock. Prompt clamping of the tube proved life-saving, and CT scan confirmed placement of the tube in the main pulmonary artery. Initial stabilization, followed by a planned surgical approach, resulted in successful removal of the tube. PMID:23188958

Biswas, Monodeep; Boruah, Pranjal Kumar; Koch, Lear Von

2012-07-01

117

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

118

Iatrogenic left main artery dissection: A catastrophic complication.  

PubMed

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

119

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.

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

120

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.

Matsumoto, Satohiro; Yoshida, Yukio

2014-01-01

121

Bleeding renal angiomyolipoma presenting as duodenal obstruction.  

PubMed

We report a case of a 60-year-old woman who had a delayed presentation of duodenal obstruction as a result of a bleeding right renal angiomyolipoma (AML) with retroperitoneal hematoma. Her duodenal obstruction did not improve upon conservative management, and a computed tomography (CT)-guided drainage of the retroperitoneal hematoma was subsequently performed. Post-intervention, CT scan confirmed hematoma resolution, and she was able to resume normal diet afterwards. We present this first reported case of a bleeding renal AML with retroperitoneal hematoma causing duodenal obstruction and discuss on the management of such condition. PMID:23775707

Teoh, Jeremy Yuen Chun; Chan, Ning Hong; Cheung, Ho Yuen; Hou, Simon See Ming; Ng, Chi-Fai

2013-08-01

122

Duodenal carcinoid tumor - a case report.  

PubMed

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

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

2014-01-01

123

Massive dissecting intramural duodenal haematoma following endoscopic haemostasis of a bleeding duodenal ulcer.  

PubMed

Intramural duodenal haematoma is a rare injury of the duodenum. Most reported cases are secondary to blunt trauma to the abdomen. Such injury following endoscopic intervention is even rarer, and there are no definite guidelines for its management. We report a case where endoscopic haemostasis of a bleeding duodenal ulcer resulted in a massive dissecting intramural duodenal haematoma with gastric outlet obstruction and obstructive jaundice. PMID:16644511

Lukman, Mohd Rashid; Jasmi, Ali Yaakub; Niza, S Shahrun

2006-04-01

124

Laparoscopic duodenoduodenostomy for duodenal atresia.  

PubMed

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

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

2001-02-01

125

Prevention and management of iatrogenic flatback deformity.  

PubMed

The most common cause of iatrogenic flatback syndrome is Harrington distraction instrumentation extending into the lower lumbar spine. Other common causes and exacerbating factors include failure to enhance regional lordosis during lumbar fusion for degenerative spondylosis, development of pseudarthrosis or postoperative loss of correction, development of kyphosis at the thoracolumbar junction, development of degeneration and decompensation cephalad or caudad to a prior fusion, and hip flexion contractures. Prevention of flatback syndrome involves preoperative assessment of sagittal balance, avoidance of distraction instrumentation and extension of long fusions into the lower lumbar spine, enhancement of physiologic lordosis during lumbar fusions, and intraoperative positioning with the hips extended. Treatment of flatback syndrome involves corrective pedicle subtraction or Smith-Petersen osteotomies with segmental instrumentation. Polysegmental osteotomies and vertebral column resection may be utilized in cases of sloping global sagittal imbalance and related severe coronal imbalance, respectively. Following surgical treatment, sagittal balance is generally improved with fair-to-good clinical outcomes, high patient satisfaction, and moderately high perioperative complication rates. PMID:15292431

Potter, Benjamin K; Lenke, Lawrence G; Kuklo, Timothy R

2004-08-01

126

Understanding placebo, nocebo, and iatrogenic treatment effects.  

PubMed

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

Bootzin, Richard R; Bailey, Elaine T

2005-07-01

127

Iatrogenic Intradural Lumbosacral Cyst Following Epiduroscopy  

PubMed Central

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

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

2012-01-01

128

Iatrogenic causes of salivary gland dysfunction.  

PubMed

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). PMID:3305644

Schubert, M M; Izutsu, K T

1987-02-01

129

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

130

Endoscopic Treatment of Duodenal Neuroendocrine Tumors  

PubMed Central

Duodenal neuroendocrine tumors (NETs) are rare neoplasms. In this study, the medical records of 14 patients with duodenal NETs diagnosed at Chonnam National University Hospital from July 2001 to August 2011 were reviewed and analyzed retrospectively. Four patients were diagnosed in the first 5 years, and 10 patients were diagnosed in the latter 5 years of the study. Ten of 12 patients (83.3%) who underwent endoscopic biopsy were confirmed to have NET before resection. Endoscopic resection was performed in 12 patients, surgical resection in one patient, and regular follow-up in one patient who refused resection. None of the patients showed recurrence or distant metastasis. Duodenal NETs are increasingly observed and are mostly detected during screening upper gastrointestinal endoscopy. Careful endoscopic examination and biopsy can improve the diagnostic yield of NETs. Most well-differentiated, nonfunctional duodenal NETs that are limited to the mucosa/submucosa can be treated effectively with endoscopic resection.

Kim, Sang Ho; Ki, Ho Seok; Jun, Chung Hwan; Park, Seon Young; Kim, Hyun Soo; Choi, Sung Kyu; Rew, Jong Sun

2013-01-01

131

Review of Duodenal and Gastric Ulcer.  

National Technical Information Service (NTIS)

Duodenal and gastric ulcer are chronic often recurring conditions that in the past were grouped together as peptic ulcer. Many diverse environmental and genetic factors, which create an imbalance between secretion of acid and pepsin by by the stomach and ...

F. C. Garland E. D. Gorham

1985-01-01

132

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

133

Inter-relationship between Gasterophilus larvae and the horse's gastric and duodenal wall with special reference to penetration.  

PubMed

The degree of penetration into the stomach and duodenum of the horse by bot fly larvae, Gasterophilus intestinalis (De Geer) and G. nasalis (Linnaeus) (Diptera : Gasterophilidae) was evaluated. Evidence of larval perforation of the stomach or duodenum was not found on gross inspection. Palpation of the intact stomach and duodenum was not effective in establishing the existence of Gasterophilus larvae within the organs. Findings suggest that larvae of both species produce an ulcer of similar depth within the gastrointestinal wall. The ulcer depth produced by larvae did not correlate with the normal, unaffected thickness of the particular stomach or duodenum. Tissue proliferation beneath ulcers of the stomach and duodenum was not correlated with the depth of the ulcer. Proliferation of the tissue beneath the ulcers of the stomach generally exceeded that found under duodenal ulcers. Gastric wall beneath the G. intestinalis ulcer frequently attained a thickness equal to or greater than the normal stomach wall. Histopathological examinations below the ulcer revealed intense fibrosis. Duodenal thickness below the G. nasalis ulcer was typically less than normal and resulted in an attenuated wall. Histopathological analysis of the affected duodenum revealed severe loss of submucosal glands in a sharply demarcated area below and surrounding the lesion. Fibrosis of the underlying lamina propria mucosae and tunica submucosa was appreciable but failed to restore the original thickness of the duodenal wall. Host tissue response and moderation of the parasite' s behavior reduce the chances of direct perforation of the gastrointestinal tissue. PMID:10496697

Cogley, T P; Cogley, M C

1999-09-30

134

Typhoid intestinal perforation: 24 perforations in one patient.  

PubMed

Intestine perforation is one of the most dreaded and common complication of typhoid fever remarkably so in developing world; it usually leads to diffuse peritonitis, requiring early surgical intervention. Despite various measures such as safe drinking water supply and safe disposal of waste, intestinal perforation from salmonellosis remains the most common emergency surgery performed. The incidence continues to rise, so also the mortality, despite new antibiotics and improvement in surgical technique. More disturbing is that we now see increasing number of ileal perforations and colonic involvement. We hereby present a case report of 35-year-old male with multiple (24) intestinal perforation in the Ileum and Cecum. PMID:24349848

Sharma, Ak; Sharma, Rk; Sharma, Sk; Sharma, A; Soni, D

2013-11-01

135

Typhoid Intestinal Perforation: 24 Perforations in One Patient  

PubMed Central

Intestine perforation is one of the most dreaded and common complication of typhoid fever remarkably so in developing world; it usually leads to diffuse peritonitis, requiring early surgical intervention. Despite various measures such as safe drinking water supply and safe disposal of waste, intestinal perforation from salmonellosis remains the most common emergency surgery performed. The incidence continues to rise, so also the mortality, despite new antibiotics and improvement in surgical technique. More disturbing is that we now see increasing number of ileal perforations and colonic involvement. We hereby present a case report of 35-year-old male with multiple (24) intestinal perforation in the Ileum and Cecum.

Sharma, AK; Sharma, RK; Sharma, SK; Sharma, A; Soni, D

2013-01-01

136

Pre duodenal portal vein as a cause of duodenal obstruction in an adult.  

PubMed

Pre duodenal portal vein (PDPV) has not been reported as a cause of duodenal obstruction in adults. We describe a 60 year old man who presented with symptoms of gastric outlet obstruction caused by PDPV, and was diagnosed at laparotomy and treated by gastrojejunostomy. PMID:15550110

John, Ajo K; Gur, Ufuk; Aluwihare, Arjuna; Cade, David

2004-11-01

137

Rapidly developing iatrogenic hyponatremia in a child following tonsillectomy.  

PubMed

Hyponatremia develops as a result of the inappropriate secretion of antidiuretic hormone. In rare cases, it develops as an iatrogenic complication. For example, acute iatrogenic post-tonsillectomy hyponatremia has been described in children following the infusion of hypo- or isotonic fluid. We report a case of rapidly developing post-tonsillectomy iatrogenic hyponatremia in a 5-year-old girl following an excessive infusion of hypotonic fluid. Her signs and symptoms began with nausea and vomiting and progressed to seizures and coma. We corrected the electrolyte disturbance by infusing a 3% sodium chloride solution until her neurologic manifestations disappeared, at which time her serum sodium concentration had risen back to 135 mEq/L. Otolaryngologists are not generally exposed to much information about hyponatremia, so we must be aware of its associated neurologic signs and symptoms. PMID:23288795

Taskin, Umit; Binay, Omer; Binay, Cigdem; Yigit, Ozgur

2012-11-01

138

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

PubMed Central

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

Gomercic Palcic, Marija; Ljubicic, Neven

2013-01-01

139

Duodenal duplication in the adult: its relationship with pancreatitis.  

PubMed

Seven cases of duodenal duplication in the adult are reported. The ultrasound and computed tomographic findings are analyzed. The relationship between duodenal duplication and pancreatitis is discussed. PMID:3049208

Procacci, C; Portuese, A; Fugazzola, C; Pederzoli, P; Caudana, R; Gallo, E; Bergamo Andreis, I A; Spiller, M; Zonta, L; Graziani, R

1988-10-01

140

Oil well perforators  

US Patent & Trademark Office Database

An oil and gas well shaped charge perforator capable of providing an exothermic reaction after detonation is provided, comprising a housing, a high explosive, and a reactive liner where the high explosive is positioned between the reactive liner and the housing. The reactive liner is produced from a composition which is capable of sustaining an exothermic reaction during the formation of the cutting jet. The composition may be selected from any known formulation which is suitable for use in an oil and gas well perforator, typically the composition will comprise at least one metal and at least one non-metal, wherein the non-metal is selected from a metal oxide, or any non-metal from Group III or Group IV or at least two metals such as to form an intermetallic reaction. Typically at least one of the metals in the invention may be selected from Al, Ce, Li, Mg, Mo, Ni, Nb, Pb, Pd, Ta, Ti, Zn or Zr. The liner composition may preferably be a pressed particulate composition, such that the material is consolidated under pressure to form the desired shape of the liner. To aid consolidation a binder may also be added.

2012-07-17

141

Helicobacter pylori infection induces duodenitis and superficial duodenal ulcer in Mongolian gerbils  

PubMed Central

Background: There is no direct evidence for an animal model of Helicobacter pylori induced duodenal ulcer. Aim: In this study we evaluated the roles of bacterial strain and age of experimental animals in induction of duodenitis and duodenal ulcer in Mongolian gerbils after H pylori infection. Methods: Specific pathogen free Mongolian gerbils were inoculated orally with three bacterial strains (H pylori ATCC 43504, TN2GF4, and K-6, a clinical isolate from a patient with gastric cancer in our clinic). These strains have both the cagA gene and VacA. Five week old gerbils were used to emulate prematurity infection and 14 week old animals were used as mature test subjects. Animals were observed for 12 weeks after inoculation. Interleukin 8 (IL-8) production in gastric epithelial cells (MKN74) after coculture with the H pylori strains was measured by ELISA. Results: Gastritis and gastric ulcers were found in all gerbils infected with the three strains. However, duodenitis and gastric metaplasia were seen more frequently in gerbils infected with TN2GF4 and K-6 strains than in the ATCC 43504 infected or control groups (p<0.05). Superficial duodenal ulcers with severe duodenitis and gastric metaplasia were found in two gerbils inoculated at 14 weeks with the TN2GF4 strain but none at five weeks. The TN2GF4 strain stimulated significantly higher levels of IL-8 than ATCC 43504 and K6 strains (p=0.0039). Conclusions: When injected into adult Mongolian gerbils, a specific strain (TN2GF4) of H pylori can induce duodenitis with gastric metaplasia and superficial duodenal ulcers. Induction of duodenal ulcer in an animal model fulfills the requirements of Koch’s postulates for establishing a role for H pylori as a causative agent.

Ohkusa, T; Okayasu, I; Miwa, H; Ohtaka, K; Endo, S; Sato, N

2003-01-01

142

Perforated midgut diverticulitis: Revisited  

PubMed Central

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

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

2012-01-01

143

Glove perforation during plastic surgery.  

PubMed

Intraoperative perforation of surgical gloves is common. Nine hundred and forty surgical gloves were tested after 100 consecutive plastic surgical operations, each involving a surgeon, a variable number of assistants and a scrub nurse. In the first 52 operations, single gloves were used and 21.5% of the staff were found to have a perforated glove. In the second 48 operations, double gloves were used by all members of the surgical team and the number with perforations (of both inner and outer gloves) was reduced to 9%. Most perforations occurred on the dorsum of the hand and fingers and on the thumb tip, especially in the non-dominant hand. The risk of acquiring AIDS due to glove perforation is low but the consequences of such an event could be lethal. PMID:2765743

Cole, R P; Gault, D T

1989-07-01

144

Duodenal rupture following trauma in a child.  

PubMed

We present a case of delayed presentation of a traumatic duodenal rupture in a 15-year-old boy. He presented 12 hours after falling six feet and sustaining blunt trauma to his anterior abdominal wall. On arrival in the Emergency Department he was shocked and peritonitic. After initial resuscitation he was stable and transferred to computed tomography where free retroperitoneal air and duodenal rupture was found. He was transferred to theatre where he underwent laparotomy and successful repair of the rupture. He made an uneventful recovery and was discharged nine days later. Duodenal rupture is a rare but serious complication of blunt abdominal trauma. Diagnosis is difficult but missed diagnosis and delayed presentation is associated with high morbidity and mortality. A high index for suspicion must be kept when dealing with blunt abdominal trauma to ensure this is not missed. PMID:21680305

McWhirter, Derek

2011-05-01

145

Duodenal bacterial overgrowth during treatment in outpatients with omeprazole  

Microsoft Academic Search

The extent of duodenal bacterial overgrowth during the pronounced inhibition of acid secretion that occurs with omeprazole treatment is unknown. The bacterial content of duodenal juice of patients treated with omeprazole was therefore examined in a controlled prospective study. Duodenal juice was obtained under sterile conditions during diagnostic upper endoscopy. Aspirates were plated quantitatively for anaerobic and aerobic organisms. Twenty

M Fried; H Siegrist; R Frei; F Froehlich; P Duroux; J Thorens; A Blum; J Bille; J J Gonvers; K Gyr

1994-01-01

146

[Perforation associated with colorectal cancer].  

PubMed

We studied 13 patients who underwent surgery for perforation associated with colorectal cancer in our institute. In 10 cases, the location of primary cancer was the rectum or the sigmoid colon. Five patients had perforation at the tumor itself, and 7 proximal to the obstructive tumor. The perforation proximal to the tumor was in a location that caused obstructive colitis in 4 cases, the diverticulum in 2 cases, and a location of unknown cause in 1 case. In all of the cases of perforation at the tumor there was locally advanced cancer that had invaded other organs or had peritoneal dissemination. In 1 case where perforation had caused obstructive colitis, the primary tumor was in the sigmoid colon, whilst the perforation was in the cecum. Twelve patients had resection of primary tumor and the perforated site, and one had palliative ileostomy. Five patients had stage II cancer, 3 stage IIIa, 1 stage IIIb, and 4 stage IV. Mortality at 30 days was 15.4% (n=2). Of those who survived more than 30 days, 9(81.8%) had curative resection. Of these 9 cases, 2(22.2%) died of cancer, 1 died as a result of re-perforation and 1 died from another cause. Six patients survived for more than 2 years, 3 of which had recurrence, and 2 survived without recurrence. Our surgical plan for perforated colorectal cancer is to remove the perforation site and the cancer itself. In conclusion, long-term survival required both aggressive management of the sepsis focus and definitive oncologic surgery. PMID:23267926

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

2012-11-01

147

Non-iatrogenic pathology of the preterm infant  

Microsoft Academic Search

Non-iatrogenic anatomical findings at autopsy provide insight into preterm infant physiology. The different patterns of lipid accumulation in the adrenal may correspond to long-term differences in stress response. Cardiac papillary muscle infarction occurs with asphyxia or shock and can explain myocardial dysfunction. Underdevelopment of preterm kidneys may correlate with susceptibility to renal disease and hypertension in adult life. Immaturity of

Robert W Bendon; Susan Coventry

2004-01-01

148

Iatrogenic skin injury in the neonatal intensive care unit.  

PubMed

Although neonatal care has become more and more meticulous with significant changes in technology in the neonatal intensive care unit (NICU) in the past 50 years, iatrogenic cutaneous injuries continue to occur. Although the incidence of severe injuries is decreasing because the more difficult procedures are being replaced by improved techniques, skin injuries have not yet been completely eliminated. However, the nature and causes of cutaneous injuries have changed, and the injuries are frequent but generally minor. The major risk factors are low birth weight, gestational age, length of stay, a central venous line, mechanical ventilation, and support with continuous positive airway pressure. The rate of iatrogenic events is about 57% at gestational ages of 24-27 weeks, compared with 3% at term. There are no current comprehensive reviews of iatrogenic cutaneous injury. The purpose of this review is to describe the iatrogenic cutaneous injuries that may occur in the newborns as a consequence of perinatal and postnatal medical procedures. With increased survival of extremely-low-birth-weight (ELBW) infants and changing modes of management in the NICU, neonatologists must make every effort to recognize injuries and prevent their occurrence in the NICU. PMID:20540679

Sardesai, Smeeta R; Kornacka, Maria K; Walas, Wojciech; Ramanathan, Rangasamy

2011-02-01

149

Iatrogenic tooth abrasion comparisons among composite materials and finishing techniques  

Microsoft Academic Search

Statement of Problem. Many different rotary instruments are available for shaping composite restorations. Whether use of these instruments causes undesirable iatrogenic abrasion of either the tooth surface or the composite restorative material is unknown. Assuming that damage occurs, which technique is least damaging is unknown. Purpose. This in vitro study quantified the loss of surface enamel and dentin surrounding Class

Christina A. Mitchell; Maria R. Pintado; William H. Douglas

2002-01-01

150

Iatrogenous superficial femoral artery pseudoaneurysm: treatment with a PFNA nail  

Microsoft Academic Search

IntroductionIatrogenic lesions of the superficial femoral artery are a severe but infrequent complication. The internal rotation and adduction of the affected limb during fracture reduction may cause the overdrilling of the locking mechanism of the intramedullary nail to damage the arterial endothelium.

F. E. Navarrete; J. L. Longares

2009-01-01

151

Iatrogenic Retinal Breaks in 25-gauge Macular Surgery  

Microsoft Academic Search

PURPOSE: To describe the incidence and characteristics of iatrogenic retinal breaks in 25-gauge macular surgery. DESIGN: Retrospective, noncomparative, interventional case series. METHODS: We included 177 consecutive operations in 171 patients who underwent 25,gauge vitrectomy for idiopathic macular pucker or idiopathic macular hole. Main outcome measures were the incidence of breaks related to the sclerotomies, the incidence of breaks occurring elsewhere,

H. Stevie Tan; Marco Mura; Marc D. de Smet

2009-01-01

152

Iatrogenic Sciatic Nerve Palsy Following Hemiarthroplasty of the Hip  

Microsoft Academic Search

We report a rare complication following insertion of an uncemented hip prosthesis that resulted in posterior perforation of\\u000a the femoral stem and a sciatic nerve palsy. To our knowledge, sciatic nerve palsy due to the femoral stem perforating the\\u000a cortex has not been previously described.

Toby J. Colegate-Stone; Saj Hussain

2008-01-01

153

Spontaneous Perforation of Pyometra  

PubMed Central

Pyometra is the accumulation of purulent material in the uterine cavity. Its reported incidence is 0.01?0.5% in gynecologic patients; however, as far as elderly patients are concerned, its incidence is 13.6% [3]. The most common cause of pyometra is malignant diseases of genital tract and the consequences of their treatment (radiotherapy). Other causes are benign tumors like leiomyoma, endometrial polyps, senile cervicitis, cervical occlusion after surgery, puerperal infections, and congenital cervical anomalies. Spontaneous rupture of the uterus is an extremely rare complication of pyometra. To our knowledge, only 21 cases of spontaneous perforation of pyometra have been reported in English literature since 1980. This paper reports an additional case of spontaneous uterine rupture.

Yildizhan, Begum; Uyar, Esra; Sismanoglu, Alper; Gulluoglu, Gulfem; Kavak, Zehra N.

2006-01-01

154

Perforated Muffler Manifold Catalyst  

NASA Astrophysics Data System (ADS)

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

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

1998-12-01

155

Esophageal perforation: diagnostic work-up and clinical decision-making in the first 24 hours  

PubMed Central

Esophageal perforation is a rare and potentially life-threatening condition. Early clinical suspicion and imaging is important for case management to achieve a good outcome. However, recent studies continue to report high morbidity and mortality greater than 20% from esophageal perforation. At least half of the perforations are iatrogenic, mostly related to endoscopic instrumentation used in the upper gastrointestinal tract, while about a third are spontaneous perforations. Surgical treatment remains an important option for many patients, but a non-operative approach, with or without use of an endoscopic stent or placement of internal or external drains, should be considered when the clinical situation allows for a less invasive approach. The rarity of this emergency makes it difficult for a physician to obtain extensive individual clinical experience; it is also challenging to obtain firm scientific evidence that informs patient management and clinical decision-making. Improved attention to non-specific symptoms and signs and early diagnosis based on imaging may translate into better outcomes for this group of patients, many of whom are elderly with significant comorbidity.

2011-01-01

156

Rare case of ileal perforation.  

PubMed

Ileitis, or inflammation of the ileum, is often caused by Crohn's disease. However, ileitis may be caused by a wide variety of other diseases. These include infectious diseases, spondyloarthropathies, vasculitides, ischemia, neoplasms, medication-induced, eosinophilic enteritis, and others. Eosinophilic enteritis can present as abdominal pain, protein loosing enteropathy, ulcers, intestinal obstruction, intussusception and perforation.Bowel perforation is an uncommon presentation of eosinophilic enteritis. We report a rare case of ileal perforation due to eosinophilic enteritis in a 57 years old female. PMID:23998095

Kumar B, Vinod; Martis, John Joseph S; Mathias, Sheldon G; Kamath, Priyatham; Shetty, Vivek

2013-07-01

157

Duodenal PEComa: A review of literature  

Microsoft Academic Search

Perivascular Epitheliod cell tumours (PEComas) are rare mesenchymal tumours characterised by co-expression of melanocytic and myocytic markers. These tumours rarely occur in the gastrointestinal tract. The authors present a case of duodenal PEComa in a 34-year-old man.

Srikanth Narayanaswamy; Nanda Venkatanarasimha; David Buckley; Mark Puckett

2008-01-01

158

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

PubMed Central

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

Maclean, William; Szentpali, Karoly

2013-01-01

159

Iatrogenic Effects of Group Treatment for Antisocial Youth  

PubMed Central

It has been argued that group treatment of antisocial adolescents may increase rather than decrease conduct problems. One mechanism that has been suggested to underlie this effect is “deviancy training” wherein during group sessions deviant peers reinforce each other’s antisocial actions and words. These two hypotheses have important implications, and warrant close review at conceptual and empirical levels. In this paper we present such a review. Conceptually, deviancy training potential of treatment sessions appears less significant than the more extensive peer influences outside treatment. Empirical findings previously cited in support of iatrogenic effects appear on close examination to provide little support. Finally, seventeen of eighteen new meta-analytic tests produced results not supportive of iatrogenic or deviancy training effects.

Weiss, Bahr; Caron, Annalise; Ball, Shelly; Tapp, Julie; Johnson, Margaret; Weisz, John R.

2014-01-01

160

Iatrogenic Cushing's syndrome with inhaled steroid plus antidepressant drugs  

PubMed Central

Current guidelines recommend the use of inhaled corticosteroids (ICS) for suppression of airway inflammation in patients with asthma. Although it is well known that ICS cause dose-related adrenocortical suppression, it is less known that they can lead to iatrogenic Cushing’s syndrome (CS). Fluticasone propionate (FP) is an ICS more potent than beclomethasone and budesonide. FP is metabolized as mediated by cytochrome P450 3A4 in the liver and the gut. Systemic bioactivity of FP can increase with the use of drugs that affect the cytochrome P450. Herein, we report the rapid development of iatrogenic CS in a patient receiving paroxetine and mirtazepine for 12 weeks in addition to inhaled FP.

2012-01-01

161

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

PubMed

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

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

2014-06-01

162

Role of Meteorological Factors in Duodenal Ulcer Seasonality  

PubMed Central

BACKGROUND Understanding disease seasonality can provide guidance for future biomedical research. OBJECTIVE To examine whether meteorological factors and calendar months impact duodenal ulcer (DU) exacerbations. DESIGN We conducted a retrospective time series analysis of population-based claims data. PARTICIPANTS DU inpatients (1997–2003; all endoscopy confirmed) from Taiwan, a small island nation, n?=?160,510. Inpatient admission was used as a proxy for exacerbation because 98.5% of cases had hemorrhage or perforation or both. MEASUREMENTS We used multivariate autoregressive integrated moving average (ARIMA) modeling to examine if DU admissions/100,000 was associated with calendar month, ambient temperature, relative humidity, rainfall, atmospheric pressure, and sunshine hours, controlling for available DU-relevant comorbidities. RESULTS DU admissions increased with age. ARIMA modeling showed a February (Chinese New Year-related) trough in all age groups (all p?

Xirasagar, Sudha; Chen, Chin-Shyan

2007-01-01

163

Non-iatrogenic pneumomediastinum in infancy and childhood  

Microsoft Academic Search

This report reviews forty-one cases of non-iatrogenic pneumomediastinum in children beyond the neonatal period. In about one-third of the children, the adventitious air was associated with asthma. Respiratory infection, unrelated to asthma, was found to be of significance in about one-fourth of the remaining patients. Another twenty-five percent of the patients had a history of recent injury, which in the

William J. Mc Sweeney; David A. Stempel

1973-01-01

164

Extensive Bilateral Intracranial Calcifications: A Case of Iatrogenic Hypoparathyroidism  

PubMed Central

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

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

2013-01-01

165

Iatrogenic Stenosis of Anterior Nares: A Case Report  

PubMed Central

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

Garag, Santosh S.; Anchan, Shibani

2014-01-01

166

Treatment of iatrogenic choriovitreal neovascularisation in sickle cell disease.  

PubMed Central

The effect of scatter photocoagulation on the perfusion of iatrogenic choriovitreal neovascularisation (CVN) has been assessed by a randomised trial in 35 CVN lesions in 18 eyes with proliferative sickle retinopathy. No difference in size or vascularity of CVN lesions was apparent between the nine treated and nine control eyes over a median follow-up of 42 months. Scatter photocoagulation by the stated protocol was not effective in the treatment of CVN. Images

Acheson, R W; Fox, P D; Chuang, E L; Serjeant, G R

1991-01-01

167

Iatrogenic risks and maternal health: Issues and outcomes.  

PubMed

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

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

2014-01-01

168

An autopsy case of iatrogenic tracheoesophageal fistula secondary to tracheostomy.  

PubMed

Tracheoesophageal fistula (TEF) is an uncommon but life-threatening sequel of prolonged use of a cuffed tracheostomy tube. We describe a patient who developed a TEF after a tracheostomy done for management of head injury due to a road traffic mishap. The patient subsequently died of sepsis after bilateral bronchopneumonia. To the best of our knowledge, this is the first autopsy case of iatrogenic TEF after tracheal intubation reported in forensic literature. PMID:24781407

Menezes, Ritesh G; Pant, Sadip; Prasad, Sampath Chandra; Rao Padubidri, Jagadish; Prabhu, Prashanth; Monteiro, Francis N P; Kanchan, Tanuj; Yallapur Prahalad, Raghavendra Babu; Bhagavath, Prashantha; Sathyanarayan Achar, Manjunath; Lasrado, Savita

2014-06-01

169

Early surgical management for periampullary retroperitoneal perforation caused by endoscopic sphincterotomy: report of a case.  

PubMed

A 67-year-old woman was admitted to our hospital for surgical management of cancer of the ascending colon. On admission, she had cholangitis due to choledocholithiasis. Abdominal computed tomography, ultrasonography, and magnetic resonance showed cholelithiasis, choledocholithiasis, and multiple liver tumors. Colonoscope showed advanced cancer of the ascending colon. Because of acute obstructive suppurative cholangitis, endoscopic sphincterotomy was performed. During the procedure, periampullary retroperitoneal perforation was identified on radiologic examination. Because computed tomography had shown extravasation of contrast medium and widespread pneumoretroperitoneum, an emergency operation was performed 2 hours after perforation. After cholecystectomy and choledocholithotomy had been performed and all bile duct stones had been removed, periampullary perforation was readily identified close to the duodenal diverticula and easily repaired. The postoperative course was uneventful. This patient could resume oral feeding soon after the operation, and colonic surgery could be performed immediately thereafter. Therefore, early surgical management is a possible first choice of treatment in patients with remaining biliary disease after periampullary perforation. PMID:19023171

Aimoto, Takayuki; Uchida, Eiji; Fujita, Itsuo; Nakamura, Yoshiharu; Tsuyuguchi, Toshio; Tajiri, Takashi

2008-10-01

170

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

PubMed Central

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

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

2012-01-01

171

Management of Simultaneous Biliary and Duodenal Obstruction: The Endoscopic Perspective  

PubMed Central

Obstructive jaundice often develops in patients with unresectable malignancy in and around the head of the pancreas. Duodenal obstruction can also occur in these patients, and usually develops late in the disease course. Palliation of both malignant biliary and duodenal obstruction is traditionally performed with surgical diversion of the bile duct and stomach, respectively. With the advent of nonsurgical palliation of biliary obstruction using endoscopic transpapillary expandable metal stent placement, a similar approach can be used to palliate duodenal obstruction by placement of expandable metal gastroduodenal stents. Endoscopic palliation can be achieved in patients who require relief of both biliary obstruction and duodenal obstruction, although this can be technically difficult to achieve depending on the level of duodenal obstruction in relation to the major papilla. This article reviews the endoscopic approaches for combined palliative relief of malignant biliary and duodenal obstruction.

2010-01-01

172

Gastrointestinal perforations in neonates with anorectal malformations.  

PubMed

We describe the presentation and management of gastrointestinal perforation in four neonates with anorectal malformations. Two neonates with high malformation had pneumoperitoneum on X-ray; surgery revealed sigmoid perforation in one patient and transverse colon perforation in the other. Colostomy was done, followed by posterior sagittal anorectoplasty at four months; both recovered satisfactorily. The third neonate had no radiological feature of gut perforation but cecal perforation was found at surgery; the neonate recovered following right hemicolectomy with stoma followed by anorectoplasty at five months. The fourth neonate presented with clinical and radiological features of perforation and recovered satisfactorily after anoplasty and colostomy. PMID:15250569

Sharma, Shyam B; Gupta, Vipul; Sharma, Vinod

2004-01-01

173

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

Microsoft Academic Search

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

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

2006-01-01

174

Embryologic and anatomic basis of duodenal surgery.  

PubMed

The following points should be remembered by surgeons (Table 1). In writing about the head of the pancreas, the common bile duct, and the duodenum in 1979, the authors stated that Embryologically, anatomically and surgically these three entities form an inseparable unit. Their relations and blood supply make it impossible for the surgeon to remove completely the head of the pancreas without removing the duodenum and the distal part of the common bile duct. Here embryology and anatomy conspire to produce some of the most difficult surgery of the abdominal cavity. The only alternative procedure, the so-called 95% pancreatectomy, leaves a rim of pancreas along the medial border of the duodenum to preserve the duodenal blood supply. The authors had several conversations with Child, one of the pioneers of this procedure, whose constant message was to always be careful with the blood supply of the duodenum (personal communication, 1970). Beger et al popularized duodenum-preserving resection of the pancreatic head, emphasizing preservation of endocrine pancreatic function. They reported that ampullectomy (removal of the papilla and ampulla of Vater) carries a mortality rate of less than 0.4% and a morbidity rate of less than 10.0%. Surgeons should not ligate the superior and inferior pancreaticoduodenal arteries because such ligation may cause necrosis of the head of the pancreas and of much of the duodenum. The accessory pancreatic duct of Santorini passes under the gastrointestinal artery. For safety, surgeons should ligate the artery away from the anterior medial duodenal wall, where the papilla is located, thereby avoiding injury to or ligation of the duct. "Water under the bridge" applies not only to the relationship of the uterine artery and ureter but also to the gastroduodenal artery and the accessory pancreatic duct. In 10% of cases, the duct of Santorini is the only duct draining the pancreas, so ligation of the gastroduodenal artery with accidental inclusion of the duct is catastrophic. With the Kocher maneuver, surgeons reconstruct the primitive mesoduodenum and achieve mobilization of the duodenum, which is useful for some surgical procedures. Surgeons should not skeletonize more than 2 cm of the first part of the duodenum. If more than 2 cm of skeletonization is done, a duodenostomy using a Foley catheter may be necessary to avoid blow-up of the stump secondary to poor blood supply. Proximal duodenojejunostomy is advised for the safe management of patients with difficult duodenal stumps. Roux-en-Y choledochojejunostomy and duodenojejunostomy divert bile and food in the treatment of the complicated duodenal diverticulum. The suspensory ligament may be transected with impunity. It should be ligated before being sectioned so that bleeding from small vessels contained within can be avoided. Failure to sever the suspensory muscle completely, which is possible if the insertion is multiple, fails to relieve the symptoms of vascular compression of the duodenum (Fig. 18). Mobilization, resection, and end-to-end anastomosis of the duodenal flexure have been performed as a uniform surgical procedure, avoiding the conventional gastrojejunostomy. With a large, penetrating posterior duodenal or pyloric ulcer, surgeons should remember that The proximal duodenum shortens because of the inflammatory process (duodenal shortening) The anatomic topography of the distal common bile duct and the opening of the duct of Santorini and the ampulla of Vater is distorted Leaving the ulcer in situ is wise Careful palpation for or visualization of the location of the ampulla of Vater or common bile duct exploration with a catheter insertion into the common bile duct and the duodenum are useful procedures In most cases, the common bile duct is located to the right of the gastroduodenal artery at the posterior wall of the first part of the duodenum. (ABSTRACT TRUNCATED) PMID:10685148

Androulakis, J; Colborn, G L; Skandalakis, P N; Skandalakis, L J; Skandalakis, J E

2000-02-01

175

Perforating Disseminated Necrobiosis Lipoidica Diabeticorum  

PubMed Central

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

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

2013-01-01

176

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

177

CT evaluation of gastrointestinal tract perforation  

Microsoft Academic Search

The purpose of this study is to review the computed tomography (CT) appearance of gastrointestinal tract (GI) perforation. Forty-two patients with 10 cases of proximal GI perforation and 32 cases of distal GI perforation were evaluated based on the CT findings of extraluminal air (which was subdivided into the CT-falciform ligament sign crossing the midline and scattered pockets of air),

Kwok-Wan Yeung; Ming-Sung Chang; Chao-Peng Hsiao; Jee-Fu Huang

2004-01-01

178

Generalized perforating granuloma annulare in an infant.  

PubMed

Generalized perforating granuloma annulare presents with flesh- to red-colored, 1-5 mm papules with a central umbilicated crust or scale that usually involves the extremities, face, neck, and trunk. Perforating granulomas are demonstrated on histopathology. Our patient is a 68-day-old girl with generalized perforating granuloma annulare. PMID:12657009

Choi, Jung-Chul; Bae, Jee-Young; Cho, Soyun; Choi, Jee-Ho; Sung, Kyung-Jeh; Moon, Kee-Chan; Koh, Jai-Kyoung

2003-01-01

179

Iatrogenic full-thickness chemical burns from monochloracetic acid.  

PubMed

A case of iatrogenic full-thickness chemical burns from monochloroacetic acid (MCA) crystal application is described, followed by a brief review of the relevant literature and discussion of both local and systemic problems that may be encountered with absorption of this chemical. We believe this to be the first reported case of full-thickness burns in association with MCA. The degree of injury and systemic side effects encountered as a procedure complication highlights the importance of using this chemical with care in any clinical setting. In addition, an apparent predilection of MCA for the germinal matrix as found in this case may further complicate reconstructive options for associated injuries. PMID:16819363

Chapman, Thomas; Mahadevan, Devendra; Mahajan, Ajay; Perez-Temprano, Alvaro; McDiarmid, James

2006-01-01

180

An iatrogenically unmasked life threatening disease: brugada syndrome.  

PubMed

Brugada syndrome is a life threatening disease that is usually overlooked during emergency service admissions. It is characterized by typical electrocardiography resembling right bundle branch block, static or dynamic ST-segment elevation in leads V 1-3. There is familial tendency in some cases. A majority of patients have a structurally normal heart and are likely to remain asymptomatic, however they may present to emergency departments with syncope and various serious arrhythmias. Therefore it is crucially important for emergency medicine physicians not to omit this potential diagnosis. Herein we report a case with Brugada syndrome which was iatrogenically unmasked after propafenone administration for atrial fibrillation. PMID:23882294

Ercan, Suleyman; Oylumlu, Muhammed; Altunbas, Gokhan; Davutoglu, Vedat

2013-06-01

181

An Iatrogenically Unmasked Life Threatening Disease: Brugada Syndrome  

PubMed Central

Brugada syndrome is a life threatening disease that is usually overlooked during emergency service admissions. It is characterized by typical electrocardiography resembling right bundle branch block, static or dynamic ST-segment elevation in leads V 1-3. There is familial tendency in some cases. A majority of patients have a structurally normal heart and are likely to remain asymptomatic, however they may present to emergency departments with syncope and various serious arrhythmias. Therefore it is crucially important for emergency medicine physicians not to omit this potential diagnosis. Herein we report a case with Brugada syndrome which was iatrogenically unmasked after propafenone administration for atrial fibrillation.

Oylumlu, Muhammed; Altunbas, Gokhan; Davutoglu, Vedat

2013-01-01

182

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.

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

2013-01-01

183

Iatrogenic penile glans amputation: major novel reconstructive procedure.  

PubMed

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

184

Spontaneous resolution of iatrogenic chylothorax in a cat.  

PubMed

Chylothorax is an uncommon condition of dogs and cats defined by the accumulation of chylous effusion within the pleural space. Chylothorax has been experimentally created in dogs and cats by ligation of the cranial vena cava and has been reported to occur spontaneously in dogs with naturally occurring obstruction of the cranial vena cava. In the cat of this report, iatrogenic chylothorax was caused by surgical ligation and transection of the left brachiocephalic vein during a tracheal resection and anastomosis procedure. The chylous effusion resolved with medical management 9 weeks after surgery. PMID:15906565

Greenberg, Marc J; Weisse, Chick W

2005-05-15

185

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.

Twombley, Katherine; Baum, Michel; Gattineni, Jyothsna

2014-01-01

186

Iatrogenic Claudication from a Vascular Closure Device after Cardiac Catheterization  

PubMed Central

We report a case of iatrogenic claudication as a result of a misplaced percutaneous arterial closure device (PACD) used to obtain hemostasis after cardiac catheterization. The patient presented one week after his procedure with complaints suggestive of right lower extremity claudication. Computed tomographic angiography demonstrated a near total occlusion of the right common femoral artery from a PACD implemented during the cardiac catheterization. The use of PACD’s to obtain rapid hemostasis is estimated to occur in half of all cardiac catheterizations. Ischemic complications as a result of these devices must be considered when evaluating post procedural patients with extremity complaints.

Hermann, Luke; Chow, Evelyn; Duvall, W. Lane

2010-01-01

187

Iatrogenic claudication from a vascular closure device after cardiac catheterization.  

PubMed

We report a case of iatrogenic claudication as a result of a misplaced percutaneous arterial closure device (PACD) used to obtain hemostasis after cardiac catheterization. The patient presented one week after his procedure with complaints suggestive of right lower extremity claudication. Computed tomographic angiography demonstrated a near total occlusion of the right common femoral artery from a PACD implemented during the cardiac catheterization. The use of PACD's to obtain rapid hemostasis is estimated to occur in half of all cardiac catheterizations. Ischemic complications as a result of these devices must be considered when evaluating post procedural patients with extremity complaints. PMID:21293776

Hermann, Luke; Chow, Evelyn; Duvall, W Lane

2010-12-01

188

Tubal perforation by ESSURE microinsert  

Microsoft Academic Search

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

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

2006-01-01

189

Non-traumatic colorectal perforations.  

PubMed

Over a 6 year period, between January 1992 and December 1997, 30 patients with non-traumatic colorectal perforations undergoing laparotomy were reviewed. The aim of this study was to evaluate predictions on the prognosis using the Mannheim Peritonitis Index (MPI) and to evaluate the risk of this complication. The mean age of the patients was 56.4 years (range 16-88 years). The male:female ratio was 19:11. All patients showed signs of peritonitis and underwent emergency operations. In 50% (15) of the patients, tumor was the cause. According to the MPI scoring, there were 18 patients with an MPI score of 26 or less and 12 patients with an MPI score of 27 or more. For patients with a score less than 27 the mortality rate was zero (0/18) and for score greater than 26, 66.6% (8/12). Overall mortality was 26.6% (8/30). Of 15 patients with perforated colorectal cancers, four patients died (26.6%). The mortality rate for benign perforations was 26.6% (4/15) also. In conclusion, colorectal cancers are the most common cause of the non-traumatic colorectal perforations. Patients with an MPI score greater than 26 represent the highest risk group. PMID:10408288

Yilmazlar, T; Toker, S; Zorluo?lu, A

1999-01-01

190

[Diagnostics and surgical treatment of traumatic intramural duodenal haematomes].  

PubMed

The duodenal trauma amounts 1,2% of all the abdominal trauma and does not exceed 10,0% in traumatic lesions of gastrointestinal organs. Authors represent analysis of surgical treatment of 8 patients with intramural duodenal hematomes. The optimal ways of diagnosis and surgical treatment of patients are suggested. PMID:18577968

Chirkov, R N; Abakumov, M M; Blokhin, V N

2008-01-01

191

Management of Descending Duodenal Injuries Secondary to Laparoscopic Cholecystectomy  

Microsoft Academic Search

Aim: To report our experience of managing patients affected by descending duodenal injuries secondary to laparoscopic cholecystectomy and to review the literature. Methods: Analysis of 5 cases of descending duodenal injury as a consequence of laparoscopic cholecystectomy managed between June 1992 and September 2006. Results: The median age was 59 (range 49–67) years.In all cases an emergency laparotomy showed an

Mario Testini; Giuseppe Piccinni; Germana Lissidini; Beatrice Di Venere; Angela Gurrado; Elisabetta Poli; Nicola Brienza; Antonio Biondi; Luigi Greco; Michele Nacchiero

2008-01-01

192

Duodenal window revisited: A histological study using human fetuses.  

PubMed

To assess the development of the duodenal window in fetuses, we examined semiserial histological sections of 59 human fetuses with a crown-rump length of 27-156 mm (?4-18 weeks of gestation). In 44 of the 54 fetuses with horizontal sections, the duodenal window was formed by interdigitation of the anterior and posterior muscle slips from the proper duodenal circular muscle coat. The anterior slips approached the common bile duct from the anterior side and wound around the bile duct from the right aspect, whereas the posterior slips approached the main pancreatic duct from the posterior side, reaching the left or outer aspect of the duct without winding. These slips may become longitudinal muscles in the ampulla after birth. Six specimens showed variations in this typical pattern, in that the posterior muscle slips as well as the duodenal longitudinal muscle coat wound around the bile duct. In the remaining four specimens, we observed an abnormal union of the bile and pancreatic ducts, with the duodenal circular muscles suddenly ending along the window or slightly inserted into the right side of the common duct after joining. In all later-stage fetuses, the common sphincter surrounded both the bile and pancreatic ducts in the ampulla. Consequently, at and along the duodenal window, the proper duodenal circular muscle seemed to contribute to fetal sphincter formation. The window was not a simple hiatus but a functional interface between the sphincter and the duodenal wall. PMID:22674759

Yang, Jae Do; Hwang, Hong Pil; Kim, Ji Hyun; Rodríguez-Vázquez, Jose Francisco; Murakami, Gen; Yu, Hee Chul; Cho, Baik Hwan

2013-07-01

193

[Malignant duodenal neoplasia: clinical-pathological profile].  

PubMed

The main purpose of the study was to learn about the clinical-pathological profile of the malignant duodenal neoplasia in our country. To that effect, a descriptive and prospective study was performed, involving the examination of 25 cases diagnosed between April 2000 and March 2002 in the Department of Digestive System Diseases of the "Edgardo Rebagliati Martins" National Hospital (Lima-Peru). Malignant duodenal neoplasia accounted for 1.6% of malignant gastro-intestinal neoplasias, with 86.2% endoscopic - histologic correlation. The average age was 64.9 years, with predominance of males (64%). The average period of the symptoms until diagnosis was reached, was of 6.2 months, the most frequent being: weight loss (84%) paleness (84%) abdominal pain (64%) and hyporexia (60%). The obstructive picture prevailed in the inframpullary lesions, high digestive hemorrhage in the suprampullary lesions and obstructive jaundice in the periampullary lesions. Metastases was evident in 64.7% of primary malignant neoplasias. The most frequent type of lesion was mixed (40%) prevailing the proliferative-ulcerated type and most had a suprampullary location (44%). The most frequent histological variation was the adenocarcinoma (52%) followed by metastatic lesions (32%), lymphoma (12%) and carcinoid tumor (4%). The treatment administered was merely supportive in 14 cases (56%), palliative in seven cases (28%) and curative in three cases (12%). Global survival by the end of the six months was of 12.5%.Conclusion: Malignant duodenal neoplasia is an unusual incident, with delayed and non-specific clinical symptoms and it is therefore diagnosed in advanced stages. A curative treatment is seldom possible, hence global survival after six months is very low. PMID:12853985

Rosas Marcos, Edith; Frisancho Velarde, Oscar; Yábar Berrocal, Alejandro

2003-01-01

194

Cholelith causing duodenal obstruction in a horse.  

PubMed

A 10-year-old Appaloosa stallion was referred for evaluation of colic. At admission, the heart rate, capillary refill time, respiratory rate, and rectal temperature were high. Fifteen liters of reflux was obtained by nasogastric intubation. Palpation of an abdominal mass per rectum elicited signs of pain. At exploratory laparotomy, a mass was palpated in the ascending portion of the duodenum. The small intestine ruptured at the site of obstruction during manipulation. The horse was euthanatized. A large cholelith was the cause of the duodenal obstruction. At necropsy, multiple choleliths of various sizes were found in the pancreatic and common bile ducts and in the stomach. PMID:1399780

Laverty, S; Pascoe, J R; Williams, J W; Funk, K A

1992-09-01

195

A case of a duodenal duplication cyst presenting as melena  

PubMed Central

Duodenal duplication cysts are benign rare congenital anomalies reported mainly in the pediatric population, but seldom in adults. Symptoms depend on the type and location and can present as abdominal pain, distension, dysphagia or dyspepsia. They have been reported to be responsible for duodenal obstruction, pancreatitis and, in rare cases, gastrointestinal bleeding. We present a case of a duodenal duplication cyst in a 43-year-old man presenting as melena. Initial gastroduodenoscopy and colonoscopy did not reveal any bleeding focus. However, the patient began passing melena after 3 d, with an acute decrease in hemoglobin levels. Subsequent studies revealed a duplication cyst in the second portion of the duodenum which was surgically resected. Histology revealed a duodenal duplication cyst consisting of intestinal mucosa. There was no further bleeding and the patient recovered completely. In rare cases, duodenal duplication cysts might cause gastrointestinal bleeding and should be included in the differential diagnosis.

Ko, Seung Yeon; Ko, Sun Hye; Ha, Sungeun; Kim, Mi Sung; Shin, Hyang Mi; Baeg, Myong Ki

2013-01-01

196

The incidence and the risk factors for iatrogenic retinal breaks during pars plana vitrectomy  

PubMed Central

Purpose To establish the frequency and the risk factors for iatrogenic retinal breaks during three-port pars plana vitrectomy (PPV). Methods A total of 2471 PPV operations were included in the study. The study period was between 2001 and 2010, all the data were entered in an electronic patient record database. All 270 consecutive eyes of 270 patients developing iatrogenic retinal breaks during primary PPV were matched to 270 controls. Univariate and multivariate analysis were performed to establish the risk factors. Results The median age of the patients with iatrogenic breaks was 60.06 years; male to female ratio was 140/130. The overall frequency of iatrogenic retinal breaks was 10.09%. The frequency of iatrogenic retinal breaks for eyes undergoing PPV for tractional retinal detachment (TRD) was 32.45%. The lens status was phakic in 79.6% of the eyes, with iatrogenic breaks compared with 34.4% of the eyes in control group (P<0.001). Posterior vitreous was attached in 58.9% of the eyes with iatrogenic breaks compared with 50.4% of the eyes in control group (P=0.04). Internal limiting, epiretinal, proliferative, or fibrovascular membrane removing manoeuvers were performed in 71.1% of the eyes with iatrogenic breaks compared with 61.9% of the eyes in control group (P=0.052). Conclusion Eyes undergoing PPV for TRD had significantly higher frequency of iatrogenic retinal breaks compared with other subgroups (P=0.0001). Phakia and absence of PVD were found to be risk factors for iatrogenic retinal breaks.

Dogramaci, M; Lee, E J K; Williamson, T H

2012-01-01

197

Acute Bleeding In Duodenal Gastrointestinal Stromal Tumor  

PubMed Central

Gastrointestinal stromal tumors (GIST) are the most common mesenchymal tumors of the gastrointestinal tract. The biological pattern of these tumors ranges from benign-appearing small lesions to malignant sarcomas. Only 3%–5% of GISTs are found in the duodenum. A duodenal GIST is a rare source of upper gastrointestinal bleeding. A remarkable percentage of duodenal GISTs are localized in the third and fourth part of the duodenum and may not be noticed on standard upper endoscopy. Push enteroscopy is sometimes advisable to find these lesions. Surgical resection either limited or pancreaticoduodenectomy can be the treatment of choice. In general, adjuvant therapy with imatinib has been proved to extend survival in patients with GIST.The current case, a 24-year-old male, presented with acute upper gastrointestinal bleeding from a submucosal ulcerated tumor located in the distal third part of the duodenum, 3 cm distal from the papilla of Vater. After primary care and blood transfusion in a local hospital, partial resection of the duodenum was performed as a definitive surgical therapy. Histopathology showed a GIST with a diameter of 3 cm and moderately malignant according to tumor grade, and <5 mitoses/10 high power field (HPF).

Mokhtare, Marjan; Taghvaei, Tarang; Tirgar Fakheri, Hafez

2013-01-01

198

Validation of the use of POSSUM score in enteric perforation peritonitis - results of a prospective study  

PubMed Central

Introduction The objective of the study was to present our last 5-years experience of peritonitis and validate POSSUM score in predicting mortality and morbidity in patients of enteric perforation (EP) peritonitis. Methods Data was collected prospectively for all peritonitis cases admitted in single surgical unit from January 2005 to December 2009. Parameters for calculating POSSUM were also retrieved; in these patients, O:E (Observed vs. Expected) ratio of mortality and morbidity were estimated after calculating predicted mortality and morbidity by exponential regression equations. Results 887 patients with peritonitis were admitted and treated in this unit during the 5 years of study period. Duodenal (n=431; 48%) followed by ileal (n=380; 42.8%) perforations were the commonest. Mean age of the patients was 34 years and 86% were males. Mean delay in presentation was 78.5 hrs. Mean duration of hospital and ICU stay was 13 and 7.2 days. Postoperative complications were seen in 481 (54%) patients, and 90 (10%) patients died. POSSUM scores and predicted mortality/morbidity were calculated in 380 patients of ileal perforation peritonitis; O:E ratio of mortality and morbidity were 0.47 and 0.85 in these patients. Conclusion POSSUM and P-POSSUM are accurate tools for predicting morbidity and mortality respectively in EP patients. Though they may sometime over or under predict morbidity as well as mortality.

Kumar, Sunil; Gupta, Amit; Chaudhary, Sujata; Agrawal, Neeraj

2011-01-01

199

Fluid pressure actuated perforating gun  

SciTech Connect

A well perforating gun assembly includes a perforating gun secured to the bottom of a tubular actuating housing containing a fluid pressure actuated hammer and a fixedly mounted primer against which the firing means is impacted. A latch normally maintains the firing means in an elevated position with respect to the primer but such latch may be released through the application of sufficient fluid pressure force to the firing means to drive it into engagement with the primer. If the primer fails to ignite, a second fluid pressure force is employed to move the firing means to its original latched position, ready for a second application of fluid pressure to release the firing means and again impact the primer.

Peterson, E. R.

1985-07-30

200

Tests reveal perforating charge performance  

SciTech Connect

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

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

1992-01-06

201

Perforated typhoid enteritis in children.  

PubMed Central

A prospective study of 65 patients with perforated typhoid enteritis managed operatively over a 3 year period at a university hospital is presented. There were 45 males and 20 females with ages ranging from 5 to 15 years. Presenting symptoms were fever, abdominal pain, vomiting and either diarrhoea or constipation. All the patients were subjected to surgery and 56 (86%) underwent two-layer bowel closure after freshening of ulcer margins. The overall mortality rate in this study was 20% and was adversely influenced by the increasing duration of perforation, presence of shock and faecal peritonitis. Early surgery after prompt and adequate resuscitation is life saving. However, prevention of typhoid fever by providing safe drinking water and better sanitary conditions appears to offer the best chance of decreasing the high rates of mortality and morbidity of this deadly disease.

Gupta, V.; Gupta, S. K.; Shukla, V. K.; Gupta, S.

1994-01-01

202

Gastric perforation after cardiopulmonary resuscitation.  

PubMed

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

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

2012-11-01

203

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.

Ozdek, S; Hasanreisoglu, M; Yuksel, E

2013-01-01

204

Reactive perforating collagenosis and phototraumatism.  

PubMed

Two pairs of siblings are reported suffering from reactive perforating collagenosis. The clinical features were recurrent crusted papules with a central keratinaceous plug. The plug was sometimes encircled by a narrow yellowish ring and a wider red ring, giving the appearance of a cockade. Lesions recurred spontaneously or were provoked by superficial injury to sun-exposed skin (phototraumatism). There were no other changes in the general health of these patients. PMID:4076499

Berlin, C; Goldberg, L H

1985-01-01

205

Prognosis of perforating eye injury  

Microsoft Academic Search

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

H P Adhikary; P Taylor; D J Fitzmaurice

1976-01-01

206

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

207

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

PubMed Central

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.

Algin, Oktay; Mustafayev, Assanaly; Ozmen, Evrim

2014-01-01

208

Immunohistochemical localisation of urogastrone to human duodenal and submandibular glands.  

PubMed Central

Urogastrone has been localised by immunostaining to granules of the cells of human duodenal (Brunner's) glands and their ducts and of acinar cells in the human submandibular gland. The immunoreactive peptide is present in large quantities in duodenal glands and their secretory ducts. Urogastrone or human epidermal growth factor promotes cellular proliferation in vivo as well as in vitro and inhibits gastric acid secretion and may, therefore, be one of the duodenal factors inhibiting gastric activity. Thus it may have an important regulatory and protective function for the intestinal mucosa and may possibly become a useful therapeutic agent. Images Fig. 1 Fig. 2 Fig. 3 Fig. 4

Heitz, P U; Kasper, M; van Noorden, S; Polak, J M; Gregory, H; Pearse, A G

1978-01-01

209

Synchronous diverticular perforation: report of a case.  

PubMed

Synchronous colonic events are rare. Diverticulitis is the most common and lethal cause of colonic perforation. The first case in the literature of a synchronous diverticular perforation is presented. The patient was admitted with peritonitis. An exploratory laparotomy showed cecal and sigmoid perforations. Resection and primary anastomosis with a protective loop ileostomy was performed. Microscopic evaluation confirmed the presence of cecal and sigmoid perforated diverticuli. Diverticular disease is present in up to two-thirds of patients 80 years of age and older. Right-sided free colonic perforation is rare. Resection and primary anastomosis is feasible in the treatment of perforated diverticular disease. In this report, we emphasize the importance of a thorough abdominal exploration at the time of surgery. PMID:16044938

Krajewski, Eduardo; Szomstein, Samuel; Weiss, Eric G

2005-06-01

210

Iatrogenic Kaposi's sarcoma in nasal cavity: a case report  

PubMed Central

Background Kaposi's sarcoma (KS) is an uncommon borderline vascular tumor involving mostly the cutaneous and mucosal sites of the body. Among the four distinctly clinicopathological presentations of KS, the iatrogenic form principally occurs in kidney transplant recipients receiving immunosuppressive therapy. It rarely occurs in the head and neck region as primary site or in other groups of patients under immunosuppressive therapy. Case presentation We present of the case of a patient with right nose KS. The patient had history of systemic lupus erythematosus (SLE) and was under immunosuppressive therapy. Conclusion Once we keep KS in mind, the definite diagnosis can be made using routine histological examination and immunohistochemical study despite the rarity of the disease in this site.

2014-01-01

211

[Iatrogenic inguinal injury of the spermatic cord from a treatment and forensic viewpoint].  

PubMed

Iatrogenic obstruction of the spermatic duct or iatrogenic occulusive azospermia, in a wider context, is more frequently diagnosed today than it used to be in the past. This is attributable to general improvement of the system of andrological care. Hints are given on avoidance of that lesion by surgical tactics as well as on provisional treatment and on compulsory notification of injuries that occurred to the spermatic duct. A rating of 20 to 30 per cent of disablement is proposed for irreversible iatrogenic occlusive azospermia. Reference is made to possible modes of financial compensation in the context of mVGE or EmU procedures. PMID:3591044

Matz, M; Zepnick, H

1987-01-01

212

MR sialography of iatrogenic sialocele: comparison with conventional sialography  

PubMed Central

Objective The objective of this study was to compare the conventional sialography with MR sialography in a series of patients with iatrogenic sialocele (sialocyst). Methods 50 salivary glands in 39 patients with suspected inflammatory disease of the salivary gland underwent conventional sialography and MR sialography. Out of these 39 patients, 6 patients (age range: 16–35 years; 4 males and 2 females; mean age: 23.8 years) had sialoceles and formed our study group. MR sialography findings were compared with conventional sialography findings regarding demonstration of ductal anatomy, the cyst and its communication with the ductal system. Results MR sialography demonstrated the site of communication of the sialocyst with the ductal system in all six patients. MR provided additional information over conventional sialography in five cases. In four cases, the ductal system proximal to the cyst was not opacified on digital sialography but was well visualized in all cases by MR sialography. Constructive interference in steady-state (CISS) sequence demonstrated the intraglandular ducts and communication of cysts with ducts better than half-fourier acquisition single-shot turbo-spin echo (HASTE) images. Conclusion Our preliminary results suggest that MR sialography is a robust, non-invasive method for demonstrating the ductal system up to second-order branches, the site of ductal injury and the focal cystic lesion. MR provided at least the same information as conventional sialography in the evaluation of site of communication but provided additional information about the sialocyst and upstream ductal system in five cases. Being a non-invasive modality, we recommend MR sialography as the investigation of choice in the evaluation of an iatrogenic sialocyst.

Gadodia, A; Bhalla, AS; Sharma, R; Thakar, A; Parshad, R

2011-01-01

213

Extreme overbalance perforating improves well performance  

Microsoft Academic Search

The application of extreme overbalance perforating, by Oryx Energy Co., is consistently outperforming the unpredictable, tubing-conveyed, underbalance perforating method which is generally accepted as the industry standard. Successful results reported from more than 60 Oryx Energy wells, applying this technology, support this claim. Oryx began this project in 1990 to address the less-than-predictable performance of underbalanced perforating. The goal was

J. M. Dees; P. J. Handren

1994-01-01

214

Cecum perforation due to biliary stent migration.  

PubMed

The endoscopic placement of biliary stents for benign and malignant biliary disease has been performed for over a decade. Several complications of stent placement have been described such as pancreatitis, hemorrhage, cholangitis, and perforation. Migration of biliary stents is a rare event, which can cause severe complications such as gastrointestinal tract perforation. We report the case of a 26-year-old woman with a cecum perforation due to biliary stent migration. We present the second case of cecal perforation related to the migration of a biliary stent. PMID:25028235

Barut, Ibrahim; Tarhan, Omer R

2014-07-01

215

Turbulent Heat Transfer Analysis of a Three-Dimensional Array of Perforated Fins Due to Changes in Perforation Sizes  

Microsoft Academic Search

Turbulent heat transfer characteristics of three-dimensional and rectangular perforated fins, including perforation like channels along the length of the fins, are investigated. Both dimensions and numbers of perforations are changed at the highest porosity in the study of Shaeri and Yaghoubi [7] to determine the effects of perforation sizes on the heat transfer characteristics of the perforated fins. Results show

Mohammad Reza Shaeri; Tien-Chien Jen

2012-01-01

216

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

Microsoft Academic Search

Antroduodenal myoelectrical activity and duodenal digesta flow rate in young cattle were assessed by implanted nichrome wire electrodes and reentrant duodenal cannulation with interposed flow-meter. In addition, a small glass electrode was inserted through a duodenal cannula to continuously measure the pH of duodenal contents. When eating only hay ad libitum, the duodenal myoelectrical activity showed the usual migrating myoelectrical

A. M. Merritt; Y. Ruckebusch

1988-01-01

217

Malrotation causing duodenal chronic obstruction in an adult  

PubMed Central

Congenital duodenal obstruction is rare in adulthood. An unusual presentation of this condition has led to difficult preoperative diagnosis. We present a case of proximal jejunal obstruction by a congenital band in an adult and review the literature.

Gong, Jun; Zheng, Zhen-Jiang; Mai, Gang; Liu, Xu-Bao

2009-01-01

218

[Cystic dystrophy of the duodenal wall in aberrant pancreas].  

PubMed

Cystic dystrophy of the duodenal wall developing in heterotopic pancreas is rare. Pancreaticoduodenectomy is usually advocated in cases of symptomatic cystic dystrophy without chronic pancreatitis but little is known about long-term results. We report a case of cystic dystrophy of the duodenum wall developing in heterotopic pancreas responsible for abdominal pain and duodenal obstruction associated with chronic pancreatitis. Pancreaticoduodenectomy allowed complete relief of symptoms. Chronic pancreatitis associated with cystic dystrophy may complicate the choice of appropriate therapy. PMID:10089671

Wind, P; Pardies, P; Roullet, M H; Rouzier, R; Zinzindohoué, F; Cugnenc, P H

1999-01-01

219

Preduodenal portal vein: a cause of prenatally diagnosed duodenal obstruction.  

PubMed

Preduodenal portal vein is a rare congenital anomaly that causes high intestinal obstruction. The authors report on a newborn who was diagnosed as having duodenal obstruction at 30 weeks' gestation. During surgery the patient was found to have duodenal obstruction caused by a preduodenal portal vein. Malrotation was an associated finding. Treatment consisted of Ladd's procedure and a diamond-shaped duodenoduodenostomy performed anterior to the portal vein. PMID:8786512

Choi, S O; Park, W H

1995-10-01

220

Acute Pancreatitis Secondary to Duodenoduodenal Intussusception in Duodenal Adenoma  

PubMed Central

Duodenoduodenal intussusception is a rare condition that is in general caused by a tumor. We describe duodenoduodenal intussusception secondary to a tubulovillous adenoma that caused acute pancreatitis in a 31-year-old female. We resected a duodenal tumor from the submucosal layer and then simply closed the duodenal wall. To the best of our knowledge, this is the first description of acute pancreatitis secondary to duodenoduodenal intussusception by tubulovillous adenoma in the second part of the duodenum in an adult.

Watanabe, Fumiaki; Noda, Hiroshi; Okamura, Jun; Toyama, Nobuyuki; Konishi, Fumio

2012-01-01

221

[Treatment of duodenal ulcer associated with chronic gastric erosions].  

PubMed

Three groups of patients received chemotherapy for duodenal ulcer and associated chronic gastric erosion. Group I was treated by the drugs combination (methacin, almagel, gastrofarm, solcoseryl, tazepam, rudotel), group II received gastrocepin, group III venter. The results of duodenal ulcer healing were similar in all the groups, yet epigastric and/or pyloroduodenal pain was relieved more rapidly in groups II and III. The latter groups were also characterized by accelerated disappearance of fibrinous patches on the surface of the erosion. PMID:1942976

Vasil'ev, Iu V; Rishi, K M

1991-07-01

222

Bleeding duodenal hemangioma: Morphological changes and endoscopic mucosal resection  

PubMed Central

Recently, the development of endoscopic procedures has increased the availability of minimally invasive treatments; however, there have been few case reports of duodenal hemangioma treated by endoscopic mucosal resection. The present report describes a case of duodenal hemangioma that showed various endoscopic changes over time and was treated by endoscopic mucosal resection. An 80-year-old woman presented with tarry stools and a loss of appetite. An examination of her blood revealed severe anemia, and her hemoglobin level was 4.2 g/dL. An emergency upper gastrointestinal endoscopy was performed. A red, protrusive, semipedunculated tumor (approximately 20 mm in diameter) with spontaneous bleeding on its surface was found in the superior duodenal angle. Given the semipedunculated appearance of the tumor, it was suspected to be an epithelial tumor with a differential diagnosis of hyperplastic polyp. The biopsy results suggested a telangiectatic hemangioma. Because this lesion was considered to be responsible for her anemia, endoscopic mucosal resection was performed for diagnostic and treatment purposes after informed consent was obtained. A histopathological examination of the resected specimen revealed dilated and proliferated capillary lumens of various sizes, which confirmed the final diagnosis of duodenal hemangioma. Neither anemia nor tumor recurrence has been observed since the endoscopic mucosal resection (approximately 1 year). Duodenal hemangiomas can be treated endoscopically provided that sufficient consideration is given to all of the possible treatment strategies. Interestingly, duodenal hemangiomas show morphological changes that are influenced by various factors, such as mechanical stimuli.

Nishiyama, Noriko; Mori, Hirohito; Kobara, Hideki; Fujihara, Shintarou; Nomura, Takako; Kobayashi, Mitsuyoshi; Masaki, Tsutomu

2012-01-01

223

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.

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

2013-01-01

224

Nutritional care routines in Italy: results from the PIMAI (Project: Iatrogenic MAlnutrition in Italy) study  

Microsoft Academic Search

Background\\/Objectives:Disease-related malnutrition is a common comorbidity at hospital admission. The purpose of the present report was to describe the data on nutritional care routines collected during the Project: Iatrogenic MAlnutrition in Italy (PIMAI) study, as these may be helpful to avoid iatrogenic malnutrition and improve nutritional policies.Subjects\\/Methods:Standards of nutritional care were assessed on the basis of (1) adherence to study

E Cereda; L Lucchin; C Pedrolli; A D'Amicis; M G Gentile; N C Battistini; M A Fusco; A Palmo; M Muscaritoli

2010-01-01

225

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

226

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.

2014-01-01

227

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

PubMed

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

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

2014-05-01

228

A hypervelocity projectile launcher for well perforation  

Microsoft Academic Search

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

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

1989-01-01

229

Barrett's ulcer: cause of spontaneous oesophageal perforation.  

PubMed Central

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

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

1989-01-01

230

Needle perforation of the bowel in childhood.  

PubMed

Accidental ingestion of foreign bodies occurs frequently in childhood. The majority of them are passed spontaneously, and conservative management generally is recommended for foreign bodies in the stomach and duodenum. However, in some cases, operative intervention should be considered to prevent undesirable complications, such as intestinal perforation. Two cases of intestinal perforation owing to accidental ingestion of a needle are reported. PMID:14966749

Li Voti, G; Di Pace, M R; Castagnetti, M; De Grazia, E; Cataliotti, F

2004-02-01

231

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

232

Anti-inflammatory and carbonic anhydrase restoring actions of yam powder (Dioscorea spp) contribute to the prevention of cysteamine-induced duodenal ulcer in a rat model.  

PubMed

Increased acid output, accompanied with a defective defense system, is considered a fundamental pathogenesis of duodenal ulcer (DU). However, relapse of DU occurs despite proton pump inhibitors and H2 receptor antagonists, hence imposing the enforcement of the defense system. Dried powder of the yam tuber (Dioscorea spp) has been used in traditional folk medicine as a nutritional fortification. We hypothesized that dried-yam powder would prevent DU through improvement of anti-inflammatory actions and carbonic anhydrase (CA) activity. Therefore, we investigated the preventive effects of dried-yam powder against the cysteamine-induced DU and elucidated the underlying mechanisms. Duodenal ulcers were induced in Sprague-Dawley rats by intragastric administration of 500 mg/kg cysteamine-HCl. The dried-yam powder was used as a pretreatment before the cysteamine-HCl. The number and size of DU were measured. The expressions of inflammation mediators were checked in duodenal tissues, and the expressions of CAs and malondialdehyde levels were also examined. Cysteamine provoked perforated DU, whereas dried-yam powder significantly prevented DU as much as pantoprazole and significantly reduced the incidence of perforation. The messenger RNA expressions of cyclooxygenase-2 and inducible nitric oxide synthase were remarkably decreased in the yam group compared with the cysteamine group, and the serum levels of proinflammatory cytokines including interleukin-1?, interleukin-6, and tumor necrosis factor were significantly attenuated in the yam group. Cysteamine significantly decreased the expression of CAs, whereas yam treatment significantly preserved the expressions of CA IX, XII, and XIV. In conclusion, dried-yam powder exerts a significant protective effect against cysteamine-induced DU by lowering the activity of inflammatory cytokines and free radicals and restoring the activity of CAs, except in CA IV. PMID:23890358

Park, Jong-Min; Kim, Yoon-Jae; Kim, Ju-Seung; Han, Young-Min; Kangwan, Napapan; Hahm, Ki Baik; Kim, Tae-Sok; Kwon, Oran; Kim, Eun-Hee

2013-08-01

233

Extreme overbalance perforating improves well performance  

SciTech Connect

The application of extreme overbalance perforating, by Oryx Energy Co., is consistently outperforming the unpredictable, tubing-conveyed, underbalance perforating method which is generally accepted as the industry standard. Successful results reported from more than 60 Oryx Energy wells, applying this technology, support this claim. Oryx began this project in 1990 to address the less-than-predictable performance of underbalanced perforating. The goal was to improve the initial completion efficiency, translating it into higher profits resulting from earlier product sales. This article presents the concept, mechanics, procedures, potential applications and results of perforating using overpressured well bores. The procedure can also be used in wells with existing perforations if an overpressured surge is used. This article highlights some of the case histories that have used these techniques.

Dees, J.M.; Handren, P.J. [Oryx Energy Co., Dallas, TX (United States)

1994-01-01

234

New insight into non-healing corneal ulcers: iatrogenic crystals  

PubMed Central

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

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

2013-01-01

235

Iatrogenic bronchopleural fistula occuring during redo cardiac surgery.  

PubMed

Cardiac re-operations are associated with increased morbidity and mortality rates due to adhesion of tissues in the anterior mediastinum. Especially, previous usage of left internal thoracic artery constitutes a major challenge for cardiovascular surgeons. In such cases, the left lung frequently adheres to the thoracic wall and may be injured during dissection. This leads to air leak and the complication may in turn increase the risk of mediastinal infections and the hospital stay. A bronchopleural fistula case treated by a novel technique is reported. In patient iatrogenic bronchopleural fistula occured during dissection of the adhesions which resulted due to the first coronary artery bypass grafting and left internal thoracic artery usage. The air leakage was successfully controlled and treated by a novel method: self adhesive BioGlue immersed and coated Surgicel patch. Although it is a single case experience it may be a promising method as it is less traumatic when compared to the classical treatment methods of bronchopleural fistula. PMID:19801731

Selimoglu, O; Ugurlucan, M; Basaran, M; Erdim, F; Ogus, T N

2009-09-01

236

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.

Meeran, Nazeer Ahmed

2013-01-01

237

Perforated endometrial appendicitis in pregnancy.  

PubMed

Background: Endometriosis is a common disorder in women of reproductive age. A rare localization is the appendix, which, in most cases, is an incidental finding during appendectomies. The incidence of symptomatic appendiceal endometriosis or endometrial appendicitis might be increased in pregnancy. Moreover, endometrial appendicitis in pregnancy is more likely to present in an advanced stage, given the physiologic changes characterizing the gravid abdomen. Materials and Methods: Description of a case of a pregnant woman presenting to the A&E with acute peritonitis attributable to advanced appendicitis. She underwent emergency laparotomy with appendectomy. The biopsy specimen was examined by the pathology laboratory of the same hospital. Results: The laparotomy revealed perforated appendicitis. The histopathology report described acute endometrial appendicitis. PMID:23935277

Giorgakis, E; Karydakis, V; Farghaly, A

2012-04-01

238

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

239

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

240

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.

2011-01-01

241

An unusual case of bowel perforation.  

PubMed

Bowel perforation is a potentially fatal complication of obstruction, ischaemia, trauma, surgery and medications. It is recognised by clinical suspicion based on history, symptoms of severe abdominal pain and signs such as rebound tenderness, as well as imaging showing free air in the abdomen. Bevacizumab (aka avastin) is an antineoplastic recombinant monoclonal antibody that inhibits angiogenesis in a variety of malignancies. Colonic perforation is a recognised but rare complication of this therapy, likely due to aforementioned bowel ischaemia or compromised mucosal microcirculation which increases susceptibility to injury. We are presenting a case of an unrecognised bowel perforation caused in a patient with abdominal carcinomatosis. PMID:24957587

Lazarescu, Roxana Elena; Bohm, Kelley

2014-01-01

242

Lifesaving Embolization of Coronary Artery Perforation  

SciTech Connect

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

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

2009-09-15

243

Laparoscopic partial cystectomy with mucosal stripping of extraluminal duodenal duplication cysts.  

PubMed

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

2014-01-28

244

Effects of intraduodenal administration of tarazepide on pancreatic secretion and duodenal EMG in neonatal calves  

Microsoft Academic Search

The influence of CCK-A receptor antagonism on pancreatic exocrine secretion and duodenal EMG, and the mechanism(s) involved in CCK-induced pancreatic secretion were studied in conscious calves. Seven 1-week-old calves were fitted with a pancreatic duct catheter, duodenal cannula and duodenal electrodes. Pancreatic exocrine secretion and duodenal EMG were studied following intraduodenal CCK-A receptor antagonist (Tarazepide), intravenous atropine, and intravenous or

Romuald Zabielski; Violetta Le?niewska; Jürgen Borlak; Peter C Gregory; Pawe? Kiela; Stefan G Pierzynowski; Wies?aw Barej

1998-01-01

245

Atypical presentation of perforated peptic ulcer disease in a 12-year-old boy.  

PubMed

A 12-year-old boy was referred to the surgical unit with 4?h history of severe lower abdominal pain and bilious vomiting. No other symptoms were reported and there was no significant medical or family history. Examination revealed tenderness in the lower abdomen, in particular the left iliac fossa. His white cell count was elevated at 19.6×10(9)/L, with a predominant neutrophilia of 15.8×10(9)/L and a C reactive protein of <0.3?mg/L. An abdominal X-ray revealed intraperitoneal gas and a chest X-ray identified free air under both hemidiaphragms. Subsequent diagnostic laparoscopy identified a perforated duodenal ulcer that was repaired by means of an omental patch. The case illustrates that although uncommon, alternate diagnoses must be borne in mind in children presenting with lower abdominal pain and diagnostic laparoscopy is a useful tool in children with visceral perforation as it avoids treatment delays and exposure to excess radiation. PMID:24973349

Mbarushimana, Simon; Morris-Stiff, Gareth; Thomas, George

2014-01-01

246

Laparoscopic repair of a right para duodenal hernia.  

PubMed

Para duodenal hernia is among the uncommon and rare causes of intestinal obstruction, but it is the most common type of internal hernia in abdomen and accounts for more than half of cases that do occur. Here, we are reporting a case of right Para duodenal hernia, reduced and repaired laparoscopically. This thirteen year old girl presented to us with features of small bowel obstruction of two days duration. Plain abdominal X-ray showed multiple fluid levels confined to right side of abdomen. A diagnostic laparoscopy was done under General Anaesthesia. Right Para duodenal hernia was found with small bowel confined to the right side between the ascending colon and hepatic flexure of colon. Laparoscopic reduction of contents of the hernia was done starting from the Ileocaecal junction. Hernial opening was closed laparoscopically with nonabsorbable suture. Patient is quite well till date and has had no recurrence of symptoms. PMID:20407574

Bhartia, Vishnu; Kumar, Anil; Khedkar, Indira; Savita, K S; Goel, N

2009-10-01

247

Laparoscopic repair of a right para duodenal hernia  

PubMed Central

Para duodenal hernia is among the uncommon and rare causes of intestinal obstruction, but it is the most common type of internal hernia in abdomen and accounts for more than half of cases that do occur. Here, we are reporting a case of right Para duodenal hernia, reduced and repaired laparoscopically. This thirteen year old girl presented to us with features of small bowel obstruction of two days duration. Plain abdominal X-ray showed multiple fluid levels confined to right side of abdomen. A diagnostic laparoscopy was done under General Anaesthesia. Right Para duodenal hernia was found with small bowel confined to the right side between the ascending colon and hepatic flexure of colon. Laparoscopic reduction of contents of the hernia was done starting from the Ileocaecal junction. Hernial opening was closed laparoscopically with nonabsorbable suture. Patient is quite well till date and has had no recurrence of symptoms

Bhartia, Vishnu; Kumar, Anil; Khedkar, Indira; Savita, K S; Goel, N

2009-01-01

248

Patient profile, indications, efficacy and safety of duodenal levodopa infusion in advanced Parkinson's disease  

Microsoft Academic Search

The studies of duodenal infusion of a levodopa on small groups of parkinsonian patients have reported beneficial effects on motor complications. However, little is known about the patient profile and indications for duodenal levo- dopa infusion. The purpose of this study is to exhaustively investigate the clinical characteristics of the population and indication, efficacy and tolerability of duodenal levodopa infusion

David Devos

2009-01-01

249

Duodenal Acid Clearance in Humans: Observations Made with Intraluminal Impedance Recording  

Microsoft Academic Search

Duodenal acid clearance appears to be involved not only in the pathogenesis of duodenal ulcer disease but also in functional dyspepsia. Duodenal contractile activity can help to maintain neutral pH in the duodenum by mixing acid with bicarbonate or by aborally transporting the acid load. Intraluminal impedance recording, allowing the detection of nonacid liquid boluses, can be carried out concomitantly

Guillaume Savoye; Jac Oors; ANDR ´ E SMOUT

2005-01-01

250

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

Microsoft Academic Search

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

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

1996-01-01

251

Duodenal bacterial overgrowth during treatment in outpatients with omeprazole.  

PubMed Central

The extent of duodenal bacterial overgrowth during the pronounced inhibition of acid secretion that occurs with omeprazole treatment is unknown. The bacterial content of duodenal juice of patients treated with omeprazole was therefore examined in a controlled prospective study. Duodenal juice was obtained under sterile conditions during diagnostic upper endoscopy. Aspirates were plated quantitatively for anaerobic and aerobic organisms. Twenty five outpatients with peptic ulcer disease were investigated after a 5.7 (0.5) weeks (mean (SEM)) treatment course with 20 mg (nine patients) or 40 mg (16 patients). The control group consisted of 15 outpatients referred for diagnostic endoscopy without prior antisecretory treatment. No patient in the control group had duodenal bacterial overgrowth. In the omeprazole group bacterial overgrowth (> or = 10(5) cfu/ml) was found in 14 (56%) patients (p = 0.0003). The number of bacteria (log10) in duodenal juice in patients treated with omeprazole was distinctly higher (median 5.7; range < 2-8.7) when compared with the control group (median < 2; range < 2-5.0; p = 0.0004). As well as orally derived bacteria, faecal type bacteria were found in seven of 14 and anaerobic bacteria in three of 14 patients. Bacterial overgrowth was similar with the two doses of omeprazole. These results indicate that duodenal bacterial overgrowth of both oral and faecal type bacteria occurs often in ambulatory patients treated with omeprazole. Further studies are needed to determine the clinical significance of these findings, particularly in high risk groups during long term treatment with omeprazole.

Fried, M; Siegrist, H; Frei, R; Froehlich, F; Duroux, P; Thorens, J; Blum, A; Bille, J; Gonvers, J J; Gyr, K

1994-01-01

252

Attenuation of weak shock waves along pseudo-perforated walls  

Microsoft Academic Search

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

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

1998-01-01

253

Rigid Projectile Perforation of Target Plates.  

National Technical Information Service (NTIS)

A new model for rigid projectile perforation of target plates is compared with experimental results for many combinations of spherical projectile diameters, target materials, target plate thickness and impact angles. In most cases of importance the model ...

G. Wijk A. Collin

2001-01-01

254

Gastric Outlet Obstruction from Duodenal Lipoma in an Adult  

PubMed Central

The duodenum is a rare site for gastrointestinal lipoma with less than 230 cases reported in the literature. Although, peptic ulcer disease remains the most common benign cause of gastric outlet obstruction (GOO), duodenal lipomas remain a rare, but possible cause of GOO and could pose a diagnostic challenge, especially in countries where access to endoscopy and modern imaging techniques poses a challenge. The authors present a case of GOO in a 40-year-old male, secondary to a duodenal lipoma. It was successfully treated by a transduodenal resection through a midline laparotomy. The histology report confirmed it was a submucosal lipoma.

Wichendu, Promise N; Dodiyi-Manuel, Amabra

2013-01-01

255

Recurrent Idiopathic Perforations of the Small Intestine  

Microsoft Academic Search

Background\\/Aims: Idiopathic perforation of the small intestine is extremely rare. The definition depends on the absence of any detectable pathology that could be responsible for the perforation. This study was undertaken to outline the criteria for determination of the condition. Methods: Case report and review of the literature. Results: A 50-year-old male patient underwent surgery including laparostomy and planned reexplorations

Julian E. Losanoff; Kirien T. Kjossev

2000-01-01

256

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.

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

2013-01-01

257

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

258

Perforating eye injuries in Cork. A review.  

PubMed

Of 95 cases of perforating eye injury during the 4-year period 1973 to 1976 reviewed, 21 had a retained intraocular foreign body. Sporting activities, including shotgun injuries, were found to be the cause in a significant number of cases. Four cases of perforating injury due to car battery explosions are also reported. None in the series was found to have sympathetic ophthalmitis. PMID:299134

Horan, E C

1979-01-01

259

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

260

Septal perforation repair: mucosal regeneration technique.  

PubMed

A novel method for repair of septal perforations. Fifteen volunteers with symptomatic septal perforations were recruited. Open technique rhinoplasty approach was preferred: auricular conchal cartilage graft with intact perichondrium on both sides was harvested and shaped to fit the perforated site and attached to the septum with absorbable sutures. All margins of the graft were covered with nasal mucosa. The severity of patient symptoms was assessed at preoperation, 3 and 6 months postoperatively via visual analogue scale (VAS). Crust formation, whistling, nasal blockage, epistaxis and overall comfort were evaluated. Mucosal physiology was assessed by nasal mucociliary clearance time. The mean age of the patients was 47.3 years. Average perforation size was 1.86 ± 0.78 cm. 14/15 (93.3%) perforations were repaired, and only one patient required revision surgery. VAS scores improved significantly (p < 0.001). Mean mucociliary clearance time improved from 17.6 ± 3.83 to 10.3 ± 3.30 min and 9.3 ± 3.36 min at 3 and 6 months, respectively. This is a novel, simple and safe method for repairing the deficient mucosal area in septal perforations up to 25 mm in diameter. PMID:22350430

Yenigun, Alper; Meric, Aysenur; Verim, Aysegul; Ozucer, Berke; Yasar, Husamettin; Ozkul, Murat Haluk

2012-12-01

261

Mucosal perforators from the facial artery.  

PubMed

The cutaneous perforators of the facial artery have been well described, but to our knowledge the oral mucosal perforators have not. We studied 10 facial arteries from 10 hemifaces in 5 cadavers. The arteries were injected with latex, and we studied all perforators that extended from the facial artery and headed directly to the oral mucosa. The diameter and length of the facial artery and its mucosal perforators were measured and compared. We found 52 oral mucosal perforators in the 10 facial arteries injected with latex. Their mean (SD) diameter was 0.5 (0.2) mm and the mean (SD) number/facial artery was 5.2 (1.1). Their mean (SD) length was 16.4 (5.3) mm. Most of those to the cheek were localised between the branching-off points of the inferior and superior labial arteries. The facial artery has perforators to the oral mucosa of the cheek, most of them between the points at which the labial arteries emerge. PMID:24703773

Coronel-Banda, Mauricio E; Serra-Renom, Jose M; Lorente, Marian; Larrea-Terán, Wendy P

2014-07-01

262

Do not get burned: preventing iatrogenic fires and burns in the emergency department.  

PubMed

Burns are a common emergency in children but are rarely sustained in the emergency department. While iatrogenic burns in the operating room have been detailed in the medical literature, there is little or no information on iatrogenic burns in the emergency department. We present 2 cases of patients who sustained burns in the emergency department and review the most common mechanisms for this to happen. It is not always evident that certain procedures can cause unexpected burns to our patients. A survey of pediatric emergency medicine fellowship programs indicates that most programs have no training about these dangers. Recommendations are made to help prevent and control iatrogenic fires in the emergency department. PMID:12972824

Hurt, Thomas L; Schweich, Paula J

2003-08-01

263

[Role of iatrogenic spondylodiscitis among pyogenic spondylodiscitis. 136 cases observed between 1980 and 1989].  

PubMed

The authors report 136 cases of spondylodiscitis due to ordinary organisms seen between 1980 and 1989 and note the increasing incidence of iatrogenic forms which during the past three years accounted for 50 per cent of cases. 60 per cent of these cases of iatrogenic spondylodiscitis complicated a medical of surgical procedure involving the spine (form by direct inoculation). In 40 per cent of cases, the organism came from a site of infection located at a distance (from by blood-borne spread). The clinical picture in cases of primary spondylodiscitis and of iatrogenic disease by blood-borne spread is essentially similar. That of iatrogenic forms by direct inoculation is different: most often young subjects, virtually exclusive involvement of the lumbar spine, fever and inflammatory syndrome less common. Escherichia coli and Staphylococcus aureus were the organisms most often responsible for primary spondylodiscitis (23 and 21.7 per cent of case respectively). Streptococci were in third position only (15.6 per cent of cases). Staphylococcus aureus remained predominant in iatrogenic spondylodiscitis (34 per cent of cases), while Escherichia coli and streptococci were significantly rarer than in primary forms and there was the appearance of Pseudomonas aeruginosa and Staphylococcus albus. No organism was found in 23 per cent of cases of primary spondylodiscitis. This figure reached 44% of iatrogenic forms by direct inoculation. Because of their increasing incidence, these cases of apparently aseptic spondylodiscitis, frequently complicating a procedure involving the spine, are modifying the picture of infectious spondylodiscitis. No doubt worthy of separate identification, they raise the problem of the significance of the concept of aseptic spondylodiscitis. PMID:1780664

Meys, E; Deprez, X; Hautefeuille, P; Flipo, R M; Duquesnoy, B; Delcambre, B

1991-12-01

264

Laparoscopic Repair for Perforated Peptic Ulcer  

PubMed Central

Objective To compare the results of open versus laparoscopic repair for perforated peptic ulcers. Summary Background Data Omental patch repair with peritoneal lavage is the mainstay of treatment for perforated peptic ulcers in many institutions. Laparoscopic repair has been used to treat perforated peptic ulcers since 1990, but few randomized studies have been carried out to compare open versus laparoscopic procedures. Methods From January 1994 to June 1997, 130 patients with a clinical diagnosis of perforated peptic ulcer were randomly assigned to undergo either open or laparoscopic omental patch repair. Patients were excluded for a history of upper abdominal surgery, concomitant evidence of bleeding from the ulcer, or gastric outlet obstruction. Patients with clinically sealed-off perforations without signs of peritonitis or sepsis were treated without surgery. Laparoscopic repair would be converted to an open procedure for technical difficulties, nonjuxtapyloric gastric ulcers, or perforations larger than 10 mm. A Gast- rografin meal was performed 48 to 72 hours after surgery to document sealing of the perforation. The primary end-point was perioperative parenteral analgesic requirement. Secondary endpoints were operative time, postoperative pain score, length of postoperative hospital stay, complications and deaths, and the date of return to normal daily activities. Results Nine patients with a surgical diagnosis other than perforated peptic ulcer were excluded; 121 patients entered the final analysis. There were 98 male and 23 female patients recruited, ages 16 to 89 years. The two groups were comparable in age, sex, site and size of perforations, and American Society of Anesthesiology classification. There were nine conversions in the laparoscopic group. After surgery, patients in the laparoscopic group required significantly less parenteral analgesics than those who underwent open repair, and the visual analog pain scores in days 1 and 3 after surgery were significantly lower in the laparoscopic group as well. Laparoscopic repair required significantly less time to complete than open repair. The median postoperative stay was 6 days in the laparoscopic group versus 7 days in the open group. There were fewer chest infections in the laparoscopic group. There were two intraabdominal collections in the laparoscopic group. One patient in the laparoscopic group and three patients in the open group died after surgery. Conclusions Laparoscopic repair of perforated peptic ulcer is a safe and reliable procedure. It was associated with a shorter operating time, less postoperative pain, reduced chest complications, a shorter postoperative hospital stay, and earlier return to normal daily activities than the conventional open repair.

Siu, Wing T.; Leong, Heng T.; Law, Bonita K. B.; Chau, Chun H.; Li, Anthony C. N.; Fung, Kai H.; Tai, Yuk P.; Li, Michael K. W.

2002-01-01

265

Iatrogenic causes of large pleural fluid collections in the premature infant: ultrasonic and radiographic findings.  

PubMed

Ten cases of large pleural collections, all of which were iatrogenically induced in premature infants, are presented. There were five instances of hypopharyngeal tears communicating with the right pleural space, three of chylothorax secondary to superior vena caval obstruction in patients undergoing total parenteral nutrition catheterization (TPN), and two of direct erosion by the inferior vena caval TPN catheter into the pleural space. Ultrasonography was most helpful in detecting these pleural collections. It is important to recognize the presence of pleural fluid in these infants as a marker of iatrogenic injury. PMID:3550662

Amodio, J; Abramson, S; Berdon, W; Stolar, C; Markowitz, R; Kasznica, J

1987-01-01

266

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

PubMed Central

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

2013-01-01

267

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.

2013-01-01

268

DWI findings in a iatrogenic lumbar epidermoid cyst. A case report.  

PubMed

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

2013-08-01

269

Coronary Perforation and Covered Stents: An Update and Review  

PubMed Central

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

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

2011-01-01

270

Treating bilio-duodenal obstruction: Combining new endoscopic technique with 6 Fr stent introducer  

PubMed Central

Periampullary cancer may cause not only biliary but also duodenal obstructions. In patients with concomitant duodenal obstructions, endoscopic biliary stenting remains technically difficult and may often require percutaneous transhepatic biliary drainage. We describe a method of metal stent placement via a thin forward-viewing endoscope in patients with simultaneous biliary and duodenal obstruction. In two consecutive patients with biliary and duodenal obstruction due to pancreatic cancer, a new biliary metal stent mounted in a slim delivery catheter was placed via a thin forward viewing endoscope after passage across the duodenal stenosis without balloon dilation. In both patients, with our new placement technique, metallic stents were successfully placed in a short time without adverse events. After biliary stenting, one patient received curative resection and the other received duodenal stenting for palliation. Metallic stent placement with a forward-viewing thin endoscope is a beneficial technique, which can avoid percutaneous drainage in patients with bilio-duodenal obstructions due to periampullary cancer.

Maetani, Iruru; Nambu, Tomoko; Omuta, Shigefumi; Ukita, Takeo; Shigoka, Hiroaki

2010-01-01

271

Treating bilio-duodenal obstruction: combining new endoscopic technique with 6 Fr stent introducer.  

PubMed

Periampullary cancer may cause not only biliary but also duodenal obstructions. In patients with concomitant duodenal obstructions, endoscopic biliary stenting remains technically difficult and may often require percutaneous transhepatic biliary drainage. We describe a method of metal stent placement via a thin forward-viewing endoscope in patients with simultaneous biliary and duodenal obstruction. In two consecutive patients with biliary and duodenal obstruction due to pancreatic cancer, a new biliary metal stent mounted in a slim delivery catheter was placed via a thin forward viewing endoscope after passage across the duodenal stenosis without balloon dilation. In both patients, with our new placement technique, metallic stents were successfully placed in a short time without adverse events. After biliary stenting, one patient received curative resection and the other received duodenal stenting for palliation. Metallic stent placement with a forward-viewing thin endoscope is a beneficial technique, which can avoid percutaneous drainage in patients with bilio-duodenal obstructions due to periampullary cancer. PMID:20533606

Maetani, Iruru; Nambu, Tomoko; Omuta, Shigefumi; Ukita, Takeo; Shigoka, Hiroaki

2010-06-14

272

Pellagra revealing a congenital duodenal diaphragm in an adult.  

PubMed

Pellagra is a nutritional disease caused by the deficiency of niacin. It is a clinical syndrome characterized by four "D's": diarrhea, dermatitis, dementia and ultimately death. We describe a case of pellagra as the initial presentation of congenital duodenal diaphragm. PMID:23168227

Khouloud, Bouslama; Haykel, Bedioui; Ahmed, Saidani; Houcine, Maghrebi; Yacine, Ben Safta; Farah, Jokho; Zoubeir, Ben Safta

2013-12-01

273

Quadruple therapy for symptomatic spontaneous duodenal ulcer disease  

PubMed Central

AIM—To investigate Helicobacter pylori eradication in duodenal ulcer patients with a new regimen, lansoprazole 30 mg daily for one or four weeks plus twice daily tetracycline 500 mg, clarithromycin 250 mg, and metronidazole 400 mg.?BACKGROUND—Spontaneous duodenal ulcer is regularly associated with H pylori, and permanent cure follows eradication of this bacterium. Numerous treatments have been proposed and none is ideal, possibly because of primary or acquired antibiotic resistance. Quadruple regimens with proton pump inhibitor therapy and three antibiotics offer promise as the most effective therapy.?METHODS—From November 1995 all patients with spontaneous duodenal ulcer were offered quadruple therapy. A month after completion a carbon 14 urea breath test (UBT) was performed. Sensitivity of H pylori to the antibiotics used was tested in 1992-3, 1996, and 1999.?RESULTS—A total of 331 patients were treated; 313 attended for a UBT, of which 299 were negative (95.5%). Of those patients who had an endoscopy with positive urease test immediately before treatment, 95/101 (94.0%) on lansoprazole for one week and 116/121 (95.8%) on lansoprazole for four weeks had a negative UBT. H pylori antibiotic sensitivity did not change.?CONCLUSION—This regimen produced some of the best results yet seen and may be generally recommended as first line therapy.???Keywords: Helicobacter pylori; duodenal ulcer

Bateson, M

2001-01-01

274

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...

275

Pyloric atresia associated with duodenal and jejunal atresia and duplication.  

PubMed

A case of congenital pyloric atresia associated with duodenal atresia, jejunal atresia, and a duplication is described. A review of the literature revealed nine previously reported cases of congenital pyloric atresia and multiple intestinal atresias, but this is the first report of such an association and a duplication. PMID:10525913

Al-Salem, A H

1999-01-01

276

Maintenance Therapy with Colloidal Bismuth Subcitrate in Duodenal Ulcer Disease  

Microsoft Academic Search

Various investigators have reported that relapses after healing of duodenal ulcers with colloidal bismuth subcitrate (CBS, De-Nol®) occur less frequently than after healing with H2- antagonists. To date, treatment with CBS has been limited to 8 weeks. After a volunteer study showed that prolonged administration of CBS did not cause safety problems, a trial was undertaken in which the effects

Bianchi Porro; M. Lazzaroni; W. R. E. Cortvriendt

1987-01-01

277

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

278

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

PubMed

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

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

2001-01-01

279

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.

Makkar, Rohit

2013-01-01

280

Large bowel perforation: morbidity and mortality.  

PubMed

Perforations of large bowel are rare but severe complications, mainly of colorectal cancer and colonic diverticulitis. The choice of the surgical procedure is still debated. We retrospectively studied peritonitis caused by large bowel perforation to assess predictors of mortality and safety of primary resection and anastomosis. We investigated 59 patients with large bowel perforation treated surgically as emergency cases: 18 patients underwent primary resection and anastomosis, 36 had primary resection of the diseased part of bowel without anastomosis, and 5 patients had non-resective procedures. The severity of peritonitis was assessed using Hinchey's classification and the Mannheim peritonitis index (MPI). Overall mortality was 16.9%. MPI score was significantly lower for survivors vs. non-survivors, and for patients with resection and anastomosis vs. those who underwent resection without anastomosis (p<0.001). The mortality rate was 11.1% for primary resection with anastomosis, and 22.2% for primary resection without anastomosis. No patient with MPI less than 25 died, while 10 (38.5%) of the patients with MPI of 26-36 died. In conclusion, a radical aggressive approach is recommended for most patients with large bowel perforation. Mortality and morbidity are closely related to the extent of intraperitoneal infection and the incidence of postoperative complications is higher in patients with perforation due to non-malignant causes. PMID:12525912

Bielecki, K; Kami?ski, P; Klukowski, M

2002-12-01

281

A model for the prevention of iatrogenic disease associated with work-related low back pain  

Microsoft Academic Search

A review of national statistics related to workers' compensation strongly suggests that the current system for managing work-related back pain is not only ineffective but may actually promote disability. It is this author's view that a comprehensive unifying solution exists within the military “forward treatment” model used to prevent iatrogenic disability in battle fatigue casualties. Because military personnel and employed

Alan Colledge

1993-01-01

282

Iatrogenic necrolytic migratory erythema: A case report and review of nonglucagonoma-associated necrolytic migratory erythema  

Microsoft Academic Search

Necrolytic migratory erythema is characterized by waves of irregular erythema in which a central bulla develops, and subsequently erodes and becomes crusted. It usually occurs in patients with an alpha-islet cell tumor of the pancreas. However, necrolytic migratory erythema has also been observed in patients without an associated glucagonoma. We describe a woman with iatrogenic necrolytic migratory erythema. She received

Elizabeth A. Mullans; Philip R. Cohen

1998-01-01

283

Autopsy case report of a rare acute iatrogenic water intoxication with a review of the literature  

Microsoft Academic Search

This paper reports a rare autopsy case, a 21-years old healthy female worker, who died of acute iatrogenic water intoxication after she had swallowed powder scraped off 17 matches in an apparent suicide attempt. Gastric lavage was performed as she was wrongly considered to have taken poison containing phosphorus. She was given 7.8 l water within 2 h. The pathological

Xinshan Chen; Guangzhao Huang

1995-01-01

284

Understanding Adverse Experiences in the Psychiatric Institution: The Importance of Child Abuse Histories in Iatrogenic Trauma  

Microsoft Academic Search

Psychiatric institutions are intended to be places of treatment and sanctuary. However, iatrogenic events in the hospital may interfere with treatment delivery and adherence (Shaw, McFarlane, & Bookless, 1997); additionally, a history of childhood abuse may increase vulnerability to negative emotional reactions to later adverse or threatening events (Chisholm, Freeman, & Cooke, 2006). The present study extends previous research on

L. Felice Reddy; William D. Spaulding

2010-01-01

285

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

Microsoft Academic Search

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

Ramazan Kutlu; Cengiz Ara; Kaya Sarac

2007-01-01

286

Perforated peptic ulcer in an infant.  

PubMed

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

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

2001-02-01

287

Acute corneal hydrops mimicking full thickness perforation  

PubMed Central

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

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

2012-01-01

288

Sigmoid diverticular perforation complicating lung transplantation.  

PubMed

We present three lung transplant recipients who had sigmoid colonic diverticular perforation within 4 weeks of transplantation, giving an overall incidence of 8.6% (3 of 35) in our population. Our cases are unusual because they all occurred in the early posttransplantation period and because the incidence of perforation is substantially higher than that reported in other transplant populations. The reason for the apparent increased incidence of perforation in our lung transplant recipients is unclear, but it is likely related to the short follow-up period, intense posttransplantation immunosuppression, perioperative hypoperfusion, and increased intraluminal pressure from the use of narcotics and bowel stimulants. We discuss these potential causes and comment on preventive measures being undertaken at our program. PMID:9229300

Fenton, J J; Cicale, M J

1997-06-01

289

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

290

A rare case of perforated caecum after acute pancreatitis.  

PubMed

Isolated caecal perforation following pancreatitis is a rare event. We report a case of severe non-necrotising pancreatitis complicated by caecal perforation that was managed successfully. PMID:22613291

Martin, L C E; Stavrou, M; El-Madani, F; Naik, V; Jain, K; Gupta, S

2012-05-01

291

Plate perforation by eroding rod projectiles  

Microsoft Academic Search

The penetration and perforation of stationary, oblique steel plates by hypervelocity tungsten-alloy projectiles is examined here. Simulations have been performed for L\\/D 10 projectiles against one- and two-plate target configurations. The plate thickness-to-rod diameter ratio t\\/D varied slightly, as did the plate spacing-to-plate thickness ratio tgap\\/t. For all simulations, t\\/D?[1.2,1.6] and tgap\\/t?[0.7,1]. Normalized line-of-sight perforation is one measure of performance,

D. J. Gee

2003-01-01

292

Perforating granuloma annulare mimicking papulonecrotic tuberculid.  

PubMed

A case is reported of a patient presenting lymph node tuberculosis and cutaneous lesions resembling papulonecrotic tuberculid, but histologically compatible with perforating granuloma annulare and which responded satisfactorily to antituberculous therapy. This is probably one of the first reports of the association of perforating granuloma annulare and tuberculosis, and it is important therefore to highlight the relevance of this disorder in the differential diagnosis of papulonecrotic tuberculid and to raise the hypothesis that this entity should also be considered to be a variant of tuberculid. PMID:24346892

Pereira, Amanda Regio; Vieira, Mariana Bellini; Monteiro, Marina Pinhas Ariza; Enokihara, Milvia Maria Simões e Silva; Michalany, Nilceo Schwery; Bagatin, Ediléia; Hassun, Karime Marques

2013-01-01

293

Autologous breast augmentation by pedicled perforator flaps.  

PubMed

A technique is described for autologous breast augmentation based on perforator flaps of the lateral chest wall. Raising these flaps as perforator flaps implies minimal donor site morbidity; however, the price to pay is a scar underneath the armpit extending from the lateral end of the inframammary fold onto the back. This scar can be relatively well hidden underneath the arm and in the brassiere. Indications depend on the aversion of the patient against prostheses and the extent of available tissue versus the desired augmentation. As typical indications, we would consider the occasional developmental asymmetry, autologous augmentation after contralateral breast reconstruction, or contour surgery in the bariatric patient. PMID:15385764

Van Landuyt, Koenraad; Hamdi, Moustapha; Blondeel, Phillip; Monstrey, Stanislas

2004-10-01

294

Intramural esophageal dissection associated with esophageal perforation.  

PubMed

Intramural esophageal dissection (IED) is a rare clinical entity involving a mucosal injury and creation of a true and false lumen within the esophagus. We report on a case of IED caused by repeated vomiting due to a small bowel obstruction associated with a small amount of pneumomediastinum on CT. IED has traditionally been believed not to be associated with esophageal perforation. Our case adds to the few reported instances where IED has been associated with extraluminal air leakage, the mildest form of esophageal perforation and demonstrates imaging not previously published in the radiology literature. Our case was successfully managed conservatively. PMID:23819141

Monu, Nicholas C; Murphy, Brian L

2013-01-01

295

Oblique Perforation of Thick Metallic Plates by Rigid Projectiles  

Microsoft Academic Search

Oblique perforation of thick metallic plates by rigid projectiles with various nose shapes is studied in this paper. Two perforation mechanisms, i.e., the hole enlargement for a sharp projectile nose and the plugging formation for a blunt projectile nose, are considered in the proposed analytical model. It is shown that the perforation of a thick plate is dominated by several

Xiaowei Chen; Qingming Li; Saucheong Fan

2006-01-01

296

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

Microsoft Academic Search

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

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

2003-01-01

297

Controlled trial of carbenoxolone sodium vs. cimetidine in duodenal ulcer.  

PubMed

The healing-rate of duodenal ulcer after short-term treatment with carbenoxolone was not significantly different from that after treatment with cimetidine. There seems to be no evidence of a significant difference in the tendency of duodenal ulceration to relapse following successful short-term therapy with either treatment. In the case of cimetidine treatment the rate of 58% relapse within 12 months after withdrawal of the drug corresponds well to the data of other authors (3, 19) and does not exceed the relapse rate during placebo medication. The post-treatment relapse study was markedly hampered by a low compliance of patients to cooperate in the long-term follow-up. The drop-out rate was greater in patients previously treated with carbenoxolone than in those of the cimetidine group. PMID:7010527

Schenk, J; Schmack, B; Rösch, W; Domschke, W

1980-01-01

298

Endoscopic mucosal resection with circumferential mucosal incision of duodenal carcinoid tumors  

PubMed Central

Duodenal carcinoids are a rare form of neuroendocrine tumors, and tend to invade the submucosa during the early stage. Endoscopic treatment is generally recommended for duodenal carcinoids less than 10 mm in diameter. Although a few reports have described the use of endoscopic resection of duodenal carcinoids, there are no published studies on endoscopic mucosal resection with circumferential mucosal incision (EMR-CMI). We performed EMR-CMI for 5 cases of duodenal carcinoids in the duodenal bulb. The mean tumor diameter was 4.6 ± 1.8 mm. Although all of the tumors were located in the submucosa, R0 resection was performed without complication in each case. EMR-CMI may thus be a safe and effective treatment for duodenal carcinoids less than 10 mm in diameter.

Otaki, Yuzo; Homma, Kiyoaki; Nawata, Yoshitakata; Imaizumi, Kazuomi; Arai, Shigeru

2013-01-01

299

P2X receptors in the rat duodenal villus  

Microsoft Academic Search

Immunohistochemical techniques were performed on freshly frozen sections of the duodenum of the rat using specific polyclonal antibodies to unique peptide sequences of P2X1-7 receptors. Of the antibodies to the seven known P2X receptor subtypes that mediate extracellular signalling by nucleotides, three reacted with discrete structures in the duodenal villus of the rat. Anti-P2X1 reacted with the capillary plexus in

Ute Gröschel-Stewart; Michelle Bardini; Tim Robson; Geoffrey Burnstock

1999-01-01

300

Duodenal atresia: associated anomalies, prenatal diagnosis and outcome  

Microsoft Academic Search

Background  The diagnosis of duodenal atresia is commonly made prenatally, either as an isolated lesion or due to its association with\\u000a other chromosomal abnormalities (Robertson et al. in Semin Perinatol 18:182–195, 1994; Hemming and Rankin in J Prenat Diagn 27:1205–1211, 2007). The aim of this study was to describe the prevalence of associated anomalies, prenatal diagnostic accuracy and survival\\u000a of cases

M. S. Choudhry; N. Rahman; P. Boyd; K. Lakhoo

2009-01-01

301

Hypervelocity Projectile Launcher for Well Perforation.  

National Technical Information Service (NTIS)

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 perforat...

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

1989-01-01

302

Hypervelocity Projectile Launcher for Well Perforation.  

National Technical Information Service (NTIS)

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. Th...

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

1989-01-01

303

A hypervelocity projectile launcher for well perforation  

Microsoft Academic Search

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

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

1989-01-01

304

Energy and momentum changes during ballistic perforation  

Microsoft Academic Search

The paper presents an investigation of the energy and momentum changes of a projectile during the perforation of monolithic and composite targets. Three approaches are adopted: an analytical approach, based on first principles, an analytical development of established penetration prediction equations and an experimental investigation. Experimental evidence indicates that the energy and momentum transfer to the target is greatest at

J. G. Hetherington

1996-01-01

305

Axial perforation of aluminum honeycombs by projectiles  

Microsoft Academic Search

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

Werner Goldsmith; Dell L. Louie

1995-01-01

306

[Spontaneous perforation of the bile ducts].  

PubMed

Spontaneous perforation of the extra-hepatic bile ducts in infancy is rare and of unknown etiology. Its finding at laparotomy in a 2 month-old premature with artificial ventilation allows to underline that the diagnosis may be difficult and may necessitate ultrasonography and even hepatobiliary scintigraphy. PMID:2735809

Brault, D; Danan, C; Ponet, M; Janaud, J C; Canet, J

1989-03-01

307

Penetration and perforation of thick FRP laminates  

Microsoft Academic Search

Analytical equations are given for the prediction of the penetration and perforation of thick FRP laminates struck normally by missiles over a wide range of impact velocities. The missiles have different nose shapes (i.e. truncated, conical, flat, ogival and hemispherical). The formulation is based on the assumption that the deformations are localized and that the mean pressure offered by the

H. M. Wen

2001-01-01

308

Thermometers and rectal perforations in the neonate  

Microsoft Academic Search

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

J D Frank; S Brown

1978-01-01

309

Vibrator-induced fatal rectal perforation  

Microsoft Academic Search

A middle-aged man was admitted to our hospital with abdominal pain and bleeding per rectum. Subsequent laparotomy indicated an established faecal peritonitis in relation to an anterior perforation of the upper rectum. He later volunteered that he had anal intercourse 2 days previously with a vibrator at an erotic party. His partner volunteered further information regarding devient practice such as

Naseem G Waraich; James S Hudson; Syed Y Iftikhar

310

Perforated small bowel diverticulitis after gastric bypass.  

PubMed

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

Corcelles, Ricard; Pavel, Mihai; Lacy, Antonio

2014-01-01

311

Perforation Peritonitis in Primary Intestinal Tuberculosis  

Microsoft Academic Search

Primary intestinal tuberculosis is unusual in European and North American countries today. Its diagnosis is often surprising and differentiation from inflammatory bowel diseases is difficult. The authors present a rare case of severe stercoral peritonitis caused by multiple intestinal perforations in a patient with primary ileocecal tuberculosis. Initial clinical and laboratory investigations led to the suspicion of inflammatory bowel disease.

R. Šefr; P. Rotterová

2001-01-01

312

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

PubMed Central

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

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

2009-01-01

313

Silymarin attenuates mycophenolate mofetil-induced duodenal disorders in rats  

PubMed Central

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

Malekinejad, Hassan; Sheikhzadeh, Sanaz; Hobbenaghi, Rahim

2014-01-01

314

Placebo effect in the treatment of duodenal ulcer  

PubMed Central

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

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

1999-01-01

315

Mechanism of action of Trolox on duodenal contractility.  

PubMed

Trolox is a hydrophilic analogue of vitamin E. The aim of this work was to study the mechanism of action of Trolox on rabbit duodenal spontaneous motility and contractility. The duodenal contractility studies in vitro were carried out in an organ bath. Trolox (12 mM) reduced the amplitude and frequency of spontaneous contractions and the acetylcholine-induced contractions in the longitudinal and circular smooth muscle of rabbit duodenum. Quinine reverted the Trolox-induced (12 mM) reduction on the amplitude and frequency of spontaneous contractions in the longitudinal and circular muscle. Charibdotoxin and glibenclamide reverted only the amplitude of spontaneous contractions in circular muscle of the duodenum. The decrease of ACh-induced contractions evoked by Trolox 12 mM in the longitudinal and circular smooth muscle of the duodenum was antagonized by quinine in longitudinal and circular muscle and by Bay K8644, 1H-[1,2,4]oxadiazolo [4, 3-?]quinoxalin-1-one (ODQ) and nimesulide in circular muscle. We conclude that in the decrease of duodenal contractility induced by Trolox participate K(+) and Ca(2+) channels, adenylyl cyclase, guanylyl cyclase and cyclooxygenase-2. PMID:24388884

Fagundes, D S; Grasa, L; Gonzalo, S; Martinez de Salinas, F; Arruebo, M P; Plaza, M A; Murillo, M D

2013-12-01

316

INCREASING DIETARY HIGH-LINOLEATE SAFFLOWER OIL AFFECTS DUODENAL FLOW OF ESTERIFIED LINOLEATE IN WETHERS  

Microsoft Academic Search

We hypothesize that lambs fed a high- concentrate diet with high-linoleate safflower oil will have increased duodenal flow of 18:2c9,c12 (18:2, linoleic acid) due primarily to flow of esterified 18:2. Four crossbred wethers (BW = 44.3 ± 15.7 kg) fitted with ruminal and duodenal cannulae were used in a 4 × 4 Latin square experiment to determine duodenal fatty acid

R. L. Atkinson; E. J. Scholljegerdes; S. L. Lake; V. Nayigihugu; B. W. Hess

2003-01-01

317

Rapid switch from oral antiparkinsonian combination drug therapy to duodenal levodopa infusion.  

PubMed

Six patients with Parkinson's disease (PD) with severe motor complications were directly switched from their oral antiparkinsonian combination drug regime to nasoduodenal levodopa infusion without previously recommended transient treatment with levodopa alone. Duodenal levodopa infusion reduced motor complications to a considerable extent. We have shown that a prior change to an oral levodopa monotherapy and a slow titration of duodenal levodopa infusion may be skipped and a direct switch to duodenal levodopa is a safe option. PMID:17987653

Meiler, Birgit; Andrich, Jürgen; Müller, Thomas

2008-01-01

318

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

Microsoft Academic Search

Recent studies from our laboratory demonstrated that Egr-1 is upregulated in the rat duodenal mucosa during cysteamine-induced duodenal ulceration and that antisense egr-1 oligonucleotide aggravates the duodenal ulcers. This study was aimed to determine the effects of cysteamine on redox-sensitive Egr-1 transcriptional activity and on other thiol-containing proteins such as redox factor-1 (Ref-1) and thioredoxin (Trx). Here we demonstrate for

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

2003-01-01

319

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

Microsoft Academic Search

The release of immunoreactive prostaglandin E2 (PGE2) and leukotriene C4 (LTC4) from antral and duodenal mucosal biopsy specimens taken from 20 patients with duodenal ulcer disease was measured by radioimmunoassay before and four weeks after treatment with colloidal bismuth subcitrate. Gastroscopic and histological examination showed complete ulcer healing in 15\\/18 patients and duodenal histology looked normal (n = 15) or

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

1992-01-01

320

[Efficacy of SMC-electrophoresis of peat mud in primary chronic duodenitis].  

PubMed

Sinusoidal modulated current (SMC) electrophoresis of peat mud was used as monotherapy of primary chronic duodenitis in Uva sanatorium. A total of 65 patients with primary chronic duodenitis received SMC electrophoresis of peat mud diluted with distilled water. The effect was followed up with fibrogastroduodenoscopy and target biopsy of duodenal mucosa with further study of its morphological structure and element composition, acid-producing function of the stomach, hormonal profile, collagen metabolism. Positive changes were observed in clinical-endoscopic and morphological picture of the disease which is explained by favourable shifts in hormonal status and normalization of collagen metabolism in duodenal mucosa. PMID:16989205

Gorbunov, Iu V; Subbotin, S P; Shkliaev, A E

2006-01-01

321

A new endoscopic metallic stenting method for duodenal stenosis: a preliminary report.  

PubMed

Palliative duodenal stenting was attempted in three patients with severe duodenal stenosis due to tumor invasion. Two methods were applied for duodenal stenting: the conventional method, which inserts the Ultraflex (stent for esophageal stenosis) along the guidewire under fluoroscopy, and a new method that uses a snare and an endoscope to guide the esophageal stent. The conventional method is often unsuccessful, because the delivery tube is too short, but the latter method appears to be a safe and effective duodenal stenting technique. PMID:10535484

Hyodo, T; Yoshida, Y; Imawari, M

1999-10-01

322

Duodenal delivery of levodopa for on-off fluctuations in parkinsonism: preliminary observations.  

PubMed

The pathogenesis of on-off motor fluctuations in parkinsonism remains incompletely understood, but slowed or erratic gastric emptying of orally administered levodopa may be involved. In 3 patients with resistant on-off fluctuations, direct duodenal continuous infusion of levodopa via a nasoduodenal tube resulted in a heightened therapeutic effect, including a reduction in motor fluctuations. In 1 of these patients, continuous duodenal levodopa infusion produced greater benefit than did intermittent duodenal levodopa administration. Direct duodenal delivery of levodopa lessens the problems with gastric emptying and may be suitable for long-term therapy in selected patients with resistant on-off motor fluctuations. PMID:3752968

Kurlan, R; Rubin, A J; Miller, C; Rivera-Calimlim, L; Clarke, A; Shoulson, I

1986-08-01

323

Determination of alpha-amylase activity in duodenal contents with the blue starch polymer.  

PubMed

The use of the blue starch polymer (Phadebas tablets) for the determination of duodenal alpha-amylase is described. 0.05% bovine or human albumin solutions are necessary for dissolution of substrate tablets as well as for dilution of duodenal contents. Concentration and output values of duodenal amylase before and after cholecystokinin-pancreozymin and secretin stimulation display a close correlation of the chromogenic and saccharogenic method. The average error of duodenal alpha-amylase in parallel examinations is low with both methods and their relative accuracy is practically the same. The chromogenic method is considered more simple and rapid. PMID:209677

Fric, P; Roth, Z

1977-01-01

324

Duodenal duplication cyst in a 52-year-old man: A challenging diagnosis and management  

PubMed Central

INTRODUCTION Duodenal duplication is a rare congenital malformation. Although more frequent in childhood, it may rarely be observed in adulthood. Pre-operative diagnosis can be difficult. PRESENTATION OF CASE We report the case of a 52-year-old man with a duodenal duplication cyst, who was misdiagnosed even after a primary surgery. Definitive treatment needed an extensive diagnostic workup and a second delicate operation. DISCUSSION This article discusses the incidence of duodenal duplications, their types, their clinical presentations, the radiologic and diagnostic features along with different therapeutic options. CONCLUSION Duodenal duplication should always be one of the differential diagnoses proposed when approaching upper abdominal cystic formations.

Al-Harake, Ali; Bassal, Ahmad; Ramadan, Mohamad; Chour, Mohomad

2013-01-01

325

Duodenal Hemorrhage from Pancreatic Cancer Infiltration Controlled through Combination Therapy with Gemcitabine and S-1  

PubMed Central

2.6% of pancreatic cancer patients have the primary manifestation of gastrointestinal bleeding. It is not feasible to stop the duodenal hemorrhage caused by the pancreatic cancer infiltration. A 43-year-old woman who was diagnosed as having pancreatic cancer with multiple hepatic metastases and duodenal infiltration was administered gemcitabine and S-1 combination therapy. During the chemotherapy, initially, bleeding occurred due to duodenal infiltration. However, we continued the chemotherapy and duodenal infiltration was markedly reduced in size and did not rebleed. Aggressive chemotherapy contributed to maintenance of performance status as well as improvement of quality of life for the patient.

Takada, Ryoji; Ioka, Tatsuya; Sueyoshi, Hironari; Ishida, Nobuko; Yamai, Takuo; Fukutake, Nobuyasu; Ashida, Reiko; Uehara, Hiroyuki; Takenaka, Akemi; Tomita, Yasuhiko; Katayama, Kazuhiro

2014-01-01

326

Endoscopic ultrasound-guided double stenting for biliary and duodenal obstruction  

PubMed Central

Endoscopic biliary stenting for malignant biliary obstruction is currently the gold standard for biliary drainage. Biliary cancer treatment is crucial. Cases of gastric outlet obstruction that includes the duodenum because of cancer invasion and biliary obstruction are seldom observed. The required treatment for such cases is simple biliary stenting and a different treatment for duodenal obstruction. Hence, double stenting for bile duct and duodenal obstruction has drawn attention. In the present review, we state different treatment strategies for malignant duodenal obstruction and then describe double stenting in biliary obstruction that also includes non-biliary cancer malignant lesions and duodenal obstruction.

Itoi, Takao; Itokawa, Fumihide; Sofuni, Atsushi; Kurihara, Toshio; Ishii, Kentaro; Tsuji, Shujiro; Ikeuchi, Nobuhito; Umeda, Junko; Tanaka, Rena; Tonozuka, Ryosuke; Moriyasu, Fuminori

2012-01-01

327

Ultrasound-guided Aspiration of the Iatrogenic Pneumothorax Caused by Paravertebral Block -A Case Report-  

PubMed Central

Thoracic paravertebral block is performed for the treatment of patients with chronic pain, such as complex regional pain syndrome (CRPS) and post-herpetic neuralgia. Thoracic paravertebral block can result in iatrogenic pneumothorax. Because pneumothorax can develop into medical emergencies and needle aspiration or chest tube placement may be needed, early diagnosis is very important. Recently, thoracic ultrasonography has begun to be used to diagnose pneumothorax. In addition, ultrasound-guided aspiration can be an accurate and safe technique for treatment of pneumothorax, as the needle position can be followed in real time. We report a case of iatrogenic pneumothorax following thoracic paravertebral block for the treatment of chronic pain due to CRPS, treated successfully by ultrasound-guided aspiration.

Park, Jin Suk; Kim, Young Hoon; Jeong, Su Ah

2012-01-01

328

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

PubMed

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

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

2013-05-01

329

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

PubMed Central

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

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

2013-01-01

330

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

PubMed Central

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

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

1992-01-01

331

[The surgical correction of iatrogenic damage to and cicatricial stricture of the extrahepatic bile ducts].  

PubMed

In treatment of 86 patients with a iatrogenic injury, or cicatricial stricture of the extrahepatic bile ducts, the Prader-Smith, Saypole-Kurian transhepatic drainage of hepatico-digestive anastomosis and that with the use of the method suggested by the authors have been used. The technique for performance of the operations is described, the special instruments are offered. After the operation, only one female patient has developed a subphrenic abscess. PMID:8207898

Vecherko, V N; Konoplia, P P; Shatalov, V F; Khatsko, V V; Shatalov, A D

1993-01-01

332

A case of Takotsubo cardiomyopathy in a patient with iatrogenic thyrotoxicosis.  

PubMed

Takotsubo cardiomyopathy is a condition caused by intense emotional or physical stress leading to rapid and severe reversible cardiac dysfunction. The etiology and mechanism of this disease are unknown. Thyroid hormone has many effects on the heart and vascular system. There were some reports of Takotsubo cardiomyopathy with hyperthyroidism, especially Grave's disease. We report a patient who presented chest pain and cardiac arrest, and finally diagnosed as Takotsubo cardiomyopathy caused by iatrogenic thyrotoxicosis. PMID:19628289

Kwon, Se-Ah; Yang, Jae Hoon; Kim, Min-Kyu; Park, Seon Wook; Kim, Seong Hwan; Park, Kyoung-Ha; Park, Woo-Jung

2010-12-01

333

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.

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

2013-01-01

334

Iatrogenic causes of large pleural fluid collections in the premature infant: ultrasonic and radiographic findings  

Microsoft Academic Search

Ten cases of large pleural collections, all of which were iatrogenically induced in premature infants, are presented. There\\u000a were five instances of hypopharyngeal tears communicating with the right pleural space, three of chylothorax secondary to\\u000a superior vena caval obstruction in patients undergoing total parenteral nutrition catheterization (TPN), and two of direct\\u000a erosion by the inferior vena caval TPN catheter into

J. Amodio; S. Abramson; W. Berdon; C. Stolar; R. Markowitz; J. Kasznica

1987-01-01

335

Female breast cancer in relation to exposure to medical iatrogenic diagnostic radiation during life  

PubMed Central

Aim of the study Exposure to radiation and aging are the leading causes of breast cancer among female patients. We aimed to investigate and assess the relationship between exposure to medical, diagnostic and iatrogenic radiation and breast cancer using a questionnaire among 100 newly diagnosed female breast cancer patients and 100 control female subjects without cancer. Material and methods A case control study using a family ambulatory based survey was conducted among 200 female patients from all municipalities of Zenica-Doboj Canton. New cases of breast cancer among subjects of experimental groups (n = 100) were diagnosed between 1 January 2003 and 31 December 2007 using the institutional clinical procedure for breast cancer diagnosis. Data were obtained using a self-rated questionnaire on radiation as a breast carcinogen. Data analysis was performed using SPSS version 19.0. Results There were no significant differences between the two groups and their subgroups for individual data and demographics except for prevalence of decreased family financial situation (practical poverty) among subjects with breast cancer in relation to control subjects (31%: 17% among control subjects; p = 0.001). Female patients who are exposed to iatrogenic radiation before the 3rd year of life (OR = 1.29; 95% CI: 0.839–1.985) and those who are exposed to CT more than twice per year are more than twice as likely to have breast carcinoma (OR = 2.02; 95% CI: 1.254–3.261) compared to control subjects. Poverty and low family income are vulnerability factors associated with elevated levels of breast carcinoma. This result is not in accordance with prior study results. ConcIusions It is necessary to develop an adequate registration system of iatrogenic exposure to radiation for each patient of any age, particularly for children aged < 3 years and for CT iatrogenic exposure.

Pranjic, Nurka; Drljevic, Kenan; Prasko, Subhija; Drljevic, Irdina; Brzezinski, Piotr

2013-01-01

336

Enhanced internal search for iatrogenic retinal breaks in 20-gauge macular surgery  

Microsoft Academic Search

PurposeTo evaluate the incidence and characteristics of iatrogenic retinal breaks in 20-gauge macular surgery with an intensified search strategy.DesignRetrospective, non-comparative interventional case series.Participants218 consecutive operations in 209 patients who underwent 20-gauge vitrectomy vitrectomy for idiopathic macular pucker or idiopathic macular hole.MethodsRetrospective review of patient records undergoing 20-gauge vitrectomy with intensified peripheral search for retinal defects.Main outcome measuresIncidence of breaks related

H Stevie Tan; Sarit Y Lesnik Oberstein; Marco Mura; Marc D de Smet

2010-01-01

337

Iatrogenic Migration of an Impacted Pharyngeal Foreign Body of the Hypopharynx to the Prevertebral Space  

PubMed Central

Impaction of foreign bodies in the upper aerodigestive tract is commonly encountered in ENT practice. The present paper describes an iatrogenic complication with migration of an impacted foreign body (chicken bone) of the hypopharynx into the prevertebral space, after unsuccessful attempt of endoscopic removal. The foreign body was visualized with cervical CT scan lying extraluminally between the major vessels of the neck. An open surgical procedure with neck exploration was necessary for the definite treatment.

Hajiioannou, Jiannis; Kousoulis, Panagiotis; Florou, Vassiliki; Stavrianou, Eleni

2011-01-01

338

Iatrogenic migration of an impacted pharyngeal foreign body of the hypopharynx to the prevertebral space.  

PubMed

Impaction of foreign bodies in the upper aerodigestive tract is commonly encountered in ENT practice. The present paper describes an iatrogenic complication with migration of an impacted foreign body (chicken bone) of the hypopharynx into the prevertebral space, after unsuccessful attempt of endoscopic removal. The foreign body was visualized with cervical CT scan lying extraluminally between the major vessels of the neck. An open surgical procedure with neck exploration was necessary for the definite treatment. PMID:22187562

Hajiioannou, Jiannis; Kousoulis, Panagiotis; Florou, Vassiliki; Stavrianou, Eleni

2011-01-01

339

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

SciTech Connect

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

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

2007-02-15

340

Management of Iatrogenic Rupture of Profunda Femoris Artery after Femoral Fracture Fixation with Stent Graft Implantation  

PubMed Central

Vascular injuries with acute or chronic arterial hemorrhage after femoral shaft fractures are a rare but a life-threatening complication. We observed a case of iatrogenic rupture of the profunda femoris artery after the internal fixation of a femoral shaft fracture. The pseudoaneurysm, presenting with painful expansile swelling and hemodynamic instability, together with the rupture was evident on femoral angiography. Endovascular stent graft placement was performed successfully, and there was no sign or symptom at 9 months’ follow-up.

Varastehravan, Hamidreza; Nough, Hossein; Ansari, Zahra

2010-01-01

341

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

Microsoft Academic Search

Iatrogenic arterial dissection leading to the development of dissecting pseudoaneurysms of the superior mesenteric artery\\u000a (SMA) is a rare complication of angiography. Surgical and endovascular treatment options exist for this important condition.\\u000a We report a case of bare stent implantation in dissecting pseudoaneurysm of the SMA that developed after angiography in a\\u000a patient with acute mesenteric ischemia. Although it is

Ramazan Kutlu; Cengiz Ara; Kaya Sarac

2007-01-01

342

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

343

Clinical Application of the Hanover Classification for Iatrogenic Bile Duct Lesions  

PubMed Central

Background. There is only limited evidence available to justify generalized clinical classification and treatment recommendations for iatrogenic bile duct lesions. Methods. Data of 93 patients with iatrogenic bile duct lesions was evaluated retrospectively to analyse the variety of encountered lesions with the Hanover classification and its impact on surgical treatment and outcomes. Results. Bile duct lesions combined with vascular lesions were observed in 20 patients (21.5%). 18 of these patients were treated with additional partial hepatectomy while the majority were treated by hepaticojejunostomy alone (n = 54). Concomitant injury to the right hepatic artery resulted in additional right anatomical hemihepatectomy in 10 of 18 cases. 8 of 12 cases with type A lesions were treated with drainage alone or direct suture of the bile leak while 2 patients with a C2 lesion required a Whipple's procedure. Observed congruence between originally proposed lesion-type-specific treatment and actually performed treatment was 66–100% dependent on the category of lesion type. Hospital mortality was 3.2% (n = 3). Conclusions. The Hannover classification may be helpful to standardize the systematic description of iatrogenic bile duct lesions in order to establish evidence-based and lesion-type-specific treatment recommendations.

Bektas, Huseyin; Kleine, Moritz; Tamac, Azad; Klempnauer, Jurgen; Schrem, Harald

2011-01-01

344

Spontaneous corneal perforation in ocular rosacea.  

PubMed

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

2010-04-01

345

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.

Al Arfaj, Khalid; Al Zamil, Waseem

2010-01-01

346

[Perforated peptic ulcer disease in the elderly].  

PubMed

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

Kondoh, Yasumasa

2010-11-01

347

Pneumomediastinum caused by colonic diverticulitis perforation  

PubMed Central

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

2011-01-01

348

Cross-sectional imaging of perforated gallbladder.  

PubMed

Gallbladder perforation is a potentially life-threatening condition commonly seen as a complication of acute cholecystitis. Urgent surgical intervention is often needed to reduce serious morbidity and mortality. It presents a diagnostic challenge due to nonspecific symptoms, leading to a delay in diagnosis. Imaging plays a vital role in early identification of this potentially fatal condition and evaluation by more than one imaging modality may be required to make the diagnosis. Knowledge of specific and ancillary imaging findings is crucial to avoid misdiagnosis. In this article, we will review the risk factors, pathophysiology, and surgical classification of gallbladder perforation and discuss the role of multimodality imaging in its diagnosis. Differential diagnoses on imaging will also be discussed. PMID:24627043

Seyal, Adeel R; Parekh, Keyur; Gonzalez-Guindalini, Fernanda D; Nikolaidis, Paul; Miller, Frank H; Yaghmai, Vahid

2014-08-01

349

Perforated Arc-Tabs for Jet Control  

NASA Astrophysics Data System (ADS)

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

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

2011-06-01

350

The influence of trisomy 21 on the incidence and severity of congenital heart defects in patients with duodenal atresia  

Microsoft Academic Search

Duodenal atresia is associated with a wide variety of congenital malformations. Trisomy 21 occurs in approximately one-thirds\\u000a of infants with duodenal atresia. Congenital heart disease in patients with trisomy 21 and duodenal atresia is well known.\\u000a However, the frequency and spectrum of congenital heart defects in infants with duodenal atresia and a normal karyotype has\\u000a not been outlined in the

Scott J. Keckler; Shawn D. St. Peter; Troy L. Spilde; Daniel J. Ostlie; Charles L. Snyder

2008-01-01

351

Projectile perforation of moving plates: experimental investigation  

Microsoft Academic Search

An experimental investigation was conducted to examine the normal impact and perforation of blunt- and 60°-conically-tipped 12.7 mm diameter hard-steel cylindrical projectiles on plates moving orthogonal to their initial trajectory with three different speeds. By means of an air or powder gun, these bullets were propelled at speeds ranging from 50 to 1000m\\/s against rotating annular disks of aluminum, steel

Xiofan Hou; Werner Goldsmith

1996-01-01

352

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

353

Urosepsis complicated by a spontaneous bladder perforation.  

PubMed

The authors present a case of a 72-year-old diabetic male s/p pelvic irradiation for prostate carcinoma who arrived in the emergency department with complaints of shaking chills. After admission for urosepsis, he developed severe abdominal pain and examination revealed a diffusely tender abdomen. The patient was diagnosed with spontaneous urinary bladder perforation and underwent surgery. After several weeks of intravenous antibiotics, he was discharged with multiple drains in place and bilateral nephrostomy tubes. PMID:22674104

Lutwak, Nancy; Dill, Curt

2011-01-01

354

Traumatic Tympanic Membrane perforation: An aetiological profile  

PubMed Central

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

2009-01-01

355

Changes in nocturnal and peak acid outputs after duodenal ulcer healing with sucralfate or ranitidine  

Microsoft Academic Search

Changes in basal and stimulated acid secretion after duodenal ulcer healing have been previously shown to be influenced by the nature of the treatment. This study aimed to determine possible changes in nocturnal acid secretion on duodenal ulcer healing in patients treated with sucralfate or ranitidine. Nocturnal acid output and peak acid output in response to pentagastrin stimulation were studied

A F Kummer; D A Johnston; I N Marks; G O Young; N A Tigler-Wybrandi; S A Bridger

1992-01-01

356

High prevalence of adenomatous polyps of the duodenal papilla in familial adenomatous polyposis  

Microsoft Academic Search

Eighteen consecutive asymptomatic patients with familial adenomatous polyposis (both familial polyposis coli and Gardner's syndrome) were studied over a 12-month period; side-viewing upper endoscopy and biopsy were used to assess the frequency of adenomatous polyps of the duodenal papilla. Nine of the 18 patients demonstrated adenomatous polyps of the papilla, varying in size and appearance from microadenomas in normalappearing duodenal

James R. Alexander; John M. Andrews; Kenneth N. Buchi; Randall G. Lee; James M. Becker; Randall W. Burt

1989-01-01

357

Adjuvant antibiotic therapy in duodenal ulcers treated with colloidal bismuth subcitrate  

Microsoft Academic Search

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

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

1990-01-01

358

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

359

Occult glove perforation during ophthalmic surgery.  

PubMed Central

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

Apt, L; Miller, K M

1992-01-01

360

Laparoscopic resection of antenataly identified duodenal duplication cyst.  

PubMed

We report the first case of complete laparoscopic resection of a duodenal duplication cyst (DDC) in an 8-mo-old patient. The cyst was diagnosed by routine antenatal ultrasound performed at 3 mo of gestational age. Although the baby was born asymptomatic without any congenital abnormalities, the cyst had continued to increase on serial sonographic examinations. Previous reports have described treatment of DDC by surgical resection (laparotomy) or endoscopic marsupialization; we describe here, the first report of laparoscopic approach to resect DDC in a pediatric patient with a favorable outcome. PMID:24018086

Ballehaninna, Umashankar K; Nguyen, Tin; Burjonrappa, Sathyaprasad C

2013-01-01

361

Intraoperative methods to stage and localize pancreatic and duodenal tumors.  

PubMed

Intraoperative methods to stage and localize tumors have dramatically improved. Advances include less invasive methods to obtain comparable results and precise localization of previously occult tumors. The use of new technology including laparoscopy and ultrasound has provided some of these advances, while improved operative techniques have provided others. Laparoscopy with ultrasound has allowed for improved staging of patients with pancreatic cancer and exclusion of patients who are not resectable for cure. We performed laparoscopy with ultrasound on 50 consecutive patients with adenocarcinoma of the pancreas or liver who appeared to have resectable tumors based on preoperative computed tomography. 22 patients (44%) were found to be unresectable because of tumor nodules on the liver and/or peritoneal surfaces or unsuspected distant nodal or liver metastases. The site of disease making the patient unresectable was confirmed by biopsy in each case. Of the 28 remaining patients in whom laparoscopic ultrasound predicted to be resectable for cure, 26 (93%) had all tumor removed. Thus laparoscopy with ultrasound was the best method to select patients for curative surgery. Intraoperative ultrasound (IOUS) has been a critical method to identify insulinomas that are not palpable. Nonpalpable tumors are most commonly in the pancreatic head. Because the pancreatic head is thick and insulinomas are small, of 9 pancreatic head insulinomas only 3 (33%) were palpable. However, IOUS precisely identified each (100%). Others have recommended blind distal pancreatectomy for individuals with insulinoma in whom no tumor can be identified. However, our data suggest that this procedure is contraindicated as these occult tumors are usually within the pancreatic head. Recent series suggest that previously missed gastrinomas are commonly in the duodenum. IOUS is not able to identify these tumors, but other methods can. Of 27 patients with 31 duodenal gastrinomas, palpation identified 19 (61%). IOUS did not image a single tumor that was not palpable. Endoscopy with duodenal transillumination found an additional 7 tumors (84%), and duodenotomy identified an additional 5 (100%). Thus duodenotomy (opening the duodenum) is indicated in all patients with gastrinoma as duodenal tumors are missed by other means including ultrasound, palpation and transillumination. In conclusion, laparoscopy with ultrasound is useful for selecting patients with pancreatic cancer for curative surgery. Ultrasound is critical for operative identification of insulinomas especially in the pancreatic head, and duodenotomy can identify duodenal wall gastrinomas that are missed by other methods. PMID:10436817

Norton, J A

1999-01-01

362

Laparoscopic Resection of Antenataly Identified Duodenal Duplication Cyst  

PubMed Central

We report the first case of complete laparoscopic resection of a duodenal duplication cyst (DDC) in an 8-mo-old patient. The cyst was diagnosed by routine antenatal ultrasound performed at 3 mo of gestational age. Although the baby was born asymptomatic without any congenital abnormalities, the cyst had continued to increase on serial sonographic examinations. Previous reports have described treatment of DDC by surgical resection (laparotomy) or endoscopic marsupialization; we describe here, the first report of laparoscopic approach to resect DDC in a pediatric patient with a favorable outcome.

Ballehaninna, Umashankar K.; Nguyen, Tin

2013-01-01

363

Effects of intraduodenal administration of tarazepide on pancreatic secretion and duodenal EMG in neonatal calves.  

PubMed

The influence of CCK-A receptor antagonism on pancreatic exocrine secretion and duodenal EMG, and the mechanism(s) involved in CCK-induced pancreatic secretion were studied in conscious calves. Seven 1-week-old calves were fitted with a pancreatic duct catheter, duodenal cannula and duodenal electrodes. Pancreatic exocrine secretion and duodenal EMG were studied following intraduodenal CCK-A receptor antagonist (Tarazepide), intravenous atropine, and intravenous or intraduodenal CCK-8 administrations. Tarazepide decreased duodenal electric activity, reduced interdigestive pancreatic secretion, especially protein; reduced cephalic and early postprandial (milk) induced secretion of bicarbonate and protein. Pancreatic protein secretion to intravenous CCK-8 was little affected by atropine, but was significantly reduced by Tarazepide+/-atropine; in contrast, protein secretion to intraduodenal CCK-8 was abolished by Tarazepide or atropine. We conclude that pre- and especially early postprandial pancreatic secretion are partly controlled via CCK-A (mainly mucosal) mediated mechanisms. PMID:9879754

Zabielski, R; Le?niewska, V; Borlak, J; Gregory, P C; Kiela, P; Pierzynowski, S G; Barej, W

1998-11-30

364

Effects of propofol and fentanyl on duodenal motility activity in pigs  

PubMed Central

Abstract To investigate the effects of propofol and fentanyl on the postprandial duodenal motility the intraluminal impedance technique was used. Six pigs were instrumented with a central venous catheter, a percutaneous enterogastrostomy (PEG), and an impedance catheter, which was introduced via the PEG into the duodenum through endoscopy. Over the following 3 d, duodenal motility was measured for 8-hour periods. Measurements were taken on each subject under 3 different sets of conditions: in the conscious unrestrained pig, during propofol sedation, and during sedation with propofol-fentanyl. Both, after morning feeding and during gastric nutrition via the PEG, duodenal feeding patterns and duodenal phase II of the migrating motor cycle were shortened during propofol and propofol-fentanyl sedation. In contrast, the duration of phase I was prolonged by propofol and propofol-fentanyl. In conclusion, either propofol or propofol-fentanyl sedation shortens duodenal feeding patterns, as well as phase II of the migrating motor cycle.

2005-01-01

365

Obstructive Jaundice Secondary to Primary Duodenal Lymphoma with CMV Duodenitis Causing Upper GI Bleed in Retro-Positive Patient: A Case Report.  

PubMed

Gastrointestinal (GI) tract is the most common site of extranodal lymphoma. Primary GI lymphoma constitutes a small amount of all lymphomas. Primary duodenal lymphoma presenting initially with obstructive jaundice is very rare. Primary B-cell lymphoma of the duodenum was shown to be the cause of biliary obstruction in a retropositive male, which was proved by endoscopic biopsy. Histopathology also showed cytomegalovirus inclusion bodies with duodenitis. PMID:24426393

Patil, Basavaraj B; Kumar P, Sampath; Suresh, B P; Dinesh, B V; Geetha, V; Sabasis, B

2013-02-01

366

Pacemaker lead perforation causing hemopericardium eight years after implantation  

PubMed Central

The number of patients with intracardiac devices, including permanent pacemakers and implantable cardioverter-defibrillators is increasing. Lead perforation is a recognized complication which most often occurs during or shortly following pacemaker implantation. Late lead perforation occurring over 30 days after device insertion is a rare, potentially life-threatening complication. We present a case of late lead perforation unmasked greater than eight years after pacemaker implantation by initiation of anticoagulation.

Liang, Jackson J.; Killu, Ammar M.; Osborn, Michael J.; Jaffe, Allan S.

2013-01-01

367

On deformation and perforation of ship structures under ballistic impacts  

Microsoft Academic Search

This paper investigates the characteristics of the deformation and perforation on thin-walled structures under ballistic impacts based on the DYNA3D numerical simulations. Perforation mechanisms of plates and numerical modelling techniques to simulate the response of thin-walled structures under ballistic impacts are discussed to some extent. A benchmark study on deformation and perforation of steel plates struck by a rigid projectile

J. K. Paik; S. H. Won

2007-01-01

368

Otoscope fogging: examination finding for perforated tympanic membrane.  

PubMed

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

Naylor, Jason F

2014-01-01

369

Perforation in cancer of the colon and rectum  

Microsoft Academic Search

Summary  The management of patients with perforation of the colon in association with cancer of the colon presents a unique and difficult\\u000a surgical problem. Surgical care of the perforation and its resultant peritonitis or abscess must take precedence over that\\u000a of the cancer.\\u000a \\u000a In this study of 45 patients with the combined lesions, perforation occurred at the site of the tumor

Virgil H. Crowder; Isidore Cohn

1967-01-01

370

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

371

Extensive subcutaneous emphysema due to colonic perforation following colonoscopy.  

PubMed

During colonoscopy, subcutaneous emphysema may occur as a result of colonic perforation into retroperitoneal area. In this report, a 54-year-old woman with sigmoid colon perforation following colonoscopy is described. Subcutaneous emphysema was the first manifestation of the perforation in this case. Initially, the patient received supportive, non-surgical treatment, but due to development of acute abdominal signs and symptoms in later stages, the patient underwent surgical treatment. PMID:19486580

Fazeli, Mohammad Sadegh; Keramati, Mohammad Reza; Lebaschi, Amir Hossein; Bashashati, Mohammad

2009-06-01

372

The inferior turbinate flap for closure of septal perforations.  

PubMed

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

Vuyk, H D; Versluis, R J

1988-02-01

373

An Unusual Etiology of Spontaneous Pyometra Perforation; A Case Report  

PubMed Central

Introduction By presenting this case we aimed to describe an uncommon complication of generalized peritonitis following spontaneous pyometra perforation in untreated cervical carcinoma. Case Presentation This report describes a 60-year-old postmenopausal woman presenting with clinical features mimicking intestinal perforation who was later diagnosed as cervical carcinoma with pyometra perforation at exploratory laparotomy. The patient had good post-operative recovery following drainage and peritoneal lavage. Conclusion Spontaneous pyometra perforation in a case of untreated carcinoma of cervix is a rare condition, yet it should be suspected and kept in the differential diagnosis of acute abdomen in elderly women.

Agarwal, Rachna; Suneja, Amita; Sharma, Abha; Vaid, Neelam Bala

2011-01-01

374

Treatment of Strip Perforation Using Root MTA: A Case Report  

PubMed Central

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

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

2013-01-01

375

Allopurinol in the treatment of acquired reactive perforating collagenosis*  

PubMed Central

Acquired reactive perforating collagenosis is a perforating dermatosis usually associated with different systemic diseases, mainly diabetes mellitus and/or chronic renal insufficiency. Different therapies have been tried but treatment is not standardized yet and remains a challenge. In the last few years, allopurinol has been reported as a good therapeutic option for acquired reactive perforating collagenosis. We describe the case of a 73-year-old man affected by acquired reactive perforating collagenosis associated with diabetes type 1 and chronic renal failure with secondary hyperparathyroidism. The patient was successfully treated with allopurinol 100mg once/day p.o..

Tilz, Hemma; Becker, Jurgen Christian; Legat, Franz; Schettini, Antonio Pedro Mendes; Inzinger, Martin; Massone, Cesare

2013-01-01

376

Duodenal and gastric delivery of levodopa in parkinsonism.  

PubMed

To clarify the influence of gastric emptying on levodopa-related motor fluctuations in Parkinson's disease, we assessed mobility and plasma levodopa concentrations in 10 patients during five modes of levodopa administration: (1) standard intermittent oral (SIO), (2) intermittent duodenal (ID), (3) continuous duodenal infusion (CDI), (4) continuous gastric infusion (CGI), and (5) controlled-release Sinemet (CR-4). The rank order from greatest to least for both percentage of time "on" and average mobility score was CDI, CGI, ID, CR-4, and SIO. The rank order for variance of means, a measure of fluctuation, from least to greatest for mobility was CDI, CGI, CR-4, ID, SIO, and for plasma levodopa concentrations was CDI, CGI, ID, SIO, and CR-4. The results demonstrate that it is possible to produce very steady plasma concentrations of levodopa with a corresponding reduction in motor fluctuations by continuous intraduodenal administration of the drug. This mode of delivery is an ideal model for the development of optimal continuous-release preparations of levodopa. Other enteral routes have produced a more variable plasma levodopa concentration and clinical response. PMID:3408240

Kurlan, R; Nutt, J G; Woodward, W R; Rothfield, K; Lichter, D; Miller, C; Carter, J H; Shoulson, I

1988-06-01

377

Duodenal bulb control of the flow rate of digesta in the fasted and fed dog.  

PubMed Central

1. Continuous measurement of the flow of digesta near the pylorus, and 5 cm aborally, was assessed in the conscious dog using a chronically implanted flowmeter. The patterns of flow were related to motor activity of the gastroduodenal junction. 2. Electromagnetic measurement of the flow was calibrated in vitro by means of a pulsatile pump. Validation was obtained in vivo by direct evaluation of the amount of chyme collected from an open duodenal cannula and indirectly by a dye-dilution technique. 3. After a 12 h fast, only small amounts of gastric contents were delivered into the duodenum. This transfer occurred during periods of irregular motor activity recorded along the gastroduodenal junction, which occupied less than 25% of the recording time. The patterns of flow near the pylorus and beyond the duodenal bulb were correlated to antral and duodenal contractions respectively. 4. After a meal, gastric emptying occurred intermittently and was related to enhanced antral motor activity beyond the duodenal bulb; digesta flowed in clusters of gushes which were related to the duodenal contractions. 5. It is concluded that the mechanical role of the duodenal bulb is to change the intermittent juxtapyloric flow of digesta into a uniform flow at the duodenal level.

Malbert, C H; Ruckebusch, Y

1989-01-01

378

Conservative treatment of an intraperitoneal bladder perforation  

PubMed Central

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

Michielsen, Dirk

2011-01-01

379

Posterior plica perforation: rare complication of adenotonsillectomy.  

PubMed

Tonsillectomy is one of the most common operations performed by otolaryngologists. Some extraordinary complications of this surgery are massive bleeding, taste perception disorders due to glossopharyngeal nerve damage, hematoma of the mouth floor, jugular vein thrombosis, Grisel syndrome, cervical osteomyelitis, nasopharyngeal stenosis, pulmonary edema, infection, and lingual artery pseudoaneurysm. In this clinical report, an 8-year-old girl presented with a posterior plica perforation after adenotonsillectomy performed 1 week previously and this complication has led to velopharyngeal insufficiency. This rare complication may result from traumatic damage or excessive cauterization of the posterior plica. PMID:25006950

Yildirim, Yavuz Selim; Senturk, Erol; Ozturan, Orhan

2014-07-01

380

Iatrogenic urethrovaginal fistula with transverse vaginal septum presenting as cyclical hematuria.  

PubMed

We present a case of iatrogenic urethrovaginal fistula with transverse vaginal septum. The patient presented with cyclical hematuria and infertility. The vagina was blind-ending. The magnetic resonance imaging (MRI) showed normal uterus with transverse vaginal septum. The cystoscopic examination during cyclical hematuria revealed bloody efflux through a small fistula below the internal urethral sphincter. Vaginoplasty and repair of the urethrovaginal fistula was done. The vagina was reconstructed using an amniotic mould. The report emphasizes the importance of MRI and cystoscopy in diagnosing such rare and complex anomalies. PMID:22279328

Singh, Abha; Kumar, Manisha; Sharma, Sumedha

2011-10-01

381

Iatrogenic water intoxication in healthy parturient causing convulsions and fractured mandible.  

PubMed

We report a case of a mandibular dentoalveolar fracture caused by severe iatrogenic hyponatremia-induced grand mal seizure in a 31-year-old pregnant lady who underwent normal vaginal delivery. She had oxytocin augmentation of her labor, and the seizure happened in the immediate postpartum period. The seizure was thought to be because of severe hyponatremia and prompt management controlled the metabolic disorder. The fracture was reduced and fixed successfully, and she was discharged after 48 hours, healing was uneventful. PMID:24562521

Abu Halaweh, Sami A; Aloweidi, Abdelkareem S; Qudaisat, Ibraheem Y; Al-Kazaleh, Fawaz A

2014-02-01

382

Framing family conversation after early diagnosis of iatrogenic injury and incidental findings  

Microsoft Academic Search

Background  Surgeons are rarely formally trained in giving bad news to patients. The aim of our study was to examine and compare techniques\\u000a of disclosure of iatrogenic and incidental operative findings among surgical residents.\\u000a \\u000a \\u000a \\u000a \\u000a Methods  General surgery residents performed a laparoscopic cholecystectomy on the SurgicalSIM device in a mock operating room. Half\\u000a (n = 8) were presented with a common bile duct injury, and

Limaris Barrios; Shawn Tsuda; Alexandre Derevianko; Sheilla Barnett; Donald Moorman; Caroline L. Cao; Alexandros N. Karavas; Daniel B. Jones

2009-01-01

383

A review of alternative approaches in the management of iatrogenic femoral pseudoaneurysms.  

PubMed Central

The management of iatrogenic pseudoaneurysms (IPAs) demands close co-operation between radiologist, vascular surgeon and plastic surgeon. Ideally, each patient should be reviewed employing a team approach. Many IPAs require only observation; those with a volume greater than 6 cm3 will require treatment as spontaneous thrombosis is uncommon. Radiological treatment options include ultrasound guided compression repair (UGCR), embolisation, and covered stenting. Occasionally, these are unsuccessful or contra-indicated, and the vascular surgical approach is discussed in detail. Finally, the role of the plastic surgeon in dealing with skin ischaemia is detailed. Images Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Figure 7

O'Sullivan, G. J.; Ray, S. A.; Lewis, J. S.; Lopez, A. J.; Powell, B. W.; Moss, A. H.; Dormandy, J. A.; Belli, A. M.; Buckenham, T. M.

1999-01-01

384

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

PubMed

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

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

2013-01-01

385

Iatrogenic Infection of Clostridium welchii Following Intramuscular Injection of Sodium Diclofenac  

PubMed Central

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

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

2013-01-01

386

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

387

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

PubMed

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

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

2013-05-01

388

Duodenal epithelial transport in functional dyspepsia: Role of serotonin  

PubMed Central

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

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

2013-01-01

389

[Actovegin treatment of duodenal ulcer associated with ischemic heart disease and diabetes mellitus].  

PubMed

Actovegin, a deproteinized hemoderivative, was used to correct bioenergetic defects of duodenal mucosa, to reduce inflammatory-cell infiltration, to stimulate blood supply of patients with duodenal ulcer associated with ischemic heart disease or diabetes mellitus. As shown by the results obtained in 194 patients (119 males and 75 females), adjuvant actovegin in patients with duodenal ulcer associated with ischemic heart disease and diabetes mellitus stimulates the ulcer healing, prolongs the recurrence-free interval. It can be used both in outpatient departments and specialized hospitals. PMID:10900865

Smolianinov, A B

2000-01-01

390

Isolated Duodenal Crohn's Disease: A Case Report and a Review of the Surgical Management  

PubMed Central

Crohn's disease may affect any segment of the gastrointestinal tract; however, isolated duodenal involvement is rather rare. It still remains a complex clinical entity with a controversial management of the disease. Initially, patients with duodenal Crohn' s disease (DCD) are managed with a combination of antiacid and immunosuppressive therapy. However, medical treatment fails in the majority of DCD patients, and surgical intervention is required in case of complicated disease. Options for surgical management of complicated DCD include bypass, resection, or stricturoplasty procedures. In this paper, we reported a 33-year-old male patient, who was diagnosed with isolated duodenal Crohn's diseases, and reviewed the surgical options in the literature.

Karateke, Faruk; Menekse, Ebru; Das, Koray; Ozyazici, Sefa; Demirturk, Pelin

2013-01-01

391

A Case of Duodenal Atresia with Apple Peel Appearance: Challenging the Current Embryology  

PubMed Central

Classically, embryology of duodenal atresia has been linked to defect in recanalization process, while apple-peal atresia of small bowel has been considered as due to vascular accident during embryonic life. We present a 33 week preterm neonate with duodenal atresia with the apple-peal appearance of proximal jejunum for which resection of the jejunum with apple-peal configuration, plication of the duodenum, and duodono-jejunal anastomosis was done. Thus, this rare case of ours questions the embryology of duodenal atresia with the apple-peal appearance suggesting it to be due to a vascular disruption phenomenon during embryonic life.

Pathak, Manish; Narula, Dipanshu

2014-01-01

392

[Intramural duodenal hematoma after blunt abdominal injury in childhood. Case report].  

PubMed

Gastrointestinal injuries after blunt abdominal trauma in childhood are seldom. In 30% of the patients, the site of injury is the duodenum. In 60% associated injuries including other abdominal or extraabdominal lesions are found. Most frequently duodenal damage consists in parietal haematoma, seldom in duodenal laceration. Duodenal haematoma can be resolved non-operatively in 50%. Operation is recommended for children in whom there is no evidence of partial resolution of the obstruction after 10-14 days or in cases with development of a parietal laceration with peritonitis and/or retroperitonitis. For diagnostic computed tomography is the examination of choice. PMID:7960916

Fasolini, F; Lichtenhahn, P; Aeberhard, P

1994-07-01

393

Isolated duodenal duplication cyst presenting as a complex solid and cystic mass in the upper abdomen  

PubMed Central

Duodenal duplication cysts are a rare subtype of gastrointestinal duplications cysts. Approximately 5% of gastrointestinal duplication cysts occur in the duodenum. An 18-year-old woman presented with epigastric pain and a subjective abdominal bulge. A computed tomography scan was subsequently performed and showed a solid and cystic mass with wall calcifications in the lesser sac of the upper abdomen. A duodenal duplication cyst was found unexpectedly on histopathologic analysis. This was also an unusual case as there was no evidence of malignancy. Four years after surgery, the patient remains asymptomatic. We present a brief literature review on duodenal duplication cysts and discuss its differential diagnosis.

Tsai, Salina D.; Sopha, Sabrina C.; Fishman, Elliot K.

2013-01-01

394

Pneumoretroperitoneum and pneumoperitoneum following argon plasma coagulation for a bleeding duodenal diverticulum: a case report.  

PubMed

Duodenal diverticula are usually asymptomatic, with an incidence of 0.16% to 22%. Symptomatic bleeding from a duodenal diverticulum is an even rarer event. The management of such a hemorrhage is almost entirely surgically based. Since the first reported case of endoscopic therapy for duodenal diverticular bleeding (DDB) by Sim et al, only two case series have been reported in the literature regarding endoscopic therapy for DDB. Hence, the optimal therapy modality for DDB remains unclear. A rare case involving massive pneumoretroperitoneum and pneumoperitoneum following argon plasma coagulation treatment for DDB is presented. A short discussion of the optimal endoscopic therapy for this rare disease is provided. PMID:20065903

Su, Pei-Yuan; Yen, Hsu-Heng

2010-02-01

395

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

PubMed

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

Dmitriev, A E; Arapov, N A

1989-01-01

396

Computed tomography features of spontaneously perforated pyometra: a case report.  

PubMed

Spontaneous perforation of pyometra is an extremely rare emergent gynecologic disease. We report a 73-year-old woman with a spontaneously perforated pyometra presenting with acute abdomen in the emergency department. A dedicated computed tomography examination of the abdominal and pelvic regions revealed the diagnosis. The patient recovered well after surgical intervention and antibiotic treatment. PMID:16604973

Chan, K S; Tan, C K; Mak, C W; Chia, C C; Kuo, C Y; Yu, W L

2006-03-01

397

Perforation of a thick plate by rigid projectiles  

Microsoft Academic Search

Perforation of a thick plate by rigid projectiles with various geometrical characteristics is studied in the present paper. The rigid projectile is subjected to the resistant force from the surrounding medium, which is formulated by the dynamic cavity expansion theory. Two perforation mechanisms, i.e., the hole enlargement for a sharp projectile nose and the plugging formation for a blunt projectile

X. W. Chen; Q. M. Li

2003-01-01

398

Photoelastic stress analysis in perforated (Rochette) resin bonded bridge design.  

PubMed

Rochette described the perforated cast metal bonded design for splinting periodontally compromised teeth. The design was later used for replacing missing teeth. The main causes of failure of the perforated (Rochette) type design were attributed to inappropriate case selection and erosion of the composite from perforations. The aim of this study was to analyse the effect of stress magnitude and direction on failure of perforated resin bonded bridges (RBBs). The objective was to compare stress magnitudes in this design with those reported on the non-perforated RBBs. Photoelastic modelling materials were selected to represent the relative stiffnesses of a posterior mandibular and an anterior maxillary perforated (Rochette) type design. The sizes of the models were scaled to x 2.5 in order to enhance visual analysis of the stress patterns. Stress magnitudes were quantified from isochromatic fringes and stress directions were evaluated from stress trajectories. These revealed a high-stress concentration around the perforations, particularly for those at the proximo-lingual/palatal (connector) areas. This experimental study revealed that the main reason for failure of Rochette designs is deformation at the perforations. PMID:10887911

Ziada, H M; Orr, J F; Benington, I C

2000-05-01

399

Spontaneous perforation of an oesophageal diverticulum in achalasia  

Microsoft Academic Search

Spontaneous perforation of the oesophagus is a rare occurrence that is usually due to vomiting and is seldom associated with an oesophageal lesion. We report a case of the spontaneous perforation of a large oesophageal diverticulum not preceded by any precipitating event in a 75-year-old male who was not known to have achalasia. The diverticulum was repaired by emergency surgery.

P Cantù; A Bozzani; R Penagini

2003-01-01

400

Wave reflection from partially perforated-wall caisson breakwater  

Microsoft Academic Search

In 1995, Suh and Park developed a numerical model that computes the reflection of regular waves from a fully perforated-wall caisson breakwater. This paper describes how to apply this model to a partially perforated-wall caisson and irregular waves. To examine the performance of the model, existing experimental data are used for regular waves, while a laboratory experiment is conducted in

Kyung-Duck Suh; Jae Kil Park; Woo Sun Park

2006-01-01

401

Laparoscopic peritoneal lavage for perforated colonic diverticulitis: a systematic review  

Microsoft Academic Search

Aim This systematic review aimed to evaluate the efficacy, morbidity and mortality of laparoscopic peritoneal lavage for patients with perforated diverticulitis. Method We searched PubMed, EMBASE, Web of Science, the Cochrane Library and CINAHL databases, Google Scholar and five major publisher websites without language restriction. All articles which reported the use of laparoscopic peritoneal lavage for patients with perforated diverticulitis

B. R. Toorenvliet; H. Swank; J. W. Schoones; J. F. Hamming; W. A. Bemelman

2010-01-01

402

Evaluation of the Relative Importance of Parameters Influencing Perforation Cleanup  

SciTech Connect

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

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

2003-10-22

403

The application of photocrosslinkable hyaluronan as a corneal perforation sealant  

Microsoft Academic Search

A novel photocrosslinkable methacrylated hyaluronic acid has been synthesized for use as a corneal perforation sealant. The adhesion strength of this hydrogel to an epithelial surface was quantitated in vitro. In vivo application of this biopolymer sealed 95% of experimental corneal perforations allowing for complete stromal healing and the re-establishment of the cornea

M. W. Grinstaff; D. Miki; A. Pfister-Serres; K. A. Dastgheib; K. A. Smeds; M. Inoue; D. L. Hatchell

1999-01-01

404

Severe metallosis leading to femoral head perforation.  

PubMed

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

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

2013-02-01

405

Nonsurgical approach for strip perforation repair using mineral trioxide aggregate  

PubMed Central

“Stripping” is lateral perforation is caused by overinstrumentation through a thin wall in the root and is most likely to occur at the inside wall of a curved canal, such as the distal wall of the mesial roots in mandibular first molars. In the past, poor prognosis for strip and furcation perforations was probably due to bacterial leakage or lack of biocompatibility of repair materials. However, the recent development in the techniques and materials such as mineral trioxide aggregate (MTA) has enhanced the prognosis for such cases. There is limited literature on use of MTA as an obturating material in the treatment of strip perforation. This study presents two cases of strip perforation that are successfully repaired nonsurgically using MTA with 2-year follow up. Cases suggest that MTA can be used as an alternative root canal obturation material for the treatment of strip perforation. The property differences between gray and white MTA are reviewed.

Adiga, Savitha; Ataide, Ida; Fernandes, Marina; Adiga, Subhash

2010-01-01

406

Optimal conditions for tissue perforation using high intensity focused ultrasound  

NASA Astrophysics Data System (ADS)

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

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

2012-10-01

407

Active Control of Liner Impedance by Varying Perforate Orifice Geometry  

NASA Technical Reports Server (NTRS)

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

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

2000-01-01

408

Intraperitoneal and extraperitoneal colonic perforation following diagnostic colonoscopy.  

PubMed

Both intraperitoneal and extraperitoneal colonic perforations have been reported after colonoscopy; however, cases with combined types of perforation are rare. We present the case of a 55-year-old man with a history of Crohn disease who complained of acute abdominal pain after a diagnostic colonoscopy. Abdominal computed tomography scan showed extensive pneumoperitoneum, pneumoretroperitoneum, pneumomediastinum, and leftsided pneumothorax. Exploratory laparotomy was performed, and the patient underwent subtotal colectomy and end ileostomy with placement of a left-sided chest drain for the left-sided pneumothorax. The patient was discharged home postoperatively in good condition. As the utility of colonoscopy continues to broaden, its complications will also be more common. Whereas intraperitoneal perforation is a known and not uncommon complication, extraperitoneal perforation is an uncommon complication. Combined intraperitoneal and extraperitoneal perforation is extremely rare, with only a few cases reported in the literature. Early diagnosis and operative management resulted in a satisfactory outcome in this particular case. PMID:24680158

Dehal, Ahmed; Tessier, Deron J

2014-01-01

409

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

PubMed Central

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

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

2013-01-01

410

Gastroesophageal reflux in duodenal ulcer patients before and after vagotomy.  

PubMed Central

Gastroesophageal reflux was investigated in 80 patients with duodenal ulcer by analysis of symptomatology and the acid reflux test. Resting gastroesophageal sphincter pressure (GESP) and postvagotomy reduction in basal and pentagastrin stimulated gastric acid secretion were also studied. Reflux symptoms were present in 40% of the patients, and this incidence was significantly reduced two months after vagotomy. In patients studied late after operation reflux symptoms were still less frequent than before operation, but not significant. After vagotomy, no significant changes in the fasting GESP or in gastroesophageal reflux as determined by the pH glass electrode were demonstrated. Thus, the decrease in reflux symptoms may be explained by the significant reduction in gastric acid secretion. Denervation of the cardia and the lower esophagus does not influence GESP or gastroesophageal reflux.

Csendes, A; Oster, M; M?ller, J T; Flynn, J; Funch-Jensen, P; Overgaard, H; Amdrup, E

1978-01-01

411

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

412

The vagus, the duodenal brake, and gastric emptying.  

PubMed Central

It has been suggested that an intact vagal supply is essential for the normal function of the recptors in the duodenum and proximal small bowel, which influence the rate of gastric emptying. This paper reports the effect of vagal denervation on gastric emptying and also examines the site and mode of action of receptors in the proximal small bowel.It has been demonstrated in the dog that most, if not all, the receptors controlling gastric emptying lie in the proximal 50 cm of the small bowel. Following truncal vagotomy the emptying time of each instillation increased significantly and the differential rate of emptying of different instillations remained unchanged. The proximal 50 cm of small bowel was capable to differentiating between different instillates even after selective extragastric vagotomy, in which the duodenum was vagally denervated and, therefore, duodenal braking receptors function independently of vagal innervation.

Shahidullah, M; Kennedy, T L; Parks, T G

1975-01-01

413

Experience with 53 portal-duodenal drained solitary pancreas transplants.  

PubMed

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

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

2014-02-01

414

Parietal cell vagotomy and dilatation for peptic duodenal stricture.  

PubMed Central

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

Mentes, A S

1990-01-01

415

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

416

Duodenal-Mucosal Bacteria Associated with Celiac Disease in Children  

PubMed Central

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

Sanchez, Ester; Donat, Ester; Ribes-Koninckx, Carmen; Fernandez-Murga, Maria Leonor

2013-01-01

417

[Do premarketing trials help to predict drug-related iatrogenic effects in elderly patients?].  

PubMed

Premarketing trials contribute poorly to predicting drug-related iatrogenic effects in elderly patients. Since their main goal is the demonstration of drug efficacy, these trials are characterised by a simplistic design, they include a limited number of young participants (volunteers only), are of a short duration, and follow a strict protocol. Results of studies in young people cannot be extrapolated to elderly people. Although licensing authorities recommend the recruitment of a meaningful number of elderly people in clinical trials (with an age distribution comparable to that expected when the drug is in routine use), even in trials that are not devoted to geriatric illnesses, elderly people remain substantially under-represented in most instances for methodological reasons (to avoid increased variance introduced by a heterogenous population), safety reasons (at this stage of drug development, it could be deleterious to include patients with comorbid conditions and unfair with regard to the brand image of the products), and ethical reasons (the decision to participate could not be taken by the elderly people alone). Exclusion of elderly participants, who are particularly exposed to drug-related iatrogenic effects, influences the generalisability of study findings. The recruitment of elderly participants, a vulnerable population, is necessary to allow valid conclusions regarding elderly people, recommendations on the appropriate dosage adjustment for elderly individuals, the avoidance of prescribing decisions based on inadequate information (with respect to a more informative summary of the characteristics of the products), and the maximum benefit for elderly people from research. PMID:15359619

Bouvenot, Gilles; Villani, Patrick

2004-01-01

418

Iatrogenic cushing syndrome secondary to ritonavir-epidural triamcinolone interaction: an illustrative case and review.  

PubMed

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

Sadarangani, Sapna; Berg, Melody L; Mauck, William; Rizza, Stacey

2014-01-01

419

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.

Berg, Melody L.

2014-01-01

420

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

PubMed

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

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

2013-01-01

421

Multidetector CT cystography for imaging colovesical fistulas and iatrogenic bladder leaks.  

PubMed

Multidetector computed tomography (MDCT) cystography currently represents the modality of choice to image the urinary bladder in traumatized patients. In this review we present our experience with MDCT cystography applications outside the trauma setting, particularly for diagnosing bladder fistulas and leaks. A detailed explanation is provided concerning exam preparation, acquisition technique, image reconstruction and interpretation. Colovesical fistulas most commonly occur as a complication of sigmoid diverticular disease, and often remain occult after extensive diagnostic work-up including cystoscopy and contrast-enhanced CT. We consistently achieved accurate preoperative visualization of colovesical fistulas using MDCT cystography. Urinary leaks and injuries represent a non-negligible occurrence after pelvic surgery, particularly obstetric and gynaecological procedures: in our experience MDCT cystography is useful to investigate iatrogenic bladder leaks or fistulas. In our opinion, MDCT cystography should be recommended as the first line modality for direct visualization or otherwise confident exclusion of both spontaneous enterovesical fistulas and bladder injuries following instrumentation procedures, obstetric or surgical interventions. Main Messages • Explanation of exam preparation, acquisition technique, image reconstruction and interpretation. • Preoperative visualization of colovesical fistulas, usually secondary to sigmoid diverticulitis. • Visualization or exclusion of iatrogenic bladder injuries following instrumentation or surgery. PMID:22696044

Tonolini, Massimo; Bianco, Roberto

2012-04-01

422

Criminal gunshot wound and iatrogenic tension pneumothorax detected by post-mortem computed tomography.  

PubMed

Post-mortem imaging at autopsy is gradually increasing in popularity among forensic practitioners. The objective of the present paper was to demonstrate that it is essential to survey the cadaver using computed tomography (CT) before autopsy. This case report presents an iatrogenic tension pneumothorax caused by left subclavian vein puncture undertaken during treatment for a gunshot-related wound. The victim, a 64-year-old woman, was shot by her husband at home, and transferred to the hospital emergency unit. Before surgical procedures were carried out, left subclavian vein puncture was performed; however, during the operation, the victim experienced sudden cardiac arrest. Subsequent intensive resuscitation was unsuccessful. The clinical cause of death was recorded as traumatic shock caused by the gunshot injury. However, before the legal autopsy took place, CT clarified the existence of tension pneumothorax not on the same side as the gunshot wound, but on the side of the iatrogenic subclavian vein puncture. Because of this information gained prior to legal dissection, a typical dissection procedure for tension pneumothorax could be performed. Post-mortem imaging prior to regular dissection is essential as an adjunct diagnostic tool. PMID:24630902

Hasegawa, Iwao; Heinemann, Axel; Tzikas, Antonios; Vogel, Hermann; Püschel, Klaus

2014-05-01

423

[Functional state of the gastro-duodenal area in gastro-esophageal reflux disease].  

PubMed

The complex study of stomach and duodenal function was performed in 150 patients with GERD. It was revealed that 84,3% of patients had increased stomach acid-production. In GERD exacerbation we found the disturbance of gastric mucosa decreasing protective properties of esophageal, stomach and duodenal mucosa. The patients had increased intragastral and intraduodenal pressure leading to decreasing of closing function of pylorus. Due to dynamic gastroscintigraphy the slowing of stomach evacuation was revealed in 69,2% patients, the acceleration - in 7,7% patients. The prevalence of bradyperistalsis was found in elecrogastromyography. The role of hormones (gastrin, insulin, cortisol, thyrotrophin, thyroxin) in disorders of gastro-duodenal complex function was shown. The complex investigation of gastro-duodenal complex function opens the pathophysiologic base of GERD and these data may be used in the choice of adequate therapy. PMID:17937002

Vakhrushev, Ia M; Potapova, L O

2007-01-01

424

Retrograde jejunal-duodenal intussusception associated with a jejunal duplication cyst in a newborn  

Microsoft Academic Search

Retrograde intussusception is a rare occurrence. We report a retrograde jejunal-duodenal intussusception associated with a jejunal duplication cyst, which presented as intermittent biliary and upper gastrointestinal (UGI) obstruction and a mobile abdominal mass in a newborn infant.

K. I. Norton; K. C. Luhlnann; S. E. Dolgin

1993-01-01

425

Enteropathy of coeliac disease in adults: increased number of enterochromaffin cells the duodenal mucosa.  

PubMed

Twenty-nine adult patients with coeliac disease and 39 patients with a normal duodenal morphology were studied with respect to the 5-ht containing enterochromaffin cells. Their number in duodenal biopsies was assessed by fluorescence histochemistry and they were examined by immunohistochemistry for peptides known or believed to occur in enterochromaffin cells. Antisera used were raised against substance P, motilin, and leu-enkephalin. In addition, the concentration of 5-HT was determined chemically. In adult coeliac disease there was a significant increase in the number of duodenal enterochromaffin cells compared with the control group. The concentration of 5-HT in the duodenal mucosa was also greatly increased. Substance P was found in a minority population of enterochromaffin cells. These cells were very few and did not increase in number in coeliac disease. Motilin cells were distinct from enterochromaffin cells. No enkephalin immunoreactive cells were found in the biopsies. PMID:7056495

Sjölund, K; Alumets, J; Berg, N O; Håkanson, R; Sundler, F

1982-01-01

426

Initiation of migrating myoelectric complex in sheep by duodenal acidification and hyperosmolarity: role of vagus nerves.  

PubMed Central

Gastrointestinal motility was studied in conscious sheep by X-radiography and by electromyography from chronically implanted electrodes before and after total thoracic vagotomy. Duodenal infusion of 0.5-3 mmol HCl (0.035-0.1 M-HCl) induced premature duodenal regular spiking activity (r.s.a.) within 1-7 min in fifteen of seventeen sheep studied when infused at 20 min after a natural r.s.a. There was no correlation between abomasal pH and any phase of the migrating myoelectric complex (m.m.c.). Duodenal alkalinization by infusion of 0.3 M-Tris buffer (pH 10.2) or 0.1 M-NaHCO3 had no influence on the occurrence of the m.m.c. Duodenal infusion of 20-50 ml 0.5 M-NaCl induced a premature duodenal r.s.a. within 1-5 min in seven of eight sheep. Vagotomy did not prevent the initiation or migration of the m.m.c., but reduced the rate of propagation of the r.s.a. from 40.5 +/- 7.2 (mean +/- S.E. of mean) to 16.7 +/- 0.1 cm/min in the duodenum, from 27.3 +/- 4.1 to 16.6 +/- 0.8 cm/min in the jejunum, and from 21.4 +/- 1.1 to 13.7 +/- 0.7 cm/min in the proximal ileum. Initially the frequency of r.s.a. increased, especially in the duodenum where they recurred at an interval of 98.4 +/- 6.8 min before vagotomy; and at 23.4 +/- 1.8 min in the first 24 h after vagotomy; the interval had lengthened to 86.7 +/- 5.2 min 2-3 weeks after vagotomy. Premature duodenal r.s.a. was not induced by duodenal infusion of HCl in five, or by duodenal infusion of hyperosmolar NaCl in three chronically vagotomized sheep. It is concluded that the vagus nerves contribute to the regulation of the frequency and propagation of the m.m.c. in sheep; duodenal acidification is not essential nor is it the normal stimulus for initiation of r.s.a., but duodenal infusion of HCl or hyperosmolar NaCl can initiate a premature duodenal r.s.a. via the vagus nerves.

Gregory, P C; Rayner, D V; Wenham, G

1984-01-01

427

CT evaluation of hepatic paragonimiasis with simultaneous duodenal or splenic involvement.  

PubMed

Paragonimiasis is a parasitic infection caused by the genus Paragonimus and usually leads to pulmonary disease. Hepatic paragonimiasis is rare, but duodenal and splenic involvement of this disease has not yet been reported in the literature. Herein, we report two rare cases of hepatic paragonimiasis with simultaneous duodenal or splenic involvement, respectively, and described their CT features. Both patients were lifelong residents of an endemic area of paragonimiasis and were confirmed clinicopathologically. PMID:22726983

Li, Xue-Ming; Yu, Jian-Qun; He, Du; Peng, Li-Qing; Chu, Zhi-Gang; Chen, Dong-Dong; Luo, Yi

2012-01-01

428

Duodenal duplication cyst manifested by duodeno-jejunal intussusception and hyperbilirubinemia.  

PubMed

A rare case of duodenal duplication cyst containing stones in a 17-year-old patient is presented. The cyst, acting as a leading point for duodeno-jejunal intussusception caused proximal small bowel obstruction and hyperbilirubinemia. Preoperative diagnosis was based on abdominal computerized tomography. At operation, the cyst wall was unroofed creating free drainage into the duodenal lumen without damaging the biliary and pancreatic ducts with resolution of symptoms. PMID:10466620

Zamir, G; Gross, E; Shmushkevich, A; Bar-Ziv, J; Durst, A L; Jurim, O

1999-08-01

429

Duodenal duplication cyst manifested by duodeno-jejunal intussusception and hyperbilirubinemia  

Microsoft Academic Search

A rare case of duodenal duplication cyst containing stones in a 17-year-old patient is presented. The cyst, acting as a leading point for duodeno-jejunal intussusception caused proximal small bowel obstruction and hyperbilirubinemia. Preoperative diagnosis was based on abdominal computerized tomography. At operation, the cyst wall was unroofed creating free drainage into the duodenal lumen without damaging the biliary and pancreatic

Gideon Zamir; Eitan Gross; Alex Shmushkevich; Jacob Bar-Ziv; Arie L Durst; Oded Jurim

1999-01-01

430

[Cystic dystrophy on an aberrant duodenal pancreas. Apropos of a case].  

PubMed

Cystic dystrophy of the aberrant pancreas is a rare poorly understood condition which is difficult to diagnose and treat. The primary clinical signs are epigastralgia associated with poor general health and complications due to stenosis of the duodenum. Endoscopy gives the most information on tissue lesions and cystic formations in the duodenal mucosa. Although the condition is benign, and due to the lack of sufficient history in endoscopically treated cases, cystic dystrophy of the aberrant duodenal pancreas appears to require duodenopancreatectomy. PMID:8815063

Barsotti, P; Schloegel, M; Ollier, J C; Ghnassia, J P; Potet, F; Adloff, M

1995-12-01

431

Iatrogenic Illness  

PubMed Central

These discussions are selected from the weekly staff conferences in the Department of Medicine, University of California, San Francisco. Taken from transcriptions, they are prepared by Homer A. Boushey, MD, Professor of Medicine, under the direction of Lloyd H. Smith, Jr, MD, Professor of Medicine and Associate Dean in the School of Medicine. Requests for reprints should be sent to the Department of Medicine, University of California, San Francisco, School of Medicine, San Francisco, CA 94143.

Tierney, Lawrence M.

1989-01-01

432

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

433

Patient profile, indications, efficacy and safety of duodenal levodopa infusion in advanced Parkinson's disease.  

PubMed

The studies of duodenal infusion of a levodopa on small groups of parkinsonian patients have reported beneficial effects on motor complications. However, little is known about the patient profile and indications for duodenal levodopa infusion. The purpose of this study is to exhaustively investigate the clinical characteristics of the population and indication, efficacy and tolerability of duodenal levodopa infusion in natural care settings. Of the 102 patients treated with duodenal levodopa infusion since 2003, 91 were enrolled in a multicentre retrospective study. The mean age was 72.7 years, with average disease duration of 17 years. Patients were at advanced stage: 91% had gait disorders, 65% had visual hallucinations, and 50% were demented (MMSE: 23). Duodenal levodopa infusion was the last line of treatment for motor complications in 98% of the patients, due to failure of or contraindication for apomorphine pump and neurosurgical treatments. Long-term treatment was observed by 73% of the population. Of these, >90% reported an improvement in motor fluctuations, quality of life, and autonomy. There were few severe adverse events. Technical problems were commonplace. Duodenal levodopa infusion seems to be an effective last-line therapy for motor complications in Parkinson's disease. Hence, technical improvements and earlier introduction should be considered. PMID:19253412

Devos, David

2009-05-15

434

The release of biologically active secretin-like immunoreactivity into duodenal lumen of dogs.  

PubMed Central

1. Immunoreactive secretin in the duodenal contents was determined in four conscious and four anaesthetized dogs in which hydrochloric acid (0.1 N) was infused into the duodenum at 2.2 ml./min. In the conscious dogs, immunoreactive secretin concentration in duodenal juice increased from 5-7 to 40-60 ng/ml. after infusion of HCl. In anaesthetized dogs, luminal immunoreactive secretin concentration increased from 2-3 to 12-16 ng/ml. after acid infusion. In both groups of dogs, a 20- to 30-fold increase in the total output of luminal immunoreactive secretin was observed. 2. Duodenal juice collected from anaesthetized dogs after diversion of both bile and exocrine pancreatic secretion was found to be the only source of luminal immunoreactive secretin. No immunoreactive secretin was found in either bile or pancreatic juice. 3. Gel filtration of the duodenal juice on a Sephadex G-50 column indicated that the immunoreactive secretin-like material in the duodenal juice possesses a molecular size similar to that of natural porcine secretin. 4. Immunoreactive secretin was partially purified from dog duodenal juice by chromatography on a SP-Sephadex column and found to be capable of stimulating pancreatic bicarbonate and water secretion in dogs.

Chang, T M; Chey, W Y; Kim, M S; Lee, K Y

1981-01-01

435

TTF-1 is useful for primary site determination in duodenal metastasis.  

PubMed

We report here on a case of duodenal metastasis from primary lung adenocarcinoma. A 69-year old man was diagnosed with primary lung adenocarcinoma. Four courses of combined chemotherapy with carboplatin and paclitaxel associated with irradiation of 60 Gy shrunk the lung tumor. However, soon after,the para-aortic lymph node became swollen. Esophagogastroduodenoscopy revealed three duodenal tumors. Differential diagnosis between malignant lymphoma and metastatic duodenal cancer was endoscopically difficult. The histology of biopsied specimens was poorly differentiated adenocarcinoma. Immunohistochemical analysis revealed a positive reaction for thyroid transcription factor-1 (TTF-1). Thus, we concluded that these were metastatic duodenal tumors from lung adenocarcinoma. Two courses of gemcitabine led to a complete remission in this duodenal metastasis and para-aortic lymph node swelling with only scarring remaining in computed tomography. He is now on the continuous generalized chemotherapy. In conclusion, duodenal metastasis from primary lung adenocarcinoma is rare and hard to diagnose. In such an instance, TTF-1 immunostaining is crucial to obtain the correct diagnosis. PMID:21160807

Miura, Tomofumi; Shimaoka, Yuichi; Nakamura, Junichiro; Yamada, Satoshi; Miura, Tsutomu; Yanagi, Masahiko; Sato, Kazuhiro; Usuda, Hiroyuki; Emura, Iwao; Takahashi, Toru

2010-09-15

436

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.

Homentcovschi, D.; Miles, R.N.

2008-01-01

437

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

438

The Bloch Approximation in Periodically Perforated Media  

SciTech Connect

We consider a periodically heterogeneous and perforated medium filling an open domain {omega} of R{sup N}. Assuming that the size of the periodicity of the structure and of the holes is O({epsilon}),we study the asymptotic behavior, as {epsilon} {sup {yields}} 0, of the solution of an elliptic boundary value problem with strongly oscillating coefficients posed in {omega}{sup {epsilon}}({omega}{sup {epsilon}} being {omega} minus the holes) with a Neumann condition on the boundary of the holes. We use Bloch wave decomposition to introduce an approximation of the solution in the energy norm which can be computed from the homogenized solution and the first Bloch eigenfunction. We first consider the case where {omega}is R{sup N} and then localize the problem for abounded domain {omega}, considering a homogeneous Dirichlet condition on the boundary of {omega}.

Conca, C. [Departamento de Ingenieria Matematica and CMM, UMI 2807, CNRS-U, Facultad de Ciencias Fisicas y Matematicas, Universidad de Chile, Casilla 170/3 - Correo 3, Santiago (Chile)], E-mail: cconca@dim.uchile.cl; Gomez, D., E-mail: gomezdel@unican.es; Lobo, M. [Departamento de Matematicas, Estadistica y Computacion, Universidad de Cantabria, Av. de los Castros s/n, 39071 Santander (Spain)], E-mail: lobom@unican.es; Perez, E. [Departamento de Matematica Aplicada y Ciencias de la Computacion, Universidad de Cantabria, Av. de los Castros s/n, 39071 Santander (Spain)], E-mail: meperez@unican.es

2005-06-15

439

Gallbladder perforation: A rare complication of enteric fever?  

PubMed Central

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

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

2013-01-01

440

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

2007-06-01

441

Management of vascular perforations that occur during neurointerventional procedures.  

PubMed

This article describes a number of treatment strategies for the management of perforations that occur during neurointerventional procedures. During the past 5 years, we have performed over 1200 endovascular procedures to treat vascular disorders involving the brain and spinal cord (400 cerebral arteriovenous malformations, 230 tumors, 197 carotid cavernous fistulas, 183 aneurysms, 130 dural fistulas, 80 spinal arteriovenous malformations, 18 vein of Galen aneurysms, and 20 cases of vasospasm). Fifteen patients (1.1%) sustained a vascular perforation as a direct result of these procedures. Among these 15 patients, indications for endovascular treatment were six symptomatic arteriovenous malformations, two spinal cord arteriovenous malformations, two cavernous sinus dural fistulas, one transverse sinus fistula, one case of vasospasm following subarachnoid hemorrhage, one direct carotid cavernous fistula, one vein of Galen malformation, and one ruptured basilar artery aneurysm. The vascular perforations were grouped into three probable mechanisms: mechanical perforation of a normal vessel (six patients), mechanical disruption of a dysplastic vessel or aneurysm (five patients), and fluid overinjection (four patients). Treatment of the perforations included immediate reversal of anticoagulants (12 patients) and direct closure of the perforation site with coils (five patients). In addition, closure of the intravascular compartment adjacent to the perforation was achieved with coils (six patients), liquid adhesives (four patients), balloons (two patients), or particles (two patients). In two patients a detachable balloon was placed transiently across the perforation site for several minutes, deflated, and removed when no further extravasation was noted. Five patients were started on anticonvulsant therapy, two of whom have had a new onset seizure related to the perforation.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:1902036

Halbach, V V; Higashida, R T; Dowd, C F; Barnwell, S L; Hieshima, G B

1991-01-01

442

Reappraising the Surgical Approach on the Perforated Gastroduodenal Ulcer: Should Gastric Resection Be Abandoned?  

PubMed Central

Background Advancements in medical care for peptic ulcer disease (PUD) have reduced the need for invasive surgical procedures such as