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Sample records for acute colonoscopic perforations

  1. Colonoscopic Perforation Management by Laparoendoscopy: An Algorithm

    PubMed Central

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

    2014-01-01

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

  2. Optimal Methods for the Management of Iatrogenic Colonoscopic Perforation

    PubMed Central

    Shin, Dae Kyu; Shin, Sun Young; Park, Chi Young; Jin, Sun Mi; Cho, Yang Hyun; Kim, Won Hee; Kwon, Chang-Il; Ko, Kwang Hyun; Hahm, Ki Baik; Park, Pil Won; Kim, Jong Woo; Hong, Sung Pyo

    2016-01-01

    Background/Aims: Colonoscopic perforations have been managed with exploratory laparotomy, and have resulted in some morbidity and mortality. Recently, laparoscopic surgery is commonly performed for this purpose. The aim of this study was to compare the outcomes of several management strategies for iatrogenic colonoscopic perforations. Methods: We retrospectively reviewed the medical records of patients who had been treated for colonoscopic perforation between January 2004 and April 2013 at CHA Bundang Medical Center in Korea. Results: A total of 41 patients with colonoscopic perforation were enrolled. Twenty patients underwent conservative management with a success rate of 90%. Surgical management was performed in 23 patients including two patients who were converted to surgical management after the failure of the initial conservative management. Among 14 patients who underwent surgery at 8 hours after the perforation, there was no considerable difference in adverse outcomes between the laparotomy group and the laparoscopic surgery group. The medical costs and claim rate were 1.45 and 1.87 times greater in the exploratory laparotomy group, respectively. Conclusions: Conservative management of colonoscopic perforation could be an option for patients without overt symptoms of peritonitis or with a small defect size. If surgical management is required, laparoscopic surgery may be considered as the initial procedure even with a delayed diagnosis. PMID:26888410

  3. Risk factors for colonoscopic perforation: A population-based study of 80118 cases

    PubMed Central

    Hamdani, Uzair; Naeem, Raza; Haider, Fyeza; Bansal, Pardeep; Komar, Michael; Diehl, David L; Kirchner, H Lester

    2013-01-01

    AIM: To assess the incidence and risk factors associated with colonic perforation due to colonoscopy. METHODS: This was a retrospective cross-sectional study. Patients were retrospectively eligible for inclusion if they were 18 years and older and had an inpatient or outpatient colonoscopy procedure code in any facility within the Geisinger Health System during the period from January 1, 2002 to August 25, 2010. Data are presented as median and inter-quartile range, for continuous variables, and as frequency and percentage for categorical variables. Baseline comparisons across those with and without a perforation were made using the two-sample t-test and Pearson’s χ2 test, as appropriate. RESULTS: A total of 50 perforations were diagnosed out of 80118 colonoscopies, which corresponded to an incidence of 0.06% (95%CI: 0.05-0.08) or a rate of 6.2 per 10000 colonoscopies. All possible risk factors associated with colonic perforation with a P-value < 0.1 were checked for inclusion in a multivariable log-binomial regression model predicting 7-d colonic perforation. The final model resulted in the following risk factors which were significantly associated with risk of colonic perforation: age, gender, body mass index, albumin level, intensive care unit (ICU) patients, inpatient setting, and abdominal pain and Crohn’s disease as indications for colonoscopy. CONCLUSION: The cumulative 7 d incidence of colonic perforation in this cohort was 0.06%. Advanced age and female gender were significantly more likely to have perforation. Increasing albumin and BMI resulted in decreased risk of colonic perforation. Having a colonoscopy indication of abdominal pain or Crohn’s disease resulted in a higher risk of colonic perforation. Colonoscopies performed in inpatients and particularly the ICU setting had substantially greater odds of perforation. Biopsy and polypectomy did not increase the risk of perforation and only three perforations occurred with screening colonoscopy

  4. Ultrasonography in acute gallbladder perforation.

    PubMed

    Soiva, M; Pamilo, M; Päivänsalo, M; Taavitsainen, M; Suramo, I

    1988-01-01

    The files of patients with acute cholecystitis from two large university hospitals from the years 1978-1985 were employed to find the cases with acute gallbladder perforation for this study. Only those patients (n = 9) were selected for the analysis of sonographic signs of acute gallbladder perforation who had less than 48 hours of symptoms before sonography, and were operated upon within 24 hours of the sonography. Patients (n = 10) with non-complicated acute cholecystitis and identical in regard to the duration of the symptoms and the timing of the sonography and the operation formed a control group. The sonographic findings in patients with gallbladder perforation were pericholecystic fluid collections, free peritoneal fluid, disappearance of the gallbladder wall echoes, focal highly echogenic areas with acoustic shadows in the gallbladder, and an inhomogeneous, generally echo-poor gallbladder wall. PMID:2964842

  5. Risk Factors for Early Colonoscopic Perforation Include Non-Gastroenterologist Endoscopists: a Multivariable Analysis

    PubMed Central

    Bielawska, Barbara; Day, Andrew G; Lieberman, David A; Hookey, Lawrence C

    2014-01-01

    Background & Aims Bowel perforation is a rare but serious complication of colonoscopy. Its prevalence is increasing with the rapidly growing volume of procedures performed. Although colonoscopies have been performed for decades, the risk factors for perforation are not completely understood. We investigated risk factors for perforation during colonoscopy, assessing variables that included sedation type and endoscopist specialty and level of training. Methods We performed a retrospective multivariate analysis of risk factors for early perforation (occurring at any point during the colonoscopy but recognized during or immediately after the procedure) in adult patients using the Clinical Outcomes Research Initiative National Endoscopic Database. Risk factors were determined from published articles. Additional variables assessed included endoscopist specialty and years of experience, trainee involvement, and sedation with propofol. Results We identified 192 perforation events during 1,144,900 colonoscopies from 85 centers entered into the database from January 2000 through March 2011. On multivariate analysis, increasing age, American Society of Anesthesia class, female sex, hospital setting, any therapy, and polyps >10 mm were significantly associated with increased risk of early perforation. Colonoscopies performed by surgeons and endoscopists of unknown specialty had higher rates of perforation than those performed by gastroenterologists (odds ratio, 2.00; 95% confidence interval, 1.30–3.08). Propofol sedation did not significantly affect risk for perforation. Conclusions In addition to previously established risk factors, non-gastroenterologist specialty was found to affect risk for perforations detected during or immediately after colonoscopy. This finding could result from differences in volume and style of endoscopy training. Further investigation into these observed associations is warranted. PMID:23891916

  6. Colonoscopic Polypectomy

    PubMed Central

    2000-01-01

    Colonoscopic polypectomy is a major advance in the therapy of colon neoplasms. The techniques for safe and efficient polyp removal are described. The uses of a variety of ancillary devices are discussed, including clips, loops, submucosal injection of fluid, and several thermal probes, including the argon plasma coagulator. The location of a lesion may be difficult to ascertain by intracolonic landmarks, but can be more precisely determined by X-ray, magnetic imaging, or intraoperative colonoscopy. Alternatively, it is possible to permanently mark the site of polyp removal with a carbon particle submucosal injection to facilitate subsequent localization either by surgery or interval colonoscopy. PMID:18493514

  7. Clinical Outcomes of Silk Patch in Acute Tympanic Membrane Perforation

    PubMed Central

    Lee, Jun Ho; Lee, Joong Seob; Kim, Dong-Kyu

    2015-01-01

    Objectives The silk patch is a thin transparent patch that is produced from silk fibroin. In this study, we investigated the treatment effects of the silk patch in patients with traumatic tympanic membrane perforation (TTMP). Methods The closure rate, otorrhea rate, and closure time in all patients and the closure time in successful patients were compared between the paper patch and silk patch groups. Results Demographic data (gender, site, age, traumatic duration, preoperative air-bone gap, and perforation size and location) were not significantly different between the two groups. The closure rate and otorrhea rate were not significantly different between the two groups. However, the closure time was different between the two groups (closure time of all patients, P=0.031; closure time of successful patients, P=0.037). Conclusion The silk patch which has transparent, elastic, adhesive, and hyper-keratinizing properties results in a more efficient closure time than the paper patch in the treatment of TTMP patients. We therefore believe that the silk patch should be recommended for the treatment of acute tympanic membrane perforation. PMID:26045909

  8. Fish bone perforation of the terminal ileum presenting as acute appendicitis

    PubMed Central

    Saunders, David; Jones, Michael; Kaushik, Monika; Thomas, William Michael

    2014-01-01

    We report a case of a bowel perforation due to a fish bone that presented as an acute abdomen. This patient's gastrointestinal perforation was treated with laparoscopic and open technique. Diagnosis can be difficult as foreign body bowel perforation can mimic other causes of acute abdomen. Diagnosis is still most commonly made intraoperatively. Laparoscopy proved useful in this case as it allowed the most appropriate surgical approach to be made. PMID:24639331

  9. Small Bowel Perforation due to Gossypiboma Caused Acute Abdomen.

    PubMed

    Colak, Tahsin; Olmez, Tolga; Turkmenoglu, Ozgur; Dag, Ahmet

    2013-01-01

    Gossypiboma, an infrequent surgical complication, is a mass lesion due to a retained surgical sponge surrounded by foreign body reaction. In this case report, we describe gossypiboma in the abdominal cavity which was detected 14 months after the hysterectomy due to acute abdominal pain. Gossypiboma was diagnosed by computed tomography (CT). The CT findings were a rounded mass with a dense central part and an enhancing wall. In explorative laparotomy, small bowel loops were seen to be perforated due to inflammation of long standing gossypiboma. Jejunal resection with end-to-end anastomosis was performed. The patient was discharged whithout complication. This case was presented to point to retained foreign body (RFB) complications and we believed that the possibility of a retained foreign body should be considered in the differential diagnosis of who had previous surgery and complained of pain, infection, or palpable mass. PMID:24288645

  10. Small Bowel Perforation due to Gossypiboma Caused Acute Abdomen

    PubMed Central

    Turkmenoglu, Ozgur; Dag, Ahmet

    2013-01-01

    Gossypiboma, an infrequent surgical complication, is a mass lesion due to a retained surgical sponge surrounded by foreign body reaction. In this case report, we describe gossypiboma in the abdominal cavity which was detected 14 months after the hysterectomy due to acute abdominal pain. Gossypiboma was diagnosed by computed tomography (CT). The CT findings were a rounded mass with a dense central part and an enhancing wall. In explorative laparotomy, small bowel loops were seen to be perforated due to inflammation of long standing gossypiboma. Jejunal resection with end-to-end anastomosis was performed. The patient was discharged whithout complication. This case was presented to point to retained foreign body (RFB) complications and we believed that the possibility of a retained foreign body should be considered in the differential diagnosis of who had previous surgery and complained of pain, infection, or palpable mass. PMID:24288645

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

    PubMed Central

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

    2014-01-01

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

  12. [Acute abdomen caused by spontaneous perforation of the colon].

    PubMed

    Balotta, F; Ghidotti, G; Pecchia, G; Santoro, A

    The literature on simple ulcer of the colon is reviewed. Three successfully treated cases of spontaneous perforation of the colon due to ulcer of the sigmoid, and single and multiple ulceration of the caecum are described, with particular reference to their aetiopathogenesis. The view that simple ulcer is caused by mechanical and circulatory factors, with or without inflammation, is expressed. Surgical management of this lesion must take the patient's age and local and general condition into account. These parameters will determine the type of operation employed, ranging from simple colorrhaphy to variously extensive resection of the perforated segment. PMID:7019756

  13. The Evolution and Current Utility of Esophageal Stent Placement for the Treatment of Acute Esophageal Perforation.

    PubMed

    Herrera, Argenis; Freeman, Richard K

    2016-08-01

    Esophageal stent placement was used primarily for the treatment of malignant strictures until the development of a new generation of biomaterials allowed the production of easily removable, occlusive stents in 2001. Since then, thoracic surgeons have gained experience using esophageal stents for the treatment of acute esophageal perforation. As part of a hybrid treatment strategy, including surgical drainage of infected spaces, enteral nutrition, and aggressive supportive care, esophageal stent placement has produced results that can exceed those of traditional surgical repair. This review summarizes the evolution of esophageal stent use for acute perforation and provides evidence-based recommendations for the technique. PMID:27427525

  14. Acute colonic pseudo-obstruction (Ogilvie's syndrome) with caecal perforation after caesarean section

    PubMed Central

    Khajehnoori, Masoomeh; Nagra, Sonal

    2016-01-01

    Ogilvie syndrome or acute colonic pseudo-obstruction is characterized by acute dilatation of the colon usually involving caecum and right hemi-colon in the absence of any mechanical obstruction. It is usually associated with an underlying severe illness/infection or surgery, mostly caesarean section and rarely occurs spontaneously. Identification of this condition is important due to the increased risk of bowel ischaemia and perforation particularly with caecal diameter >9 cm. This is a case report of bowel perforation following caesarean section leading to urgent laparotomy. PMID:27554827

  15. Spontaneous uterine perforation of pyometra presenting as acute abdomen.

    PubMed

    Kitai, Toshihiro; Okuno, Kentaro; Ugaki, Hiromi; Komoto, Yoshiko; Fujimi, Satoshi; Takemura, Masahiko

    2014-01-01

    Pyometra is the accumulation of pus in the uterine cavity, and spontaneous perforation of pyometra resulting in generalized diffuse peritonitis is extremely uncommon. We report a rare case of diffuse peritonitis caused by spontaneous perforation of pyometra. A 66-year-old postmenopausal woman with diffuse abdominal pain and vomiting was admitted to our institution. She had a history of mixed connective-tissue disease and had been taking steroids for 20 years. Under a diagnosis of generalized peritonitis secondary to perforation of the gastrointestinal tract or uterus, supravaginal hysterectomy and bilateral salpingo-oophorectomy were performed. Unfortunately, wound dehiscence and infection occurred during the postoperative course, which were exacerbated by her immunocompromised state. Despite intensive care and a course of antibiotics, the patient died of multiple organ failure resulting from sepsis on the 36th postoperative day. Although correct diagnosis, early intervention, and proper treatment can reduce morbidity and mortality of spontaneous perforation of pyometra, if severe infection occurs, this disease can be life threatening for immunocompromised hosts. PMID:25057420

  16. Korean Guideline for Colonoscopic Polypectomy

    PubMed Central

    Lee, Suck-Ho; Shin, Sung Jae; Kim, Seong-Eun; Jeon, Hae Jeong; Kim, Se Hyung; Hong, Sung Pil; Hong, Sung Noh; Yang, Dong-Hoon; Lee, Bo In; Kim, Young-Ho; Kim, Hyun-Soo; Kim, Hyun Jung; Yang, Suk-Kyun; Kim, Hyo Jong

    2012-01-01

    There is indirect evidence to suggest that 80% of colorectal cancers (CRC) develop from adenomatous polyps and that, on average, it takes 10 years for a small polyp to transform into invasive CRC. In multiple cohort studies, colonoscopic polypectomy has been shown to significantly reduce the expected incidence of CRC by 76% to 90%. Colonoscopic polypectomy is performed frequently in primary outpatient clinics and secondary and tertiary medical centers in Korea. However, there are no evidence-based, procedural guidelines for the appropriate performance of this procedure, including the technical aspects. For the guideline presented here, PubMed, Medline, and Cochrane Library literature searches were performed. When little or no data from well-designed prospective trials were available, an emphasis was placed on the results from large series and reports from recognized experts. Thus, these guidelines for colonoscopic polypectomy are based on a critical review of the available data as well as expert consensus. Further controlled clinical studies are needed to clarify aspects of this statement, and revision may be necessary as new data become available. This guideline is intended to be an educational device to provide information that may assist endoscopists in providing care to patients. This guideline is not a rule and should not be construed as a legal standard of care or as encouraging, advocating, requiring, or discouraging any particular treatment. Clinical decisions for any particular case involve a complex analysis of the patient's condition and the available courses of action. PMID:22741130

  17. Spontaneous perforation of pyometra presenting as acute abdomen and pneumoperitoneum mimicking those of gastrointestinal origin.

    PubMed

    Yamada, Takahiro; Ando, Nanako; Shibata, Naoshi; Suitou, Motomu; Takagi, Hiroshi; Matsunami, Kazutoshi; Ichigo, Satoshi; Imai, Atsushi

    2015-01-01

    Gastrointestinal (GI) perforation accounts for over 90% of acute abdomen and pneumoperitoneum. The presence of pneumoperitoneum secondary to spontaneously perforated pyometra is an interesting yet confusing finding given the absence of gastrointestinal (GI) perforation, because pyometra is more common in postmenopausal women. We report an instructive case of diffuse peritonitis caused by spontaneous perforation of pyometra. A 70-year-old postmenopausal female was admitted to surgical emergency with signs of diffuse peritonitis. After resuscitation, an emergency laparotomy was performed because of suspicion of GI perforation. At laparotomy, about 2,000 mL of purulent fluid was found to be present in peritoneal cavity, while GI tract was intact. A rent with a diameter of 5 mm was found on anterior fundus of uterus. A total abdominal hysterectomy with a bilateral salpingo-oophorectomy was performed. Despite intensive care and a course of antibiotics, the patient died of multiple organ failure resulting from sepsis on postoperative day 16. Our case illustrates the importance of clinical knowledge of acute gynecological diseases, which are not uncommonly encountered by the general surgeon. Moreover, good appreciation of pelvic anatomy and close collaboration with gynecology and GI surgery colleagues is essential as operative intervention is often required. PMID:25628913

  18. Spontaneous Perforation of Pyometra Presenting as Acute Abdomen and Pneumoperitoneum Mimicking Those of Gastrointestinal Origin

    PubMed Central

    Yamada, Takahiro; Ando, Nanako; Shibata, Naoshi; Suitou, Motomu; Takagi, Hiroshi; Matsunami, Kazutoshi; Ichigo, Satoshi

    2015-01-01

    Gastrointestinal (GI) perforation accounts for over 90% of acute abdomen and pneumoperitoneum. The presence of pneumoperitoneum secondary to spontaneously perforated pyometra is an interesting yet confusing finding given the absence of gastrointestinal (GI) perforation, because pyometra is more common in postmenopausal women. We report an instructive case of diffuse peritonitis caused by spontaneous perforation of pyometra. A 70-year-old postmenopausal female was admitted to surgical emergency with signs of diffuse peritonitis. After resuscitation, an emergency laparotomy was performed because of suspicion of GI perforation. At laparotomy, about 2,000 mL of purulent fluid was found to be present in peritoneal cavity, while GI tract was intact. A rent with a diameter of 5 mm was found on anterior fundus of uterus. A total abdominal hysterectomy with a bilateral salpingo-oophorectomy was performed. Despite intensive care and a course of antibiotics, the patient died of multiple organ failure resulting from sepsis on postoperative day 16. Our case illustrates the importance of clinical knowledge of acute gynecological diseases, which are not uncommonly encountered by the general surgeon. Moreover, good appreciation of pelvic anatomy and close collaboration with gynecology and GI surgery colleagues is essential as operative intervention is often required. PMID:25628913

  19. Meckel's diverticular perforation presenting as acute abdomen in the second trimester of pregnancy.

    PubMed

    Ahmed, Z; Chhabra, S; Kankaria, J; Jenaw, R K

    2016-01-01

    Meckel's diverticular perforation is a rare cause of acute abdomen during pregnancy. We report the case of a 24-year-old woman at 24 weeks of gestation who presented with abdominal pain for 4 days accompanied with abdominal distension, tenderness and guarding in right lower quadrant. Ultrasonography was inconclusive. The patient underwent exploratory laparotomy with the clinical suspicion of appendicular perforation peritonitis. Intraoperatively, a perforated Meckel's diverticulum was detected. Owing to gross contamination of the peritoneal cavity, a diverticulectomy with ileostomy was performed. She had a normal full-term vaginal delivery, and ileostomy was reversed 1 month after delivery. The physiological and anatomical changes in pregnancy can make a straightforward clinical diagnosis difficult. A high index of suspicion is required to prevent delay in diagnosis and surgical intervention, which could prove detrimental to the mother and fetus. PMID:27507693

  20. Spontaneous perforation of pyometra presenting as acute abdomen: a rare condition with considerable mortality.

    PubMed

    Yin, Wan-Bin; Wei, Yan-Hua; Liu, Guang-Wei; Zhao, Xiao-Tang; Zhang, Mao-Shen; Hu, Ji-Lin; Zhang, Nan-Yang; Lu, Yun

    2016-04-01

    Pyometra is an uncommon and potentially lethal disease that occurs mainly in postmenopausal women. Spontaneous perforation of pyometra presenting as acute abdomen is an extremely rare complication of pyometra, and the patients are always admitted to the emergency department. An additional case is reported herein. In addition, a literature review was performed between 1949 and 2015. A correct preoperative diagnosis was made in 21.05% of all the cases. Of all cases, 25.71% were associated with malignant disease. The mortality rate of spontaneous perforation of pyometra is 31.88%. Thus, it should be considered in the differential diagnosis of acute abdomen in elderly women. Total hysterectomy along with bilateral salpingo-oophorectomy is the preferred treatment. Administration of broad-spectrum antibiotics and postoperative intensive care support are essential to reduce the high mortality. PMID:26365324

  1. A rare cause of acute abdomen: spontaneous common hepatic duct perforation.

    PubMed

    Pülat, Hüseyin; Karaköse, Oktay; Benzin, Mehmet Fatih; Sabuncuoğlu, Mehmet Zafer; Çetin, Recep

    2016-01-01

    Spontaneous extrahepatic bile duct perforation is generally seen in infants. Although rarely seen in adults, it may be seen with fatal bile peritonitis. Therefore, for a patient presenting with acute abdominal symptoms, differential diagnosis must be made with radiological imaging such as abdominal ultrasonography or computed tomography, without any loss of time. In these imaging tests, in cases of gallstone disease together with perihepatic free fluid or choledocus which can not be monitored, it should be considered in the differential diagnosis. An emergency surgical intervention should be planned to avoid serious complications. The aim of this paper was to present the rare cause of acute abdomen which developed associated with spontaneous common hepatic canal perforation in an adult. PMID:27135087

  2. A rare cause of acute abdominal disease: two reports of caecal diverticulum perforation.

    PubMed

    Çiftci, Fatih; Abdurrahman, İbrahim; Eren, Abdülkadir

    2016-05-01

    Diverticulum of the caecum is a rare lesion. From a clinical point of view, the inflammation it causes can mimic symptoms of acute appendicitis, causing difficulties in diagnosis and thus prescription of appropriate treatment. It is almost impossible to differentiate this disease from acute appendicitis through physical examination alone, and radiological imaging may also prove insufficient. For this reason, it is common to perioperatively diagnose diverticula of the caecum. Two cases of patients who underwent surgery for perforated caecal diverticula are presently described. PMID:27598596

  3. Perforated appendicitis masquerading as acute pancreatitis in a morbidly obese patient.

    PubMed

    Forster, Michael-J; Akoh, Jacob-A

    2008-03-21

    Diagnosis and treatment of common conditions in morbidly obese patients still pose a challenge to physicians and surgeons. Sometimes too much reliance is put on investigations that can lead to a misdiagnosis. This case demonstrates an obese woman admitted under the medical team with a presumed diagnosis of pneumonia, who was later found to have an acute abdomen and raised amylase, which led to an assumed diagnosis of pancreatitis. She died within 24 h of admission and post mortem confirmed the cause of death as systemic sepsis due to perforated appendicitis, with no evidence of pancreatitis. Significantly elevated serum amylase level may occur in non-pancreatitic acute abdomen. PMID:18350613

  4. Anesthesia management of surgery for sigmoid perforation and acute peritonitis patient following heart transplantation: case report

    PubMed Central

    Yang, Xu-Li; Dai, Shu-Hong; Zhang, Juan; Zhang, Jing; Liu, Yan-Jun; Yang, Yan; Sun, Yu-E; Ma, Zheng-Liang; Gu, Xiao-Ping

    2015-01-01

    Here we described a case in which a patient underwent emergency laparotomy for acute peritonitis and sigmoid perforation under general anesthesia with a history of heart transplantation. A good knowledge in the physiology of the transplanted heart is critical for effective and safe general anesthesia. We chose etomidate that have a weaker impact on cardiovascular function plus propofol for induction, and propofol plus cisatracurium for maintenance with intermittently analgesics and vasoactive drugs to facilitate the anesthesia. In addition, fluid input, electrolyte and acid-base balance were well adjusted during the whole procedure. The patient was in good condition after the surgery. In this case report we are aiming to provide some guidance for those scheduled for non-cardiac surgery after heart transplant. PMID:26379997

  5. Performance evaluation of video colonoscope systems

    NASA Astrophysics Data System (ADS)

    Picciano, Lawrence D.; Keller, James P.

    1994-05-01

    A comparative engineering performance evaluation was performed on video colonoscope systems from all three of the current U.S. suppliers: Fujinon, Olympus, and Pentax. Video system test methods, results, and conclusions based on their clinical significance are the focus of this paper.

  6. Dual field of view optical system for colonoscope

    NASA Astrophysics Data System (ADS)

    Katkam, Rajender

    The present dual field of view flexible colonoscope can provide both forward view and radial or backward view of the colon to improve detection of cancerous polyps. The colonoscope has its own illumination that illuminates the parts of the colon viewed by imaging optics. The optical system, limited only by the diffraction effects at the exit pupil over the entire visible spectrum, can provide high resolution and is suitable for color imaging. The flexible colonoscope has an on-board sensor at the proximal end of the colonoscope to improve resolution. The proximal end of colonoscope measures only 8 mm in diameter and 20 mm in length. The present colonoscope has the potential to be scaled down to as small as 6 mm inner diameter from the present 8 mm.

  7. High cytokine levels in perforated acute otitis media exudates containing live bacteria.

    PubMed

    Skovbjerg, S; Roos, K; Nowrouzian, F; Lindh, M; Holm, S E; Adlerberth, I; Olofsson, S; Wold, A E

    2010-09-01

    Acute otitis media (AOM) is an inflammatory response to microbes in the middle ear, sometimes associated with rupture of the tympanic membrane. Human leukocytes produce different patterns of inflammatory mediators in vitro when stimulated with Gram-positive and Gram-negative bacteria, respectively. Here, we investigated the cytokine and prostaglandin E2 (PGE2) responses in middle ear fluids (MEFs) from children with spontaneously perforated AOM, and related the mediator levels to the presence of pathogens detected by culture (live) or PCR (live or dead). Furthermore, the in vivo cytokine pattern was compared with that induced in leukocytes stimulated by dead bacteria in vitro. MEFs with culturable pathogenic bacteria contained more interleukin (IL)-1β (median: 110 μg/L vs. <7.5 μg/L), tumour necrosis factor (TNF) (6.3 μg/L vs. <2.5 μg/L), IL-8 (410 μg/L vs. 38 μg/L) and IL-10 (0.48 μg/L vs. <0.30 μg/L) than culture-negative fluids, irrespective of PCR findings. IL-6 and PGE2 were equally abundant (69-110 μg/L) in effusions with live, dead or undetectable bacteria. Cytokine levels were unrelated to bacterial species and to the presence or absence of virus. Similar levels of TNF and IL-6 as found in the MEFs were obtained by in vitro stimulation of leukocytes, whereas 11 times more IL-1β and 3.5 times more IL-8 were produced in vivo, and 22 times more IL-10 was produced in vitro. Vigorous production of proinflammatory cytokines accompanies AOM with membrane rupture, regardless of the causative agent, but the production seems to cease rapidly once the bacteria are killed and fragmented. IL-6 and PGE2, however, remain after bacterial disintegration, and may play a role in the resolution phase. PMID:19832705

  8. Successful Endovascular Repair of an Iatrogenic Perforation of the Superficial Femoral Artery Using Self-Expanding Nitinol Supera Stents in a Patient with Acute Thromboembolic Limb Ischemia.

    PubMed

    Eisele, Tom; Muenz, Benedikt M; Korosoglou, Grigorios

    2016-01-01

    The treatment of acute thromboembolic limb ischemia includes well-established surgical thrombectomy procedures and, in recent times, also percutaneous rotational thrombectomy using Straub Rotarex® system. This modality not only enables efficient treatment of such thrombotic occlusion but also in rare cases may imply the risk of perforation of the occluded artery. Herein, we report the case of a perforation of the superficial femoral artery (SFA) in an elderly female patient with thromboembolic limb ischemia. The perforation was successfully treated by implantation of self-expanding nitinol Supera stents and without the need for implantation of a stent graft. PMID:27213074

  9. Successful Endovascular Repair of an Iatrogenic Perforation of the Superficial Femoral Artery Using Self-Expanding Nitinol Supera Stents in a Patient with Acute Thromboembolic Limb Ischemia

    PubMed Central

    Eisele, Tom; Muenz, Benedikt M.

    2016-01-01

    The treatment of acute thromboembolic limb ischemia includes well-established surgical thrombectomy procedures and, in recent times, also percutaneous rotational thrombectomy using Straub Rotarex® system. This modality not only enables efficient treatment of such thrombotic occlusion but also in rare cases may imply the risk of perforation of the occluded artery. Herein, we report the case of a perforation of the superficial femoral artery (SFA) in an elderly female patient with thromboembolic limb ischemia. The perforation was successfully treated by implantation of self-expanding nitinol Supera stents and without the need for implantation of a stent graft. PMID:27213074

  10. Giant Bauhin valve adenoma and laparoscopically assisted colonoscopic polypectomy.

    PubMed

    Mikalauskas, Saulius; Račkauskas, Rokas; Zeromskas, Paulius; Strupas, Kęstutis

    2014-09-01

    Nowadays colonoscopic polypectomy has become a routine procedure, which is performed daily. Almost every colorectal benign tumor can be removed endoscopically, although there are some problematic adenomas which are either large in size or difficult to approach. In the past two decades laparoscopically assisted colonoscopic polypectomy has become established in the endoscopic world, which reduced the need of operations for those patients with lesions that are large or hard to approach. The first laparoscopically monitored colonoscopic polypectomy was performed by Franklin in 1991, and reported publicly in 1993. We present a case report of a patient who was diagnosed with Bauhin valve giant adenoma and underwent laparoscopically assisted polypectomy. PMID:25337179

  11. Spontaneous gallbladder perforation

    SciTech Connect

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

    1989-05-01

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

  12. Subcutaneous Emphysema, Pneumomediastinum, Pneumoretroperitoneum, and Pneumoscrotum: Unusual Complications of Acute Perforated Diverticulitis

    PubMed Central

    Fosi, S.; Giuricin, V.; Girardi, V.; Di Caprera, E.; Costanzo, E.; Di Trapano, R.; Simonetti, G.

    2014-01-01

    Pneumomediastinum, and subcutaneous emphysema usually result from spontaneous alveolar wall rupture and, far less commonly, from disruption of the upper airways or gastrointestinal tract. Subcutaneous neck emphysema, pneumomediastinum, and retropneumoperitoneum caused by nontraumatic perforations of the colon have been infrequently reported. The main symptoms of spontaneous subcutaneous emphysema are swelling and crepitus over the involved site; further clinical findings in case of subcutaneous cervical and mediastinal emphysema can be neck and chest pain and dyspnea. Radiological imaging plays an important role to achieve the correct diagnosis and extension of the disease. We present a quite rare case of spontaneous subcutaneous cervical emphysema, pneumomediastinum, and pneumoretroperitoneum due to perforation of an occult sigmoid diverticulum. Abdomen ultrasound, chest X-rays, and computer tomography (CT) were performed to evaluate the free gas extension and to identify potential sources of extravasating gas. Radiological diagnosis was confirmed by the subsequent surgical exploration. PMID:25136471

  13. 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 . ...

  14. Coagulation syndrome: Delayed perforation after colorectal endoscopic treatments

    PubMed Central

    Hirasawa, Kingo; Sato, Chiko; Makazu, Makomo; Kaneko, Hiroaki; Kobayashi, Ryosuke; Kokawa, Atsushi; Maeda, Shin

    2015-01-01

    Various procedure-related adverse events related to colonoscopic treatment have been reported. Previous studies on the complications of colonoscopic treatment have focused primarily on perforation or bleeding. Coagulation syndrome (CS), which is synonymous with transmural burn syndrome following endoscopic treatment, is another typical adverse event. CS is the result of electrocoagulation injury to the bowel wall that induces a transmural burn and localized peritonitis resulting in serosal inflammation. CS occurs after polypectomy, endoscopic mucosal resection (EMR), and even endoscopic submucosal dissection (ESD). The occurrence of CS after polypectomy or EMR varies according previous reports; most report an occurrence rate around 1%. However, artificial ulcers after ESD are largely theoretical, and CS following ESD was reported in about 9% of cases, which is higher than that for CS after polypectomy or EMR. Most cases of post-polypectomy syndrome (PPS) have an excellent prognosis, and they are managed conservatively with medical therapy. PPS rarely develops into delayed perforation. Delayed perforation is a severe adverse event that often requires emergency surgery. Since few studies have reported on CS and delayed perforation associated with CS, we focused on CS after colonoscopic treatments in this review. Clinicians should consider delayed perforation in CS patients. PMID:26380051

  15. Coagulation syndrome: Delayed perforation after colorectal endoscopic treatments.

    PubMed

    Hirasawa, Kingo; Sato, Chiko; Makazu, Makomo; Kaneko, Hiroaki; Kobayashi, Ryosuke; Kokawa, Atsushi; Maeda, Shin

    2015-09-10

    Various procedure-related adverse events related to colonoscopic treatment have been reported. Previous studies on the complications of colonoscopic treatment have focused primarily on perforation or bleeding. Coagulation syndrome (CS), which is synonymous with transmural burn syndrome following endoscopic treatment, is another typical adverse event. CS is the result of electrocoagulation injury to the bowel wall that induces a transmural burn and localized peritonitis resulting in serosal inflammation. CS occurs after polypectomy, endoscopic mucosal resection (EMR), and even endoscopic submucosal dissection (ESD). The occurrence of CS after polypectomy or EMR varies according previous reports; most report an occurrence rate around 1%. However, artificial ulcers after ESD are largely theoretical, and CS following ESD was reported in about 9% of cases, which is higher than that for CS after polypectomy or EMR. Most cases of post-polypectomy syndrome (PPS) have an excellent prognosis, and they are managed conservatively with medical therapy. PPS rarely develops into delayed perforation. Delayed perforation is a severe adverse event that often requires emergency surgery. Since few studies have reported on CS and delayed perforation associated with CS, we focused on CS after colonoscopic treatments in this review. Clinicians should consider delayed perforation in CS patients. PMID:26380051

  16. Esophageal perforation

    MedlinePlus

    ... object or caustic chemicals, such as household cleaners, disk batteries, and battery acid Trauma or injury to ... may have esophageal perforation. Prevention These injuries are hard to prevent. Alternative Names Perforation of the esophagus ...

  17. New vision based navigation clue for a regular colonoscope's tip

    NASA Astrophysics Data System (ADS)

    Mekaouar, Anouar; Ben Amar, Chokri; Redarce, Tanneguy

    2009-02-01

    Regular colonoscopy has always been regarded as a complicated procedure requiring a tremendous amount of skill to be safely performed. In deed, the practitioner needs to contend with both the tortuousness of the colon and the mastering of a colonoscope. So, he has to take the visual data acquired by the scope's tip into account and rely mostly on his common sense and skill to steer it in a fashion promoting a safe insertion of the device's shaft. In that context, we do propose a new navigation clue for the tip of regular colonoscope in order to assist surgeons over a colonoscopic examination. Firstly, we consider a patch of the inner colon depicted in a regular colonoscopy frame. Then we perform a sketchy 3D reconstruction of the corresponding 2D data. Furthermore, a suggested navigation trajectory ensued on the basis of the obtained relief. The visible and invisible lumen cases are considered. Due to its low cost reckoning, such strategy would allow for the intraoperative configuration changes and thus cut back the non-rigidity effect of the colon. Besides, it would have the trend to provide a safe navigation trajectory through the whole colon, since this approach is aiming at keeping the extremity of the instrument as far as possible from the colon wall during navigation. In order to make effective the considered process, we replaced the original manual control system of a regular colonoscope by a motorized one allowing automatic pan and tilt motions of the device's tip.

  18. Wound management in perforated appendicitis.

    PubMed

    Lemieur, T P; Rodriguez, J L; Jacobs, D M; Bennett, M E; West, M A

    1999-05-01

    Open wound management after perforated appendicitis was common practice but, recently, primary closure has been advocated to reduce costs and morbidity. Hospital records from 319 adults who underwent appendectomy from 1993 to 1996 were reviewed to identify surgical wound infections (SWIs) and examine risk factors. Information about age, length of stay (LOS), operative time, white blood cell count, and antibiotic administration were obtained. Perforation was either noted at operation or identified microscopically by the pathologist. If primary wound closure was performed, patients with acute appendicitis and perforation had a 4-fold higher readmission rate, a 5-fold increase in SWI, and twice the LOS compared with patients with acute appendicitis without perforation. Patients with grossly perforated acute appendicitis had no difference in LOS if the wound was treated open or closed primarily. No patient with microscopic perforation and primary wound closure developed SWI. Primary wound closure after acute appendicitis was safe in the absence of clinical perforation. In the presence of clinical appendiceal perforation the wound should be left open. PMID:10231213

  19. Does the variable-stiffness colonoscope makes colonoscopy easier? A meta-analysis of the efficacy of the variable stiffness colonoscope compared with the standard adult colonoscope

    PubMed Central

    2012-01-01

    Background The variable-stiffness colonoscope (VSC) appears to have advantages over the standard adult colonoscope (SAC), although data are conflicting. To provide a comprehensive up-to-date review, we conducted a meta-analysis to compare the efficacies of the VSC and SAC. Methods Electronic databases, including PubMed, EMBASE, the Cochrane library and the Science Citation Index, were searched to retrieve relevant trials. In addition, meeting abstracts and the reference lists of retrieved articles were reviewed for further relevant studies. Results Eight randomized controlled trials (RCTs), enrolling a total of 2033 patients, were included in the meta-analysis. There was no significant heterogeneity among these studies. The cecal intubation rate was higher with the use of VSC (RR = 1.03, 95% CI 1.01 to 1.06, 8 RCTs). The VSC was also associated with fewer position changes made during colonoscopy. Time to cecal intubation was similar with VSC and SAC (WMD −0.54, 95% CI −1.40 to 0.32) but shorter in subgroup analysis with the use of VSC (WMD = −1.36, 95% CI −2.29 to −0.43). Sedation dose used with the two types of instruments showed no evidence of differences either. For all trials, only patients were blinded because of the nature of the interventions. Conclusion Use of the VSC significantly improved the cecal intubation rate and reduced ancillary maneuvers made during the procedure. Cecal intubation time was similar for the two colonoscope types over all trials, whereas a shortened time with the use of the adult VSC was seen in subgroup analysis. PMID:23095461

  20. Genetic Polymorphisms of Functional Candidate Genes and Recurrent Acute Otitis Media With or Without Tympanic Membrane Perforation.

    PubMed

    Esposito, Susanna; Marchisio, Paola; Orenti, Annalisa; Spena, Silvia; Bianchini, Sonia; Nazzari, Erica; Rosazza, Chiara; Zampiero, Alberto; Biganzoli, Elia; Principi, Nicola

    2015-10-01

    Evaluation of the genetic contribution to the development of recurrent acute otitis media (rAOM) remains challenging. This study aimed to evaluate the potential association between single nucleotide polymorphisms (SNPs) in selected genes and rAOM and to analyze whether genetic variations might predispose to the development of complicated recurrent cases, such as those with tympanic membrane perforation (TMP).A total of 33 candidate genes and 47 SNPs were genotyped in 200 children with rAOM (116 with a history of TMP) and in 200 healthy controls.INFγ rs 12369470CT was significantly less common in the children with rAOM than in healthy controls (odds ratio [OR] 0.5, 95% confidence interval [CI] 0.25-1, P = 0.04). Although not significant, interleukin (IL)-1β rs 1143627G and toll-like receptor (TLR)-4 rs2737191AG were less frequently detected in the children with rAOM than in controls. The opposite was true for IL-8 rs2227306CT, which was found more frequently in the children with rAOM than in healthy controls. The IL-10 rs1800896TC SNP and the IL-1α rs6746923A and AG SNPs were significantly more and less common, respectively, among children without a history of TMP than among those who suffered from this complication (OR 2.17, 95% CI 1.09-4.41, P = 0.02, and OR 0.42, 95% CI 0.21-0.84, P = 0.01).This study is the first report suggesting an association between variants in genes encoding for factors of innate or adaptive immunity and the occurrence of rAOM with or without TMP, which confirms the role of genetics in conditioning susceptibility to AOM. PMID:26496338

  1. Genetic Polymorphisms of Functional Candidate Genes and Recurrent Acute Otitis Media With or Without Tympanic Membrane Perforation

    PubMed Central

    Esposito, Susanna; Marchisio, Paola; Orenti, Annalisa; Spena, Silvia; Bianchini, Sonia; Nazzari, Erica; Rosazza, Chiara; Zampiero, Alberto; Biganzoli, Elia; Principi, Nicola

    2015-01-01

    Abstract Evaluation of the genetic contribution to the development of recurrent acute otitis media (rAOM) remains challenging. This study aimed to evaluate the potential association between single nucleotide polymorphisms (SNPs) in selected genes and rAOM and to analyze whether genetic variations might predispose to the development of complicated recurrent cases, such as those with tympanic membrane perforation (TMP). A total of 33 candidate genes and 47 SNPs were genotyped in 200 children with rAOM (116 with a history of TMP) and in 200 healthy controls. INFγ rs 12369470CT was significantly less common in the children with rAOM than in healthy controls (odds ratio [OR] 0.5, 95% confidence interval [CI] 0.25–1, P = 0.04). Although not significant, interleukin (IL)-1β rs 1143627G and toll-like receptor (TLR)-4 rs2737191AG were less frequently detected in the children with rAOM than in controls. The opposite was true for IL-8 rs2227306CT, which was found more frequently in the children with rAOM than in healthy controls. The IL-10 rs1800896TC SNP and the IL-1α rs6746923A and AG SNPs were significantly more and less common, respectively, among children without a history of TMP than among those who suffered from this complication (OR 2.17, 95% CI 1.09–4.41, P = 0.02, and OR 0.42, 95% CI 0.21–0.84, P = 0.01). This study is the first report suggesting an association between variants in genes encoding for factors of innate or adaptive immunity and the occurrence of rAOM with or without TMP, which confirms the role of genetics in conditioning susceptibility to AOM. PMID:26496338

  2. The water jet deformation sign: a novel provocative colonoscopic maneuver to help diagnose an inverted colonic diverticulum.

    PubMed

    Cappell, Mitchell S

    2009-03-01

    Colonoscopic differentiation of an inverted colonic diverticulum from a true colonic polyp is important because a true colonic polyp usually requires colonoscopic snare polypectomy or at least biopsy, whereas these maneuvers are contraindicated for an inverted diverticulum due to the risk of colonic perforation. Previously described diagnostic maneuvers to evert an inverted diverticulum include probing it with a closed biopsy forceps or intraluminal air insufflation during colonoscopy. On colonoscopy, a 59-year-old female had two intraluminal colonic projections. Probing these projections and using air insufflation failed to indent or evert them. Spraying these lesions with a water jet, however, flattened or partly everted them. This novel maneuver provided conclusive evidence that these intraluminal projections represented inverted diverticula. The proposed pathophysiology is that water pressure causes an inverted diverticulum to indent or evert due to its thin wall. The currently reported maneuver may be easier and safer than probing an inverted diverticulum with biopsy forceps and may prove a more reliable diagnostic maneuver than air insufflation. PMID:19204608

  3. Modeling and In Vitro Experimental Validation for Kinetics of the Colonoscope in Colonoscopy

    PubMed Central

    Cheng, Wu-Bin; Di, Yun-Yun; Zhang, Edwin M.; Moser, Michael A. J.; Kanagaratnam, Sivaruban; Korman, Louis Y.; Sarvazyan, Noune; Zhang, Wen-Jun

    2013-01-01

    Colonoscopy is the most sensitive and specific means for detection of colon cancers and polyps. To make colonoscopy more effective several problems must be overcome including: pain associated with the procedure, the risk of perforation, and incomplete intubation colonoscopy. Technically, these problems are the result of loop formation during colonoscopy. Although, several solutions such as modifying the stiffness of the colonoscope, using an overtube and developing image-guided instruments have been introduced to resolve the looping problem, the results of these systems are not completely satisfactory. A new paradigm to overcome loop formation is proposed that is doctor-assistive colonoscopy. In this approach, the endoscopists performance is enhanced by providing using a kinetic model that provides information such as the shape of the scope, direction of the colon and forces exerted within certain sections. It is expected that with the help of this model, the endoscopist would be able to adjust the manipulation to avoid loop formation. In the present studies, the kinetic model is developed and validated using an ex vivo colonoscopy test-bed with a comprehensive kinematic and kinetic data collection. The model utilizes an established colon model based on animal tissue with position tracking sensors, contact force sensors for the intraluminal portion of the scope and a Colonoscopy Force Monitor for the external insertion tube. PMID:23358801

  4. Spontaneous Perforation of Pyometra.

    PubMed

    Sharma, Nalini; Singh, Ahanthem Santa; Bhaphiralyne, Wankhar

    2016-04-01

    Pyometra is collection of purulent material which occurs when there is interference with its normal drainage. It is an uncommon condition with incidence of 0.1 to 0.5% of all gynecological patients. Spontaneous rupture of uterus is an extremely rare complication of pyometra. A 65-year-old lady presented with pain abdomen and purulent vaginal discharge. Preoperative diagnosis of pyometra was made by magnetic resonance imaging (MRI). Laparotomy followed by peritoneal lavage and repair of perforation was performed. Although spontaneously perforated pyometra is rare, the condition must be borne in mind with regard to elderly women with acute abdominal pain. Preoperative diagnosis of perforated pyometra is absolutely essential. Computed tomography (CT) and MRI are diagnostic tools. In selected cases conservative approach at surgery can be opted. PMID:27152313

  5. Spontaneous Perforation of Pyometra

    PubMed Central

    Singh, Ahanthem Santa; Bhaphiralyne, Wankhar

    2016-01-01

    Pyometra is collection of purulent material which occurs when there is interference with its normal drainage. It is an uncommon condition with incidence of 0.1 to 0.5% of all gynecological patients. Spontaneous rupture of uterus is an extremely rare complication of pyometra. A 65-year-old lady presented with pain abdomen and purulent vaginal discharge. Preoperative diagnosis of pyometra was made by magnetic resonance imaging (MRI). Laparotomy followed by peritoneal lavage and repair of perforation was performed. Although spontaneously perforated pyometra is rare, the condition must be borne in mind with regard to elderly women with acute abdominal pain. Preoperative diagnosis of perforated pyometra is absolutely essential. Computed tomography (CT) and MRI are diagnostic tools. In selected cases conservative approach at surgery can be opted. PMID:27152313

  6. Femur chondrosarcoma misdiagnosed as acute knee arthritis and osteomyelitis--further developing a hitherto unreported complication of tumor embolic ischemic ileal perforation after arthroscopic lavage.

    PubMed

    Chow, Louis Tsun Cheung

    2014-12-01

    The differentiation between osteomyelitis and bone tumor may be difficult due to their overlapping clinical and radiological features. A 25-year-old lady presented with left knee pain and joint effusion associated with redness and hotness. A sub-optimally taken plain radiograph showed mixed osteolytic and osteoblastic lesion in the left lower femur with surrounding soft tissue swelling. Since the clinical diagnosis was acute osteomyelitis and arthritis, arthroscopic lavage was performed as a diagnostic and therapeutic procedure. The removed loose bodies and fibrinous tissue showed pathological features suspicious of chondrosarcoma. Subsequent MRI revealed an infiltrative tumor eroding through the cortex and joint cartilage. En bloc excision of the left lower femur, upper tibia including the knee joint and patella was performed, and the final diagnosis was grade 2 chondrosarcoma. The patient developed bilateral pulmonary metastasis 33 months after operation. Five months later, she suffered from a hitherto undescribed complication of ischemic perforation of the terminal ileum secondary to tumor embolic arterial obstruction with no macroscopic intestinal or peritoneal tumor deposit. The patient developed multiple brain metastases and died 43 months after initial presentation. Our case illustrates that malignant bone tumor as a differential diagnosis of acute osteomyelitis and arthritis merits recognition and exclusion before arthroscopic lavage, which may enhance tumor dissemination and in our patient results in embolic ischemic ileal perforation. PMID:25242025

  7. Multifiber optical bend sensor to aid colonoscope navigation

    NASA Astrophysics Data System (ADS)

    Kesner, Jessica E.; Gavalis, Robb M.; Wong, Peter Y.; Cao, Caroline G. L.

    2011-12-01

    A colonoscopy's near-blind navigation process frequently causes disorientation for the scope operator, leading to harm for the patient. Navigation can be improved if real-time colonoscope shape, location, and orientation information is provided by a shape-tracking aid, such as a fiber optic bend sensor. Fiber optic bend sensors provide advantages over conventional electromechanical shape-trackers, including low cost and ease of integration. However, current fiber optic bend sensors lack either the ability to detect both bending direction and curvature, or the ability to detect multiple localized bends. An inexpensive multifiber bend sensor was developed to aid users in navigation during colonoscopy. The bend sensor employs active-cladding optical fibers modified with fluorescent quantum dots, bandpass filters, and a complementary metal-oxide-semiconductor imager as key components. Results from three-fiber sensors demonstrate the bend sensor's ability to measure curvature (error of 0.01 mm), direction (100% accuracy), and location (predetermined distance) of a bend in the fiber bundle. Comparison with spectroscopy data further confirmed the accuracy of the bending direction measurement for a three-fiber sensor. Future work includes improvements in fiber manufacturing to increase sensor sensitivity and consistency. An expanded 31 fiber bundle would be needed to track the full length of a colonoscope.

  8. Esophageal perforation

    MedlinePlus

    ... esophagus into the space around the lungs Collapsed lung. X-rays taken after you drink a non-harmful dye can help pinpoint the location of the perforation. You may also have chest CT scan look for an abscess in the chest or esophageal cancer.

  9. Acute effects of electro-acupuncture (EA) on hippocampal long term potentiation (LTP) of perforant path-dentate gyrus granule cells synapse related to memory.

    PubMed

    He, Xiaokuo; Yan, Tiebin; Chen, Rongfa; Ran, Dongzhi

    2012-01-01

    Acupuncture, a traditional Chinese therapeutic method, has been widely used in clinical practice to treat diseases such as stroke, Bell's palsy, Alzheimer disease, Parkinson diseases, dysmenorrhea and chronic pain. Mounting lab data had suggested that electro-acupuncture could alleviate dementia and restore long term potentiation of hippocampus in rat. Clinical data also indicated that electro-acupuncture could improve electrical activity of brain in vascular dementia patients. However, its biological basis and acute effects on hippocampal long term potentiation (LTP) remain not well understood. Therefore, we sought to investigate whether acute electro-acupuncture (acupoints: ST36 and SP6; continuous wave, 2 mV, 2Hz; lasted 20 min) could enhance LTP of perforant path-dentate gyrus granule cells in anesthetized rat and explore its underlying mechanisms. We found that electro-acupuncture could significantly increase PS2/PS 1 in pair pulse test (P <0.05, inter-pulse interval: 20ms and 90ms). When compared to control group, electro-acupuncture could significantly enhance LTP to about 234% which was about 143% of that in control group (P <0.05). It suggested that electro-acupuncture could modulate the function of interneurons in hippocampus hence increase LTP. PMID:23156202

  10. Management of a Septic Open Abdomen Patient with Spontaneous Jejunal Perforation after Emergent C/S with Confounding Factor of Mild Acute Pancreatitis

    PubMed Central

    Yetisir, Fahri; Sarer, Akgün Ebru; Acar, Hasan Zafer; Osmanoglu, Gokhan; Özer, Mehmet; Yaylak, Faik

    2016-01-01

    Introduction. We report the management of a septic Open Abdomen (OA) patient by the help of negative pressure therapy (NPT) and abdominal reapproximation anchor (ABRA) system in pregnant woman with spontaneous jejunal perforation after emergent cesarean section (C/S) with confounding factor of mild acute pancreatitis (AP). Presentation of Case. A 29-year-old and 34-week pregnant woman with AP underwent C/S. She was arrested after anesthesia induction and responded to cardiopulmonary resuscitation (CPR). There were only ash-colored serosanguinous fluid within abdomen during C/S. After C/S, she was transferred to intensive care unit (ICU) with vasopressor support. On postoperative 1st day, she underwent reoperation due to fecal fluid coming near the drainage. Leakage point could not be identified exactly and operation had to be deliberately abbreviated due to hemodynamic instability. NPT was applied. Two days later source control was provided by conversion of enteroatmospheric fistula (EAF) to jejunostomy. ABRA was added and OA was closed. No hernia developed at 10-month follow-up period. Conclusion. NPT application in septic OA patient may gain time to patient until adequate source control could be achieved. Using ABRA in conjunction with NPT increases the fascial closure rate in infected OA patient. PMID:27006853

  11. Perforated monolayers

    SciTech Connect

    Regen, S.L.

    1992-12-01

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

  12. Selective treatment of duodenal ulcer with perforation.

    PubMed Central

    Donovan, A J; Vinson, T L; Maulsby, G O; Gewin, J R

    1979-01-01

    Selective treatment of duodenal ulcer with perforation has been based on several premises: 1) The natural history of the ulcer following closure of a perforation is generally favorable with an acute and unfavorable with a chronic ulcer. 2) An upper gastrointestinal series with water soluble contrast media can reliably document a spontaneously sealed perforation. 3) With a spontaneous seal, nonsurgical therapy is an acceptable option and is preferable for an acute ulcer or a chronic ulcer with poor surgical risk. 4) The treatment of choice for an unsealed perforation of an acute ulcer is simple surgical closure. 5) The treatment of choice of perforation of a chronic ulcer with acceptable surgical risk is an ulcer definitive operation. Sixty cases of perforation of duodenal ulcer have been treated. Nonsurgical therapy was employed without complication in eight cases with radiologically documented spontaneous seal. Truncal vagotomy and pyloroplasty in 36 cases and truncal vagotomy and antrectomy in two cases were each without mortality. Four fatalities occurred among 13 cases of closure and omental patch, each a case with severe associated disease. The mortality was 6.7% among the 60 cases; 2.4% for chronic ulcer and 16% for acute ulcer. Images Fig. 1. Fig. 2. PMID:443915

  13. Duodenal Perforation Precipitated by Scrub Typhus.

    PubMed

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

    2015-01-01

    Scrub typhus is an acute febrile illness usually presenting with fever, myalgia, headache, and a pathognomonic eschar. Severe infection may lead to multiple organ failure and death. Gastrointestinal tract involvement in the form of gastric mucosal erosions and ulcerations owing to vasculitis resulting in gastrointestinal bleeding is common. This process may worsen a pre-existent asymptomatic peptic ulcer, causing duodenal perforation, and present as an acute abdomen requiring surgical exploration. We report the case of a patient with no previous symptoms or risk factors for a duodenal ulcer, who presented with an acute duodenal perforation, probably precipitated by scrub typhus infection. PMID:26069430

  14. Ogilvie's syndrome-acute colonic pseudo-obstruction.

    PubMed

    Pereira, P; Djeudji, F; Leduc, P; Fanget, F; Barth, X

    2015-04-01

    Ogilvie's syndrome describes an acute colonic pseudo-obstruction (ACPO) consisting of dilatation of part or all of the colon and rectum without intrinsic or extrinsic mechanical obstruction. It often occurs in debilitated patients. Its pathophysiology is still poorly understood. Since computed tomography (CT) often reveals a sharp transition or "cut-off" between dilated and non-dilated bowel, the possibility of organic colonic obstruction must be excluded. If there are no criteria of gravity, initial treatment should be conservative or pharmacologic using neostigmine; decompression of colonic gas is also a favored treatment in the decision tree, especially when cecal dilatation reaches dimensions that are considered at high risk for perforation. Recurrence is prevented by the use of a multiperforated Faucher rectal tube and oral or colonic administration of polyethylene glycol (PEG) laxative. Alternative therapeutic methods include: epidural anesthesia, needle decompression guided either radiologically or colonoscopically, or percutaneous cecostomy. Surgery should be considered only as a final option if medical treatments fail or if colonic perforation is suspected; surgery may consist of cecostomy or manually-guided transanal pan-colorectal tube decompression at open laparotomy. Surgery is associated with high rates of morbidity and mortality. PMID:25770746

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

    PubMed

    Acıpayam, Can; Aldıç, Güliz; Akçora, Bülent; Çelikkaya, Mehmet Emin; Aşkar, Hasan; Dorum, Bayram Ali

    2014-01-01

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

  16. Acquired reactive perforating collagenosis.

    PubMed

    Basak, P Y; Turkmen, C

    2001-01-01

    Acquired perforating disorder has been recognized as an uncommon distinct dermatosis in which altered collagen is eliminated through the epidermis. Several disorders accompanied by itching and scratching were reported to be associated with reactive perforating collagenosis. A 67-year-old white woman diagnosed as acquired reactive perforating collagenosis with poorly controlled diabetes mellitus and congestive cardiac failure is presented. PMID:11525959

  17. Active contours for localizing polyps in colonoscopic NBI image data

    NASA Astrophysics Data System (ADS)

    Breier, Matthias; Gross, Sebastian; Behrens, Alexander; Stehle, Thomas; Aach, Til

    2011-03-01

    Colon cancer is the third most common type of cancer in the United States of America. Every year about 140,000 people are newly diagnosed with colon cancer. Early detection is crucial for a successful therapy. The standard screening procedure is called colonoscopy. Using this endoscopic examination physicians can find colon polyps and remove them if necessary. Adenomatous colon polyps are deemed a preliminary stage of colon cancer. The removal of a polyp, though, can lead to complications like severe bleedings or colon perforation. Thus, only polyps diagnosed as adenomatous should be removed. To decide whether a polyp is adenomatous the polyp's surface structure including vascular patterns has to be inspected. Narrow-Band imaging (NBI) is a new tool to improve visibility of vascular patterns of the polyps. The first step for an automatic polyp classification system is the localization of the polyp. We investigate active contours for the localization of colon polyps in NBI image data. The shape of polyps, though roughly approximated by an elliptic form, is highly variable. Active contours offer the flexibility to adapt to polyp variation well. To avoid clustering of contour polygon points we propose the application of active rays. The quality of the results was evaluated based on manually segmented polyps as ground truth data. The results were compared to a template matching approach and to the Generalized Hough Transform. Active contours are superior to the Hough transform and perform equally well as the template matching approach.

  18. Feasibility of full-spectrum endoscopy: Korea’s first full-spectrum endoscopy colonoscopic trial

    PubMed Central

    Song, Jeong-Yeop; Cho, Youn Hee; Kim, Mi A; Kim, Jeong-Ae; Lee, Chun Tek; Lee, Moon Sung

    2016-01-01

    AIM: To evaluate the full-spectrum endoscopy (FUSE) colonoscopy system as the first report on the utility thereof in a Korean population. METHODS: We explored the efficacy of the FUSE colonoscopy in a retrospective, single-center feasibility study performed between February 1 and July 20, 2015. A total of 262 subjects (age range: 22-80) underwent the FUSE colonoscopy for colorectal cancer screening, polyp surveillance, or diagnostic evaluation. The cecal intubation success rate, the polyp detection rate (PDR), the adenoma detection rate (ADR), and the diverticulum detection rate (DDR), were calculated. Also, the success rates of therapeutic interventions were evaluated with biopsy confirmation. RESULTS: All patients completed the study and the success rates of cecal and terminal ileal intubation were 100% with the FUSE colonoscope; we found 313 polyps in 142 patients and 173 adenomas in 95. The overall PDR, ADR and DDR were 54.2%, 36.3%, and 25.2%, respectively, and were higher in males, and increased with age. The endoscopists and nurses involved considered that the full-spectrum colonoscope improved navigation and orientation within the colon. No colonoscopy was aborted because of colonoscope malfunction. CONCLUSION: The FUSE colonoscopy yielded a higher PDR, ADR, DDR than did traditional colonoscopy, without therapeutic failure or complications, showing feasible, effective, and safe in this first Korean trial. PMID:26937150

  19. Training methods and models for colonoscopic insertion, endoscopic mucosal resection, and endoscopic submucosal dissection.

    PubMed

    Yoshida, Naohisa; Fernandopulle, Nilesh; Inada, Yutaka; Naito, Yuji; Itoh, Yoshito

    2014-09-01

    Colonoscopic examination is considered an effective examination for the detection of colorectal cancers. Additionally, early colorectal cancers can be resected using endoscopic techniques such as endoscopic mucosal resection and endoscopic submucosal dissection. However, those examinations and treatments need special techniques. Various training methods are practiced to acquire such endoscopic techniques throughout the world. In clinical cases, magnetic positioning devices help endoscopic insertion by less experienced endoscopists. There is a physical model made by polyvinyl chloride and a virtual simulator for training of colonoscopic insertion. Various techniques including a method to apply pressure to the abdomen and consideration for patient's pain can be trained using these models. In view of extensive training of endoscopic mucosal resection and endoscopic submucosal dissection, animal models are useful and actually used. Live animal models of minipig, which entails blood flow, are ideal and used frequently, but are cumbersome to prepare. On the other hand, ex vivo animal models using intestine of porcine and bovine are convenient for preparation and less expensive. Unique ex vivo animal models with blood flow have been developed recently and techniques for hemostasis can be practiced. With respect to a method of training for colorectal endoscopic submucosal dissection, a stepwise system has been adopted throughout the world. Thus, first they observe the expert's technique, then practice training of animal models, and finally, they perform clinical rectal cases. The system is useful for a safe and definite procedure. In this review, we reveal various training methods for colonoscopic examinations and treatments. PMID:25102984

  20. Well perforating methods

    SciTech Connect

    Revett, L. W.

    1985-09-17

    A well completion method comprising suspending NaCl crystals in the interval of the well bore to be perforated where the NaCl crystals are sized to bridge the perforations when the hydraulic pressure in the well bore exceeds the hydraulic pressure in the earth formation. The perforator is arranged to produce penetrations in the well bore in a radial pattern about the circumference of the well bore so as to effectively penetrate the entire circumference over a short interval. This enhances the perforation of vertical fractures in the earth formations.

  1. Gastric perforation presenting as empyema in a patient with pancreatic cancer on bevacizumab treatment.

    PubMed

    Shao, Yu-Yun; Lin, Zhong-Zhe; Liang, Po-Chin; Tien, Yu-Wen; Cheng, Ann-Lii

    2009-05-01

    Bowel perforation is a rare but life-threatening complication of bevacizumab, a new anticancer treatment. Patients with bowel perforation usually present with acute abdominal symptoms. Here a case history is presented to highlight a pancreatic cancer patient on bevacizumab chemotherapy who developed empyema as the first manifestation of gastric perforation. This unusual presentation warns physicians that bevacizumab-related bowel perforation can arise as a thoracic complication, without typical gastrointestinal manifestations, in an advanced cancer patient. PMID:19443383

  2. Integrating geology and perforating

    SciTech Connect

    Araujo, P.F. de; Souza Padilha, S.T.C. de

    1997-02-01

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

  3. Unusual presentation of gallbladder perforation

    PubMed Central

    Jayasinghe, G.; Adam, J.; Abdul-Aal, Y.

    2015-01-01

    Introduction Gall bladder perforation is associated with high mortality rates and therefore must be recognised and managed promptly. We present an unusual presentation of spontaneous gall bladder perforation. Case presentation An elderly lady with multiple medical co-morbidities was admitted with sepsis following a fall. Initial assessment lead to a diagnosis of pneumonia, however a rapidly expanding right flank mass was incidentally noted during routine nursing care. Imaging studies were inconclusive, however incision and drainage of the mass revealed bile stained pus draining cutaneously from an acutely inflamed gallbladder. The patient made a good recovery following surgery, and was discharged with outpatient follow-up. Discussion Despite focussed post-hoc history taking she denied any prodromal symptoms of cholecystitis. In addition to reporting an unusual cause for a common presentation, we highlight the importance of a full body examination in the context of sepsis, regardless of whether the source has been identified. In addition, we advocate that surgical intervention in sepsis should not be delayed by imaging in cases where an abscess is suspected. Conclusions Percutaneous abscesses arising from the gallbladder are a rare but potentially serious consequence of acute cholecystitis, and may present in a wide variety of locations. Therefore it is imperative to conduct a full body inspection in the septic patient, even when a source has been identified. PMID:26686488

  4. Laparoscopic right-sided colonic resection with transluminal colonoscopic specimen extraction

    PubMed Central

    Kayaalp, Cuneyt; Kutluturk, Koray; Yagci, Mehmet Ali; Ates, Mustafa

    2015-01-01

    AIM: To study the transcolonic extraction of the proximally resected colonic specimens by colonoscopic assistance at laparoscopic colonic surgery. METHODS: The diagnoses of our patients were Crohn’s disease, carcinoid of appendix and adenocarcinoma of cecum. We preferred laparoscopic total mesocolic resections. Colon and terminal ileum were divided with endoscopic staplers. A colonoscope was placed per anal and moved proximally in the colon till to reach the colonic closed end under the laparoscopic guidance. The stump of the colon was opened with laparoscopic scissors. A snare of colonoscope was released and the intraperitoneal complete free colonic specimen was grasped. Specimen was moved in to the colon with the help of the laparoscopic graspers and pulled gently through the large bowel and extracted through the anus. The open end of the colon was closed again and the ileal limb and the colon were anastomosed intracorporeally with a 60-mm laparoscopic stapler. The common enterotomy orifice was closed in two layers with a running intracorporeal suture. RESULTS: There were three patients with laparoscopic right-sided colonic resections and their specimens were intended to remove through the remnant colon by colonoscopy but the procedure failed in one patient (adenocarcinoma) due to a bulky mass and the specimen extraction was converted to transvaginal route. All the patients had prior abdominal surgeries and had related adhesions. The operating times were 210, 300 and 500 min. The lengths of the specimens were 13, 17 and 27 cm. In our cases, there were no superficial or deep surgical site infections or any other complications. The patients were discharged uneventfully within 4-5 d and they were asymptomatic after a mean 7.6 mo follow-up (ranged 4-12). As far as we know, there were only 12 cases reported yet on transcolonic extraction of the proximal colonic specimens by colonoscopic assistance after laparoscopic resections. With our cases, success rate of the

  5. Perforating Thin Metal Sheets

    NASA Technical Reports Server (NTRS)

    Davidson, M. E.

    1985-01-01

    Sheets only few mils thick bonded together, punched, then debonded. Three-step process yields perforated sheets of metal. (1): Individual sheets bonded together to form laminate. (2): laminate perforated in desired geometric pattern. (3): After baking, laminate separates into individual sheets. Developed for fabricating conductive layer on blankets that collect and remove ions; however, perforated foils have other applications - as conductive surfaces on insulating materials; stiffeners and conductors in plastic laminates; reflectors in antenna dishes; supports for thermal blankets; lightweight grille cover materials; and material for mockup of components.

  6. Ileal perforation associated with dengue in the paediatric age group: an uncommon presentation.

    PubMed

    Kumar, Piyush; Gupta, Archika; Pandey, Anand; Kureel, Shiv Narain

    2016-01-01

    Acute abdomen in dengue, a common arboviral disease found in tropical and subtropical countries, is not uncommon and can occasionally present as acute surgical emergency requiring urgent surgical intervention. The spectrum of acute abdomen presenting as surgical emergency in dengue infection that raises suspicion of an abdominal catastrophe includes acute appendicitis, acute cholecystitis, appendicitis and, rarely, intestinal perforation. All cases of intestinal perforation including appendicular, gastric and jejunal perforation have been reported in adult patients during the course of dengue infection. However, intestinal perforation during the course of dengue infection in the paediatric age group has never been reported. We report two cases of ileal perforation in children occurring during the course of dengue infection. PMID:27485879

  7. Small bowel perforation due to fish bone: A case report.

    PubMed

    Pulat, Huseyin; Karakose, Oktay; Benzin, Mehmet Fatih; Benzin, Seyma; Cetin, Recep

    2015-09-01

    Accidental ingestion of foreign bodies are a common condition in clinical practice. However, small bowel perforation which dues to ingestion foreign bodies has been rarely seen. In this article, we report a case of small bowel perforation which dues to ingestion foreign body. A 80-year-old female patient, presenting with complaints of acute abdomen, was admitted to the emergency department. She denied abdominal pain, nausea and vomiting. The patient had tenderness and defense on the right lower quadrant. Contrast enhanced abdominal computed tomography has been used on the patient's diagnosis. This revealed small bowel perforation due to the ingestion of foreign body. The patient was operated emergency. A microperforation due to fish bone was detected on the terminal ileum. The patient underwent debridement and primary repair. The patient was discharged postoperative 7th day without problem. Bowel perforation due to the ingestion of foreign bodies should be considered in the differential diagnosis of acute abdomen. PMID:27239615

  8. The Versatile Modiolus Perforator Flap

    PubMed Central

    Gunnarsson, Gudjon Leifur; Thomsen, Jorn Bo

    2016-01-01

    Background: Perforator flaps are well established, and their usefulness as freestyle island flaps is recognized. The whereabouts of vascular perforators and classification of perforator flaps in the face are a debated subject, despite several anatomical studies showing similar consistency. In our experience using freestyle facial perforator flaps, we have located areas where perforators are consistently found. This study is focused on a particular perforator lateral to the angle of the mouth; the modiolus and the versatile modiolus perforator flap. Methods: A cohort case series of 14 modiolus perforator flap reconstructions in 14 patients and a color Doppler ultrasonography localization of the modiolus perforator in 10 volunteers. Results: All 14 flaps were successfully used to reconstruct the defects involved, and the location of the perforator was at the level of the modiolus as predicted. The color Doppler ultrasonography study detected a sizeable perforator at the level of the modiolus lateral to the angle of the mouth within a radius of 1 cm. This confirms the anatomical findings of previous authors and indicates that the modiolus perforator is a consistent anatomical finding, and flaps based on it can be recommended for several indications from the reconstruction of defects in the perioral area, cheek and nose. Conclusions: The modiolus is a well-described anatomical area containing a sizeable perforator that is consistently present and readily visualized using color Doppler ultrasonography. We have used the modiolus perforator flap successfully for several indications, and it is our first choice for perioral reconstruction. PMID:27257591

  9. Determinants of participation in colonoscopic screening by siblings of colorectal cancer patients in France

    PubMed Central

    2010-01-01

    Background Targeted colonosocopic screening is recommended for first-degree relatives of colorectal cancer patients diagnosed before the age of 60 and offers the possibility of reducing morbidity and mortality, but participation remains too low. The objective of this study was to determine in a French population the factors that affect siblings' participation in screening, notably those relating to the individuals, their medical care, their family and their social network. Methods A cross sectional survey was conducted in siblings of index patients having undergone surgery for colorectal cancer between 1999 and 2002 in two French counties. Siblings were contacted during 2007 and 2008 through the index patient. The factors affecting participation in colonoscopic screening were studied by logistic regression taking into account family cluster effect. Results 172 siblings of 74 index cases were included. The declared rate of undergoing at least one colonoscopy among siblings was 66%; 95%CI 59-73%. Five variables were independently associated with colonoscopic screening: perceiving fewer barriers to screening (OR = 3.2; 95%CI 1.2-8.5), having received the recommendation to undergo screening from a physician (OR = 4.9; 1.7-13.7), perceiving centres practising colonoscopy as more accessible (OR = 3.2, 1.3-7.8), having discussed screening with all siblings (OR = 3.9; 1.6-9.6) and being a member of an association (OR = 2.6; 1.0-6.6). Conclusions The factors independently associated with participation in CRC screening by an individual at increased risk belonged to each of four dimensions relating to his individual psychosocial characteristics, to his relationship with a physician, within the family and social environment. The relevance of these results to clinical practice may help to improve compliance to recommendations in a global preventive strategy including all stages of the information pathway from the physician to the index patient and his relatives. PMID:20602807

  10. Feature extraction and pattern classification of colorectal polyps in colonoscopic imaging.

    PubMed

    Fu, Jachih J C; Yu, Ya-Wen; Lin, Hong-Mau; Chai, Jyh-Wen; Chen, Clayton Chi-Chang

    2014-06-01

    A computer-aided diagnostic system for colonoscopic imaging has been developed to classify colorectal polyps by type. The modules of the proposed system include image enhancement, feature extraction, feature selection and polyp classification. Three hundred sixty-five images (214 with hyperplastic polyps and 151 with adenomatous polyps) were collected from a branch of a medical center in central Taiwan. The raw images were enhanced by the principal component transform (PCT). The features of texture analysis, spatial domain and spectral domain were extracted from the first component of the PCT. Sequential forward selection (SFS) and sequential floating forward selection (SFFS) were used to select the input feature vectors for classification. Support vector machines (SVMs) were employed to classify the colorectal polyps by type. The classification performance was measured by the Az values of the Receiver Operating Characteristic curve. For all 180 features used as input vectors, the test data set yielded Az values of 88.7%. The Az value was increased by 2.6% (from 88.7% to 91.3%) and 4.4% (from 88.7% to 93.1%) for the features selected by the SFS and the SFFS, respectively. The SFS and the SFFS reduced the dimension of the input vector by 57.2% and 73.8%, respectively. The SFFS outperformed the SFS in both the reduction of the dimension of the feature vector and the classification performance. When the colonoscopic images were visually inspected by experienced physicians, the accuracy of detecting polyps by types was around 85%. The accuracy of the SFFS with the SVM classifier reached 96%. The classification performance of the proposed system outperformed the conventional visual inspection approach. Therefore, the proposed computer-aided system could be used to improve the quality of colorectal polyp diagnosis. PMID:24495469

  11. Forty-Year Analysis of Colonoscopic Surveillance Program for Neoplasia in Ulcerative Colitis: An Updated Overview

    PubMed Central

    Choi, Chang-Ho Ryan; Rutter, Matthew D; Askari, Alan; Lee, Gui Han; Warusavitarne, Janindra; Moorghen, Morgan; Thomas-Gibson, Siwan; Saunders, Brian P; Graham, Trevor A; Hart, Ailsa L

    2015-01-01

    Objectives: This study provides an overview of the largest and longest-running colonoscopic surveillance program for colorectal cancer (CRC) in patients with long-standing ulcerative colitis (UC). Methods: Data were obtained from medical records, endoscopy, and histology reports. Primary end points were defined as death, colectomy, withdrawal from surveillance, or censor date (1 January 2013). Results: A total of 1,375 UC patients were followed up for 15,234 patient-years (median, 11 years per patient). CRC was detected in 72 patients (incidence rate (IR), 4.7 per 1,000 patient-years). Time-trend analysis revealed that although there was significant decrease in incidence of colectomy performed for dysplasia (linear regression, R=−0.43; P=0.007), IR of advanced CRC and interval CRC have steadily decreased over past four decades (Pearson's correlation, −0.99; P=0.01 for both trends). The IR of early CRC has increased 2.5-fold in the current decade compared with past decade (χ2, P=0.045); however, its 10-year survival rate was high (79.6%). The IR of dysplasia has similarly increased (χ2, P=0.01), potentially attributable to the recent use of chromoendoscopy that was twice more effective at detecting dysplasia compared with white-light endoscopy (χ2, P<0.001). CRCs were frequently accompanied by synchronous CRC or spatially distinct dysplasia (37.5%). Finally, the risk of CRC was not significantly different between “indefinite” or low-grade dysplasia (log-rank, P=0.78). Conclusions: Colonoscopic surveillance may have a significant role in reducing the risk of advanced and interval CRC while allowing more patients to retain their colon for longer. Given the ongoing risk of early CRC, patients with any grade of dysplasia who are managed endoscopically should be monitored closely with advanced techniques. PMID:25823771

  12. Expanding the view of a standard colonoscope with the Third Eye® Panoramic™ cap

    PubMed Central

    Rubin, Moshe; Lurie, Leigh; Bose, Konika; Kim, Sang H

    2015-01-01

    AIM: To evaluate a new imaging device for colonoscopy that adds two side viewing CMOS lenses, the Third Eye® Panoramic™ cap. METHODS: In this prospective observational feasibility study, 33 patients, 18 male and 15 female, underwent routine screening, surveillance or diagnostic colonoscopy with the new Third Eye® Panoramic™ cap clipped on to the distal tip of a high definition Fuji EC530-LS Slim Colonoscope®. All procedures were performed at the New York Presbyterian-Queens Endoscopy unit by two experienced endoscopists (Rubin M and Kim SH). Main outcome measurements included evaluation of the image quality of the Third Eye® Panoramic™ cap, adenoma detection rate, cecal intubation rate, withdrawal time and total procedure time. RESULTS: The Third Eye® Panoramic™ cap enabled enhanced views without affecting the quality of the colonoscope’s image or its handling characteristics through the colon. Ileal intubation was accomplished in most cases, but was more challenging. The side view lenses detected polyps and diverticula hidden behind folds and in flexures not seen on the standard view. The side view lenses were easily cleaned utilizing an Endogator® Irrigation Pump (Medivators, Minneapolis, MN, United States) by angling the scope tip against the mucosa while washing. The cecum was reached in all 33 patients. Mean cecal intubation time was 8.19 ± 2.17 min, mean withdrawal time was 10.15 ± 5.56 min and mean total procedure time was 20.31 ± 5.14 min. The overall adenoma detection rate was 44%. CONCLUSION: The Third Eye® Panoramic™ cap enables wide view colonoscopy with enhanced visualization utilizing standard forward view colonoscopes. PMID:26457029

  13. High Cecal Intubation Rates With a New Computer-Assisted Colonoscope: A Feasibility Study

    PubMed Central

    Groth, Stefan; Rex, Douglas K; Rösch, Thomas; Hoepffner, Nicolas

    2011-01-01

    OBJECTIVES: The acceptability of colonoscopy as a screening test is limited by several factors including patient discomfort. A new self-propelled colonoscope, the Invendo SC20 (Invendo Medical GmbH), may be helpful in reducing sedation. It consists of a sheathed endoscope contained within an “inverted sleeve,” and having an instrument channel and an electrohydraulic bendable tip; it is steered using a handheld device and propelled by a motorized drive unit. This study assessed the safety and efficacy of this new endoscope in volunteers undergoing colorectal cancer (CRC) screening. METHODS: Paid healthy volunteers aged 50–70 years and eligible for screening colonoscopy were included. Total colonoscopy using carbon dioxide insufflation or water instillation on demand was attempted, with all procedures being started without sedation. The main outcome parameters were safety and the cecal intubation rate. RESULTS: A total of 61 volunteers participated (34 men and 27 women; mean age 57.5 years). The cecum was reached in 60 volunteers (cecal intubation rate of 98.4%). The median time to reach the cecum was 15 min (range 7–53.5). Sedation was given in three individuals (4.9%). On withdrawal (median time 15 min), the material for histological evaluation was obtained from 33 polyps (mean size 4.8 mm) in 23 people by biopsy forceps or snare. No device-related complications were encountered. CONCLUSIONS: A new computer-assisted colonoscope, controlled using a handheld device, showed excellent cecal intubation rates during screening examinations, with sedation required in only ∼5% of screenees. Further clinical and comparative studies are warranted. PMID:21386833

  14. Gastrointestinal perforation: ultrasonographic diagnosis

    PubMed Central

    2013-01-01

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

  15. [Jejunal perforation as initial metastatic manifestation of laryngeal carcinoma].

    PubMed

    Claros González, I; Santonja Garriga, J L; Rubio Barbón, S; Santamaría Girón, L; Triviño López, A; Velasco Alvarez, A

    1994-01-01

    A case of acute abdominal pain due to jejunal perforation in a patient with dissemination of laryngeal carcinoma is presented. Six jejunal intramural nodes of squamous cell carcinoma, one of them perforated, were observed at laparotomy. At the same time, a lesion suspicious of local recurrence in the tracheostomy orifice was observed. The patient died in the postoperative period. The rarity of intestinal perforation as an initial manifestation of metastatical dissemination of a laryngeal squamous cell carcinoma as well as its poor prognosis are discussed. The hematogenous spread is proposed in our case. Finally the inclusion of metastases in the differential diagnosis in a clinical episode of intestinal perforation in patients with a history of neoplasm is emphasized. PMID:8186002

  16. Complications of coronary intervention: abrupt closure, dissection, perforation

    PubMed Central

    Dash, Debabrata

    2013-01-01

    The introduction of drug-eluting stents (DESs) and superior anticoagulation has successfully improved the safety and patency rates of complex percutaneous coronary interventions (PCIs). The evolving techniques of contemporary PCI have been unable to completely eliminate coronary injury and mechanical complications. Primary causes for abrupt closure include dissection, thrombus formation and acute stent thrombosis. Initial treatment for abrupt closure includes balloon redilatation, optimisation of activated clotting time (ACT) and deployment of stent to stabilise a dissection. Coronary perforation is one of the most challenging and feared complications of PCI. It is most frequently due to distal wire or balloon/stent oversizing and should be fixed with balloon occlusion. Covered stent may be needed for large perforation in major proximal vessels. Perforations in small or distal vessels not resolving with balloon occlusion may be managed by coil or Gelfoam embolisation. Referral to emergency coronary artery bypass surgery (CABG) should be an option in case perforations do not seal.

  17. [Ventricular Septal Perforation after Inferior Myocardial Infarction].

    PubMed

    Sato, Hisashi; Nakayama, Yoshihiro; Tanaka, Hideya; Takahashi, Baku

    2016-07-01

    We report a rare case of ventricular septal perforation (VSP) after inferior myocardial infarction. Surgical repair of VSP after inferior infarction is technically difficult because of its anatomical location. An 81-year-old female presented with dyspnea on the 8th day after percutaneous coronary intervention for acute inferior myocardial infarction. Echocardiography revealed a ventricular septal perforation. Urgent operation was performed. There was a VSP around the base of the ventricular septum. The myocardial infarction extended to the adjacent muscle of the mitral valve annulus. Two bovine pericardial patches were used in the left ventricular cavity. The patches were sewn on the mitral valve annulus which was the only normal tissue in the region. The 1st patch was used to close the VSP directly, and the 2nd patch was sutured to the normal myocardium to exclude the infracted area. No residual shunt flow was observed. The postoperative course was uneventful. PMID:27365060

  18. Cross-sectional imaging of perforated gallbladder.

    PubMed

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

    2014-08-01

    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

  19. Rapunzel syndrome resulting in gastric perforation.

    PubMed

    Parakh, J S; McAvoy, A; Corless, D J

    2016-01-01

    We report the case of an 18-year-old female patient with no past medical history who presented to the emergency department with acute abdominal pain and vomiting on the background of a long history of ingesting hair (trichophagia). Computed tomography revealed pneumoperitoneum and free fluid in keeping with visceral perforation. In addition, a large hair bolus was seen extending in contiguity from the stomach to the jejunum. A laparotomy was performed, revealing an anterior gastric perforation secondary to a 120cm long trichobezoar, which had formed a cast of the entire stomach, duodenum and proximal jejunum. The bezoar was removed and an omental patch repair to the anterior ulcer was performed. The patient made an excellent postoperative recovery and was discharged home with psychiatric follow-up review. PMID:26688419

  20. Well perforation inspection

    SciTech Connect

    Katahara, K.W.

    1993-06-08

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

  1. Rat Endovascular Perforation Model

    PubMed Central

    Sehba, Fatima A.

    2014-01-01

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

  2. Chromoendoscopy with a Standard-Resolution Colonoscope for Evaluation of Rectal Aberrant Crypt Foci.

    PubMed

    Kowalczyk, Marek; Siermontowski, Piotr; Mucha, Dariusz; Ambroży, Tadeusz; Orłowski, Marcin; Zinkiewicz, Krzysztof; Kurpiewski, Waldemar; Paśnik, Krzysztof; Kowalczyk, Iwona; Pedrycz, Agnieszka

    2016-01-01

    Colorectal cancer (CRC) is the second most common cause of death worldwide. According to the theory by Vogelstein, colorectal carcinogenesis involves a series of successive changes in the normal colonic mucosa, starting with excessive proliferation and focal disorders of intestinal crypts, followed by adenoma and its subsequent malignant transformation. The first identifiable changes in CRC carcinogenesis are aberrant crypt foci (ACF). ACF are invisible during routine colonoscopy yet are well identifiable in chromoendoscopy using methylene blue or indigo carmine. High-resolution colonoscopes are used for assessment of ACF. The aim of the present study was to evaluate the usefulness of standard-resolution colonoscopy for identification of rectal ACF. The following parameters were evaluated: duration of chromoendoscopy of a given rectal segment, type of ACF, sensitivity and specificity of endoscopy combined with histopathological evaluation. The mean duration of colonoscopy and chromoendoscopy was 26.8 min. In the study population, typical ACF were found in 73 patients (p = 0.489), hyperplastic ACF in 49 (p = 0.328), and dysplastic ACF in 16 patients (p = 0.107). Mixed ACF were observed in 11 individuals (p = 0.073). The sensitivity of the method was found to be 0.96 whereas its specificity 0.99. Identification of rectal ACF using standard-resolution colonoscopy combined with rectal mucosa staining with 0.25% methylene blue is characterised by high sensitivity and specificity. PMID:26886097

  3. Refractory pseudomembranous colitis that was treated successfully with colonoscopic fecal microbial transplantation

    PubMed Central

    Shin, Jun Young; Ko, Eun Jung; Lee, Seung Ho; Shin, Jong Bum; Kim, Shin Il; Kwon, Kye Sook; Kim, Hyung Gil; Shin, Yong Woon

    2016-01-01

    Pseudomembranous colitis (PMC) is a nosocomial and opportunistic infection caused by Clostridium difficile. PMC is related to the use of antibiotics leading to intestinal dysbiosis and an overgrowth of C. difficile. Metronidazole or vancomycin is considered to be the standard therapy for the management of PMC. However, PMC has a 15%–30% recurrence rate and can be refractory to standard treatments, resulting in morbidity and mortality. Here we describe a patient who experienced refractory PMC who was treated with fecal microbiota transplantation. A 69-year-old woman was admitted to the hospital with consistent abdominal pain and diarrhea, which had been present for 5 months. She was diagnosed with PMC by colonoscopy and tested positive for C. difficile toxin. Even though she took metronidazole for 10 days, followed by vancomycin for 4 weeks, her symptoms did not improve. Because of her recurrent and refractory symptoms, we decided to perform fecal microbiota transplantation. Fifty grams of fresh feces from a donor were obtained on the day of the procedure, mixed with 500 mL of normal saline, and then filtered. The filtered solution was administered to the patient's colon using a colonoscope. After the procedure, her symptoms rapidly improved and a follow-up colonoscopy showed that the PMC had resolved without recurrence. PMID:26884739

  4. Chromoendoscopy with a Standard-Resolution Colonoscope for Evaluation of Rectal Aberrant Crypt Foci

    PubMed Central

    Orłowski, Marcin; Zinkiewicz, Krzysztof; Kurpiewski, Waldemar; Kowalczyk, Iwona

    2016-01-01

    Colorectal cancer (CRC) is the second most common cause of death worldwide. According to the theory by Vogelstein, colorectal carcinogenesis involves a series of successive changes in the normal colonic mucosa, starting with excessive proliferation and focal disorders of intestinal crypts, followed by adenoma and its subsequent malignant transformation. The first identifiable changes in CRC carcinogenesis are aberrant crypt foci (ACF). ACF are invisible during routine colonoscopy yet are well identifiable in chromoendoscopy using methylene blue or indigo carmine. High-resolution colonoscopes are used for assessment of ACF. The aim of the present study was to evaluate the usefulness of standard-resolution colonoscopy for identification of rectal ACF. The following parameters were evaluated: duration of chromoendoscopy of a given rectal segment, type of ACF, sensitivity and specificity of endoscopy combined with histopathological evaluation. The mean duration of colonoscopy and chromoendoscopy was 26.8 min. In the study population, typical ACF were found in 73 patients (p = 0.489), hyperplastic ACF in 49 (p = 0.328), and dysplastic ACF in 16 patients (p = 0.107). Mixed ACF were observed in 11 individuals (p = 0.073). The sensitivity of the method was found to be 0.96 whereas its specificity 0.99. Identification of rectal ACF using standard-resolution colonoscopy combined with rectal mucosa staining with 0.25% methylene blue is characterised by high sensitivity and specificity. PMID:26886097

  5. Clinical evaluation of fibre-optic sigmoidoscopy employing the Olympus CF-SB colonoscope

    PubMed Central

    Salmon, P. R.; Branch, R. A.; Collins, C.; Espiner, H.; Read, A. E.

    1971-01-01

    Fifty-one patients with large bowel disease were examined with the Olympus CF-SB fibreoptic colonoscope. With adequate bowel preparation and employing inhalational analgesia administered by a self-demand valve the whole sigmoid colon could be examined in the majority of patients within 30 minutes. In 23% of cases (12/51) the diagnosis was either made or confirmed by this procedure alone. Fibreoptic sigmoidoscopy is especially helpful in patients with either equivocal or failed barium enemas and is indicated in patients with unexplained rectal bleeding, extending the search for polyps and cancer, and studying patients with inflammatory bowel disease. About one quarter of biopsies taken from a flat mucosal surface with the Olympus flexible biopsy forceps may be insufficient for detailed histology due to their small size. For this reason multiple biopsies may be taken. Adequate biopsies were always obtained from projecting lesions and could be very accurately sited. Colour photography employing automatic exposure control is used to supplement the information obtained. It is concluded that fibreoptic sigmoidoscopy is a valuable additional investigation in selected patients with suspected disease of the large bowel and to date has been without complications. ImagesFig. 1Fig. 2Fig. 3Fig. 4Fig. 5Fig. 6Fig. 7Fig. 8Fig. 9Fig. 10Fig. 11Fig. 12 PMID:5315423

  6. Colonoscopic allergen provocation (COLAP): a new diagnostic approach for gastrointestinal food allergy.

    PubMed Central

    Bischoff, S C; Mayer, J; Wedemeyer, J; Meier, P N; Zeck-Kapp, G; Wedi, B; Kapp, A; Cetin, Y; Gebel, M; Manns, M P

    1997-01-01

    BACKGROUND: The clinical relevance of gastrointestinal food allergy in adults is largely unknown because the mechanisms are poorly understood and the diagnosis is difficult to confirm. AIMS: To improve the diagnostic means for confirming intestinal food allergy on an objective basis, a new colonoscopic allergen provocation (COLAP) test was developed. PATIENTS: The COLAP test was performed in 70 adult patients with abdominal symptoms suspected to be related to food allergy, and in five healthy volunteers. METHODS: During the COLAP test, the caecal mucosa was challenged endoscopically with three food antigen extracts, a buffer control, and a positive control (histamine). The mucosal weal and flare reaction was registered semiquantitatively 20 minutes after challenge, and tissue biopsy specimens were examined for mast cell and eosinophil activation. RESULTS: No severe systemic anaphylactic reactions were found in response to intestinal challenge. The COLAP test was positive to at least one food antigen in 54 of 70 patients (77%), whereas no reaction in response to antigen was found in healthy volunteers. Antigen induced weal and flare reactions were correlated with intestinal mast cell and eosinophil activation, as well as with patients' history of adverse reactions to food, but not with serum concentrations of total or specific IgE or skin test results. CONCLUSION: The COLAP test may be a useful diagnostic measure in patients with suspected intestinal food allergy and may provide a new tool for the study of underlying mechanisms. Images PMID:9245928

  7. Small bowel perforation due to indistinguishable metastasis of angiosarcoma: case report and brief literature review.

    PubMed

    Uchihara, Tomoyuki; Imamura, Yu; Iwagami, Shiro; Kajihara, Ikko; Kanemaru, Hisashi; Karashima, Ryuichi; Ida, Satoshi; Ishimoto, Takatsugu; Baba, Yoshifumi; Sakamoto, Yasuo; Miyamoto, Yuji; Yoshida, Naoya; Watanabe, Masayuki; Iyama, Ken-Ichi; Ihn, Hironobu; Baba, Hideo

    2016-12-01

    Intestinal metastasis of angiosarcoma is extremely rare. We herein report a case of intestinal perforation due to intestinal metastasis of angiosarcoma. The patient was a 72-year-old Japanese man with multiple recurrent angiosarcomas of the scalp. He developed acute abdominal pain with guarding, and we performed an emergency exploratory laparotomy. An intestinal perforation was found 80 cm from the ligament of Treitz, and partial jejunectomy was successfully performed. Macroscopic inspection revealed no obvious injury, ulcer, or tumor at or around the perforation site. Pathological examination revealed angiosarcoma cells penetrating through all layers of the jejunum at the site of intestinal perforation. This is the first reported case of intestinal perforation caused by indistinguishable intestinal metastasis of angiosarcoma. This case emphasizes intestinal metastasis of angiosarcoma as a possible cause of small bowel perforation in patients with advanced angiosarcoma, even when no visible tumor is present during surgery. PMID:27156097

  8. Peritonitis caused by jejunal perforation with Taenia saginata: report of a case.

    PubMed

    Bekraki, Ali; Hanna, Khalil

    2016-03-01

    Complicated Taeniasis necessitating surgical intervention is extremely rare and is usually reported to occur in the distal ileal region of the Gastrointestinal tract. A case of peritonitis secondary to proximal jejunal perforation due to Taenia saginata is presented. Preoperative evaluation suggested the diagnosis of acute duodenal ulcer perforation. Although no real change in management and outcome is present, Taenia remains an exceptional direct cause of intestinal perforation, and should be kept on the list of differential diagnosis of peritonitis and acute abdomen in endemic geographical locations. PMID:27065626

  9. Glove perforation during plastic surgery.

    PubMed

    Cole, R P; Gault, D T

    1989-07-01

    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

  10. Late presentation of jejunal perforation after thoracic trauma.

    PubMed

    Kouritas, Vasileios K; Matheos, Efthimiou; Baloyiannis, Ioannis; Spyridakis, Michalis; Desimonas, Nikolaos; Hatzitheofilou, Kostas

    2009-11-01

    Jejunal perforation is extremely rare in trauma especially without initial involvement of the abdomen. We present the case of a delayed jejunal perforation after thoracic trauma with no initial indication of abdominal trauma in a 55-year-old man who was admitted to our department after a road traffic accident. The patient sustained thoracic trauma with rib fractures of the left hemithorax and hemopneumothorax and a mild head injury. On the fourth day of his in-hospital stay, he complained of severe abdominal pain and signs of acute abdomen were observed. He underwent emergency laparotomy where a perforation of the jejunum near the ligament of Treitz was noticed and sutured. His postoperative recovery was uneventful. Physicians treating trauma should always have a high degree of suspicion regarding rare abdominal injuries, with delayed presentation, even if no abdominal involvement is noticed during the initial survey. PMID:19931795

  11. Vibration of perforated cylindrical shells

    NASA Astrophysics Data System (ADS)

    Cousseau, Peter L.

    For a credible design of an inertial confinement fusion (ICF) target chamber, the vibration characteristics of the chamber must be completely understood. Target chambers are usually cylindrical or spherical in shape and contain hundreds of perforations (called ports) to allow access to the inside of the chamber. The fusion reaction within the chamber creates a uniform impulsive loading, which the chamber walls must be designed to contain. Also prior to an implosion, a delicate alignment process of the drivers and diagnostics takes place. The vibration of the chamber from rotating machinery, e.g., vacuum pumps, and ambient sources must be completely understood and accounted for during these alignment procedures. This dissertation examines the vibration characteristics of perforated cylindrical shells. Because the target chambers' thickness-to-radius ratio is small, such chambers can be modeled as thin shells. Included in the text is a literature review of perforated plates and shells and examples of the use of perforated structures in constructed and proposed ICF target chambers. The natural frequencies and corresponding mode shapes of perforated and unperforated cylindrical shells are studied analytically, numerically (via finite elements) and experimentally. Conclusions and comparisons between the different solution methods are made for both the perforated and unperforated cases. In addition, the dynamic response of perforated cylindrical shells to an axisymmetric impulsive loading has been identified. A demonstration showing how the convolution integral can be used to determine the response of a cylinder to a non-impulsive loading is presented.

  12. Method and apparatus for borehole perforating

    SciTech Connect

    Bullard, G.D.

    1980-01-29

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

  13. A case of colon perforation due to enteropathy-associated T-cell lymphoma

    PubMed Central

    Kim, Jun Bong; Kim, Seong Hwan; Cho, Young Kwan; Ahn, Sang Bong; Jo, Yun Ju; Park, Young Sook; Lee, Ji Hyun; Kim, Dong Hee; Lee, Hojung; Jung, Yun Young

    2013-01-01

    Enteropathy-associated T-cell lymphoma (EATL) is an extremely rare disease, which is often related to gluten-sensitive enteropathy. It is an uncommon intestinal lymphoma with very poor prognosis and high mortality rate. In the absence of specific symptoms or radiological findings, it is difficult to diagnose early. Major complications of EATL have been known as intestinal perforation or obstruction, and only 5 cases of EATL are reported in South Korea. In this study, we report a case of 71-year-old male with symptoms of diarrhea, which later it progressed into cancer perforation of the colon. The initial colonoscopic findings were normal and computed tomography scan demonstrated a segmental wall thickening of the distal ascending colon with nonspecific multiple small lymphnodes, along the ileocolic vessels, but no signs of mass or obstruction. The histologic findings of resected specimen confirmed EATL type II. Patient expired two weeks after the operation. Therefore, we emphasize the need of random biopsy in the presence of normal mucosa appearance on colonoscopy for the early diagnosis of EATL. PMID:23555174

  14. Rare cause of oesophagus perforation

    PubMed Central

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

    2014-01-01

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

  15. A novel colonoscope with panoramic visualization detected more simulated polyps than conventional colonoscopy in a live swine model

    PubMed Central

    Gluck, Nathan; Fishman, Sigal; Melhem, Alaa; Goldfarb, Sharon; Halpern, Zamir; Santo, Erwin

    2015-01-01

    Background and study aims: The Aer-O-Scope™ Colonoscope System (AOS) combines panoramic 360° view with standard forward view. We assessed the AOS’s ability to identify lesions implanted in live swine, compared to conventional colonoscopy (CC). Patients and methods: Twelve swine colons were surgically ligated and beads sewn within. Five procedures (3 AOS and 2 CC) were performed on each swine and findings reported. Physicians were blinded to number, size, and color of beads. The sequence of procedures and physicians was randomized. Pigs, physicians, and colonoscopes were randomly alternated between examination rooms, maintaining physician blindness. Two independent blinded physicians interpreted procedure videos offline. Results: A total of 259 /273 (94.9 %) of lesions were visualized by AOS compared to 158 /182 with CC (86.8 %) (P = 0.002). Miss rates of lesions ≥ 6 mm were 2.6 % and 10.5 %, respectively (P = 0.022), and 6.9 % and 15.1 %, respectively, for lesions < 6 mm (P = 0.031). Mean agreement between AOS and CC for lesion detection was 88.3 %. The benefit of AOS was maintained in offline video review. Conclusions: AOS, featuring panoramic 360° view, demonstrated high detection rates for simulated colonic lesions in a live swine model. PMID:26716128

  16. Perforated Duodenal Ulcer in High Risk Patients: Is Percutaneous Drainage Justified?

    PubMed Central

    Saber, Aly; Gad, Mohammad A; Ellabban, Gouda M

    2012-01-01

    Background: Conservative treatment was recommended as the treatment of choice in perforated acute peptic ulcer. Here, we adjunct percutaneous peritoneal drainage with nonoperative conservative treatment in high risk elderly patients with perforated duodenal ulcer. Aim: The work was to study the efficacy of percutaneous peritoneal drainage under local anesthesia supported by conservative measures in high risk elderly patients, according to the American Society of Anesthesiologists grading, with perforated duodenal ulcer. Patients and Methods: Twenty four high risk patients with age >65 years having associated medical illness with evidence of perforated duodenal ulcer. Results: The overall morbidity and mortality were comparable with those treated by conservative measures alone. Conclusion: In high risk patients with perforated peptic ulcer and established peritonitis, percutaneous peritoneal drainage under local anesthesia seems to be effective with least operative trauma and mortality rate. PMID:22393546

  17. Necrotizing fasciitis caused by perforated appendicitis: a case report

    PubMed Central

    Hua, Jie; Yao, Le; He, Zhi-Gang; Xu, Bin; Song, Zhen-Shun

    2015-01-01

    Acute appendicitis is one of the most common causes of acute abdominal pain. Accurate diagnosis is often hindered due to various presentations that differ from the typical signs of appendicitis, especially the position of the appendix. A delay in diagnosis or treatment may result in increased risks of complications, such as perforation, which is associated with increased morbidity and mortality rates. Necrotizing fasciitis caused by perforated appendicitis is extremely rare. We herein report a case of 50-year-old man presenting with an appendiceal abscess in local hospital. After ten days of conservative treatment with intravenous antibiotics, the patient complained about pain and swelling of the right lower limb and computed tomography (CT) demonstrated a perforated appendix and gas and fluid collection extending from his retroperitoneal cavity to the subcutaneous layer of his right loin and right lower limb. He was transferred to our hospital and was diagnosed with necrotizing fasciitis caused by perforated appendicitis. Emergency surgery including surgical debridement and appendectomy was performed. However, the patient died of severe sepsis and multiple organ failure two days after the operation. This case represents an unusual complication of a common disease and we should bear in mind that retroperitoneal inflammation and/or abscesses may cause necrotizing fasciitis through lumbar triangles. PMID:26045863

  18. Necrotizing fasciitis caused by perforated appendicitis: a case report.

    PubMed

    Hua, Jie; Yao, Le; He, Zhi-Gang; Xu, Bin; Song, Zhen-Shun

    2015-01-01

    Acute appendicitis is one of the most common causes of acute abdominal pain. Accurate diagnosis is often hindered due to various presentations that differ from the typical signs of appendicitis, especially the position of the appendix. A delay in diagnosis or treatment may result in increased risks of complications, such as perforation, which is associated with increased morbidity and mortality rates. Necrotizing fasciitis caused by perforated appendicitis is extremely rare. We herein report a case of 50-year-old man presenting with an appendiceal abscess in local hospital. After ten days of conservative treatment with intravenous antibiotics, the patient complained about pain and swelling of the right lower limb and computed tomography (CT) demonstrated a perforated appendix and gas and fluid collection extending from his retroperitoneal cavity to the subcutaneous layer of his right loin and right lower limb. He was transferred to our hospital and was diagnosed with necrotizing fasciitis caused by perforated appendicitis. Emergency surgery including surgical debridement and appendectomy was performed. However, the patient died of severe sepsis and multiple organ failure two days after the operation. This case represents an unusual complication of a common disease and we should bear in mind that retroperitoneal inflammation and/or abscesses may cause necrotizing fasciitis through lumbar triangles. PMID:26045863

  19. Gastrointestinal perforation: relation to corticosteroid use and COPD - a case report.

    PubMed

    Nguyen, Michael H K; Isaac, Krista M; Dougherty, Rebecca

    2016-01-01

    Gastrointestinal perforations are a complication of 2-10% of duodenal ulcers. There are a variety of etiologies associated with duodenal ulcer formation and its complications. Corticosteroid use is associated with an increased risk of duodenal ulcer perforation, with the first documented case in 1950. Other important medications associated with perforation include NSAIDS and opioids. Beyond medication, one of the most common disease processes, chronic obstructive pulmonary disease (COPD), has been found to be associated with peptic ulcer disease. Up to 30% of COPD patients have been found to have peptic ulcers, and COPD frequency in peptic ulcer disease is 2-3 times the general population. We herein present a case of an acute duodenal ulcer perforation in a patient receiving corticosteroid treatment for an acute COPD exacerbation. PMID:27609727

  20. Stercoral Perforation of the Colon during Pregnancy: A Case Report and Review of the Literature

    PubMed Central

    Costales, Anthony B.; Agarwal, Amit K.; Chauhan, Suneet P.; Refuerzo, Jerrie S.; Taub, Ethan A.

    2015-01-01

    Stercoral perforation of the colon, though rare, is associated with high mortality. Review of the literature identified only three prior cases reported during pregnancy. We report a case on a multiparous female presenting at 31 weeks of gestation with acute abdominal pain. Computed tomography suggested a sigmoid colon perforation. An urgent exploratory laparotomy was performed where feculent peritonitis and a stercoral perforation of the sigmoid colon was confirmed. A cesarean delivery and sigmoid colectomy with descending end colostomy was performed. While the newborn had an uncomplicated course, the mother developed an intra-abdominal abscess requiring operative management. PMID:26199793

  1. Colonic perforation in Behçet’s syndrome

    PubMed Central

    Dowling, Catherine M; Hill, Arnold DK; Malone, Carmel; Sheehan, John J; Tormey, Shona; Sheahan, Kieran; McDermott, Enda; O’Higgins, Niall J

    2008-01-01

    A 17-year-old gentleman was admitted to our hospital for headache, the differential diagnosis of which included Behçet’s syndrome (BS). He developed an acute abdomen and was found to have air under the diaphragm on erect chest X-ray. Subsequent laparotomy revealed multiple perforations throughout the colon. This report describes an unusual complication of Behcets syndrome occurring at the time of presentation and a review of the current literature of reported cases. PMID:19030217

  2. Tension pneumothorax due to perforated colon.

    PubMed

    Abdullah, Muhammad; Stonelake, Paul

    2016-01-01

    A very rare case of traumatic diaphragmatic hernia is reported in a 65-year-old woman who presented 46 years after her initial thoracoabdominal injury with tension faecopneumothorax caused by a perforated colon in the chest cavity. She presented in a critical condition with severe respiratory distress, sepsis and acute kidney injury. She had a long-standing history of bronchial asthma with respiratory complications and had experienced progressive shortness of breath for the past year. A recent CT scan had excluded the presence of a diaphragmatic hernia but showed a significantly raised left hemidiaphragm. On admission, chest X-rays showed a significantly raised left hemidiaphragm and mediastinal shift, but the possibility of a diaphragmatic hernia with strangulated bowel in the chest was not suspected until the patient was reviewed by the surgical and intensive care unit consultants the next morning and a repeat CT performed. She had a successful outcome after her emergency operation. PMID:27247208

  3. Laparoscopic treatment of perforated appendicitis

    PubMed Central

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

    2014-01-01

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

  4. Low Level Engraftment and Improvement following a Single Colonoscopic Administration of Fecal Microbiota to Patients with Ulcerative Colitis

    PubMed Central

    Damman, Christopher J.; Brittnacher, Mitchell J.; Westerhoff, Maria; Hayden, Hillary S.; Radey, Matthew; Hager, Kyle R.; Marquis, Sara R.; Miller, Samuel I.; Zisman, Timothy L.

    2015-01-01

    Objective Fecal microbiota transplantation (FMT) is an investigational treatment for diseases thought to involve alterations in the intestinal microbiota including ulcerative colitis (UC). Case reports have described therapeutic benefit of FMT in patients with UC, possibly due to changes in the microbiota. We measured the degree to which the transplanted microbiota engraft following FMT in patients with UC using a donor similarity index (DSI). Methods Seven patients with mild to moderate UC (UC disease activity index scores 3–10) received a single colonoscopic administration of FMT. Metagenomic sequence data from stool were analyzed using an alignment-free comparison tool, to measure the DSI, and a phylogenetic analysis tool, to characterize taxonomic changes. Clinical, endoscopic, histologic, and fecal calprotectin outcome measures were also collected. Results One of 5 patients from whom sequencing data were available achieved the primary endpoint of 50% donor similarity at week 4; an additional 2 patients achieved 40% donor similarity. One patient with 40% donor similarity achieved clinical and histologic remission 1 month after FMT. However, these were lost by 2−3 months, and loss correlated with a decrease in DSI. The remaining patients did not demonstrate clinical response or remission. Histology scores improved in all but 1 patient. No patients remained in remission at 3 months after FMT. Conclusions Following a single colonoscopic fecal transplant, a DSI of 40-50% is achieved in about two-thirds of recipients. This level of engraftment correlated with a temporary clinical improvement in only 1/5 patients. Larger sample sizes could further validate this method for measuring engraftment, and changes in transplant frequency or method might improve microbiota engraftment and efficacy. Trial Registration ClinicalTrials.gov NCT01742754 PMID:26288277

  5. Triple gastric peptic ulcer perforation.

    PubMed

    Radojkovic, Milan; Mihajlovic, Suncica; Stojanovic, Miroslav; Stanojevic, Goran; Damnjanovic, Zoran

    2016-03-01

    Patients with advanced or metastatic cancer have compromised nutritional, metabolic, and immune conditions. Nevertheless, little is known about gastroduodenal perforation in cancer patients. Described in the present report is the case of a 41-year old woman with stage IV recurrent laryngeal cancer, who used homeopathic anticancer therapy and who had triple peptic ulcer perforation (PUP) that required surgical repair. Triple gastric PUP is a rare complication. Self-administration of homeopathic anticancer medication should be strongly discouraged when evidence-based data regarding efficacy and toxicity is lacking. PMID:27193988

  6. Glove Perforations During Interventional Radiological Procedures

    SciTech Connect

    Leena, R. V. Shyamkumar, N. K.

    2010-04-15

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

  7. Subfascial endoscopic perforator surgery: a review.

    PubMed

    Anwar, S; Shrivastava, V; Welch, M; al-Khaffaf, H

    2003-08-01

    Approximately 1-2% of the UK population suffers from venous ulcers. Incompetent perforator leg veins are thought to be a major contributory factor. Subfascial endoscopic perforator surgery treats incompetent perforators in a minimally invasive fashion with significant improvement in wound healing and reduction in ulcer recurrence rates. PMID:12958760

  8. Deep circumflex iliac perforator flap.

    PubMed

    Kimata, Yoshihiro

    2003-07-01

    The increased freedom of the DCIP flap from the harvested iliac crest facilitates correct positioning. To ensure that the DCIP flap can be safely elevated, however, the presence of perforators (approximately 1 cm in diameter) must be confirmed preoperatively and intraoperatively. PMID:12916597

  9. Asymptomatic Tuberculosis-Induced Ileal Perforation in an HIV- Infected Individual; A Case Report

    PubMed Central

    Tahmasebi, Sedigheh; Moslemi, Sam; Tahamtan, Maryam; Taheri, Lohrasb; Davarpanah, Mohammad Ali

    2013-01-01

    The co-existence of acquired immune deficiency syndrome (AIDS) and tuberculosis is a major cause of morbidity and mortality because of a widespread organ involvement. The gastrointestinal tract is a common site for localization of opportunistic microorganisms in AIDS. However, surgical abdominal emergencies such as intestinal perforation resulted from tuberculosis are uncommon in these patients. The asymptomatic occurrence of such intestinal perforation has not been reported our knowledge. We represent an HIV and HCV co-infected man with miliary tuberculosis and an incidentally detected free air under  diaphragm in the chest X-ray eventually resulting in exploratory laparotomy which then revealed two tubercular-induced intestinal perforations. It seems that as the tuberculosis is increasing in incidence, mostly due to reactivation in HIV-infected patients especially in developing countries, we should not underestimate its acute abdominal emergencies such as bowel perforation. PMID:27162854

  10. Perforation peritonitis and the developing world.

    PubMed

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

    2014-01-01

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

  11. A Review on Perforation Repair Materials

    PubMed Central

    Veeramachaneni, Chandrasekhar; Majeti, Chandrakanth; Tummala, Muralidhar; Khiyani, Laxmi

    2015-01-01

    Perforation is an artificial communication between the root canal system and supporting tissues of the teeth. Root perforation complicates the treatment and deprives the prognosis if not properly managed. A wide variety of materials to seal the perforations have been suggested in literature. There are many comparative studies showing the efficacy of one material over the other. Literature shows many reviews on diagnosis, treatment plan and factors affecting prognosis of perforation repair; but none of these articles elaborated upon various materials available to seal the perforation. The present article aims at describing all the materials used for perforation repair from the past till date; it also offers a literature review of all the articles published over last four decades referred to the treatment of perforation with various root repair materials. PMID:26501031

  12. Spontaneous Biliary Perforations: An Uncommon yet Important Entity in Children

    PubMed Central

    Goel, Prabudh; Jain, Vishesh; Manchanda, Vivek; Sengar, Mamta; Gupta, Chhabi Ranu; Mohta, Anup

    2013-01-01

    Spontaneous or idiopathic biliary perforations are an infrequently encountered but an important cause of surgical jaundice in paediatric patients and one of the most common causes of surgical jaundice in infancy. A pre-operative diagnosis with a clinical history and physical findings may not be possible in most of the cases. The exact cause of the perforation remains unclear and the diagnosis is made at the time of laparotomy for an acute abdomen. An early, efficient and an effective surgical management is associated with a good prognosis; however, a delay in the correct diagnosis or an inappropriate management may result in bacterial contamination of the biliary ascites, with an unfavourable outcome. The relative rarity of this condition is reflected by the very few case reports, limited case studies and scarcity of published literature. PMID:23905142

  13. Superficial ulnar artery perforator flap.

    PubMed

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

    2014-09-01

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

  14. Perforated double appendicitis: Horseshoe type.

    PubMed

    Bulut, Serap Pamak; Cabıoğlu, Neslihan; Akıncı, Muzaffer

    2016-01-01

    Appendix vermiformis duplex is an infrequent malformation. However if it is missed out, there might be some complications and medicolegal troubles. A surgeon must be aware of any other appendix during appendectomy. Therefore, the possible locations and shapes described in the Cave-Wallbridge classification should be considered by the surgeon. In this case report, we present a patient with a horseshoe-type dupplication of appendix in a perforated appendicitis diagnosed during an emergency laparotomy. PMID:27436939

  15. Perforated double appendicitis: Horseshoe type

    PubMed Central

    Bulut, Serap Pamak; Cabıoğlu, Neslihan; Akıncı, Muzaffer

    2016-01-01

    Appendix vermiformis duplex is an infrequent malformation. However if it is missed out, there might be some complications and medicolegal troubles. A surgeon must be aware of any other appendix during appendectomy. Therefore, the possible locations and shapes described in the Cave-Wallbridge classification should be considered by the surgeon. In this case report, we present a patient with a horseshoe-type dupplication of appendix in a perforated appendicitis diagnosed during an emergency laparotomy. PMID:27436939

  16. Combining rhinoplasty with septal perforation repair.

    PubMed

    Foda, Hossam M T; Magdy, Emad A

    2006-11-01

    A combined septal perforation repair and rhinoplasty was performed in 80 patients presenting with septal perforations (size 1 to 5 cm) and external nasal deformities. The external rhinoplasty approach was used for all cases and the perforation was repaired using bilateral intranasal mucosal advancement flaps with a connective tissue interposition graft in between. Complete closure of the perforation was achieved in 90% of perforations of size up to 3.5 cm and in only 70% of perforations that were larger than 3.5 cm. Cosmetically, 95% were very satisfied with their aesthetic result. The external rhinoplasty approach proved to be very helpful in the process of septal perforation repair especially in large and posteriorly located perforations and in cases where the caudal septal cartilage was previously resected. Our results show that septal perforation repair can be safely combined with rhinoplasty and that some of the routine rhinoplasty maneuvers, such as medial osteotomies and dorsal lowering, could even facilitate the process of septal perforation repair. PMID:17131270

  17. Subterranean well casing perforating gun

    SciTech Connect

    Stout, G. W.; Nelson, J. A.

    1984-10-30

    The invention provides a subterranean well casing perforating gun device which employs shaped explosive charges to perforate the well casing. The device generally defines an outer tubular housing assembly concentrically insertable in the well and defining a vertical axis, cylindrical chamber. A tubular carrier of polygonal cross sectional configuration is insertable in the chamber in concentric relationship to the cylindrical wall of the cylindrical chamber. Each of the faces of the carrier have a plurality of spaced passages therethrough, each passage having a configuration substantially corresponding to the configuration of the polygonal face. A shaped charge container has its cylindrical body insertable in any selected one of the passages and a radial flange on the outer end for abutting the polygonal face portion adjacent the respective passage, thereby limiting the insertion of each of the containers into the selected passage. Selectively disengageable fastening means are operable from the exterior of the carrier for clamping the radial flange against the respective polygonal face and for selective disengagement therefrom from the exterior of the carrier. The invention also contemplates a method of utilization of the carrier and the gun, as well as to incorporation of same into a particular perforating and gravel packing method and apparatus.

  18. Totally Laparoscopic Repair of an Ileal and Uterine Iatrogenic Perforation Secondary to Endometrial Curettage

    PubMed Central

    Vecchio, Rosario; Marchese, Salvatore; Leanza, Vito; Leanza, Antonio; Intagliata, Eva

    2015-01-01

    Small bowel perforation is a unique, serious complication during endometrial biopsy. The authors report a case of a double uterine-ileal perforation totally managed by primary laparoscopic repair. A 63-year-old female was admitted with acute abdomen 2 days after an endometrial curettage. Abdominal X-ray shows signs of pneumoperitoneum. Emergency diagnostic laparoscopy was performed and a uterine-ileal perforation was identified. Repair was accomplished by a totally laparoscopic intracorporeally suturing of the 2 breaches. Postoperative course showed only a delayed ileus and the patient was discharged after 5 days with no complications. When acute abdomen arises following uterine biopsy, a potential iatrogenic intestinal laceration always has to be ruled out. Laparoscopic approach is a quick and safe technique in these cases. Totally laparoscopic primary closure of the iatrogenic ileal laceration may be accomplished with low morbidity. PMID:25692425

  19. Free thin paraumbilical perforator-based flaps.

    PubMed

    Koshima, I; Moriguchi, T; Soeda, S; Tanaka, H; Umeda, N

    1992-07-01

    A free paraumbilical perforator-based flap fed by a muscle perforator from the inferior deep epigastric artery and with no muscle was used in 13 patients. Among them, a free thin paraumbilical perforator-based flap with a thin layer of fat, to protect the subdermal plexus of the vessels, was used in seven patients. The dominant pedicle perforator of this thin flap is usually located around the umbilicus and a large flap can be obtained. Its critical length-to-breath ratio is considered to be 4:3. The advantages of this flap are a long and large vascular pedicle, rare postoperative abdominal herniation, little bulkiness of the flap, and a relatively large skin territory. The disadvantages are technical difficulties in dissection of the perforator and anatomical variation in the location of the perforator. We believe this flap largely overcomes the problems of the conventional rectus abdominis musculocutaneous flap. PMID:1386718

  20. Nonsteroidal anti-inflammatory drug-induced duodenal ulceration and perforation in a mature rottweiler

    PubMed Central

    Reed, Suma

    2002-01-01

    A mature male rottweiler was evaluated for acute collapse and abdominal pain. The history consisted of concurrent administration of meloxicam and aspirin. On exploratory laparotomy, a large perforated ulcer was discovered in the proximal duodenum, with secondary peritonitis. The pathogenesis of NSAID-induced gastrointestinal ulceration and the supposed safety of COX-2 selective agents are discussed. PMID:12561693

  1. Pneumatosis cystoidis intestinalis presenting as bowel perforation, a rare entity

    PubMed Central

    Hanna, Philippe; Kassir, Radwan; Tarek, Debs; Bassile, Bashir; Saint-Eve, Patrick; Elias, Bachir

    2016-01-01

    Introduction Pneumatosis cystoides intestinalis (PCI) is an uncommon condition. This following article describes a case of primary PCI presenting as acute abdomen due to perforation of a small bowel cyst. Presentation of case This following article describes the case of an 88 year-old woman admitted at the hospital with peritonitis and consequently operated for a presumed bowel ischemia and perforation. However surgical exploration revealed perforated PCI. Discussion The pathophysiology of secondary PCI is poorly understood. Gas produced by Gas-forming bacteria may enter the mucosal barrier due and consequently this gas accumulates within the bowel wall. Also malnutrition can prevent the digestion of carbohydrates, which leads to increased bacterial fermentation, and production of large volumes of gas leading to distention and ischemia and subsequently the submucosal dissection of gas. Colonoscopy is helpful in excluding other colonic lesions and it shows the submucosal cysts that have a typical dual appearance: multiple white small cysts coupled to a sub-atrophic mucosa or larger cysts (up to 3 cm) with a reddened overlying mucosa. Conclusion The treatment unless complicated should be conservative even in the presence of pneumoperitoneum, after excluding complications. PMID:26774416

  2. Endoscopic management of gastrointestinal perforations, leaks and fistulas

    PubMed Central

    Rogalski, Pawel; Daniluk, Jaroslaw; Baniukiewicz, Andrzej; Wroblewski, Eugeniusz; Dabrowski, Andrzej

    2015-01-01

    Gastrointestinal perforations, leaks and fistulas may be serious and life-threatening. The increasing number of endoscopic procedures with a high risk of perforation and the increasing incidence of leakage associated with bariatric operations call for a minimally invasive treatment for these complications. The therapeutic approach can vary greatly depending on the size, location, and timing of gastrointestinal wall defect recognition. Some asymptomatic patients can be treated conservatively, while patients with septic symptoms or cardio-pulmonary insufficiency may require intensive care and urgent surgical treatment. However, most gastrointestinal wall defects can be satisfactorily treated by endoscopy. Although the initial endoscopic closure rates of chronic fistulas is very high, the long-term results of these treatments remain a clinical problem. The efficacy of endoscopic therapy depends on several factors and the best mode of treatment will depend on a precise localization of the site, the extent of the leak and the endoscopic appearance of the lesion. Many endoscopic tools for effective closure of gastrointestinal wall defects are currently available. In this review, we summarized the basic principles of the management of acute iatrogenic perforations, as well as of postoperative leaks and chronic fistulas of the gastrointestinal tract. We also described the effectiveness of various endoscopic methods based on current research and our experience. PMID:26457014

  3. [Perforation of the appendix and observation of Enterobius vermicularis].

    PubMed

    Schou-Jensen, Katrine; Antipina, Elena Nikolaevna; Brisling, Steffen Kirstein; Azawi, Nessn

    2014-12-15

    A nine-year-old girl was admitted to the paediatric ward due to fever and lower abdomen pain through a day. Acute laparoscopic exploration showed a large necrotic perforation at the distal end of the appendix. During the appendectomy multiple small, live Enterobius vermicularis (pinworms) were observed. The patient was admitted for three days of observation and received relevant treatment with intravenous antibiotics and antihelminthic treatment. The histology showed numerous pinworms in the lumen of the appendix and invasion of the pinworms of the submucosal layer and the wall of the appendix. PMID:25534223

  4. [Surgical treatment of duodenal perforation].

    PubMed

    Csáky, G; Bezsilla, J; Sikorszki, L; Tóth, D

    2000-04-01

    Duodenal ulcer can be cured successfully by the eradication of Helicobacter pylori (H. p.) and administration of anti-acid secretory drugs, however, from among the complications of duodenal ulcer, perforation with unchanged incidence continues to need an urgent operation. The authors examined the case histories, results of preoperative examinations, data of operations, and postoperative events of 175 patients hospitalized for perforation of duodenal ulcer in the past five years. The average age of the 38 women was more than 20 years greater than that of the 137 men. The time between the appearance of the serious symptoms and the operation exceeds 24 hours in 31 patients. There was serious preoperative general condition (ASA IV. and V.) in 13.7% of the cases. In the last year infection with H. p. was proved with Pylori Screen II (Orion Diagnostica) serological examination in 22 patients. Closure of the perforation was made in open fashion in 155 (average operative time: 54.1 min.), laparoscopically in 7 (average operative time: 117.9 min.) and gastric resection was necessary in 12 patients (average operative time: 154.6 min.). In 20.4% of the survivors a complication was observed. All of the 18 non-survivors (10.3%) were operated on in poor condition and beyond recovery. Seven patients operated on laparoscopically experienced undisturbed recovery, and stayed in the hospital the shortest time (average: 5.4 days). In the authors opinion the preoperative knowledge of H. p. infection influences the method of the operation of choice, and they recommend the laparoscopic access in elected cases. PMID:11299619

  5. A field study of underbalance pressures necessary to obtain clean perforations using tubing-conveyed perforating

    SciTech Connect

    King, G.E.; Anderson, A.R.; Ringham, M.D.

    1986-06-01

    A study of 90 wells perforated with the tubing-conveyed perforating system showed a correlation between underbalanced pressure and formation permeability that can be used to achieve clean perforations. The data, from gas and oil producers in clean sandstones, are from wells that were perforated, tested, acidized, and retested. There is a clear minimum underbalance line separating the data sets of wells that had clean perforations (unassisted by acidizing) from those wells that showed a significant productivity increase after acidizing. The study includes data from oil and gas wells in the Gulf of Mexico, Lousiana (Tuscaloosa trend), New Mexico (Morrow sandstone), Rocky Mountain overthrust, and Alberta, Canada.

  6. Bowel perforation detection using metabolic fluorescent chlorophylls

    NASA Astrophysics Data System (ADS)

    Han, Jung Hyun; Jo, Young Goun; Kim, Jung Chul; Choi, Sujeong; Kang, Hoonsoo; Kim, Yong-Chul; Hwang, In-Wook

    2016-03-01

    Thus far, there have been tries of detection of disease using fluorescent materials. We introduce the chlorophyll derivatives from food plants, which have longer-wavelength emissions (at >650 nm) than those of fluorescence of tissues and organs, for detection of bowel perforation. To figure out the possibility of fluorescence spectroscopy as a monitoring sensor of bowel perforation, fluorescence from organs of rodent models, intestinal and peritoneal fluids of rodent models and human were analyzed. In IVIS fluorescence image of rodent abdominal organ, visualization of perforated area only was possible when threshold of image is extremely finely controlled. Generally, both perforated area of bowel and normal bowel which filled with large amount of chlorophyll derivatives were visualized with fluorescence. The fluorescence from chlorophyll derivatives penetrated through the normal bowel wall makes difficult to distinguish perforation area from normal bowel with direct visualization of fluorescence. However, intestinal fluids containing chlorophyll derivatives from food contents can leak from perforation sites in situation of bowel perforation. It may show brighter and longer-wavelength regime emissions of chlorophyll derivatives than those of pure peritoneal fluid or bioorgans. Peritoneal fluid mixed with intestinal fluids show much brighter emissions in longer wavelength (at>650 nm) than those of pure peritoneal fluid. In addition, irrigation fluid, which is used for the cleansing of organ and peritoneal cavity, made of mixed intestinal and peritoneal fluid diluted with physiologic saline also can be monitored bowel perforation during surgery.

  7. High power laser perforating tools and systems

    DOEpatents

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

    2014-04-22

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

  8. Dimensional scaling for impact cratering and perforation

    NASA Technical Reports Server (NTRS)

    Watts, Alan; Atkinson, Dale; Rieco, Steve

    1993-01-01

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

  9. Coronary perforation: What color is your parachute?

    PubMed

    Seto, Arnold H; Kern, Morton J

    2015-09-01

    Coronary perforation is a rare but devastating complication of PCI, requiring rescue devices such as covered stents. This paper documents the successful use of a pericardial covered stent in 9/9 patients for coronary perforation. Pericardial covered stents have theoretical advantages over PTFE covered stents, but clinical studies proving this are not feasible. PMID:26276233

  10. Perforation from endoscopic small bowel biopsy.

    PubMed Central

    Scott, B; Holmes, G

    1993-01-01

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

  11. Extreme overbalance perforating improves well performance

    SciTech Connect

    Dees, J.M.; Handren, P.J.

    1994-01-01

    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.

  12. Idiopathic perforation of acalculous gallbladder after insertion of a transpapillary pancreatic stent

    PubMed Central

    Katagiri, Tomoko; Irisawa, Atsushi; Wakabayashi, Hiroto; Tsunoda, Takuya; Tomoda, Hiroyuki; Saito, Ryo; Kinuta, Shunji

    2016-01-01

    Background and study aims: Endoscopic retrograde pancreatocholangiography (ERCP) is associated with many types of adverse events (AEs) but idiopathic perforation of the gallbladder (IPGB) is very rare. Pancreatobiliary reflux is one of the factors involved with occurrence of IPGB 1. Here we present a case of acalculous gallbladder perforation as an AE following the insertion of an indwelling endoscopic nasal pancreatic drainage (ENPD) tube (a pancreatic stent) to obtain pancreatic fluid. In this case, acute pancreatobiliary reflux might have been caused by the insertion of the ENPD-tube. PMID:27540570

  13. Primary omental gangrene mimicking appendicular perforation peritonitis—A case report

    PubMed Central

    Kumar, A.; Shah, J.; Vaidya, P.

    2016-01-01

    Introduction Primary omental torsion is a rare cause of acute abdomen in adults and presents with variable signs and symptoms. Establishing a preoperative diagnosis may be difficult in the emergency setting. It is rarely diagnosed preoperatively as it mimics common surgical emergencies such as acute appendicitis, appendicular perforation, acute cholecystitis and perforated peptic ulcers and can lead to the clinical deterioration of patient if missed Presentation of case A 47 years old male was taken to the operating room with a diagnosis of appendicular perforation peritonitis and during surgery was found to have a primary omental gangrene with pyoperitoneum, for which omentectomy and peritoneal lavage was performed. Discussion Torsion of the omentum is a condition in which the organ twists on its long axis to such an extent that its vascularity is compromised. Omental torsion can be primary (idiopathic) or secondary, depending on an underlying cause. Primary omental torsion was first described by Eitel in 1899. However, very few cases have been reported. Our case was a rare case presenting with omental gangrene with pyoperitoneum mimicking appendicular perforation peritonitis. Conclusion Primary omental torsion is a rare diagnosis. A high index of clinical suspicion is required for a preoperative diagnosis. In doubtful cases a CT scan may be helpful. Surgical excision of the omentum remains the treatment of choice; however, conservative management may be attempted in an uncomplicated omental torsion. PMID:26945486

  14. Perforation of the Pregnant Uterus during Laparoscopy for Suspected Internal Herniation after Gastric Bypass

    PubMed Central

    Harsem, N. K.; Røstad, S.; Mathisen, L. C.; Jacobsen, A. F.

    2014-01-01

    We report perforations of a pregnant uterus during laparoscopy for suspected internal herniation after gastric bypass at 24 weeks of gestation. Abdominal access and gas insufflation were achieved by the use of a 12 mm optic trocar. An additional 5 mm trocar was positioned. The perforations were handled by suturing following laparotomy and mobilisation of the high located uterus. The uterine fundus was located in the subcostal area. Internal herniation was not verified. A cesarean section was made 6 weeks later due to acute low abdominal pain. During delivery the uterus was found normal. At 5 months of age the child has developed normal and seems healthy. Optical trocars should be used with caution for abdominal access during laparoscopy in pregnancy. Open access should probably be preferred in most cases. Accidental perforations of the uterine cavity may be handled in selected cases with simple closure even following the use of large trocars under close postoperative surveillance throughout the pregnancy. PMID:25548693

  15. Gastric trichobezoar associated with perforated peptic ulcer and Candida glabrata infection

    PubMed Central

    Morales, Héctor Losada; Catalán, Cecilia Huenchullán; Demetrio, Rodrigo Arriagada; Rivas, Macarena Espinoza; Parraguez, Natalia Castagnoli; Alvarez, Martín Alanis

    2014-01-01

    Bezoars are accumulations of human or plant fiber located in the gastrointestinal tract of both humans and animals. Patients remain asymptomatic for several years, and the symptoms develop as these accumulations increase in size to the point of obstruction or perforation. We report the case of a 21-year-old patient at 10 d postpartum, who presented with acute abdomen associated with sepsis. Given the urgency of the clinical picture, at no point was the presence of a giant bezoar at gastric level suspected, specifically a trichobezoar. The emergency abdominal and pelvic ultrasound revealed only unspecific signs of perforated hollow viscus. Diagnosis was therefore made intraoperatively. A complete gastric trichobezoar was found with gastric perforation and secondary peritonitis. The peritoneal fluid culture revealed Candida glabrata. PMID:25516871

  16. Mitral Valve Perforation in Libman-Sacks Endocarditis: A Heart-Wrenching Case of Lupus.

    PubMed

    Aby, Elizabeth S; Rosol, Zachary; Simegn, Mengistu A

    2016-08-01

    Libman-Sacks (LS) endocarditis is one of the most common cardiac manifestations of systemic lupus erythematosus. Rarely, however, it can lead to serious complications, including severe valvular regurgitation or superimposed bacterial endocarditis. We describe the initial diagnostic challenges, clinical course, imaging studies and histopathological findings of a patient who presented with life-threatening lupus complicated by hemoptysis and respiratory failure secondary to a rare complication of LS endocarditis, acute mitral valve perforation. We review the current literature on valve perforation in the setting of LS endocarditis. In conclusion, although the disease is often asymptomatic and hemodynamically insignificant, it can result in serious and potentially fatal complications secondary to valve perforation, which may demand emergency surgical management. PMID:26976291

  17. Spontaneous choledochal cyst perforation in pregnancy with co-existent chronic pancreatitis.

    PubMed

    Singh, Harjeet; Gupta, Rahul; Dhaliwal, Lakhbir; Singh, Rajinder

    2014-01-01

    Choledochal cysts are a congenital disorder of the bile duct, usually presenting in childhood. As they cause weakening of the wall of the bile duct, any distal obstruction, infection or reflux of amylase-rich fluid in the biliary tract can predispose to spontaneous perforation. A 25-year-old pregnant woman at 35 weeks of gestation presented with acute abdominal and fetal distress. On emergency laparotomy, common bile duct perforations were detected. T-tube drainage and caesarean section were performed. A t-tube cholangiogram revealed the diagnosis of a choledochal cyst with an abnormal pancreatobiliary junction and chronic pancreatitis. The patient later underwent cyst excision with Roux en Y hepaticojejunostomy. Spontaneous choledochal cyst perforation in pregnancy can be successfully managed by a two-stage operation. PMID:25398924

  18. Asymptomatic Cecal Perforation in a Renal Transplant Recipient After Sodium Polystyrene Sulfonate Administration.

    PubMed

    Singla, Montish; Shikha, Deep; Lee, Sunggeun; Baumstein, Donald; Chaudhari, Ashok; Carbajal, Roger

    2016-01-01

    Sodium polystyrene sulfonate (SPS) is a medication commonly used for the treatment of hyperkalemia. There have been many cases of colonic necrosis and perforation associated with administration of SPS. There are very few such cases reported in renal transplant patients. We present a case of renal transplant recipient who developed cecal perforation after a single oral dose of SPS. She had no signs or symptoms suggestive of intestinal perforation and was incidentally diagnosed with it on abdominal imaging performed to find cause of acute blood loss anemia. This case underlines the importance of recognizing this severe and potentially life-threatening complication associated with SPS. The clinicians should also consider renal/solid organ transplant and immunosuppression as potential risk factors. PMID:25415544

  19. Backsurging perforations can increase production rates

    SciTech Connect

    Brieger, E.F.

    1991-07-01

    Subjecting formations to a large pressure differential or underbalance is a common means of surging perforations to remove damage and increase flow from oil and gas wells. Underbalanced perforating, a standard industry completion technique, is normally used to obtain the pressure differentials intended to dislodge debris from perforations and flush the surrounding compacted zone. Gradually applied pressure underbalance can be achieved by swabbing or jetting to reduce hydrostatic head. Suddenly applied underbalance is achieved by evacuating the tubing in conjunction with a rupture disc, tubing-conveyed perforating systems or by using a new wireline-set, through-tubing backsurge tool. These techniques, except for the through-tubing method, are often utilized only during later workovers due to the expense and difficulty of achieving an adequate underbalance. Many operators prefer to perforate in balanced or overbalanced pressures conditions. This typically leaves perforations completely or partially plugged with gun debris, mud solids and shattered formation material that has been recompacted. Production logging shows that wells often produce from only 10 to 20% of the total interval apparently because of ineffective, plugged perforations.

  20. Wash tool for well having perforated casing

    SciTech Connect

    Burroughs, T.C.

    1989-03-28

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

  1. Perforator Flaps in Head and Neck Reconstruction

    PubMed Central

    Chana, Jagdeep S.; Odili, Joy

    2010-01-01

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

  2. [Perforations near the cardia in benign diseases].

    PubMed

    Schröder, W; Leers, J M; Bludau, M; Herbold, T; Hölscher, A H

    2014-12-01

    Esophageal perforations nearby the cardia are a clinical disorder of various causes. Perforations occur most often following diagnostic or interventional endoscopy but spontaneous perforations (Boerhaave syndrome) are less frequent. Due to the heterogeneous etiology there is a broad range of therapeutic options. In most cases the esophageal perforation site can be covered by an endoscopic stent. Recent endoscopic procedures are the intraluminal application of an endoscopic vacuum-assisted closure system (endo-VAC) or clipping of the esophageal defect. Surgical procedures include direct suturing with external coverage of the defect or transhiatal blunt dissection of the esophagus without primary reconstruction. All endoscopic and surgical procedures often require an additional drainage of the mediastinum and if necessary of the thoracic and abdominal cavities. The clinical presentation ranges from a simple perforation without concomitant esophageal pathology to a defect of considerable length with pleural perforation and associated septic multiple organ failure. The severity of the septic course is the crucial parameter for the choice of the procedure. An early multiple organ failure indicates an insufficient drainage of the septic focus and is indicative for surgical resection. The overall mortality is given as 12 % in the current literature and primarily depends on the localization and the etiology of the perforation. The highest mortality rates are observed with Boerhaave syndrome. The most important prognostic variable is the time interval between perforation and initiation of therapy whereby the mortality rises up to 20 % if the interval exceeds 24 h. Due to the complex therapy and the poor prognosis esophageal perforations should be treated in specialized centers. PMID:25488114

  3. Esophagectomy in esophageal perforations: an analysis.

    PubMed

    Abu-Daff, S; Shamji, F; Ivanovic, J; Villeneuve, P J; Gilbert, S; Maziak, D E; Sundaresan, R S; Seely, A J E

    2016-01-01

    This study aimed to study the factors that are associated with urgent esophagectomy for the treatment of esophageal perforations and the impact of this therapy. A retrospective review of all esophageal perforations treated at a tertiary care hospital from January 1984 to January 2012 was performed. Compiling demographics, cause and site of perforations, time to presentation, comorbidities, radiological tests, the length of perforation, the hemodynamic status of the patient, type of treatment required, and outcomes were performed. Univariate, multivariate, and Cox regression analyses were conducted. Of 127 cases of esophageal perforation, it was spontaneous in 44 (35%), iatrogenic in 53 (44%), foreign body ingestion in 22 (17%), and traumatic perforation in 7 (6%) cases. Overall, 85 of the 127 (67%) patients were managed operatively, 35 (27.6%) patients were treated conservatively, and 7 (6.3%) patients were treated by endoscopic stent placement. Of the 85 patients who were managed operatively, 21 (16.5%) required esophagectomies, 13 (15.3%) had esophagectomy with immediate reconstruction, 5 (5.9%) patients had esophagectomy followed by delayed reconstruction, and 3 (3.5%) patients failed primary repair and required an esophagectomy as a secondary definitive procedure. Multivariate analysis revealed that esophagectomy in esophageal perforations was associated with the presence of benign or malignant esophageal stricture (P = 0.001) and a perforation >5 cm (P = 0.001). Mortality was mainly associated with the presence of a benign or malignant esophageal stricture (P = 0.04). The presence of pre-existing benign or malignant stricture or large perforation (>5 cm) is associated with the need for an urgent esophagectomy with or without immediate reconstruction. Performing esophagectomy was not found to be a significant prognosticator for mortality. PMID:25327568

  4. Lifesaving Embolization of Coronary Artery Perforation

    SciTech Connect

    Katsanos, Konstantinos; Patel, Sundip; Dourado, Renato; Sabharwal, Tarun

    2009-09-15

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

  5. Regeneration of Chronic Tympanic Membrane Perforation Using an EGF-Releasing Chitosan Patch

    PubMed Central

    Seonwoo, Hoon; Kim, Seung Won; Kim, Jangho; Chunjie, Tian; Lim, Ki Taek; Kim, Yeon Ju; Pandey, Shambhavi; Choung, Pill-Hoon

    2013-01-01

    Most chronic tympanic membrane (TM) perforations require surgical interventions such as tympanoplasty because, unlike with acute perforations, it is very difficult for the perforations to heal spontaneously. The purpose of this study was to develop novel therapeutic techniques and scaffolds that release growth factors to treat chronic TM perforations. We evaluated the cell proliferation effects of the epidermal growth factor (EGF) and fibroblast growth factor (FGF) on in vitro cultures of TM cells using an MTT assay. They both showed similar efficacy, so we used EGF because of its lower cost. We then constructed an EGF-releasing chitosan patch scaffold (EGF-CPS) based on previous studies. We analyzed its toxicity and strength, and we studied it using scanning electron microscopy. EGF was released from the EGF-CPS for 8 weeks in an in vitro system. In animal studies, the EGF group, which was treated with EGF-CPS, showed healing in 56.5% of the animals (13/23), while the control group, which did not receive any treatment, revealed 20.8% healing (4/24) (p=0.04). Transmission electron microscopic studies of regenerated eardrums in the EGF group showed much greater preservation of histological features, and TMs of the EGF group were thinner than spontaneously healed TMs. In conclusion, this novel EGF-CPS can be used as a nonsurgical intervention technique for treatment of chronic TM perforations. PMID:23627815

  6. A case of diffuse infiltrating gastrointestinal stromal tumor of sigmoid colon with perforation.

    PubMed

    Yamashita, Daisuke; Usami, Yu; Toyosawa, Satoru; Hirota, Seiichi; Imai, Yukihiro

    2014-01-01

    Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal neoplasms of the gastrointestinal tract, and typically present as discrete well-circumscribed but non-encapsulated tumor masses. In this report, we describe a case of colonic perforation caused by an unusual form of GIST. A 72-year-old Japanese woman presented to the emergency department with acute abdominal pain. Under the provisional diagnosis of sigmoid colon perforation, a laparoscopic sigmoidectomy was performed. Although the tumor mass was undetectable during the preoperative examination, a spindle cell lesion with a diffuse longitudinal growth pattern replacing the muscularis propria was revealed by microscopic examination. The spindle cell lesion was exposed at the perforation, suggesting a causal relationship between the lesion and the perforation. The spindle cell lesion was KIT-positive and had a mutation in the C-KIT gene at exon 11. We diagnosed it as diffuse infiltrating GIST. We consider that the lesion would be a cause of the colonic perforation, and emphasize the importance of accurate diagnosis of the lesion by histological, immunohistochemical and genetic examinations. PMID:24471968

  7. Comparison of the efficacy of disinfectants in automated endoscope reprocessors for colonoscopes: tertiary amine compound (Sencron2®) versus ortho-phthalaldehyde (Cidex®OPA)

    PubMed Central

    Seo, Hyun Il; Lee, Dae Sung; Yoon, Eun Mi; Kwon, Min-Jung; Park, Hyosoon; Jung, Yoon Suk; Park, Jung Ho; Sohn, Chong Il

    2016-01-01

    Background/Aims To prevent the transmission of pathogens by endoscopes, following established reprocessing guidelines is critical. An ideal reprocessing step is simple, fast, and inexpensive. Here, we evaluated and compared the efficacy and safety of two disinfectants, a tertiary amine compound (TAC) and ortho-phthalaldehyde (OPA). Methods A total of 100 colonoscopes were randomly reprocessed using two same automated endoscope reprocessors, according to disinfectant. The exposure time was 10 minutes for 0.55% OPA (Cidex® OPA, Johnson & Johnson) and 5 minutes for 4% TAC (Sencron2®, Bab Gencel Pharma & Chemical Ind. Co.). Three culture samples were obtained from each colonoscope after reprocessing. Results A total of nine samples were positive among the 300 culture samples. The positive culture rate was not statistically different between the two groups (4% for OPA and 2% for TAC, P=0.501). There were no incidents related to safety during the study period. Conclusions TAC was non-inferior in terms of reprocessing efficacy to OPA and was safe to use. Therefore, TAC seems to be a good alternative disinfectant with a relatively short exposure time and is also less expensive than OPA. PMID:27175119

  8. Case Report: Rectal perforation during CT colonography

    PubMed Central

    Zukiwskyj, Marianna; Arafat, Yasser

    2016-01-01

    Introduction Computer tomography colonoscopy (CTC) is an increasingly prevalent procedure for the investigation of colorectal symptoms, or as a component of colorectal cancer screening.  It is considered a low risk procedure, however colonic perforation is a recognized significant complication. Case Report We report the case of an 81-year-old female patient who underwent CTC after failed optical colonoscopy as part of routine colorectal cancer screening.  Perforation of the rectum with surrounding pararectal air was confirmed on CTC.  The patient had minimal symptoms and was treated successful non-operatively with bowel rest and antibiotics. Conclusion Perforation sustained during CTC is an uncommon complication.  The incidence of perforation during CTC is still lower than that during optical colonoscopy.  In the absence of significant abdominal signs and symptoms, this rare complication may be successfully managed non-operatively. PMID:27019696

  9. Oesophageal perforation following perioperative transoesophageal echocardiography.

    PubMed

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

    2000-05-01

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

  10. The Perforated Intrauterine Device: Endoscopic Retrieval

    PubMed Central

    Heinberg, Eric M.; McCoy, Travis W.

    2008-01-01

    Background: Uterine perforation is the most serious complication associated with an intrauterine contraceptive device (IUD). Minimally invasive techniques, such as hysteroscopy and advanced laparoscopy, are ideally suited to the diagnosis and surgical management of the perforated IUD. Case Reports: Three cases of uterine perforation caused by an IUD and treated with endoscopic surgery are presented. In all 3 cases, the IUD was located by using x-rays, ultrasonography, or pelvic magnetic resonance imaging. Diagnostic laparoscopy was performed to identify the specific location of the IUD and to remove it. All patients recovered without incident. Conclusion: The gynecologic surgeon should acquire familiarity with the complications of, and proficiency in managing, perforated and ectopic IUDs by using modern surgical techniques that permit the patient's rapid return to health. PMID:18402749

  11. Perforated appendicitis caused by foreign body ingestion.

    PubMed

    Baek, Seong Kyu; Bae, Ok Suk; Hwang, Ilseon

    2012-04-01

    Most ingested foreign bodies pass through the gastrointestinal tract without any incident. However, foreign bodies lodged in the appendix can cause an inflammatory reaction with or without perforation. Here, we present a case of a 54-year-old woman with perforated appendicitis who consumed wild game containing a shot pellet. Five months before admission, she had eaten the meat of a pheasant that had been shot with a shotgun. Abdominal computed tomography confirmed the diagnosis of perforated appendicitis with abscess due to a foreign body. Subsequently, a laparoscopic appendectomy was performed. Follow-up radiographs obtained after the surgery did not identify the foreign body. Histolopathologic examination confirmed appendiceal perforation with focal inflammation secondary to a foreign body. PMID:22487649

  12. Acute chylous peritonitis due to acute pancreatitis.

    PubMed

    Georgiou, Georgios K; Harissis, Haralampos; Mitsis, Michalis; Batsis, Haralampos; Fatouros, Michalis

    2012-04-28

    We report a case of acute chylous ascites formation presenting as peritonitis (acute chylous peritonitis) in a patient suffering from acute pancreatitis due to hypertriglyceridemia and alcohol abuse. The development of chylous ascites is usually a chronic process mostly involving malignancy, trauma or surgery, and symptoms arise as a result of progressive abdominal distention. However, when accumulation of "chyle" occurs rapidly, the patient may present with signs of peritonitis. Preoperative diagnosis is difficult since the clinical picture usually suggests hollow organ perforation, appendicitis or visceral ischemia. Less than 100 cases of acute chylous peritonitis have been reported. Pancreatitis is a rare cause of chyloperitoneum and in almost all of the cases chylous ascites is discovered some days (or even weeks) after the onset of symptoms of pancreatitis. This is the second case in the literature where the patient presented with acute chylous peritonitis due to acute pancreatitis, and the presence of chyle within the abdominal cavity was discovered simultaneously with the establishment of the diagnosis of pancreatitis. The patient underwent an exploratory laparotomy for suspected perforated duodenal ulcer, since, due to hypertriglyceridemia, serum amylase values appeared within the normal range. Moreover, abdominal computed tomography imaging was not diagnostic for pancreatitis. Following abdominal lavage and drainage, the patient was successfully treated with total parenteral nutrition and octreotide. PMID:22563182

  13. Complex histopathological and surgical aspects in a case of giant malignant gastric perforation

    PubMed Central

    Serban, D; Branescu, C; Savlovschi, C; El-Khatib, A; Tudor, C; Nica, A; Kraft, A; Dascalu, AM

    2016-01-01

    We present the case of a 52-year-old male patient, hospitalized on an emergency basis in the University Emergency Hospital in Bucharest, after being diagnosed with pneumoperitoneum acute abdomen, for which emergency surgery was mandatory. A 3,5-4 cm malignant gastric perforation, ascitis and peritoneal carcinomatosis were found. The histopathological exam revealed infiltrative mucinous gastric carcinoma with epiploic metastasis. Due to the lack of available gastric material, an atypical surgical solution was performed: gastric packing with epiploic material by means of transgastric traction. The solution proved to be successful for short-term recovery. The underlying condition was not focused on, the patient being directed to the Oncology Department. Acute gastric perforation is a rare complication of gastric cancer, and the association with gastric linitis is uncommon. This specific histopathological condition made the classical surgical repair techniques unsuitable for the presented case and an atypical solution had to be performed. PMID:27453758

  14. Complex histopathological and surgical aspects in a case of giant malignant gastric perforation.

    PubMed

    Serban, D; Branescu, C; Savlovschi, C; El-Khatib, A; Tudor, C; Nica, A; Kraft, A; Dascalu, A M

    2016-01-01

    We present the case of a 52-year-old male patient, hospitalized on an emergency basis in the University Emergency Hospital in Bucharest, after being diagnosed with pneumoperitoneum acute abdomen, for which emergency surgery was mandatory. A 3,5-4 cm malignant gastric perforation, ascitis and peritoneal carcinomatosis were found. The histopathological exam revealed infiltrative mucinous gastric carcinoma with epiploic metastasis. Due to the lack of available gastric material, an atypical surgical solution was performed: gastric packing with epiploic material by means of transgastric traction. The solution proved to be successful for short-term recovery. The underlying condition was not focused on, the patient being directed to the Oncology Department. Acute gastric perforation is a rare complication of gastric cancer, and the association with gastric linitis is uncommon. This specific histopathological condition made the classical surgical repair techniques unsuitable for the presented case and an atypical solution had to be performed. PMID:27453758

  15. Lateral Nasal Artery Perforator Flaps: Anatomic Study and Clinical Applications

    PubMed Central

    Tamburino, Serena; Tracia, Luciano; Tarico, Maria Stella; Perrotta, Rosario Emanuele

    2016-01-01

    Background Previous studies have investigated facial artery perforators, but have reported inconsistent results regarding lateral nasal artery (LNA) perforators. Although several authors have described the use of LNA perforators for ala nasi and nasal sidewall reconstruction, the literature contains little information regarding the cadaveric dissection of LNA perforators, and most previously published studies have focused on facial artery perforators. Methods Sixteen hemifaces from eight fresh cadavers were dissected to study the LNA perforators. After the dissection was performed, the total length and diameter of the LNA and its perforators were measured. The quantity and the distribution of the LNA perforators supplying the overlying skin were then assessed. LNA perforator flaps were used for reconstruction in 10 nasal and perinasal defects. Results The mean total lengths of the LNA and its perforators were 49.37 mm and 16.06 mm, respectively. The mean diameters of the LNA and its perforators were 2.08 mm and 0.91 mm, respectively. Based on our findings, we mapped the face to indicate zones with a higher probability of finding perforators. No infection, hematoma, or complete flap necrosis were observed after the procedures. Conclusions Nasal reconstruction is a challenging procedure, and LNA propeller/V-Y perforator flaps are an excellent reconstructive option in certain cases. Based on our cadaveric study, we were able to identify an area in the upper third of the nasolabial groove with a high density of perforators. PMID:26848450

  16. Perforators, the Underlying Anatomy of Acupuncture Points.

    PubMed

    Zhi Wei, Ding; Yu, Shi; Yongqiang, Zhang

    2016-03-01

    Context • As a critical concept in acupuncture, acupuncture points, or acupoints for short, are currently believed to be 3-dimensional structures composed of skin, muscles, tendons, nerves, blood vessels, lymph nodes, and other special tissues. No known specific tissue or organ has been confirmed to be an acupoint. However, from a microsurgeon's point of view, a special vascular structure exists around each acupoint (ie, perforators or arterioles of 0.3-1.5 mm that pierce deeply through the fascia). Objective • The current research team investigated the theory that perforators are the anatomical basis of acupoints. Design • A reference list of acupoints and of perforators near the acupoints was proposed, and the distributions were analyzed. Using the World Health Organization (WHO) list, "Standard Acupuncture Point Locations in the Western Pacific Region," 2 experienced acupuncturists identified the needling depth and angle as well as verified the acupoint locations. Perforators with amplitudes of 1 cm or more were identified by 3 veteran microsurgeons. Setting • The study was carried out in an osteopathic research center at the 89th Hospital of the People's Liberation Army, in Weifang, Shandong, China. From October 2013 to October 2014, patients who required skin flap transplantation were enrolled for observation. Outcome Measures • To evaluate the theory, the current research team observed subcutaneous perforating points in flap donor sites and operative incision areas and compared those points with the acupoints located by acupuncturists. Results • The perforators and acupoints were found to be closely correlated. Several distribution patterns of acupoints and perforators have emerged and further confirmed the research team's theory. Conclusions • The hypothesis could facilitate theoretical understanding of the mechanism and essence of acupuncture. PMID:27228269

  17. Small Bowel Perforations: What the Radiologist Needs to Know.

    PubMed

    Lo Re, Giuseppe; Mantia, Francesca La; Picone, Dario; Salerno, Sergio; Vernuccio, Federica; Midiri, Massimo

    2016-02-01

    The incidence of small bowel perforation is low but can develop from a variety of causes including Crohn disease, ischemic or bacterial enteritis, diverticulitis, bowel obstruction, volvulus, intussusception, trauma, and ingested foreign bodies. In contrast to gastroduodenal perforation, the amount of extraluminal air in small bowel perforation is small or absent in most cases. This article will illustrate the main aspects of small bowel perforation, focusing on anatomical reasons of radiological findings and in the evaluation of the site of perforation using plain film, ultrasound, and multidetector computed tomography equipments. In particular, the authors highlight the anatomic key notes and the different direct and indirect imaging signs of small bowel perforation. PMID:26827735

  18. Subfascial endoscopic perforator surgery for venous ulcers.

    PubMed

    Lee, D W H; Lam, Y H; Chan, A C W; Chung, S C S

    2003-08-01

    We report the treatment and outcomes of 12 patients who underwent subfascial endoscopic perforator surgery for severe chronic venous insufficiency and venous ulceration. All patients had received prior superficial venous ablative surgery and presented with incompetent perforating veins in the calf and persistent venous ulceration (lasting >10 years). Outcome measures included ulcer healing time, recurrence, clinical symptom, and disability scores. There was one wound complication after subfascial endoscopic perforator surgery. The cumulative ulcer healing rate was 25% at 3 months, 42% at 6 months, and 92% at 1 year. One patient developed ulcer recurrence at 12 months after surgery. The mean clinical score and disability score decreased from 13.00 (standard deviation, 2.26) to 4.83 (1.47) and 1.75 (0.45) to 0.50 (0.52), respectively (P<0.001) after a median follow-up of 15.0 months (interquartile range, 12.0-21.5 months). Subfascial endoscopic perforator surgery was safe and effective in the treatment of patients with severe chronic venous insufficiency and venous ulceration caused by incompetent perforating veins in the calf. PMID:12904616

  19. Basic Perforator Flap Hemodynamic Mathematical Model

    PubMed Central

    Tao, Youlun; Ding, Maochao; Wang, Aiguo; Zhuang, Yuehong; Chang, Shi-Min; Mei, Jin; Hallock, Geoffrey G.

    2016-01-01

    Background: A mathematical model to help explain the hemodynamic characteristics of perforator flaps based on blood flow resistance systems within the flap will serve as a theoretical guide for the future study and clinical applications of these flaps. Methods: There are 3 major blood flow resistance network systems of a perforator flap. These were defined as the blood flow resistance of an anastomosis between artery and artery of adjacent perforasomes, between artery and vein within a perforasome, and then between vein and vein corresponding to the outflow of that perforasome. From this, a calculation could be made of the number of such blood flow resistance network systems that must be crossed for all perforasomes within a perforator flap to predict whether that arrangement would be viable. Results: The summation of blood flow resistance networks from each perforasome in a given perforator flap could predict which portions would likely survive. This mathematical model shows how this is directly dependent on the location of the vascular pedicle to the flap and whether supercharging or superdrainage maneuvers have been added. These configurations will give an estimate of the hemodynamic characteristics for the given flap design. Conclusions: This basic mathematical model can (1) conveniently determine the degree of difficulty for each perforasome within a perforator flap to survive; (2) semiquantitatively allow the calculation of basic hemodynamic parameters; and (3) allow the assessment of the pros and cons expected for each pattern of perforasomes encountered clinically based on predictable hemodynamic observations.

  20. Gastric Perforation by Ingested Rabbit Bone Fragment

    PubMed Central

    Gambaracci, Giulio; Mecarini, Eleonora; Franceschini, Maria Silvia; Scialpi, Michele

    2016-01-01

    The majority of accidentally ingested foreign bodies is excreted from the gastrointestinal (GI) tract without any complications. Sometimes sharp foreign bodies – like chicken and fish bones – can lead to intestinal perforation and may present insidiously with a wide range of symptoms and, consequently, different diagnoses. We report the case of a 59-year-old woman presenting with fever and a 1-month history of vague abdominal pain. Computed tomography (CT) showed the presence of a hyperdense linear image close to the gastric antrum surrounded by a fluid collection and free peritoneal air. At laparotomy, a 4-cm rabbit bone fragment covered in inflamed tissue was detected next to a gastric wall perforation. Rabbit bone fragment ingestion, even if rarely reported, should not be underestimated as a possible cause of GI tract perforation. PMID:27403113

  1. Evaluation of urgent esophagectomy in esophageal perforation

    PubMed Central

    de AQUINO, José Luis Braga; de CAMARGO, José Gonzaga Teixeira; CECCHINO, Gustavo Nardini; PEREIRA, Douglas Alexandre Rizzanti; BENTO, Caroline Agnelli; LEANDRO-MERHI, Vânia Aparecida

    2014-01-01

    Background Esophageal trauma is considered one of the most severe lesions of the digestive tract. There is still much controversy in choosing the best treatment for cases of esophageal perforation since that decision involves many variables. The readiness of medical care, the patient's clinical status, the local conditions of the perforated segment, and the severity of the associated injuries must be considered for the most adequate therapeutic choice. Aim To demonstrate and to analyze the results of urgent esophagectomy in a series of patients with esophageal perforation. Methods A retrospective study of 31 patients with confirmed esophageal perforation. Most injuries were due to endoscopic dilatation of benign esophageal disorders, which had evolved with stenosis. The diagnosis of perforation was based on clinical parameters, laboratory tests, and endoscopic images. ‪The main surgical technique used was transmediastinal esophagectomy followed by reconstruction of the digestive tract in a second surgical procedure. Patients were evaluated for the development of systemic and local complications, especially for the dehiscence or stricture of the anastomosis of the cervical esophagus with either the stomach or the transposed colon. Results Early postoperative evaluation showed a survival rate of 77.1% in relation to the proposed surgery, and 45% of these patients presented no further complications. The other patients had one or more complications, being pulmonary infection and anastomotic fistula the most frequent. The seven patients (22.9%) who underwent esophageal resection 48 hours after the diagnosis died of sepsis. At medium and long-term assessments, most patients reported a good quality of life and full satisfaction regarding the surgery outcomes. Conclusions Despite the morbidity, emergency esophagectomy has its validity, especially in well indicated cases of esophageal perforation subsequent to endoscopic dilation for benign strictures. PMID:25626932

  2. Management of inflammatory corneal melt leading to central perforation in children: a retrospective study and review of literature.

    PubMed

    Medsinge, A; Gajdosova, E; Moore, W; Nischal, K K

    2016-04-01

    PurposeTo assess the outcome of early therapeutic penetrating keratoplasty (PKP) for corneal melt leading to perforation in children.MethodsCase notes of all the consecutive patients presenting with acute corneal perforation that underwent urgent therapeutic PKP between 2000 and 2010 to the practice of one of the authors, both NHS at Great Ormond Street Hospital for Children and private, were retrospectively reviewed. Onset of perforation, underlying cause, medical and surgical treatment, pre- and post-operative visual acuity, graft clarity, length of follow-up, and post-operative complications were recorded.ResultsFour eyes of four consecutive patients (mean age of 9.5 years and median 8.5 years, range 4-17 years) were treated for acquired acute onset corneal perforations. There were three females and one male. Etiologies included herpes simplex keratitis secondary to immune recovery disease post bone marrow transplantation, acanthamoeba keratitis, recessive dystrophic epidermolysis bullosa, and blepharokeratoconjunctivitis with acne rosacea. Pre-operative visual acuity ranged from hand movements to 6/150. All the patients had severe anterior chamber inflammation. All eyes improved in visual acuity ranging from 6/9 to 6/18 with clear grafts at last follow-up. There was no recurrence of melt or perforation. Mean follow-up was 67 months (median 44 months).ConclusionPKP during the acute phase together with aggressive medical therapy and close follow-up may achieve good visual outcomes in children with corneal melt with perforation and should be considered. Waiting may sometimes allow the marked inflammatory response seen in children to cause irreversible structural and/or functional damage. PMID:26821761

  3. Scrotal reconstruction using a superficial circumflex iliac artery perforator flap following Fournier's gangrene.

    PubMed

    Han, Hyun H; Lee, Jung H; Kim, Sue M; Jun, Young J; Kim, Young J

    2014-08-01

    Fournier's gangrene is a type of necrotising fasciitis around the scrotum and perineum. Because of its aggressive nature, patients should be treated with broad-spectrum antibiotics and emergency, radical debridement during the acute phase. After recovering from the acute phase, reconstruction of the scrotal and perineal soft tissue defects is needed and is often challenging. Traditionally, various reconstruction methods have been used, including skin grafts, fasciocutaneous flaps and musculocutaneous flaps, each with its pros and cons. We successfully covered a wide scrotal defect using a superficial circumflex iliac artery perforator flap, which has not been previously reported for this indication. The design and operative technique are introduced in this study. PMID:25091799

  4. Select fire perforating system application in Norway

    SciTech Connect

    1995-11-01

    Phillips Petroleum Co. Norway, used the special features of the Halliburton Selector Fire (HSF) System to perforate selected reservoir sections over very long intervals in horizontal wells in Greater Ekofisk Area fields in the Norwegian North Sea. Basic operations of the tool and three case history applications were presented at Offshore Europe `95 in Aberdeen by E. Kleepa and R. Nilson, Halliburton Norway (Inc.) and K. Bersaas, Phillips Petroleum Co. Norway, in paper SPE 30409 ``Tubing conveyed perforating in the Greater Ekofisk Area using the Halliburton Select Fire System.`` Highlights are summarized here.

  5. Impact of perforation variables on well productivity at Prudhoe Bay

    SciTech Connect

    Twyford, L.R.; Tyler, T.N.

    1984-04-01

    Numerical models and laboratory studies have been performed by other investigators to define the impact of various perforation parameters on well productivity. Field verification of these findings is difficult due to uncontrolled factors such as charge performance, drilling invasion, and reservoir quality. Using information from Prudhoe Bay, a study of perforation parameters affecting well productivity was undertaken in an effort to identify the most significant perforation variables in terms of initial and long term well performance. Findings from the study of field data verifies that perforation penetration is the most significant factor affecting well performance. Wells perforated with deep penetrating casing guns have lower drawdowns and significantly lower decline rates than wells perforated with through tubing guns. The high decline rates at Prudhoe Bay are a result of calcium carbonate scale buildup, which is exacerbated by perforations of poor quality. The data also suggests that O /SUP ./ gun phasing is comparable to other phasing when perforating in deviated, large diameter well bores.

  6. Esophageal perforation after anterior cervical spine surgery: a systematic review of the literature.

    PubMed

    Halani, Sameer H; Baum, Griffin R; Riley, Jonathan P; Pradilla, Gustavo; Refai, Daniel; Rodts, Gerald E; Ahmad, Faiz U

    2016-09-01

    pneumonia (n = 6), mediastinitis (n = 4), osteomyelitis (n = 3), sepsis (n = 3), acute respiratory distress syndrome (n = 2), and recurrent laryngeal nerve damage (n = 1). The mortality rate of esophageal perforation in the analysis was 3.92% (6 of 153 reported patients). CONCLUSIONS Esophageal perforation after anterior cervical spine surgery is a rare complication. This systematic review demonstrates that these perforations can be stratified into 3 categories based on the timing of symptomatic onset: intraoperative, early postoperative (within 30 days of anterior spinal surgery), and delayed. The most common source of esophageal injury is hardware erosion or migration, each of which may vary in their time to symptomatic manifestation. PMID:27081708

  7. Radiofrequency perforation and conventional needle percutaneous transseptal left heart access: pathological features.

    PubMed

    Veldtman, Gruschen R; Wilson, Gregory J; Peirone, Alejandro; Hartley, Amanda; Estrada, Marvin; Norgard, Gunnar; Leung, Ramsey K; Visram, Naheed; Benson, Lee N

    2005-08-01

    Perforating radiofrequency (PRF) energy has been used to obtain percutaneous transseptal left heart access. Contrary to ablative radiofrequency (RF), myocardial tissue responses to PRF thermal injury are incompletely defined. In this study, a newly developed RF catheter system for transseptal left atrial entry was compared with conventional needle puncture. Of 15 piglets having transfemoral cardiac catheterization, 12 had transseptal procedures. Needle punctures (NP) and PRF were followed by acute (1 hr; 3 NP, 3 PRF) and chronic necropsy (1 month; 3 NP, 3 PRF). The remaining three piglets had intentional RF aortic perforation through the atrial roof with necropsy at 1 month. Gross and histopathological effects were examined. Acutely, the gross RF lesion was similar to needle puncture. Histologically, the RF lesions had minimal mural thrombus, an inner zone of thermal injury characterized by grayish cytoplasmic staining (elastic trichrome), and a bubbly transformation of the cytoplasm in innermost cardiomyocytes, partial persistence of cross-striations, and an acute inflammatory reaction. The outer extent of the lesion (< 1 mm) was defined by a halo of contraction band necrosis similar to needle puncture. Acute NP injury showed comparable depth and extent of myocyte necrosis (principally contraction bands) with adjacent tissue hemorrhage and edema. At 1 month, a well-developed densely collagenous scar was present in both aortic and transseptal PRF lesions. The extent of acute RF injury is similar to that seen in conventional NP, but the characteristics of tissue insult are different. Both show well-developed healing at 1 month. PMID:16010688

  8. Perforated diverticulitis presenting as necrotising fasciitis of the leg.

    PubMed

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

    2008-01-01

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

  9. Extensive Tympanic Membrane Cholesteatoma with Marginal Perforation: An Unusual Case

    PubMed Central

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

    2013-01-01

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

  10. Trichobezoar Causing Gastric Perforation: A Case Report

    PubMed Central

    Ahmad, Zeeshanuddin; Sharma, Apoorv; Ahmed, Minhajuddin; Vatti, Vikram

    2016-01-01

    Trichobezoars are impactions of swallowed hairs in the stomach and occasionally in the intestine. They occur in emotionally disturbed, depressed, or mentally retarded patients who have trichotillomania and trichophagia. Trichobezoars are usually diagnosed on CT scan or upper GI endoscopy. They can give rise to complications like gastroduodenal ulceration, haemorrhage, perforation, peritonitis, or obstruction, with a high rate of mortality. The treatment is endoscopic, laparoscopic, or surgical removal and usually followed by psychiatric opinion. Herein, we report a case of gastric trichobezoar presenting as gastric perforation in a patient of trichotillomania and trichophagia that was accidentally found on laparotomy. As the patient was in shock on admission, relevant history of trichophagia could not be elicited. Henceforth, she was operated for perforation peritonitis. Trichobezoar was discovered intraoperatively and removed. The perforation was repaired with Graham’s omental patch. Postoperatively, history of trichophagia was corroborated with scarring alopecia of scalp. Trichobezoars is usually seen in adolescent girls, often with an underlying psychiatric or social problem. Laparotomy is the gold standard treatment. Surgical treatment should be followed by behavioral and psychiatric treatment. The patient should be vigilantly monitored for this impulsive disorder, as recurrences are common. PMID:26722149

  11. Perforation of woven fabric by spherical projectiles

    SciTech Connect

    Shim, V.P.W.; Tan, V.B.C.; Tay, T.E.

    1995-12-31

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

  12. Landing gear noise control using perforated fairings

    NASA Astrophysics Data System (ADS)

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

    2010-05-01

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

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

    PubMed Central

    2014-01-01

    Introduction Dermatomyositis is an autoimmune disease characterized by proximal myopathy, cutaneous Gottron papules and heliotrope rash; intestinal involvement associated to acute vasculitis is less common but could be a life-threatening condition. Methods A 21-year-old woman, affected by dermatomyositis, presented to our attention with a three-day story of severe abdominal pain, no bowel movement and biliary vomit. She was diagnosed with acute abdomen. A CT scan with bowel contrast demonstrated the presence of a leakage from the retroperitoneal aspect of duodenum. The surgical and clinical management in the light of literature review is presented. Results Our first approach consisted in primary repair of the duodenal perforation with omentopexy. Post-operative course was complicated by hemorrhage. A reintervention showed a new perforation associated with multiple ischemic intestinal areas. We performed a gastroenteric anastomosis with functional exclusion of the damaged duodenum and positioning of drainages to create a biliary fistula. A nutritional enteric tube and an open abdomen vacuum-assisted closure system to monitor the fistula creation and to prevent abdominal contamination and collections were positioned. To reduce the amount of biliary leakage, a percutaneous transhepatic biliary drainage was placed, with progressive fistula flow disappearance in four months. Conclusions In patients with dermatomyositis, when clinical findings and symptoms suggest abdominal vasculitis, it is very important to be aware of the risk of bowel and particularly duodenal perforations. Open abdomen treatment favors control of contamination by gastrointestinal contents, offers temporary abdominal closure, helps ICU care and delays definitive surgery. PMID:26085838

  14. The in vivo anatomy of the deep circumflex iliac artery perforators: defining the role for the DCIA perforator flap.

    PubMed

    Ting, Jeannette W C; Rozen, Warren M; Grinsell, Damien; Stella, Damien L; Ashton, Mark W

    2009-01-01

    The deep circumflex iliac artery (DCIA) provides a dependable option for use as an osteo-musculo-cutaneous flap, particularly in mandibular reconstruction. Modifications to flaps based on DCIA perforators have been sought to prevent donor site morbidity as a consequence of muscle cuff harvest. Previous studies have been inconsistent in their descriptions of perforator anatomy, and means of assessing these preoperatively have not been widely described. A clinical anatomical study was undertaken, with a cohort of 44 hemiabdominal walls in 22 consecutive patients undergoing preoperative computed tomographic angiography (CTA) before free flap surgery. The feasibility of CTA and the regional vascular anatomy were both assessed. The use of CTA was shown to demonstrate DCIA perforators with high resolution and to be able to assess vessel size and location. In 44 hemiabdominal walls, there were 44 perforators of >0.8 mm diameter. There were no suitable perforators in 40% of sides, with 32% of sides having one perforator >0.8 mm diameter, 16% having two perforators, <10% had three perforators, and only one side had over four perforators. Perforators emerged from the deep fascia on an average of 5.1 cm cranial and 3.9 cm posterior to the anterior superior iliac spine (ASIS). Of the 44 perforators identified, 82% of perforators were located within a 4 cm by 4 cm area, 3 cm superior, and 2 cm posterior to the ASIS. The current study has demonstrated the utility of preoperative CTA for identifying DCIA perforators, and for selecting patients who may be suitable for a DCIA perforator flap given the variable perforator anatomy. PMID:19296521

  15. Determination of surgical priorities in appendicitis based on the probability of undetected appendiceal perforation

    PubMed Central

    Lee, Sang Chul; Park, Geon; Choi, Byung-Jo; Kim, Say-June

    2015-01-01

    AIM: To identify risk factors of actual appendiceal perforation when computed tomography (CT) scans suggest nonperforated appendicitis and accordingly determine surgical priority. METHODS: We collected database of 1362 patients who underwent an appendectomy for acute appendicitis between 2006 and 2013. A single radiologist selected 1236 patients whose CT scans were suggestive of nonperforated appendicitis. Patients were divided into 2 groups: actual nonperforation group and actual perforation group according to intraoperative and pathologic features. Comparison of the 2 groups were made using binary logistic regression. RESULTS: Of 1236 patients, 90 (7.3%) were found to have actual appendiceal perforation. Four risk factors related with actual appendiceal perforation were identified: body temperature ≥ 37.6  °C (HR = 1.912, 95%CI: 1.161-3.149; P = 0.011), out-of-hospital symptom duration ≥ 72 h (HR = 2.454, 95%CI: 1.292-4.662; P = 0.006), age ≥ 35 years (HR = 3.358, 95%CI: 1.968-5.728; P < 0.001), and appendiceal diameter on CT scan ≥ 8 mm (HR = 4.294, 95%CI: 1.034-17.832; P = 0.045). Actual appendiceal perforation group showed longer operation time, later initiation of diet, longer use of parenteral narcotics, longer hospital stay, and higher incidence of postoperative complications (P < 0.05). CONCLUSION: We proposed here new criteria to select patients with adverse clinical outcomes after appendectomy among the patients with radiologically nonperforated appendicitis. Surgical appendectomy outcomes could be improved by determining the surgical priority according to our criteria. PMID:25717248

  16. Laparoscopic Repair of Perforated Peptic Ulcer: Outcome and Associated Morbidity and Mortality

    PubMed Central

    Alemrajabi, Mahdi; Safari, Saeed; Tizmaghz, Adnan; Alemrajabi, Fatemeh; Shabestanipour, Ghazaal

    2016-01-01

    Introduction The mainstay of treatment for perforated peptic ulcer is Omental patch closure. With the advent of laparoscopic surgery, this approach is being used for the treatment of perforated peptic ulcer. The aim of this study was to evaluate the outcome of laparoscopy in Firoozgar general hospital over a period of 18 months. The outcome of the laparoscopic approach and the associated morbidity and mortality, operation time, conversion rate and hospital stay were assessed. Methods A prospective analysis of 29 consecutive patients (mean age 37.5 years; 23 men) with perforated peptic ulcers and who had undergone laparoscopic surgery was carried over a period of 18 months from March 2014 until September 2015. Pre-operative, intra-operative, and post-operative clinical data were collectively analyzed by SPSS 19 for Windows. Results Seventeen patients had a history of cigarette smoking, 11 patients had a history of opium consumption, 19 were chronic NSAID users, 26 had Helicobacter pylori infections, and six had a co-morbid condition. Previous surgical history included laparotomy for pancreatic cancer in two patients, for sigmoid colon cancer in one patient, and for acute appendicitis in four patients. The average operating time for all cases was 47.5 + 20 min. The mean lag time between onset of symptoms and surgery was 20.4 hours. All patients underwent laparoscopic closure of the perforation with Omental patch closure. No morbidity was observed, and none of the patients needed conversion to open surgery. One patient died after 11 months of follow-up due to the progression of underlying pancreatic cancer. The mean postoperative hospital stay was 4.2 days. Conclusions The results of the laparoscopic approach for perforated peptic ulcer were promising, with no conversion to open surgery, no morbidity, and mortality. PMID:27504170

  17. Perforated Meckel's diverticulum in a very preterm baby revealed at birth.

    PubMed

    Borgi, Aida; Bouziri, Asma; Boujelbene, Nedia; Sghairoun, Nedia; Belhadj, Serra; Benjeballah, Najla

    2014-04-01

    Perforated Meckel's diverticulum (MD) in a preterm baby is very rare. We report a case of a very preterm baby, born at 29-week gestation, with a birth weight of 1400 g, admitted in the third hour of life to our intensive care unit (ICU) for respiratory distress syndrome with abdominal distention. An abdominal radiograph showed a pneumoperitoneum. Laparotomy revealed Meckel's perforation. The baby was discharged healthy at the age of 16 days. MD should be kept in mind as one cause of an acute abdomen in preterm neonates mimicking necrotizing enterocolitis. To our knowledge, our patient is the third reported case described in the literature and the first one revealed at birth. PMID:24328940

  18. Perforated sub-hepatic appendix; rare presentation of a common disease.

    PubMed

    Jaliawala, Huzaifa Ali; Mannan, Fatima; Gill, Roger Christopher; Alvi, Abdul Rehman

    2016-06-01

    An elderly gentleman presented to our emergency with a 10-day history of right upper quadrant pain and nausea with associated tenderness on examination. His white cell counts were raised with predominant neutrophils with ultrasound evidence of a heterogeneous sub-hepatic collection, not associated with fever, diarrhoea or vomiting. He had a similar episode 3 weeks ago, which resolved with antibiotics. Initially thought to be a perforated acute appendicitis or a liver abscess a CT scan was done to further substantiate our finding. This to the contrary revealed a perforated sub hepatic appendix. Patient was treated conservatively with IV fluids and antibiotics and the sub hepatic collection was aspirated under ultrasound guidance. He responded well to treatment and made an uneventful recovery. PMID:27339586

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

    SciTech Connect

    Tariq, S.M. ); Ayestaran, L.C. )

    1991-02-01

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

  20. Overbalance perforating and stimulation method for wells

    SciTech Connect

    Dees, J.M.; Handren, P.J.; Jupp, T.B.

    1992-07-21

    This patent describes a method for decreasing the resistance to fluid flow in a subterranean formation around a well having unpreforated casing fixed therein, the casing extending at least partially through the formation. It comprises providing a liquid in the casing opposite the formation to be treated; placing perforating means in the casing at a depth opposite the formation to be treated; injecting gas into the well until the pressure in the liquid opposite the formation to be treated will be at least as large as the fracturing pressure of the formation when the liquid pressure is applied to the formation; activating the perforating means; and at a time before pressure in the well at the depth of the formation to be treated has substantially decreased, injecting fluid at an effective rate to fracture the formation.

  1. Thyroid storm precipitated by duodenal ulcer perforation.

    PubMed

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

    2015-01-01

    Thyroid storm is a rare and life-threatening complication of thyrotoxicosis that requires prompt treatment. Thyroid storm is also known to be associated with precipitating events. The simultaneous treatment of thyroid storm and its precipitant, when they are recognized, in a patient is recommended; otherwise such disorders, including thyroid storm, can exacerbate each other. Here we report the case of a thyroid storm patient (a 55-year-old Japanese male) complicated with a perforated duodenal ulcer. The patient was successfully treated with intensive treatment for thyroid storm and a prompt operation. Although it is believed that peptic ulcer rarely coexists with hyperthyroidism, among patients with thyroid storm, perforation of a peptic ulcer has been reported as one of the causes of fatal outcome. We determined that surgical intervention was required in this patient, reported despite ongoing severe thyrotoxicosis, and reported herein a successful outcome. PMID:25838951

  2. Esophageal perforation in a sword swallower.

    PubMed

    Scheinin, S A; Wells, P R

    2001-01-01

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

  3. Thyroid Storm Precipitated by Duodenal Ulcer Perforation

    PubMed Central

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

    2015-01-01

    Thyroid storm is a rare and life-threatening complication of thyrotoxicosis that requires prompt treatment. Thyroid storm is also known to be associated with precipitating events. The simultaneous treatment of thyroid storm and its precipitant, when they are recognized, in a patient is recommended; otherwise such disorders, including thyroid storm, can exacerbate each other. Here we report the case of a thyroid storm patient (a 55-year-old Japanese male) complicated with a perforated duodenal ulcer. The patient was successfully treated with intensive treatment for thyroid storm and a prompt operation. Although it is believed that peptic ulcer rarely coexists with hyperthyroidism, among patients with thyroid storm, perforation of a peptic ulcer has been reported as one of the causes of fatal outcome. We determined that surgical intervention was required in this patient, reported despite ongoing severe thyrotoxicosis, and reported herein a successful outcome. PMID:25838951

  4. Liquid nitrogen ingestion followed by gastric perforation.

    PubMed

    Berrizbeitia, Luis D; Calello, Diane P; Dhir, Nisha; O'Reilly, Colin; Marcus, Steven

    2010-01-01

    Ingestion of liquid nitrogen is rare but carries catastrophic complications related to barotrauma to the gastrointestinal tract. We describe a case of ingestion of liquid nitrogen followed by gastric perforation and respiratory insufficiency and discuss the mechanism of injury and management of this condition. Liquid nitrogen is widely available and is frequently used in classroom settings, in gastronomy, and for recreational purposes. Given the potentially lethal complications of ingestion, regulation of its use, acquisition, and storage may be appropriate. PMID:20065833

  5. Contained colonic perforation due to cecal retroflexion

    PubMed Central

    Geng, Zhuo; Agrawal, Deepak; Singal, Amit G; Kircher, Stephen; Gupta, Samir

    2016-01-01

    Complications of cecal retroflexion performed during colonoscopy have not previously been reported to occur. We report a case of contained colonic perforation secondary to using cecal retroflexion technique to examine the colon, and review available published reports of complications associated with this technique. We conclude that complications may rarely occur with use of cecal retroflexion, and that the clinical benefit of this technique is uncertain. PMID:27004007

  6. Mediastinitis and Bronchial Perforations Due to Mucormycosis.

    PubMed

    Dhooria, Sahajal; Agarwal, Ritesh; Chakrabarti, Arunaloke

    2015-10-01

    Diabetes mellitus is the most common predisposing condition for mucormycosis, which is emerging as an important invasive fungal infection worldwide. Isolated mediastinitis is a very rare presentation of mucormycosis. A 57-year-old woman with uncontrolled type 2 diabetes mellitus and ketoacidosis presented with septic shock and was subsequently found to have mucor mediastinitis with multiple bronchial perforations. The organism was identified as Rhizopus oryzae with the help of DNA sequencing. PMID:26348693

  7. Perforating devices for use in wells

    DOEpatents

    Jacoby, Jerome J.; Brooks, James E.; Aseltine, Clifford L.

    2002-01-01

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

  8. Spontaneous rupture of pyometra manifesting as an acute abdomen: a case report.

    PubMed

    Singh, Alpana; Mundhra, Rajlaxmi; Agarwal, Tannavi; Radhakrishnan, Gita

    2015-07-01

    Spontaneous perforation of pyometra is a rare entity with a reported incidence in the range of 0.01-0.05%. The clinical picture is similar to peritonitis arising from intestinal perforation and commonly the correct diagnosis is only made perioperatively. We report a case in an elderly postmenopausal woman presenting with an acute abdomen. PMID:25999354

  9. Acoustic impedance of micro perforated membranes: Velocity continuity condition at the perforation boundary.

    PubMed

    Li, Chenxi; Cazzolato, Ben; Zander, Anthony

    2016-01-01

    The classic analytical model for the sound absorption of micro perforated materials is well developed and is based on a boundary condition where the velocity of the material is assumed to be zero, which is accurate when the material vibration is negligible. This paper develops an analytical model for finite-sized circular micro perforated membranes (MPMs) by applying a boundary condition such that the velocity of air particles on the hole wall boundary is equal to the membrane vibration velocity (a zero-slip condition). The acoustic impedance of the perforation, which varies with its position, is investigated. A prediction method for the overall impedance of the holes and the combined impedance of the MPM is also provided. The experimental results for four different MPM configurations are used to validate the model and good agreement between the experimental and predicted results is achieved. PMID:26827008

  10. Low Voltage Electric Current Causing Ileal Perforation: A Rare Injury

    PubMed Central

    Mathur, Vinay; Tanger, Ramesh; Gupta, Arun Kumar

    2016-01-01

    Post-electric burn ileal perforation is a rare but severe complication leading to high morbidity and mortality if there is delay in diagnosis and management. We are describing a case of electric current injury of left forearm, chest, and abdominal wall with perforation of ileum in an 8-year old boy. Patient was successfully managed by primary closure of the ileal perforation. PMID:27170922

  11. Conservative Treatment of a Large Facial Midroot Perforation

    PubMed Central

    Bronnec, François

    2015-01-01

    Aim. To report on the endodontic and periodontal management of a root and alveolar process perforation in a maxillary front tooth. Summary. Perforation during access cavity preparation is an infrequent complication during endodontic therapy, leading to potential periodontal tissue breakdown. The case described the two-stage management of a massive facial root perforation requiring a connective tissue graft to correct a mucosal fenestration persisting after orthograde repair of the root defect with MTA. PMID:25838948

  12. Sonographic appearance of suspected iatrogenic uterine perforation. A case report.

    PubMed

    Lajinian, S; Margono, F; Mroueh, J

    1994-11-01

    A case of iatrogenic uterine perforation occurred during dilation and curettage for treatment of a missed abortion at 14 weeks' gestation. Real-time transabdominal sonography was used to detect the fundal perforation and to follow serially the amount of fluid in the cul-de-sac. It is recommended that this noninvasive and direct diagnostic tool be used in the management of uterine perforation. PMID:7853285

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

    PubMed Central

    Cavanagh, James E.

    1996-01-01

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

  14. Gastrointestinal Tract Perforation in the Newborn and Child: Imaging Assessment.

    PubMed

    Schooler, Gary R; Davis, Joseph T; Lee, Edward Y

    2016-02-01

    Gastrointestinal tract perforation can arise from various underlying etiologies ranging from congenital causes to ingested foreign bodies in the pediatric patient population. Imaging assessment in patients with suspected gastrointestinal tract perforation plays a central role in making the diagnosis and follow-up evaluation. This article reviews the more common etiologies of gastrointestinal tract perforation in pediatric patients, their imaging manifestations, and strategies for imaging assessment to assist the radiologist in arriving at a timely and accurate diagnosis. PMID:26827739

  15. Limit load analysis of perforated disks with square penetration pattern

    SciTech Connect

    Rogalska, E.; Kakol, W.; Guerlement, G.; Lamblin, D.

    1997-02-01

    The problem of limit analysis of perforated disks is important in design of many modern engineering structures, especially for tubesheet heat exchangers. Here, limit load analysis of perforated disks with a square penetration pattern is presented. The results of limit analysis are used to obtain yield surfaces for solid material equivalent to perforated disk based on homogenization approach. Theoretical and experimental results are compared. Approximations of the yield surfaces are proposed.

  16. Otoscope fogging: examination finding for perforated tympanic membrane

    PubMed Central

    Naylor, Jason F

    2014-01-01

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

  17. The use of propeller perforator flaps for diabetic limb salvage: a retrospective review of 25 cases

    PubMed Central

    Georgescu, Alexandru V.; Matei, Ileana R.; Capota, Irina M.

    2012-01-01

    Background Peripheral vascular disease and/or diabetic neuropathy represent one of the main etiologies for the development of lower leg and/or diabetic foot ulcerations, and especially after acute trauma or chronic mechanical stress. The reconstruction of such wounds is challenging due to the paucity of soft tissue resources in this region. Various procedures including orthobiologics, skin grafting (SG) with or without negative pressure wound therapy and local random flaps have been used with varying degrees of success to cover diabetic lower leg or foot ulcerations. Other methods include: local or regional muscle and fasciocutaneous flaps, free muscle and fasciocutaneous, or perforator flaps, which also have varying degrees of success. Patients and methods This article reviews 25 propeller perforator flaps (PPF) which were performed in 24 diabetic patients with acute and chronic wounds involving the foot and/or lower leg. These patients were admitted beween 2008 and 2011. Fifteen PPF were based on perforators from the peroneal artery, nine from the posterior tibial artery, and one from the anterior tibial artery. Results A primary healing rate (96%) was obtained in 18 (72%) cases. Revisional surgery and SG for skin necrosis was performed in six (24%) cases with one complete loss of the flap (4%) which led to a lower extremity amputation. Conclusions The purpose of this article is to review the use of PPF as an effective method for soft tissue coverage of the diabetic lower extremity and/or foot. In well-controlled diabetic patients that present with at least one permeable artery in the affected lower leg, the use of PPF may provide an alternative option for soft tissue reconstruction of acute and chronic diabetic wounds. PMID:23050066

  18. Underbalanced perforation characteristics as affected by differential pressure

    SciTech Connect

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

    1988-02-01

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

  19. Endoluminal vacuum therapy for iatrogenic perforation of the proximal oesophagus.

    PubMed

    Möschler, O; Müller, M K

    2014-03-01

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

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

    PubMed

    de Bakker, Jk; Bruin, Sc

    2012-01-01

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

  1. Successful laparoscopic repair of a large traumatic sigmoid perforation

    PubMed Central

    de Bakker, JK; Bruin, SC

    2012-01-01

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

  2. Aortic Pseudoaneurysm Secondary to Mediastinitis due to Esophageal Perforation

    PubMed Central

    Zuluaga, Claudia Patricia; Aluja Jaramillo, Felipe; Velásquez Castaño, Sergio Andrés; Rivera Bernal, Aura Lucía; Granada, Julio Cesar; Carrillo Bayona, Jorge Alberto

    2016-01-01

    Esophageal perforation is a condition associated with high morbidity and mortality rates; it requires early diagnosis and treatment. The most common complication of esophageal rupture is mediastinitis. There are several case reports in the literature of mediastinitis secondary to esophageal perforation and development of aortic pseudoaneurysm as a complication. We report the case of a patient with an 8-day history of esophageal perforation due to foreign body (fishbone) with mediastinitis and aortic pseudoaneurysm. The diagnosis was made using Computed Tomography (CT) with intravenous and oral water-soluble contrast material. An esophagogastroduodenoscopy did not detect the perforation. PMID:26977330

  3. Allopurinol in the treatment of acquired reactive perforating collagenosis*

    PubMed Central

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

    2013-01-01

    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.. PMID:23539010

  4. Bowel perforation in the newborn: diagnosis with metrizamide

    SciTech Connect

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

    1984-01-01

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

  5. Novel treatment options for perforations of the upper gastrointestinal tract: endoscopic vacuum therapy and over-the-scope clips.

    PubMed

    Mennigen, Rudolf; Senninger, Norbert; Laukoetter, Mike G

    2014-06-28

    Endoscopic management of leakages and perforations of the upper gastrointestinal tract has gained great importance as it avoids the morbidity and mortality of surgical intervention. In the past years, covered self-expanding metal stents were the mainstay of endoscopic therapy. However, two new techniques are now available that enlarge the possibilities of defect closure: endoscopic vacuum therapy (EVT), and over-the-scope clip (OTSC). EVT is performed by mounting a polyurethane sponge on a gastric tube and placing it into the leakage. Continuous suction is applied via the tube resulting in effective drainage of the cavity and the induction of wound healing, comparable to the application of vacuum therapy in cutaneous wounds. The system is changed every 3-5 d. The overall success rate of EVT in the literature ranges from 84% to 100%, with a mean of 90%; only few complications have been reported. OTSCs are loaded on a transparent cap which is mounted on the tip of a standard endoscope. By bringing the edges of the perforation into the cap, by suction or by dedicated devices, such as anchor or twin grasper, the OTSC can be placed to close the perforation. For acute endoscopy associated perforations, the mean success rate is 90% (range: 70%-100%). For other types of perforations (postoperative, other chronic leaks and fistulas) success rates are somewhat lower (68%, and 59%, respectively). Only few complications have been reported. Although first reports are promising, further studies are needed to define the exact role of EVT and OTSC in treatment algorithms of upper gastrointestinal perforations. PMID:24976714

  6. Novel treatment options for perforations of the upper gastrointestinal tract: Endoscopic vacuum therapy and over-the-scope clips

    PubMed Central

    Mennigen, Rudolf; Senninger, Norbert; Laukoetter, Mike G

    2014-01-01

    Endoscopic management of leakages and perforations of the upper gastrointestinal tract has gained great importance as it avoids the morbidity and mortality of surgical intervention. In the past years, covered self-expanding metal stents were the mainstay of endoscopic therapy. However, two new techniques are now available that enlarge the possibilities of defect closure: endoscopic vacuum therapy (EVT), and over-the-scope clip (OTSC). EVT is performed by mounting a polyurethane sponge on a gastric tube and placing it into the leakage. Continuous suction is applied via the tube resulting in effective drainage of the cavity and the induction of wound healing, comparable to the application of vacuum therapy in cutaneous wounds. The system is changed every 3-5 d. The overall success rate of EVT in the literature ranges from 84% to 100%, with a mean of 90%; only few complications have been reported. OTSCs are loaded on a transparent cap which is mounted on the tip of a standard endoscope. By bringing the edges of the perforation into the cap, by suction or by dedicated devices, such as anchor or twin grasper, the OTSC can be placed to close the perforation. For acute endoscopy associated perforations, the mean success rate is 90% (range: 70%-100%). For other types of perforations (postoperative, other chronic leaks and fistulas) success rates are somewhat lower (68%, and 59%, respectively). Only few complications have been reported. Although first reports are promising, further studies are needed to define the exact role of EVT and OTSC in treatment algorithms of upper gastrointestinal perforations. PMID:24976714

  7. Versatility of the Perforator-Based Adipose, Adipofascial, and Fasciocutaneous Flaps in Reconstruction of Distal Leg and Foot Defects.

    PubMed

    Acartürk, Tahsin Oğuz; Tunc, Suphan; Acar, Firat

    2016-01-01

    Reconstruction of the distal leg, ankle, and foot is challenging, and local perforator flaps have emerged as valuable options. The aim of the present study was to evaluate the outcomes of local perforator flaps in the distal lower extremity. A total of 14 local perforator flaps were used in 12 patients (9 males [75%] and 3 females [25%], aged 19 to 83 years). The etiologies included 7 motor vehicle accidents (50%), 2 acute burns (14.29%), 2 chronic wounds (14.29%), 1 postburn contracture (7.14%), 1 gunshot wound (7.14%), and 1 malignancy (7.14%). The defects were localized to the mid-leg in 3 cases (21.43%), ankle in 4 (28.57%), calcaneus in 4 (28.57%), and foot in 3 (21.43%). A peroneal artery perforator flap (11 sites [78.57%]) or a posterior tibial artery perforator flap (3 sites [21.43%]) was used. Of the 14 flaps, 8 (57.14%) were fasciocutaneous, 4 (28.57%) were adipofascial, and 2 (14.29%) were adipose. The flap transfers were rotational in 9 cases (64.29%), flipped in 2 (14.29%), propeller in 2 (14.29%), and transcrural in 1 (7.14%). The flap dimensions ranged from 8 cm × 5 cm to 22 cm × 5 cm. Finally, 12 flaps (85.71%) remained viable, 1 (7.14%) had partially sloughed, and 1 (7.14%) had completely died owing to a hypercoagulable state. Overall, 13 flaps (92.86%) had good outcomes after a median follow-up period of 19 (range 12 to 37) months. Perforator flaps in the lower extremity are versatile in terms of size, design, composition, and axis of rotation. They are reliable and safe when used to reconstruct local defects. PMID:25661783

  8. 'Broken-heart' syndrome: ventricular septal perforation in a takotsubo cardiomyopathy.

    PubMed

    Pepe, Martino; Paradies, Valeria; Bortone, Alessandro; De Cillis, Emanuela; Cafaro, Alessandro; Acquaviva, Tommaso; Masi, Filippo; Quagliara, Donato; Favale, Stefano

    2016-05-01

    Takotsubo cardiomyopathy (TTC) is a form of acute left ventricular dysfunction usually reversible and with favorable prognosis. Ventricular septal perforation (VSP) is a very rare life-threatening complication. Percutaneous closure of VSP, despite being challenging, is a possible alternative to surgical repair. We present the first case of an 84-year-old patient with a TTC-related VSP treated by percutaneous approach. The case highlights the need of reconsidering the worldwide accepted consideration of TTC as benignant and allows some speculations on the optimal management of VSP in terms of timing, patient selection and possible alternative interventions. PMID:27091371

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

    PubMed Central

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

    2015-01-01

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

  10. An unusual presentation of perforated appendicitis in epigastric region☆

    PubMed Central

    Odabasi, Mehmet; Arslan, Cem; Abuoglu, Hasan; Gunay, Emre; Yildiz, Mehmet Kamil; Eris, Cengiz; Ozkan, Erkan; Aktekin, Ali; Muftuoglu, M.A. Tolga

    2013-01-01

    INTRODUCTION Atypical presentations of appendix have been reported including backache, left lower quadrant pain and groin pain from a strangulated femoral hernia containing the appendix. We report a case presenting an epigastric pain that was diagnosed after computed tomography as a perforated appendicitis on intestinal malrotation. PRESENTATION OF CASE A 27-year-old man was admitted with a three-day history of epigastric pain. Physical examination revealed tenderness and defense on palpation of epigastric region. There was a left subcostal incision with the history of diaphragmatic hernia repair when the patient was 3 days old. He had an intestinal malrotation with the cecum fixed at the epigastric region and the inflamed appendix extending beside the left lobe of liver. DISCUSSION While appendicitis is the most common abdominal disease requiring surgical intervention seen in the emergency room setting, intestinal malrotation is relatively uncommon. When patients with asymptomatic undiagnosed gastrointestinal malrotation clinically present with abdominal pain, accurate diagnosis and definitive therapy may be delayed, possibly increasing the risk of morbidity and mortality. CONCLUSION Atypical presentations of acute appendicitis should be kept in mind in patients with abdominal pain in emergency room especially in patients with previous childhood operation for diaphragmatic hernia. PMID:24441442

  11. Pressure enhanced penetration with shaped charge perforators

    DOEpatents

    Glenn, Lewis A.

    2001-01-01

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

  12. Small bowel perforation during suprapubic tube exchange.

    PubMed

    Mongiu, Anne K; Helfand, Brain T; Kielb, Stephanie J

    2009-02-01

    Suprapubic tube placement is a common urological procedure with a low incidence of complications, including hematuria, catheter blockage, recurrent urinary tract infections, and rarely, injury to adjacent organs. Fortunately, most serious complications are discovered shortly after initial suprapubic tube placement and are readily corrected. Very few cases of delayed complications or injuries have been reported. We report a case of Foley perforation into the ileum during suprapubic tube exchange discovered more than 8 months after initial placement, and preceding numerous monthly changes that occurred without incident. While a rare complication, physicians should be conscious of the potential for delayed injury in patients managed with long term suprapubic tube placement. PMID:19222896

  13. Perforated Duodenal Ulcer in a Cow

    PubMed Central

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

    1982-01-01

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

  14. Jejunoileal diverticulosis, a rare cause of ileal perforation – Case report

    PubMed Central

    Tenreiro, Nádia; Moreira, Herculano; Silva, Sílvia; Marques, Rita; Monteiro, Ana; Gaspar, João; Oliveira, António

    2016-01-01

    Introduction Jejunoileal diverticulosis (JID) is a rare condition associated with nonspecific symptoms, consisting of acquired false diverticula. It frequently co-exists with colonic diverticulosis. Diagnosis is usually made incidentally or after complications. These include hemorrhage, obstruction and diverticulitis, with or without perforation. Presentation of case 81-year-old man presented with a painful abdominal mass in the right lower quadrant (RLQ), diffuse abdominal discomfort and fever. Abdominal examination confirmed a well-defined mass in the RLQ without rebound tenderness. Laboratory analysis revealed elevated inflammatory markers and CT scan showed a cavitated lesion with an air-fluid level in the RLQ, without evidence of intraperitoneal free air or fluid. Admitted for conservative treatment, failure to improve led to laparotomy on the 6th day of hospitalization, with identification of jejunoileal diverticulosis complicated with diverticulitis and walled-off perforation. We performed segmental enterectomy. Discussion The incidence of JID is estimated at 0.2–7% and it is usually diagnosed in the sixth/seventh decade of life. From a diagnostic perspective, JID is a challenging disorder, without reliable diagnostic tests. Diverticulitis is the most common complication. Perforation generally causes only localized peritonitis, as involved diverticula are often walled off by the surrounding mesentery. In selected cases, medical therapy may suffice. For all other patients prompt laparotomy with segmental intestinal resection is the treatment of choice. Conclusion JID remains under diagnosed. When it presents as an acute complication it may require immediate surgical intervention. In an elderly person, especially with known gastrointestinal diverticulosis, one must have a high index of suspicion for perforation. PMID:26949530

  15. Acute neonatal appendicitis in a preterm.

    PubMed

    Mammou, Sihem; Ayadi, Imen; Ben Hamida, Emira; Marrakchi, Zahra

    2015-01-01

    Acute neonatal appendicitis is very rare in the neonatal period. It is usually associated with comorbidity including prematurity. Symptoms are non-specific. The prognosis is marked by high risk of mortality and morbidity. Here, we report a case of preterm new born who presented with sepsis, apnoea, and digestive signs. The laparotomy revealed perforated appendicitis complicated with peritonitis. PMID:26712299

  16. Acute neonatal appendicitis in a preterm

    PubMed Central

    Mammou, Sihem; Ayadi, Imen; Hamida, Emira Ben; Marrakchi, Zahra

    2015-01-01

    Acute neonatal appendicitis is very rare in the neonatal period. It is usually associated with comorbidity including prematurity. Symptoms are non-specific. The prognosis is marked by high risk of mortality and morbidity. Here, we report a case of preterm new born who presented with sepsis, apnoea, and digestive signs. The laparotomy revealed perforated appendicitis complicated with peritonitis. PMID:26712299

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

    SciTech Connect

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

    2003-10-22

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

  18. A simplified classification and repair system for sinus membrane perforations.

    PubMed

    Fugazzotto, Paul A; Vlassis, James

    2003-10-01

    A classification and repair system is presented for the management of sinus membrane perforations, based upon membrane location and severity. The results of 19 consecutively treated cases are presented. All cases of sinus membrane perforation were appropriately managed, resulting in successful sinus augmentation therapy, implant placement, and restoration. All implants were functioning successfully at the time of statistical compilation. PMID:14653401

  19. Cheek mucosa territories perfused by perforators from the facial artery.

    PubMed

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

    2015-01-01

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

  20. An atypical presentation of intrahepatic perforated cholecystitis: a modern indication to open cholecystectomy. Report of a case

    PubMed Central

    2014-01-01

    Background Intrahepatic gallbladder perforation with chronic liver abscess formation was anecdotically reported in the literature. The aim of this work is to report a case of intrahepatic gallbladder perforation and its atypical clinical presentation. Case presentation A 62-year-old male patient came to our observation; his medical history showed intermittent fever up to 39-40°C of about 2 weeks and anorexia, with an overall weight loss of about 12 Kg. Physical examination of the abdomen was negative. An ultrasound of the liver and an abdominal CT angiogram detected a disomogeneous hypoechoic-hypodense area in the 5th segment of the liver. Differential diagnosis between hepatic abscess or gallbladder cancer remained open. A surgical exploration was planned. After laparoscopic exploration, a conversion to open procedure with an atypical resection of the 5th hepatic segment was performed. Histologic examination of the specimen showed an intrahepatic chronic perforation of the gallbladder with intrahepatic abscess. Conclusion To the best of our knowledge, 18 cases have been reported in the literature as a Niemeier type I perforation. Clinical presentation, even in its extreme rarity, is more often acute. Differential diagnosis between gallbladder cancer versus liver abscess remains controversial. Open approach is mandatory in such cases. PMID:24468118

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

    PubMed Central

    Robotis, John; Karabinis, Andreas

    2014-01-01

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

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

    NASA Technical Reports Server (NTRS)

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

    2000-01-01

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

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

    NASA Astrophysics Data System (ADS)

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

    2012-10-01

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

  4. Acute recurrent appendicitis with appendicolith.

    PubMed

    Hollerman, J J; Bernstein, M A; Kottamasu, S R; Sirr, S A

    1988-11-01

    Appendiceal disease can be acute, acute recurrent, or chronic. Acute appendicitis is the most common form. Acute recurrent appendicitis is more common than chronic appendicitis. In children the clinical manifestations of appendicitis are variable. Patients who have an appendicolith usually develop appendicitis, often with perforation. A case is presented of 3-year follow-up of a patient with an appendicolith and acute recurrent appendicitis. The literature about appendicoliths is reviewed. In the appropriate clinical setting, a history of prior episodes of similar right lower quadrant pain does not preclude the diagnosis of appendiceal disease. Awareness of the less common forms of appendicitis is important so that appropriate treatment is not delayed. PMID:3052484

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

    PubMed

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

    2014-04-01

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

  6. Spontaneous perforation of Meckel's diverticulum: a case report and review of literature.

    PubMed

    Farah, Robleh Hassan; Avala, Prude; Khaiz, Driss; Bensardi, Fatmazahra; Elhattabi, Khalid; Lefriyekh, Rachid; Berrada, Saad; Fadil, Abdelaziz; Zerouali, Najib Ouariti

    2015-01-01

    Meckel's diverticulum is the commonest congenital abnormality of the gastrointestinal tract. Hemorrhage, obstruction and inflammation are the three main categories of complications resulting from Meckel's diverticulum. Spontaneously perforation of Meckel's diverticulum is very rare and mimics acute appendicitis. We report a case of 26 year-old male, who presented since 5 days worsening abdominal pain predominantly in the right iliac fossa associated with high grade fever. On physical examination his abdomen was distended with guarding and rigidity. A provisional diagnosis of appendiculaire peritonitis was made. Our patient had an emergency laparotomy, where a perforated Meckel's diverticulum and advanced peritonitis were discovered. A diverticulectomy with ileostomy were performed. Heterotopic mucosa of diverticulitis was confirmed on histopathology. The patient made an uneventful recovery postoperatively and ileostomy reconstruction was done two months later. This case report is an interesting and unusual case of Meckel's diverticulum complications and highlights the importance of considering Meckel's diverticulum as a differential diagnosis in every patient presenting with acute abdomen. PMID:26175810

  7. Bowel Perforation During Peritoneal Dialysis Catheter Placement.

    PubMed

    Abreo, Kenneth; Sequeira, Adrian

    2016-08-01

    Interventional nephrologists and radiologists place peritoneal dialysis catheters using the percutaneous fluoroscopic technique in both the inpatient and outpatient setting. Nephrologists caring for such patients may have to diagnose and manage the complications resulting from these procedures. Abdominal pain can occur following peritoneal dialysis catheter placement when the local and systemic analgesia wears off. However, abdominal pain with hypotension is suggestive of a serious complication. Bleeding into the abdomen and perforation of the colon or bladder should be considered in the differential diagnosis. In the case reported here, the peritoneogram showed contrast in the bowel, and correct interpretation by the interventionist would have prevented this complication. The characteristic pattern of peritoneogram images in this case will guide interventionists to avoid this complication, and the discussion of the differential diagnosis and management will assist nephrologists in taking care of such patients. PMID:26857647

  8. Intertwined Multiple Spiral Fracture in Perforated Sheets

    NASA Astrophysics Data System (ADS)

    Fuentealba, Juan-Francisco; Hamm, Eugenio; Roman, Benoît

    2016-04-01

    We study multiple tearing of a thin, elastic, brittle sheet indented with a rigid cone. The n cracks initially prepared symmetrically propagate radially for n ≥4 . However, if n <4 the radial symmetry is broken and fractures spontaneously intertwine along logarithmic spiral paths, respecting order n rotational symmetry. In the limit of very thin sheets, we find that fracture mechanics is reduced to a geometrical model that correctly predicts the maximum number of spirals to be strictly 4, together with their growth rate and the perforation force. Similar spirals are also observed in a different tearing experiment (this time up to n =4 , in agreement with the model), in which bending energy of the sheet is dominant.

  9. Intertwined Multiple Spiral Fracture in Perforated Sheets.

    PubMed

    Fuentealba, Juan-Francisco; Hamm, Eugenio; Roman, Benoît

    2016-04-22

    We study multiple tearing of a thin, elastic, brittle sheet indented with a rigid cone. The n cracks initially prepared symmetrically propagate radially for n≥4. However, if n<4 the radial symmetry is broken and fractures spontaneously intertwine along logarithmic spiral paths, respecting order n rotational symmetry. In the limit of very thin sheets, we find that fracture mechanics is reduced to a geometrical model that correctly predicts the maximum number of spirals to be strictly 4, together with their growth rate and the perforation force. Similar spirals are also observed in a different tearing experiment (this time up to n=4, in agreement with the model), in which bending energy of the sheet is dominant. PMID:27152809

  10. Detection of Perforators Using Smartphone Thermal Imaging.

    PubMed

    Hardwicke, Joseph T; Osmani, Omer; Skillman, Joanna M

    2016-01-01

    Thermal imaging detects infrared radiation from an object, producing a thermogram that can be interpreted as a surrogate marker for cutaneous blood flow. To date, high-resolution cameras typically cost tens of thousands of dollars. The FLIR ONE is a smartphone-compatible miniature thermal imaging camera that currently retails at under $200. In a proof-of-concept study, patients and healthy volunteers were assessed with thermal imaging for (1) detecting and mapping perforators, (2) defining perforasomes, and (3) monitoring free flaps. Preoperative, intraoperative, and postoperative thermograms can assist in the planning, execution, and monitoring of free flaps, and the FLIR ONE provides a low-cost adjunct that could be applied to other areas of burns and plastic surgery. PMID:26710006

  11. Viscous damping of perforated planar micromechanical structures

    PubMed Central

    Homentcovschi, D.; Miles, R.N.

    2008-01-01

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

  12. Dimensional scaling for impact cratering and perforation

    NASA Technical Reports Server (NTRS)

    Watts, Alan J.; Atkinson, Dale

    1995-01-01

    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.

  13. Visible Perforating Lateral Osteotomy: Internal Perforating Technique with Wide Periosteal Dissection.

    PubMed

    Rho, Bong Il; Lee, In Ho; Park, Eun Soo

    2016-01-01

    There are two general categories of lateral osteotomy techniques-the external perforating method and the internal continuous method. Regardless of which technique is used, procedural effectiveness is hampered by limited visualization in the surgical field. Considering this point, we devised a new technique that involves using a wide subperiosteal dissection and internal perforation under direct visualization. Using an intranasal approach, whereby the visibility of the intended fracture line was maintained, enabled a greater degree of control, and in turn, results that were more precise, and thus predictable and reproducible. Traditionally, it has been taken as dogma that the periosteum must be preserved, considering the potential for dead space and bony instability; however, under sufficient visualization of the surgical field with an internal perforating method, complete osteotomy with fully preserved intranasal mucosa could be conducted exactly as intended. This intact mucosal lining compensates for the elevated periosteum. Compressive dressing and drainage through a Silastic angio-needle catheter enabled the elimination of dead space. Therefore, precise, reproducible, and predictable osteotomy minimizing the potential for associated complications such as ecchymosis, that is, bruising owing to hemorrhage, could be performed. In this article, we introduce a novel technique for lateral osteotomy with improved visualization. PMID:26848452

  14. Visible Perforating Lateral Osteotomy: Internal Perforating Technique with Wide Periosteal Dissection

    PubMed Central

    Rho, Bong Il; Lee, In Ho

    2016-01-01

    There are two general categories of lateral osteotomy techniques—the external perforating method and the internal continuous method. Regardless of which technique is used, procedural effectiveness is hampered by limited visualization in the surgical field. Considering this point, we devised a new technique that involves using a wide subperiosteal dissection and internal perforation under direct visualization. Using an intranasal approach, whereby the visibility of the intended fracture line was maintained, enabled a greater degree of control, and in turn, results that were more precise, and thus predictable and reproducible. Traditionally, it has been taken as dogma that the periosteum must be preserved, considering the potential for dead space and bony instability; however, under sufficient visualization of the surgical field with an internal perforating method, complete osteotomy with fully preserved intranasal mucosa could be conducted exactly as intended. This intact mucosal lining compensates for the elevated periosteum. Compressive dressing and drainage through a Silastic angio-needle catheter enabled the elimination of dead space. Therefore, precise, reproducible, and predictable osteotomy minimizing the potential for associated complications such as ecchymosis, that is, bruising owing to hemorrhage, could be performed. In this article, we introduce a novel technique for lateral osteotomy with improved visualization. PMID:26848452

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

    PubMed Central

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

    2014-01-01

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

  16. Wave run-up on a coaxial perforated circular cylinder

    NASA Astrophysics Data System (ADS)

    Zhu, Da-Tong

    2011-06-01

    This paper describes a plane regular wave interaction with a combined cylinder which consists of a solid inner column and a coaxial perforated outer cylinder. The outer perforated surface is a thin porous cylinder with an annular gap between it and the inner cylinder. The non-linear boundary condition at the perforated wall is a prime focus in the study; energy dissipation at the perforated wall occurs through the resistance to the fluid across the perforated wall. Explicit analytical formulae are presented to calculate the wave run-up on the outer and inner surfaces of the perforated cylinder and the surface of the inner column. The theoretical results of the wave run-up are compared with previous experimental data. Numerical results have also been obtained: when the ratio of the annular gap between the two cylinders to incident wavelength ( b- a)/ L≤0.1, the wave run-up on the inner surface of the perforated cylinder and the surface of inner column can partially or completely exceed the incident wave height.

  17. Influence of operating microscope in the sealing of cervical perforations

    PubMed Central

    Schmidt, Bruna Schwingel; Zaccara, Ivana Maria; Reis Só, Marcus Vinícius; Kuga, Milton Carlos; Palma-Dibb, Regina Guenka; Kopper, Patrícia Maria Poli

    2016-01-01

    Context: Accidental root canal perforations are among the main complications of endodontic treatment. Aim: This study evaluated the influence of operating microscope (OM) in the marginal adaptation of mineral trioxide aggregate (MTA) (Angelus®) and glass ionomer (Vitremer) inserted into cervical perforations. Materials and Methods: Perforations were made in the cervical third of the buccal wall of the root canal in mandibular incisors. Next, the teeth were divided into four groups (N = 10): MG — MTA without OM; VG — Vitremer without OM; MOMG — MTA with OM; VOMG — Vitremer with OM. The perforations were sealed according to the group and the teeth were prepared for analysis by confocal laser scanning microscope. Images of perforation region (1,024×) were made and the gap presented by the materials was measured using the Image J program. LEXT OLS4100 three dimensional (3D) measuring laser microscope measured the volumetric misfit. Data of gap were analyzed by Kruskal-Wallis and Dunn's tests. Analysis of variance (ANOVA) and Tukey's tests compared the volumetric misfits. Results: The results showed lower volume and gap in the interface dentin/material in VOMG compared to the other groups (P < 0.05). Conclusion: The use of OM improved the quality of cervical perforations sealed with Vitremer, being indicated in clinical situations of iatrogenic cervical perforations. PMID:27099422

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

    PubMed

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

    2015-01-01

    A 19-year-old male patient underwent right percutaneous nephrolithotomy (PNL) for right renal 1.5 × 1.5 cm lower pole stone. The procedure was completed uneventfully with complete stone clearance. The patient developed peritonitis and shock 48 h after the procedure. Exploratory laparotomy revealed a large amount of bile in the abdomen along with three small perforations in the gall bladder (GB) and one perforation in the caudate lobe of the liver. Retrograde cholecystectomy was performed but the patient did not recover and expired post-operatively. This case exemplifies the high mortality of GB perforation after PNL and the lack of early clinical signs. PMID:26166971

  19. Congenital bowel perforation in twin-to-twin transfusion syndrome.

    PubMed

    Philip, I; Ford, A; Haslam, R

    2002-12-01

    Two unrelated survivors of twin-to-twin transfusion syndrome (TTTS) presented with intestinal perforation at birth. Both were localised perforations without any suggestion of widespread ischaemic disease to the splanchnic bed. Histopathology from the perforation site showed evidence of focal ischaemic necrosis, presumably from a vascular accident. One infant later died of multiple organ failure with major brain damage, but the other survived without long-term sequelae. These two cases appear to represent an unreported variation of the ischaemic intestinal complications of TTTS. PMID:12598976

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

    PubMed

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

    2015-07-01

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

  1. Primary perforating granulomatous folliculitis--scarring deep type.

    PubMed

    Arin, Meral J; Kurschat, Peter; Mahrle, Gustav

    2010-01-01

    Perforating folliculitis is characterized by asymptomatic skin-coloured or erythematous scattered and aggregated follicular papules with a central keratotic plug. Histologically, a superficial type can be distinguished from the profound type where perforations and rupture of the follicular wall take place at different levels of the hair follicle. This goes along with a granulomatous reaction of the entire pilary complex with destruction of the follicle epithelium and sebaceous gland. Often cases are associated with systemic disorders such as renal diseases or diabetes mellitus. We describe two patients with the profunda type of perforating folliculitis with scarring that manifested in early adulthood without any underlying disorders. PMID:20176545

  2. Double Guide Catheter Technique for Sealing an Iatrogenic Coronary Perforation

    PubMed Central

    Rodriguez-Santamarta, Miguel; Estevez-Loureiro, Rodrigo; Cuellas, Carlos; Benito-Gonzalez, Tomas; Perez de Prado, Armando; Lopez-Benito, Maria; Fernandez-Vazquez, Felipe

    2016-01-01

    Introduction: Coronary vessel perforation is one of the most feared complications of coronary angioplasty. The treatment of this complication relies mostly on the implantation of covered stents. However, due to their design, covered stents are difficult to advance in a tortuous or calcified vessel. Case Presentation: We present a case of a grade III coronary perforation in which the double guiding catheter technique helped us to deliver the graft stent. Conclusions: The double-guiding technique is useful in emergency situations to increase the safety and efficacy of sealing a coronary perforation. PMID:26949692

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

    SciTech Connect

    Hovem, K.; Joeranson, H.; Espedal, A.; Wilson, S.

    1995-12-31

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

  4. Perforation of the bowel due to cytomegalovirus infection in a man with AIDS: surgery is not always necessary!

    PubMed

    Yoganathan, Katie Tharshana; Morgan, Andrew Roger; Yoganathan, Kathir G

    2016-01-01

    Cytomegalovirus (CMV) infection is the most common viral opportunistic infection in immunocompromised patients and is a rare cause of bowel perforation. It invariably requires surgical intervention and is often fatal. We report a 50-year-old Caucasian man with AIDS, presented 3 weeks after developing abdominal pain and distension. He was treated for CMV retinitis in the past. His adherence to antiretroviral therapy was poor. Examination revealed a recurrence of active CMV retinitis. His abdomen was tender and distended. The plain X-ray of the abdomen revealed a double wall sign (Rigler's sign), indicating pneumoperitoneum due to the bowel perforation. The upper endoscopy was normal. His CD4 count was 30 cells/mm(3) He was treated with cidofovir infusion. He made a full recovery, without requiring any form of surgery. However, he died of adult respiratory distress syndrome 14 months later, due to iatrogenic acute pancreatitis. PMID:27440845

  5. Role of Multidetector Computed Tomography in the Diagnosis of Colorectal Perforations.

    PubMed

    Saturnino, Pietro Paolo; Pinto, Antonio; Liguori, Carlo; Ponticiello, Gianluca; Romano, Luigia

    2016-02-01

    Colonic perforations can be classified into perforations that occur at the site of a localized pathologic process and cecal perforations that occur secondary to distal colonic obstructions. Rectal perforations may result from foreign bodies inserted into the rectum; moreover, deep rectal biopsies, polypectomy, improper cleansing enema, or thermometer placement may also lead to rectal perforation. Correct identification of the cause and site of the perforation is crucial for appropriate management and surgical planning. Multidetector row computed tomography has a pivot role in planning the type of operative treatment, the prognosis, and in assessing those patients who have clinical symptoms of peritonitis but no radiographic signs of perforation. PMID:26827738

  6. Perforation forces of the intact porcine anterior lens capsule.

    PubMed

    Ullrich, Franziska; Lussi, Jonas; Felekis, Dimitrios; Michels, Stephan; Petruska, Andrew J; Nelson, Bradley J

    2016-09-01

    During the first step of cataract surgery, the lens capsule is perforated and a circular hole is created with a sharp instrument, a procedure called capsulorhexis. To develop automated systems that can assist ophthalmologists during capsulorhexis, the forces required must be quantified. This study investigates perforation forces of the central anterior lens capsule in porcine eyes, which are used as a conservative model for the human eye. A micro-mechanical characterisation method is presented that measures capsular bag perforation forces with a high precision positioning and high-resolution force sensing system. The force during perforation of the anterior lens capsule was measured with various sized needles and indentation speeds and is found to be 15-35mN. A bio-mechanical model is identified that describes an exponential correlation between indentation force and depth, indicating strain hardening behaviour of the porcine anterior lens capsule. PMID:27254279

  7. Oblique Perforation of Thick Metallic Plates by Rigid Projectiles

    NASA Astrophysics Data System (ADS)

    Chen, Xiaowei; Li, Qingming; Fan, Saucheong

    2006-08-01

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

  8. Pulmonary Artery Perforation Repair During Thrombectomy Using Microcoil Embolization

    SciTech Connect

    Tajima, Hiroyuki Murata, Satoru; Kumazaki, Tatsuo; Abe, Yutaka; Takano, Teruo

    2006-02-15

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

  9. Surgical Resection of Perforated Abomasal Ulcers in Calves

    PubMed Central

    Tulleners, E. P.; Hamilton, G. F.

    1980-01-01

    Surgical resection of perforating abomasal ulcers was successful in four of ten suckling calves. Mortality, usually occurring within 48 hours, was attributed to diffuse fibrinopurulent peritonitis, toxemia and shock. PMID:6254628

  10. A novel technique to close large perforation of sinus membrane

    PubMed Central

    CLEMENTINI, M.; OTTRIA, L.; PANDOLFI, C.; BOLLERO, P.

    2013-01-01

    SUMMARY Maxillary sinus floor elevation is generally accepted as a regenerative procedure to facilitate dental implants placement in the posterior atrophic maxilla. Although the sinus lift procedure is relatively safe, some potential problems could be occur. The most prevalent intraoperative complication is perforation of sinus membrane, which can lead to graft infection and early failure. The Aim of this work Is to present a new technique to repair large perforation of sinus membrane. This case report Is focused on a 10 mm perforation of sinus membrane occurred during preparation of the sinus window. The obliteration of the perforation was obtained by means of suturing sinus membrane with a resorbable material to the bone directly lateral to the osteotomy site. Sinus augmentation procedure could complete and the insertion of a graft was permitted. PMID:23991280

  11. Gallstone spillage caused by spontaneously perforated hemorrhagic cholecystitis

    PubMed Central

    Kim, Young Chul; Park, Mi-Suk; Chung, Yong Eun; Lim, Joon Suk; Kim, Myeong-Jin; Kim, Ki Whang

    2007-01-01

    There are occasional incidences of gallstone spillage during laparoscopic cholecystectomy, and there have been frequent reports on such a topic in the literature. To the best of our knowledge, however, there have been no reports about spilled stones caused by spontaneously perforated hemorrhagic cholecystitis. Here, we report the radiologic findings of spilled stones caused by spontaneously perforated hemorrhagic cholecystitis in a 55-year-old man. PMID:17907301

  12. Clinicopathological Analysis of Factors Related to Colorectal Tumor Perforation

    PubMed Central

    Medina-Arana, Vicente; Martínez-Riera, Antonio; Delgado-Plasencia, Luciano; Rodríguez-González, Diana; Bravo-Gutiérrez, Alberto; Álvarez-Argüelles, Hugo; Alarcó-Hernández, Antonio; Salido-Ruiz, Eduardo; Fernández-Peralta, Antonia M.; González-Aguilera, Juan J.

    2015-01-01

    Abstract Colorectal tumor perforation is a life-threatening complication of this disease. However, little is known about the anatomopathological factors or pathophysiologic mechanisms involved. Pathological and immunohistochemical analysis of factors related with tumoral neo-angiogenesis, which could influence tumor perforation are assessed in this study. A retrospective study of patients with perforated colon tumors (Group P) and T4a nonperforated (controls) was conducted between 2001 and 2010. Histological variables (differentiation, vascular invasion, and location) and immunohistochemical (CD31, Growth Endothelial Vascular Factor (VEGF) and p53) related with tumor angiogenesis were analyzed. Of 2189 patients, 100 (4.56%) met the inclusion criteria. Of these, 49 patients had nonperforated (2.23%) and 51 had perforated tumors (2.32%). The P group had lower number of right-sided tumors (7/51, 13.7%) compared with controls (13/49, 36.7%) (P = .01). The high-grade tumors (undifferentiated) represented only 3.9% of the perforated tumors; the remaining 96.1% were well differentiated (P = .01). No differences between groups in the frequency of TP53 mutation or VEGF and CD31 expression were found. In the P group, only 2 (3.9%) had vascular invasion (P = .01). Of the 12 tumors with vascular invasion, only 2 were perforated (16.6%). The median number of metastatic lymph-nodes in P Group was 0 versus 3 in controls (Z = −4.2; P < .01). Pathological analysis of variables that indirectly measure the presence of tumor angiogenesis (differentiation, vascular invasion, and the number of metastatic lymph nodes) shows a relationship between this and the perforation, location, and tumor differentiation. We could not directly validate our hypothesis, by immunohistochemistry of TP53, VEGF, and CD31, that perforated tumors exhibit less angiogenesis. PMID:25881846

  13. Perforated-Layer Implementation Of Radio-Frequency Lenses

    NASA Technical Reports Server (NTRS)

    Dolgin, Benjamin P.

    1996-01-01

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

  14. An unusual presentation of colon perforation following percutaneous nephrolithotomy

    PubMed Central

    Chubak, Barbara; Stern, Joshua M.

    2014-01-01

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

  15. Megacystis microcolon intestinal hypoperistalsis syndrome complicated by perforation.

    PubMed

    Jain, Vishal K; Garge, Saurabh; Singh, Sangram; Lahoti, Brijesh

    2011-01-01

    Megacystis microcolon intestinal hypoperistalsis syndrome (MMIHS) is a quite rare congenital and fatal disease. The disease is three to four times more prevalent in females than males. Most of the cases die within the early months of their lives. We present the case of a newborn male with antenatal ultrasound suggesting the diagnosis of MMIHS. The case was admitted for perforation complicated with prematurity after birth. This case is th e only one where MMIHS presented as perforation. PMID:21478590

  16. Tympanic membrane perforation descriptors and hearing levels in otitis media.

    PubMed

    Prasansuk, S; Hinchcliffe, R

    1982-01-01

    The air conduction threshold of hearing was determined at 0.5,1 and 2 kHz by manual audiometry on a consecutive series of young Thai adults with bilateral chronic suppurative otitis media. At the same time, after visual inspection of each tympanic membrane, the perforation was drawn, as faithfully as possible in respect of both shape and relative size, on a 40-mm diagram of a tympanic membrane. A study of the shapes of perforations showed that they could be described as elliptical, reniform or cardioid. For the purposes of calculating the area of a perforation, a reniform perforation was considered to be the result of substracting a smaller ellipse from a larger ellipse, which ellipses were in contact at the point of least curvature. The hearing threshold level was found to be a function of the size of the perforation. A power function best described this relationship. The relationship was such that a total perforation would be associated with a hearing loss of about 60 dB HL over the frequency range 0.5-2 kHz. PMID:7055479

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

    PubMed Central

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

    2014-01-01

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

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

    PubMed

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

    2014-01-01

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

  19. Perforator propeller flaps for sacral and ischial soft tissue reconstruction

    PubMed Central

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

    2010-01-01

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

  20. On the phenomenology of the perforating vein of the elbow.

    PubMed

    Lomonte, Carlo; Basile, Carlo

    2009-01-01

    The perforating veins, as the name suggests, are the veins that perforate the muscular aponeuroses ensuring communication between the superficial and the deep veins. Located at the bend of the elbow, almost constantly, there is a vein, named perforating vein of the elbow, which is of great interest to the nephrologist who is responsible for the management of vascular access for hemodialysis (HD). It represents, in fact, because of its intrinsic characteristics and topographical reasons, a valuable resource for the creation of a vascular access for HD, especially in obese patients, elderly patients, diabetics, and patients affected by peripheral vasculopathy. Arterio-venous fistulae (AVF) constructed with the perforating vein of the elbow are relatively easy to perform, have an excellent patency rate, a low incidence of early thrombosis, adequate flows, and a low incidence of the steal syndrome. In other types of AVFs, the perforating vein of the elbow subtracts flow to the superficial veins slowing or preventing their full maturation, and can become a problem in measuring the blood flow of the AVF. But still, its presence can maintain patent a fistula in case of poor compliance of the superficial veins, while awaiting for interventional procedures able to accelerate a subsequent maturation. This review intends to explore the role that the perforating vein of the elbow plays in the physiology and pathology of the AVF, in relation to the issues that most frequently occur in clinical practice. PMID:19573011

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

    PubMed Central

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

    2014-01-01

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

  2. Single-Port Laparoscopic Interval Appendectomy for Perforated Appendicitis With a Periappendiceal Abscess

    PubMed Central

    Bae, Sung Uk; Jeong, Woon Kyung

    2016-01-01

    Purpose Nonoperative management followed by an interval appendectomy is a commonly used approach for treating patients with perforated appendicitis with abscess formation. As minimally-invasive surgery has developed, single-port laparoscopic surgery (SPLS) is increasingly being used to treat many conditions. We report our initial experience with this procedure using a multichannel single-port. Methods The study included 25 adults who underwent a single-port laparoscopic interval appendectomy for perforated appendicitis with periappendiceal abscess by using a single-port with or without needlescopic grasper between June 2014 and January 2016. Results Of the 25 patients, 9 (36%) required percutaneous drainage for a median of 7 days (5–14 days) after insertion, and 3 (12%) required conversion to reduced-port laparoscopic surgery with a 5-mm port insertion because of severe adhesions to adjacent organs. Of 22 patients undergoing SPLS, 13 underwent pure SPLS (52.0%) whereas 9 patients underwent SPLS with a 2-mm needle instrument (36.0%). Median operation time was 70 minutes (30–155 minutes), and a drainage tube was placed in 9 patients (36.0%). Median total length of incision was 2.5 cm (2.0–3.0 cm), and median time to soft diet initiation and length of stay in the hospital were 2 days (0–5 days) and 3 days (1–7 days), respectively. Two patients (8.0%) developed postoperative complications: 1 wound site bleeding and 1 surgical site infection. Conclusion Conservative management followed by a single-port laparoscopic interval appendectomy using a multichannel single-port appears feasible and safe for treating patients with acute perforated appendicitis with periappendiceal abscess. PMID:27437392

  3. Simulating perforation permeability damage and cleanup

    SciTech Connect

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

    2000-12-15

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

  4. Simulating Perforation Permeability Damage and Cleanup

    SciTech Connect

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

    2000-09-01

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

  5. A hypervelocity projectile launcher for well perforation

    SciTech Connect

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

    1989-01-01

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

  6. [Intraperitoneal perforation of hepatic hydatid cyst].

    PubMed

    El Malki, Hadj Omar; El Mejdoubi, Yasser; Mohsine, Raouf; Ifrine, Lahcen; Belkouchi, Abdelkader

    2006-10-01

    The incidence of the rupture of hydatid cyst of the liver is about 15 to 40% of the cases. In 2 to 7% of the cases the cyst can perforate into the peritoneum. The occurrence of a sclerosing peritonitis secondary to the rupture of the hydatid cyst of the liver was described, to our knowledge, only once. We report the observation of a 43 year-old woman in whom the diagnostis of peritoneal rupture of a liver hydatid cyst was made after 3 months. The patient was treated by albendazole (10 mg/kg/d). Two months after the beginning of this treatment, the patient was operated. A sclerosing peritonitis was discovered. The parasitologic studies of the different specimens were negative. The surgical treatment consisted of a good washing with H2O2 of the fibrous hull of the sclerosing peritonitis and drainage without any dissection. The evolution was satisfactory with albendazole treatment for 14 months. Currently, she is in good health without recurrence and without any abnormalities with a 2 years follow-up. We think that albendazole in the treatment of the hydatid disease is very effective in condition to give a continuous treatment for a long time. The occurrence of a sclerosing peritonitis is fortunately an exceptional situation whose surgical management is very delicate. PMID:17075481

  7. UNDESCENDED TESTICLE COMPLICATING ACUTE APPENDICITIS*

    PubMed Central

    Herzig, Maximilian L.

    1924-01-01

    1. Symptoms referable to compression of the spermatic cord and incarceration of right testicle, obscure the underlying pathologic changes occurring in the vermiform appendix. 2. Testicular underdevelopment and resulting subnormal cerebration. 3. Operative technique: (a) Pre-operative diagnosis: Incarceration of right testicle and possible perforative appendicitis. (b) Descent of right incarcerated testicle. Bassini closure. (c) Exploratory laparotomy: Intramuscular gridiron incision. 4. Operative findings: (a) Strangulation and incarceration of undescended right testicle and spermatic cord in inguinal canal. (b) Copious pus, free in peritoneal cavity. An adherent, sloughing, perforative, retrocecal appendix identified, left undisturbed and free drainage established. 5. Progress: (a) Eventful recovery from acute suppurative appendicitis following drainage of appendical focus. (b) Marked development following the operative descent of an incarcerated testicle in a backward boy, age twelve, who had a bilateral cryptorchism. PMID:18739377

  8. Perforated Gastric Gangrene without Pneumothorax in an Adult Bochdalek Hernia due to Volvulus

    PubMed Central

    Sebastian, George Mathew; Ambady, Venugopal; Hariharan, Ramesh

    2016-01-01

    Bochdalek hernia is the most frequent congenital diaphragmatic hernia which occurs due to a defect in the posterior attachment of the diaphragm when there is a failure of closure of the pleuroperitoneal membrane in utero. It rarely presents for the first time in adults. We report one such case of a 23-year-old male patient who presented with an acute abdomen. Chest X-ray showed air under diaphragm and he was taken up for an emergency laparotomy. Intraoperatively an organoaxial volvulus of the stomach was found in a bochdaleks hernia with a focal gangrene of the stomach fundus with perforation and peritonitis. However, there was no breach of pleural cavity. A sleeve resection of the gangrenous portion of the stomach was performed and the diaphragmatic defect was repaired. Patient made an uneventful postoperative recovery. Gastric gangrene with perforation as a manifestation of the adult bochdalek hernia is indeed rare. A concomitant pneumothorax occurs along with this condition which requires an intercostal drainage tube prior to the laparotomy. We report this case for its unique presentation without pneumothorax. PMID:27190884

  9. Differential Recruitment of Dentate Gyrus Interneuron Types by Commissural Versus Perforant Pathways.

    PubMed

    Hsu, Tsan-Ting; Lee, Cheng-Ta; Tai, Ming-Hong; Lien, Cheng-Chang

    2016-06-01

    Gamma-aminobutyric acidergic (GABAergic) interneurons (INs) in the dentate gyrus (DG) provide inhibitory control to granule cell (GC) activity and thus gate incoming signals to the hippocampus. However, how various IN subtypes inhibit GCs in response to different excitatory input pathways remains mostly unknown. By using electrophysiology and optogenetics, we investigated neurotransmission of the hilar commissural pathway (COM) and the medial perforant path (MPP) to the DG in acutely prepared mouse slices. We found that the short-term dynamics of excitatory COM-GC and MPP-GC synapses was similar, but that the dynamics of COM- and MPP-mediated inhibition measured in GCs was remarkably different, during theta-frequency stimulation. This resulted in the increased inhibition-excitation (I/E) ratios in single GCs for COM stimulation, but decreased I/E ratios for MPP stimulation. Further analysis of pathway-specific responses in identified INs revealed that basket cell-like INs, total molecular layer- and molecular layer-like cells, received greater excitation and were more reliably recruited by the COM than by the MPP inputs. In contrast, hilar perforant path-associated and hilar commissural-associational pathway-related-like cells were minimally activated by both inputs. These results demonstrate that distinct IN subtypes are preferentially recruited by different inputs to the DG, and reveal their relative contributions in COM-mediated feedforward inhibition. PMID:26045570

  10. Effects of cortical bone perforation on experimental guided bone regeneration.

    PubMed

    Nishimura, Ichiro; Shimizu, Yoshinaka; Ooya, Kiyoshi

    2004-06-01

    This study was designed to evaluate the effects of cortical bone perforation histologically and histomorphometrically on guided bone regeneration (GBR) in rabbits. After elimination of the periosteum, cortical bone defects of two sizes were made in the external cortical plate of the frontal bone (Group A: 1 x 15 mm; Group B: 3 x 15 mm). A non-resorbable membrane filled with autogenous blood was placed in the experimental area and secured with titanium pins. After 1 and 2 weeks, vascularized connective tissue and new bone were generated in the space surrounding the defects in both the groups. The amount of vascularized connective tissue generated in Group B was greater than that in Group A at 1 week. Alkaline phosphatase (ALP) was expressed on the bone surrounding the perforation. The expression of ALP was more extensive in Group B than in Group A and was proportional to the breadth of perforation. At 2 weeks, the perforated region was almost covered with new bone in Group A. ALP was expressed at the periphery of newly formed bone. The expression of ALP was proportional to the breadth and height of perforation. At 6 weeks, semicircular outgrowth of bone towards the periphery of the perforated region was observed in both the groups. Newly formed bone volume and ALP expression in Group B were more extensive than those in Group A. At 12 weeks, the space was filled with bone and connective tissue in both the groups. There was no difference in ALP expression between Groups A and B. Histomorphometric analysis showed significant differences between both the groups (two-way ANOVA, P<0.01). We conclude that a larger perforation is associated with prompter bone formation in the secluded space during GBR. PMID:15142091

  11. A classification system for sinus membrane perforations during augmentation procedures with options for repair.

    PubMed

    Vlassis, J M; Fugazzotto, P A

    1999-06-01

    A classification system for sinus membrane perforations encountered during a sinus augmentation procedure is presented. Five of the perforations are discussed, as are the therapeutic options for their repair. Class I and Class II perforations are most easily repaired, while Class IV is the most difficult to successfully treat. In addition, the effect of the sinus membrane perforation on the course of proposed therapy is discussed. When classified and managed appropriately, sinus membrane perforations are not an absolute indication for aborting the augmentation procedure which is in progress. This paper provides a system of classification that can be used by clinicians to collect data on membrane perforations and repair results. PMID:10397526

  12. Unexpected Delayed Colon Perforation after the Endoscopic Submucosal Dissection with Snaring of a Laterally Spreading Tumor

    PubMed Central

    Ko, Young Bo; Lee, Jeong-Mi; Kim, Wan Soo; Kwak, Min Seob; Lee, Ji Wan; Shin, Dong Yeol; Yang, Dong-Hoon; Byeon, Jeong-Sik

    2015-01-01

    Colonic perforation may occur as a complication of diagnostic and therapeutic colonoscopy. The risk factors for perforation after colorectal endoscopic submucosal dissection (ESD) include an inexperienced endoscopist, a large tumor size, and submucosal fibrosis. The mechanisms of perforation include unintended endoscopic resection/dissection and severe thermal injury. Here, we report a case of colon perforation that occurred after ESD with snaring of a laterally spreading tumor. The perforation was completely unexpected because there were no colorectal ESD-associated risk factors for perforation, deep dissection, or severe coagulation injury in our patient. PMID:26668808

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

    SciTech Connect

    Ozkan, Ugur

    2009-09-15

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

  14. Synovial fluid dynamics with small disc perforation in temporomandibular joint.

    PubMed

    Xu, Y; Zhan, J; Zheng, Y; Han, Y; Zhang, Z; Xi, Y; Zhu, P

    2012-10-01

    The articular disc plays an important role as a stress absorber in joint movement, resulting in stress reduction and redistribution in the temporomandibular joint (TMJ). The flow of synovial fluid in the TMJ may follow a regular pattern during movement of the jaw. We hypothesised that the regular pattern is disrupted when the TMJ disc is perforated. By computed tomography arthrography, we studied the upper TMJ compartment in patients with small disc perforation during jaw opening-closing at positions from 0 to 3 cm. Finite element fluid dynamic modelling was accomplished to analyse the pattern of fluid flow and pressure distribution during the movements. The results showed that the fluid flow in the upper compartment generally formed an anticlockwise circulation but with local vortexes with the jaw opening up to 2 cm. However, when the jaw opening-closing reached 3 cm, an abnormal flow field and the fluid pressure change associated with the perforation may increase the risk of perforation expansion or rupture and is unfavourable for self-repair of the perforated disc. PMID:22582815

  15. Colon perforation related to percutaneous nephrolithotomy: from diagnosis to treatment.

    PubMed

    Akbulut, Fatih; Tok, Adem; Penbegul, Necmettin; Daggulli, Mansur; Eryildirim, Bilal; Adanur, Senol; Gurbuz, Gokhan; Celik, Huseyin; Utangac, Mehmet Mazhar; Dede, Onur; Bodakcı, Mehmet Nuri; Tepeler, Abdulkadir; Sarica, Kemal

    2015-11-01

    We present our experience with the largest series of colon perforation (CP) as complication of percutaneous nephrolithotomy (PNL). From January 1998 to August 2014, 22 cases that presented with PNL-related CP from seven referral centers were retrospectively reviewed. The patients with CP were evaluated in terms of probable risk factors. Peri-operative and postoperative findings, timing of diagnosis, and treatment modalities of the CP were reviewed. Of the 22 patients, previous ipsilateral renal surgery (n:2) and retrorenal colon (n:5) were the risk factors for CP. The CP was directly visualized via nephroscopy during the surgery in 3 (13.6%) and with nephrostography at the end of the procedure in 4 patients (18.2%). In two patients, perforation was realized via the passage of contrast into the colon with nephrostography on the postoperative second day. Postoperative passage of feces through the nephrostomy tube was seen in six patients. The clinical signs in 13 cases directed CP diagnosis. The confirmation of the CP was achieved with a CT scan in all the patients. The patients with extraperitoneal perforation were primarily managed conservatively. Open surgical treatment was performed in cases with intraperitoneal perforation (n:5) and those with extraperitoneal perforation resistant to conservative treatment (n:5). Meticulous evaluation of the risk factors preoperatively is the initial step in the prevention of CP. Timely diagnosis plays essential role in the management of this PNL complication. Although extraperitoneal CP may be managed conservatively, surgery is required for intraperitoneal CPs. PMID:26033042

  16. Endoscopic duodenal perforation: surgical strategies in a regional centre

    PubMed Central

    2014-01-01

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

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

    PubMed Central

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

    2014-01-01

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

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

    PubMed

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

    2014-02-01

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

  19. Cascaded Perforates as One-Dimensional, Bulk Absorbers

    NASA Technical Reports Server (NTRS)

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

    2006-01-01

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

  20. Serrated needle design facilitates precise round window membrane perforation.

    PubMed

    Stevens, James P; Watanabe, Hirobumi; Kysar, Jeffrey W; Lalwani, Anil K

    2016-07-01

    The round window membrane (RWM) has become the preferred route, over cochleostomy, for the introduction of cochlear implant electrodes as it minimizes inner ear trauma. However, in the absence of a tool designed for creating precise perforation, current practices lead to tearing of the RWM and significant intracochlear pressure fluctuations. On the basis of RWM mechanical properties, we have designed a multi-serrated needle to create consistent holes without membrane tearing or damaging inner ear structures. Four and eight-serrated needles were designed and produced with wire electrical discharge machining (EDM). The needle's ability to create RWM perforations was tested in deidentified, commercially acquired temporal bones with the assistance of a micromanipulator. Subsequently, specimens were imaged under light and scanning electron microscopy (SEM). The needles created consistent, appropriately sized holes in the membrane with minimal tearing. While a four-serrated crown needle made rectangular/trapezoid perforations, the octagonal crown formed smooth oval holes within the membrane. Though designed for single use, the needle tolerated repeated use without significant damage. The serrated needles formed precise perforations in the RWM while minimizing damage during cochlear implantation. The octagonal needle design created the preferred oval perforation better than the quad needle. © 2016 Wiley Periodicals, Inc. J Biomed Mater Res Part A: 104A: 1633-1637, 2016. PMID:26914984

  1. Alcoholic delirium tremens with hollow viscus perforation scheduled for emergency laparotomy.

    PubMed

    Talikoti, Anand T; Sindhu, Bs; Kavyashree, Sp; Kumar, Ks Kishore

    2012-03-01

    Alcohol is a drug consumed at some time in life by up to 80% of the population according to western statistics. Wide differences in socioeconomic status in India contribute to various degrees and severity of alcoholism and its associated complications. The symptoms of alcohol withdrawal range from such minor ones as insomnia and tremulousness to severe complications such as withdrawal seizures and delirium tremens. Although alcohol withdrawal syndrome has been reported in the literature in post-operative periods and in Intensive Care Unit, there is paucity of information on treatment and preparation of a patient with alcohol withdrawal syndrome coming for emergency surgical procedures. The surgical stress and deranged liver function in such cases poses an additional challenge to the anaesthesiologist. Here, we report the successful management of a case of acute alcoholic delirium tremens who presented with hollow viscous perforation for emergency exploratory laparotomy. PMID:22701216

  2. Acute cholecystitis

    MedlinePlus

    ... that forms in the wall of the gallbladder) Pancreatitis (inflamed pancreas) Persistent bile duct blockage Inflammation of ... draining the liver (may occur after gallbladder surgery) Pancreatitis Perforation Peritonitis (inflammation of the lining of the ...

  3. Relationship between sympathetic nervous activity and inflammatory response after subarachnoid hemorrhage in a perforating canine model.

    PubMed

    Gao, Cheng; Liu, Xiangzhen; Shi, Huaizhang; Xu, Shancai; Ji, Zhiyong; Wang, Chunlei; Wu, Pei; Liu, Zhen; Zhao, Shiguang

    2009-05-11

    The objective of the present study was to evaluate the correlation between sympathetic nerve activation and inflammatory response in the acute stage of subarachnoid hemorrhage (SAH) in a canine perforating model. SAH was induced by perforation of the basilar artery with the use of a microcatheter via the femoral artery in 20 mongrel dogs. Hemodynamic parameters and intracranial pressure were recorded, and blood sample for C3a, C5b-9, IL-6, IL-8 and noradrenaline kinetic determination were measured at 0, 5, 15, 30, 60, 120, and 180 min after SAH. Noradrenaline (pg/mL) increased abruptly from 104+/-59 to 2010+/-918 at 5 min after SAH. C3a and C5b-9 reached peak values at 15 min and IL-6 and IL-8 reached peak values at 30 min after SAH, respectively. The peak values of C3a and C5b-9 correlated positively with the peak value of noradrenaline (r=0.743 and r=0.753, respectively). The peak values of IL-6 and IL-8 also correlated positively with the peak values of noradrenaline (r=0.603 and r=0.681, respectively).These results suggest that a pronounced activation of the sympathetic nervous system and the inflammatory response occurs in acute stage of SAH. Significant association between the rate of spillover of norepinephrine to plasma and the plasma levels of inflammatory markers indicates that the two processes, sympathetic activation and immune response are quantitatively linked in early stage after SAH. The exact mechanisms underlying this phenomenon deserved further investigations. PMID:19217831

  4. Extensive Mine-Shrapnel and Gunshot Wound Closure Using Keystone Island Perforator Flaps

    PubMed Central

    Sliesarenko, Sergii V.; Sliesarenko, Kirill S.

    2016-01-01

    Background: During military operations, one aspect of a plastic surgeon’s work is to restore extensive and deep wound defects in a short period of time and provide a high degree of functional recovery to the damaged area. Because many injuries caused by military operations cannot be closed using a primary suture, the specialist has to select another surgical approach to close the wound defect. Surgeons must select methods that not only cover the extensive wound defect in 1 step but also allow skin coverage that is anatomically, functionally, and visually similar to the surrounding tissues to reduce the length of the hospital stay and ensure optimal functional recovery of the damaged organ. Methods: From 2014 to 2015, 25 patients underwent 36 reconstructions at our center after receiving mine-shrapnel and gunshot wounds. All reconstructions occurred during the acute period and used keystone island perforator flaps. The authors’ wound management technique was characterized by an aggressive surgical and antibiotic therapy protocol. Results: In all cases, after surgical debridement, the mine-shrapnel and gunshot wound defects were completely closed in 1 stage during the acute period. The working time in the operating room to perform the transposition of the flap ranged from 45 to 90 minutes, with an average of 68 minutes. All displaced flaps were similar in structure and color to the surrounding tissues and did not change the contours of the body. The adequate restoration of skin allowed patients to begin early recovery of functional activity. Conclusions: Local keystone island perforator flaps can be considered one of the primary methods of plastic closure of extensive defects caused by mine-shrapnel and gunshot wounds at different anatomical locations, providing that the tissue surrounding the defect is intact and usable as a donor resource. PMID:27579247

  5. Unusual presentation of sigmoid diverticulitis as an acute scrotum.

    PubMed

    Klutke, C G; Miles, B J; Obeid, F

    1988-02-01

    We report a case of inflammation of the spermatic cord and testicle resulting from a perforated diverticulum of the sigmoid colon. Management included sigmoid resection with diversion, right orchiectomy and débridement of the right groin. To our knowledge this is the first reported case of retroperitoneal necrotizing fasciitis presenting initially as an acute scrotum. PMID:3339751

  6. Intestinal perforation management using T-tube drainage

    PubMed Central

    Wakahara, Tomoyuki; Kaji, Masahide; Harada, Yuko; Tsuchida, Shinobu; Toyokawa, Akihiro

    2016-01-01

    In cases of small bowel perforation with gross contamination, enterostomy has traditionally been the treatment of choice. An 86-year-old woman was diagnosed with perforative peritonitis. Emergency laparotomy revealed a small bowel perforation with gross contamination, and a T-tube enterostomy was performed. The T-tube was used for intestinal decompression for the first few days and was then accompanied by enteral feeding. When oral intake was sufficient, the T-tube was removed. The abdominal wall’s fistula healed within 2 days of removal. Except for wound infection, the patient developed no postoperative complications. Under specific circumstances, a T-tube enterostomy can be an effective alternative for a traditional enterostomy. Its advantages include less or no anastomotic leakage, easier management of fluid and electrolyte levels, postoperative enteral feeding from the tube, a shorter operative time and no need for a second operation to close the stoma. PMID:27177890

  7. Perforation of esophagus and subsequent mediastinitis following mussel shell ingestion

    PubMed Central

    Park, Il Hwan; Lim, Hyun Kyo; Song, Seung Woo

    2016-01-01

    Esophageal perforation is a very rare occurrence because accidental swallowing of foreign bodies is uncommon in adults. Thus, perforation due to swallowing of a foreign body and subsequent development of mediastinitis is rarely encountered by physicians. We experienced such a case and described an adult male patient who had perforated esophagus after accidentally swallowing a mussel shell. The patient visited our emergency department complaining of painful dysphagia for 4 days. A review of history revealed that he consumed a spicy seafood noodle soup containing mussel shells 4 days ago. Computed tomography (CT) of the chest showed the foreign body in the esophagus and pneumomediastinum was identified. We removed the mussel shell fragment using rigid esophagoscopy; explo-thoracotomy, debridement of mediastinal abscess and irrigation were performed.

  8. [Intrathoracic esophageal perforation of unknown cause in four horses].

    PubMed

    Graubner, C; Gerber, V; Imhasly, A; Gorgas, D; Koch, C

    2011-10-01

    Three horses (age 17 - 23 years) were referred to the equine clinic of the University of Berne due to colic, fever, tachycardia and tachypnea. All horses showed pleural effusion. Clinical findings in 2 of the horses were highly suggestive of an intra-thoracic esophageal perforation. Severe septic pleuropneumonia without suspicion of an esophageal lesion was diagnosed in the 3rd horse. In addition, an 11 year old stallion was referred to the equine clinic for treatment of a presumptive large colon impaction. The horse was given laxatives after nasogastric intubation. Subsequent dramatic clinical deterioration and signs consistent with severe pleuropneumonia suggest that esophageal perforation had occurred when passing the nasogastric tube. All 4 horses were euthanized due to a poor prognosis. Esophageal perforation was diagnosed or confirmed post mortem in all cases. A hypertrophy of the tunica muscularis of the intra-thoracic esophagus was found in 3 of 4 horses. PMID:21971675

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

    PubMed Central

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

    2011-01-01

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

  10. Primary Gastro Intestinal Lymphoma Presenting as Perforation Peritonitis

    PubMed Central

    Ramachandra, Chandrashekar Shastry; Jackaya, Reuben Prakash

    2016-01-01

    Primary gastrointestinal lymphoma is very rare compared to gastrointestinal tract lymphoma arising Secondary to Primary nodal disease. Extra nodal lymphoma can involve any part of the gastrointestinal tract, most commonly being the stomach followed by small intestine and ileocecal region. They are indistinguishable from other benign and malignant conditions and clinically non-specific. Here, we have an interesting case where a patient presented with peritonitis and was found to have a perforated swelling in jejunum. Subsequently resection and anastomosis was done. Biopsy showed lymphoma. Patient was evaluated further by doing CECT of abdomen and thorax, which didn’t show any other site of lymphadenopathy. Patient improved with chemotherapy and is on regular follow up. Perforation in patient undergoing treatment for lymphoma are common but presentation of primary gastrointestinal lymphoma as perforation is rare and needs proper evaluation and management. PMID:27134938

  11. Acoustic Liner Drag: Measurements on Novel Facesheet Perforate Geometries

    NASA Technical Reports Server (NTRS)

    Howerton, Brian M.; Jones, Michael G.

    2016-01-01

    Interest in characterization of the aerodynamic drag of acoustic liners has increased in the past several years. This paper details experiments in the NASA Langley Grazing Flow Impedance Tube to quantify the relative drag of several perforate-over-honeycomb liner configurations at flow speeds of centerline flow Mach number equals 0.3 and 0.5. Various perforate geometries and orientations are investigated to determine their resistance factors using a static pressure drop approach. Comparison of these resistance factors gives a relative measurement of liner drag. For these same flow conditions, acoustic measurements are performed with tonal excitation from 400 to 3000 hertz at source sound pressure levels of 140 and 150 decibels. Educed impedance and attenuation spectra are used to determine the impact of variations in perforate geometry on acoustic performance.

  12. Microsporidium infection and perforation peritonitis: A rare association

    PubMed Central

    Tanveer, Nadeem; Barman, Sandip

    2015-01-01

    Enteric protozoan infections are a well-documented cause of diarrhea in immunocompromised patients. Special stains on stool specimens are routinely performed in such patients to diagnose these protozoa namely cryptosporidium, microsporidium, and isospora. Duodenal and jejunal biopsies can also be performed to obtain a tissue diagnosis. We report a case of microsporidium enteritis diagnosed on histopathological examination of small bowel resection specimen in a case of perforation peritonitis. The patient was a known HIV-positive on antiretroviral treatment for 2 years and on antitubercular treatment for 3 months. This case report highlights the importance of carefully screening the resection specimens for protozoal infections in immunocompromised individuals. The association of perforation peritonitis and microsporidium is rare. Hence, the possibility that untreated microsporidium infection can lead to perforation cannot be ruled out. PMID:26692615

  13. Pneumoperitoneum secondary to a perforated gastric ulcer in a cat.

    PubMed

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

    2003-06-15

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

  14. Procedural design considerations associated with tubing-conveyed underbalanced perforating

    SciTech Connect

    Young, W.S.; Zaleski, T.E.

    1985-03-01

    Thirty-two tubing conveyed underbalanced perforating jobs conducted in the Gulf of Mexico between May, 1980, and May, 1982, have been carefully reviewed in order to draw correlations between procedural variations and trouble prone jobs. General procedural guidelines designed to avoid past problems were formulated and are presented. The procedures are designed for the generalized case where the perforating guns will be pulled out of the well in order to gravel pack and not for those run as part of a permanent completion. Careful application of these procedural guidelines has resulted in reducing rig time requirements by an average of 35% on 33 additional tubing conveyed underbalanced perforating jobs conducted subsequent to the establishment of the guidelines contained in this paper.

  15. High-energy gas fracturing in cased and perforated wellbores

    SciTech Connect

    Cuderman, J.F.

    1986-06-01

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

  16. Esophageal perforation during gastric bypass: delayed diagnosis and management.

    PubMed

    Endara, Santiago A; Serrano, Armando J; Sandoval, Bernardo A; Davalos, Gerardo A

    2007-07-01

    Mediastinitis secondary to esophageal perforation is usually a life-threatening problem associated with high morbidity and mortality. We present a 44-year-old morbidly obese female who underwent laparoscopic gastric bypass, during which she suffered perforation of the distal thoracic esophagus diagnosed 5 days later during progression of mediastinitis. She was treated with left posterolateral thoracotomy, drainage of a peri-esophageal abscess and primary repair of the esophagus with intercostal muscle reinforcement, and cervical esophagostomy. Thereafter, she had an uneventful hospital course, and remains well on 12-month follow-up. PMID:17894163

  17. Magnetic resonance angiography in perforator flap breast reconstruction.

    PubMed

    Vasile, Julie V; Levine, Joshua L

    2016-04-01

    Magnetic resonance angiography (MRA) is an extremely useful preoperative imaging test for evaluation of the vasculature of donor tissue to be used in autologous breast reconstruction. MRA has sufficient spacial resolution to reliably visualize 1 mm perforating vessels and to accurately locate vessels in reference to a patient's anatomic landmarks without exposing patients to ionizing radiation or iodinated contrast. The use of a blood pool contrast agent and the lack of radiation exposure allow multiple studies of multiple anatomic regions in one examination. The following article is a detailed description of our MRA protocol developed with our radiologists with examples that illustrate the utility of MRA in perforator flap breast reconstruction. PMID:27047787

  18. Radiographic signs of gastrointestinal perforation in children: A pictorial review

    PubMed Central

    Awolaran, Olugbenga T.

    2015-01-01

    Plain abdominal radiographs remain an important aid for clinicians in the diagnosis of gastrointestinal perforation, especially in neonates and very sick children where clinical features of peritonitis may not be as prominent. Suggestive radiographic features are not always very obvious, especially when taken in the supine position and may lead to delayed or missed diagnosis. Through a pictorial review of plain radiographs, this article highlights a number of documented features of gastrointestinal perforation on X-ray in the paediatric setting, which increases the accuracy of diagnosis. PMID:26612119

  19. Ileal perforation caused by cytomegalovirus infection in an immunocompetent adult.

    PubMed

    Van Schaeybroeck, S; Hiele, M; Miserez, M; Croes, R

    2002-01-01

    A 71-year-old woman developed a small bowel perforation due to cytomegalovirus infection. She did not taken any immunosuppressive medication and her cellular immunity was normal. Surgical resection and antiviral therapy with ganciclovir led to complete recovery. As far as we know, this paper reports the first case of small bowel perforation due to cytomegalovirus infection in a non-immunocompromised patient. Nevertheless the patient was known with diabetes mellitus. It should be emphasised that elderly patients have impaired immune defences and may be unsuspected hosts of opportunistic infections. PMID:12212357

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

    PubMed

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

    2011-05-01

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

  1. Delayed perforation after endoscopic submucosal dissection for early gastric cancer: Clinical features and treatment

    PubMed Central

    Yano, Takafumi; Tanabe, Satoshi; Ishido, Kenji; Azuma, Mizutomo; Wada, Takuya; Suzuki, Mizuto; Kawanishi, Natsuko; Yamane, Sakiko; Sasaki, Tohru; Katada, Chikatoshi; Mikami, Tetsuo; Katada, Natsuya; Koizumi, Wasaburo

    2016-01-01

    Perforation is an important procedural complication of endoscopic submucosal dissection (ESD) for early gastric cancer. Although the incidence of delayed perforation after ESD is low, extreme caution is necessary because many cases require surgical intervention. Among 1984 lesions of early gastric cancer treated in our hospital by ESD in 1588 patients from September 2002 through March 2015, delayed perforation developed in 4 patients (4 lesions, 0.25%). A diagnosis of delayed perforation requires prompt action, including surgical intervention when required. PMID:27114751

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

    PubMed Central

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

    2013-01-01

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

  3. Comparative study of software techniques for 3D mapping of perforators in deep inferior epigastric artery perforator flap planning

    PubMed Central

    Hunter-Smith, David J.; Rozen, Warren Matthew

    2016-01-01

    Background Computed tomographic (CT) angiography (CTA) is widely considered the gold standard imaging modality for preoperative planning autologous breast reconstruction with deep inferior epigastric artery (DIEA) perforator (DIEP) flap. Improved anatomical understanding from CTA has translated to enhanced clinical outcomes. To achieve this, the use of appropriate CT hardware and software is vital. Various CT scanners and contrast materials have been demonstrated to consistently produce adequate scan data. However, the availability of affordable and easily accessible imaging software capable of generating 3D volume-rendered perforator images to clinically useful quality has been lacking. Osirix (Pixmeo, Geneva, Switzerland) is a free, readily available medical image processing software that shows promise. We have previously demonstrated in a case report the usefulness of Osirix in localizing perforators and their course. Methods In the current case series of 50 consecutive CTA scans, we compare the accuracy of Osirix to a commonly used proprietary 3D imaging software, Siemens Syngo InSpace 4D (Siemens, Erlangen, Germany), in identifying perforator number and location. Moreover, we compared both programs to intraoperative findings. Results We report a high rate of concordance with Osirix and Siemens Syngo InSpace 4D (99.6%). Both programs correlated closely with operative findings (92.2%). Most of the discrepancies were found in the lateral row perforators (90%). Conclusions In the current study, we report the accuracy of Osirix that is comparable to Siemens Syngo InSpace 4D, a proprietary software, in mapping perforators. However, it provides an added advantage of being free, easy-to-use, portable, and potentially a superior quality of 3D reconstructed image. PMID:27047778

  4. [Experimental ultrasound analysis of the appendix. Contribution to improving the diagnosis of acute inflammation in routine clinical practice].

    PubMed

    Meiser, G; Meissner, K; Sattlegger, P

    1989-03-01

    Sonographic investigations of fresh operative specimens - 50 non-infected, 50 chronic and 50 acute inflammatory appendices - and also of 335 pertinent operated patients with "typical" appendiceal disorders were performed. All other entities, mimicking acute or perforated appendicitis were excluded from this study. Under experimental conditions, negative, chronic and acute or phlegmonous appendices appeared as "cockade" or "pseudokidney sign" with reflecting wall and echoless lumen. The application of a 5 Mz linear transducer made the differentiation of three wall layers feasible, in negative appendices as well as in dilated acute appendicitis, whereas in chronic inflammation and in obliterating acute appendicitis a wall layer stratification was not possible. In clinical application of 335 operated patients we only could demonstrate cases of acute or perforated appendicitis (n = 182/220), but no cases of non-infected appendix. In 57% of pertinent cases the objectivation of lumen dilatation, in 35% a wall layer stratification was feasible. Acute, phlegmonous or perforated appendicitis was proven by demonstrating an immobile "pseudotumor mass" with dominating constant hypodense reflex property. The pertinent diameters as measured in clinical acute appendicitis exceeded significantly the diameters observed in experimental sonography of negative appendices with a differential intact mobility. Intraluminary coproliths and hyperdense reflecting attached omental segments facilitated a sonographic diagnosis. In 101/115 patients correct negative diagnosis was established. On the basis of these criteria, a sensitivity of 83%, a specificity of 88% and a diagnostic accuracy of 85% related to the diagnosis of acute or perforated appendicitis was obtained in this study. PMID:2656123

  5. Coronary artery perforation in a patient with STEMI and a myocardial bridge: an increased risk for coronary artery perforation?

    PubMed

    Becher, Tobias; Baumann, Stefan; Huseynov, Aydin; Behnes, Michael; Borggrefe, Martin; Akin, Ibrahim

    2015-06-01

    We present the case of a patient with ST-elevation myocardial infarction (STEMI) due to subtotal occlusion of the left anterior descending coronary artery caused by an atherosclerotic lesion and a myocardial bridge (MB). Stenting of the MB caused coronary artery perforation resulting in a fistula to the right ventricle that was closed by implantation of a PTFE-covered stent. Follow-up coronary angiography showed persistent shunting, which was sealed by inflation of a high-pressure balloon over the site of extravasation guided by intravascular ultrasound. Additionally, we provide a short review of cases with coronary artery perforation after stenting of an MB. PMID:25842348

  6. Coronary Artery Perforation following PCI: An Interesting Finding into the Pericardial Space

    PubMed Central

    Dimitrakakis, Georgios; Von Oppell, Ulrich Otto; Balachandran, Subramaniam; Pericleous, Agamemnon; Anderson, Richard

    2013-01-01

    Coronary artery perforation is a known complication of percutaneous coronary intervention and potentially life threatening. Normally, these perforations are small and localized. We report the successful surgical management of a coronary artery perforation following stent insertion with extrusion of an 8-cm endarterectomy length of the circumflex coronary artery with a brief review of the recent literature. PMID:24436619

  7. Modified dual guide catheter ("ping-pong") technique to treat left internal mammary artery graft perforation.

    PubMed

    Assad-Kottner, Christian; Hakeem, Abdul; Uretsky, Barry F

    2015-07-01

    Perforation of a left internal mammary artery (LIMA) graft during percutaneous coronary intervention is a rare event. We report a case of mid-LIMA perforation treated by a polytetrafluoroethylene-covered stent using a modification of the dual catheter ("ping pong") technique. We propose that use of this modification when possible will further improve safety of treating a perforation. PMID:25044448

  8. Successful non-operative management of spontaneous type II gallbladder perforation in a patient with Alzheimer's disease

    PubMed Central

    Alessiani, Mario; Peloso, Andrea; Tramelli, Paola; Magnani, Enzo

    2014-01-01

    A 77-year-old man with Alzheimer's disease was admitted to a rural hospital in June 2012 and an acute cholecistytis was first diagnosed. Surgery was not considered as a possible option due to the critical condition of the patient and his severe comorbidities. After 2 days of broad-spectrum antibiotics, the patient worsened and developed severe sepsis. A gallbladder perforation with intrahepatic abscess formation was diagnosed on ultrasonography (US) and abdominal CT scan. The patient underwent percutaneous US-guided gallbladder drainage with resolution of the sepsis and rapid clinical improvement. After 1 month, the drainage was removed and the patient was discharged. He survived in good condition for 18 months and he passed away from pneumonitis in December 2013. This case shows that in a case of acute cholecystitis with gallbladder perforation, percutaneous gallbladder drainage can be a lifesaving procedure in elderly patients with severe comorbidities (including Alzheimer's disease) who are not candidates for elective surgery. PMID:24859733

  9. Outcome of surgical treatment of intestinal perforation in typhoid fever

    PubMed Central

    Sümer, Aziz; Kemik, Özgür; Dülger, Ahmet Cumhur; Olmez, Aydemir; Hasirci, Ismail; Kişli, Erol; Bayrak, Vedat; Bulut, Gulay; Kotan, Çetin

    2010-01-01

    AIM: To represent our clinical experience in the treatment of intestinal perforation arising from typhoid fever. METHODS: The records of 22 surgically-treated patients with typhoid intestinal perforation were evaluated retrospectively. RESULTS: There were 18 males and 4 females, mean age 37 years (range, 8-64 years). Presenting symptoms were fever, abdominal pain, diarrhea or constipation. Sixteen cases were subjected to segmental resection and end-to-end anastomosis, while 3 cases received 2-layered primary repair following debridement, one case with multiple perforations received 2-layered primary repair and end ileostomy, one case received segmental resection and end-to-end anastomosis followed by an end ileostomy, and one case received segmental resection and end ileostomy with mucous fistula operation. Postoperative morbidity was seen in 5 cases and mortality was found in one case. CONCLUSION: Intestinal perforation resulting from Salmonella typhi is an important health problem in Eastern and Southeastern Turkey. In management of this illness, early and appropriate surgical intervention is vital. PMID:20806433

  10. Sural Versus Perforator Flaps for Distal Medial Leg Wounds.

    PubMed

    Schannen, Andrew P; Truchan, Lisa; Goshima, Kaoru; Bentley, Roger; DeSilva, Gregory L

    2015-12-01

    Soft tissue coverage of distal medial ankle wounds is a challenging problem in orthopedic surgery because of the limited local tissues and prominent instrumentation. Traditionally, these wounds required free tissue transfer to achieve suitable coverage and subsequent bony union. To better respect the reconstructive ladder and to avoid the inherent difficulty of free flap coverage, rotational flaps have been used to cover these wounds. Both sural fasciocutaneous flaps and rotational fasciocutaneous perforator (propeller) flaps have been described for distal medial soft tissue coverage. The authors performed a retrospective chart review of patients who underwent distal medial leg coverage with the use of either sural flaps or rotational fasciocutaneous perforator flaps. The authors identified 14 patients by Current Procedural Terminology code who met the study criteria. The average age and degree of medical comorbidities were comparable in the 2 groups. The authors reviewed their medical records to evaluate fracture healing, flap size, complications, and return to normal shoe wear. All 7 sural flaps healed without incident, with underlying fracture healing. Of the 7 perforator flaps, 6 healed without incident, with underlying fracture healing. One perforator-based flap was complicated by superficial tip necrosis and went on to heal with local wound care. All patients returned to normal shoe wear. Both sural artery rotational flaps and posterior tibial artery-based rotational flaps are viable options for coverage of the distal medial leg. Coverage can be achieved reliably without microsurgery, anticoagulation, or monitoring in the intensive care unit. PMID:26652325

  11. Mechanisms of gold nanoparticle mediated ultrashort laser cell membrane perforation

    NASA Astrophysics Data System (ADS)

    Schomaker, M.; Baumgart, J.; Motekaitis, D.; Heinemann, D.; Krawinkel, J.; Pangalos, M.; Bintig, W.; Boulais, E.; Lachaine, R.; St.-Louis Lalonde, B.; Ngezahayo, A.; Meunier, M.; Heisterkamp, A.

    2011-03-01

    The gold nanoparticle (AuNP) mediated ultrashort laser cell membrane perforation has been proven as an efficient delivery method to bring membrane impermeable molecules into the cytoplasm. Nevertheless, the underlying mechanisms have not been fully determined yet. Different effects may occur when irradiating a AuNP with ultrashort laser pulses and finally enable the molecule to transfer. Depending on the parameters (pulse length, laser fluence and wavelength, particle size and shape, etc.) light absorption or an enhanced near field scattering can lead to perforation of the cell membrane when the particle is in close vicinity. Here we present our experimental results to clarify the perforation initiating mechanisms. The generation of cavitation and gas bubbles due to the laser induced effects were observed via time resolved imaging. Additionally, pump-probe experiments for bubble detection was performed. Furthermore, in our patch clamp studies a depolarization of the membrane potential and the current through the membrane of AuNP loaded cell during laser treatment was detected. This indicates an exchange of extra- and intra cellular ions trough the perforated cell membrane for some milliseconds. Additionally investigations by ESEM imaging were applied to study the interaction of cells and AuNP after co incubation. The images show an attachment of AuNP at the cell membrane after several hours of incubation. Moreover, images of irradiated and AuNP loaded cells were taken to visualize the laser induced effects.

  12. Jejunal perforation due to porcupine quill ingestion in a horse

    PubMed Central

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

    2014-01-01

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

  13. Jejunal perforation due to porcupine quill ingestion in a horse.

    PubMed

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

    2014-02-01

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

  14. Pneumoretroperitoneum and Pneumomediastinum Revealing a Left Colon Perforation

    PubMed Central

    Montori, Giulia; Di Giovanni, Giacomo; Mzoughi, Zeineb; Angot, Cedric; Al Samman, Sophie; Solaini, Leonardo; Cheynel, Nicolas

    2015-01-01

    Left colon perforation usually occurs in complicated diverticulitis or cancer. The most frequent signs are intraperitoneal abscess or peritonitis. In cases of retroperitoneal colonic perforation, diagnosis may be difficult. A 59-year-old woman presented with left thigh pain and with abdominal discomfort associated with mild dyspnea. Computed tomography scan showed air bubbles and purulent collection in the retroperitoneum, with subcutaneous emphysema extending from the left thigh to the neck. Computed tomography scan also revealed portal vein gas and thrombosis with multiple liver abscesses. An emergency laparotomy revealed a perforation of the proximal left colon. No masses were found. A left colectomy was performed. The retroperitoneum was drained and washed extensively. A negative pressure wound therapy was applied. A second-look laparotomy was performed 48 hours later. The retroperitoneum was drained and an end colostomy was performed. Intensive Care Unit postoperative stay was 9 days, and the patient was discharged on the 32nd postoperative day. Pneumoretroperitoneum and pneumomediastinum are rare signs of colonic retroperitoneal perforation. The diagnosis may be delayed, especially in the absence of peritoneal irritation. Clinical, laboratory, and especially radiologic parameters might be useful. Surgical treatment must be prompt to improve prognosis. PMID:26414818

  15. Evaluation of a new, perforated heat flux plate design

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Accurate measurement of heat flux is essential to optimize structural and process design and to improve understanding of energy transfer in natural systems. Laboratory and field experiments evaluated the performance of a new, perforated heat flux plate designed for environmental applications. Labora...

  16. Intrathoracic gastric perforation secondary to corrosive ingestion: a rare complication

    PubMed Central

    Varma Gunturi, Surya Ramachandra; Arora, Abhishek; Parmar, Abhijot

    2016-01-01

    This case report describes a rare and serious case of acid ingestion in a 50-year-old man who developed necrosis and perforation of gastric fundus and diaphragm with extension of air and fluid collection in the thorax. To the best of our knowledge, this complication has not been described so far in the literature. PMID:27190774

  17. Percutaneous peritoneal drainage in isolated neonatal gastric perforation

    PubMed Central

    Aydin, Mustafa; Deveci, Ugur; Taskin, Erdal; Bakal, Unal; Kilic, Mehmet

    2015-01-01

    A comment on the article by He et al, “Idiopathic neonatal pneumoperitoneum with favorable outcome: A case report and review”, published on World Journal of Gastroenterology that reported a case of idiopathic neonatal pneumoperitoneum, possibly due to gastric perforation, with a favorable outcome without surgical intervention. PMID:26668521

  18. Laparoscopic repair in children with traumatic bladder perforation.

    PubMed

    Karadag, Cetin Ali; Tander, Burak; Erginel, Basak; Demirel, Dilek; Bicakci, Unal; Gunaydin, Mithat; Sever, Nihat; Bernay, Ferit; Dokucu, Ali Ihsan

    2016-01-01

    Here, we report two patients with a traumatic intraperitoneal bladder dome rupture repaired by laparoscopic intracorporeal sutures. The first patient was a 3-year old boy was admitted with a history of road accident. He had a traumatic lesion on his lower abdomen and a pelvic fracture. Computed tomography (CT) scan revealed free intraabdominal fluid. The urethragram showed spreading contrast material into the abdominal cavity. Laparoscopic exploration revealed a 3-cm-length perforation at the top of the bladder. The injury was repaired in a two fold fashion. Post-operative follow-up was uneventful. The second case was a 3-year-old boy fell from the second floor of his house on the ground. He had traumatic lesion on his lower abdomen and a pelvic fracture. Due to bloody urine drainage, a cystography was performed and an extravasation from the dome of the bladder into the peritoneum was detected. On laparoscopy, a 3-cm long vertical perforation at the dome of the bladder was found. The perforation was repaired in two layers with intracorporeal suture technique. The post-operative course was uneventful. Laparoscopic repair of traumatic perforation of the bladder dome is a safe, effective and minimally invasive method. The cosmetic outcome is superior. PMID:27279407

  19. Scour around a perforated disk modeling a marine hydrokinetic device

    NASA Astrophysics Data System (ADS)

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

    2013-12-01

    A study was conducted to investigate the behavior of scour hole dimensions and scour rates around a bottom-mounted cylindrical support structure of a perforated disk. The experiments focus on collecting temporal variations of scour depth around the support structure of the perforated disk for two scour regimes: transitional (ReD = 8500 and 9400) and live-bed (ReD = 10200). A perforated disk is used to approximate the drag of a submerged, horizontal axis, marine hydrokinetic (MHK) turbine. The goal is to compare the scour behavior around a perforated disk to that of a marine hydrokinetic (MHK) device. This study is motivated by the need to predict the environmental effect of MHK devices on an erodible bed. Testing is conducted in the small-scale hydraulic flume facility (1.2 m wide, 0.38 m deep, and 9.75 m long) at Bucknell University. The base of the support structure is marked incrementally to allow for time based observations of changes in scour depth. Bed form topologies are then acquired after a three hour time interval using a 2D sediment bed profiler. Experimental results show that scour rate is dependent on flow speed. Additionally, an increase in scour hole size occurs as the scour conditions are varied from transitional to live-bed.

  20. The Deltopectoral Flap Revisited: The Internal Mammary Artery Perforator Flap.

    PubMed

    Ibrahim, Amir; Atiyeh, Bishara; Karami, Reem; Adelman, David M; Papazian, Nazareth J

    2016-03-01

    Pharyngo-esophageal and tracheostomal defects pose a challenge in head and neck reconstruction whenever microanastomosis is extremely difficult in hostile neck that is previously dissected and irradiated. The deltopectoral (DP) flap was initially described as a pedicled flap for such reconstruction with acceptable postoperative results. A major drawback is still that the DP flap is based on 3 perforator vessels leading to a decreased arc of rotation. The DP flap also left contour deformities in the donor site. The internal mammary artery perforator flap was described as a refinement of the deltopectoral flap. It is a pedicled fasciocutaneous flap based on a single perforator, with comparable and reliable blood supply compared with the DP flap, giving it the benefit of having a wide arc of rotation. It is both thin and pliable, with good skin color match and texture. The donor site can be closed primarily with no esthetic deformity and minimal morbidity. The procedure is relatively simple and does not require microvascular expertise. In this report, the authors describe a patient in whom bilateral internal mammary artery perforator flaps were used for subtotal pharyngo-esophageal reconstruction and neck resurfacing. The flaps healed uneventfully bilaterally with no postoperative complications. PMID:26854779

  1. Numerical method for wave forces acting on partially perforated caisson

    NASA Astrophysics Data System (ADS)

    Jiang, Feng; Tang, Xiao-cheng; Jin, Zhao; Zhang, Li; Chen, Hong-zhou

    2015-04-01

    The perforated caisson is widely applied to practical engineering because of its great advantages in effectively wave energy consumption and cost reduction. The attentions of many scientists were paid to the fluid-structure interaction between wave and perforated caisson studies, but until now, most concerns have been put on theoretical analysis and experimental model set up. In this paper, interaction between the wave and the partial perforated caisson in a 2D numerical wave flume is investigated by means of the renewed SPH algorithm, and the mathematical equations are in the form of SPH numerical approximation based on Navier-Stokes equations. The validity of the SPH mathematical method is examined and the simulated results are compared with the results of theoretical models, meanwhile the complex hydrodynamic characteristics when the water particles flow in or out of a wave absorbing chamber are analyzed and the wave pressure distribution of the perforated caisson is also addressed here. The relationship between the ratio of total horizontal force acting on caisson under regular waves and its influence factors is examined. The data show that the numerical calculation of the ratio of total horizontal force meets the empirical regression equation very well. The simulations of SPH about the wave nonlinearity and breaking are briefly depicted in the paper, suggesting that the advantages and great potentiality of the SPH method is significant compared with traditional methods.

  2. [Lethal complications caused by perforating esophageal injuries (author's transl)].

    PubMed

    Thiel, M

    1981-01-01

    Symptoms, complications, and pathoanatomic findings of three cases, in which the esophageal perforation originally caused the death, are demonstrated. The first case deals with an pressure-errosion as a result of gavage, the second an incised wound by a razor blade, and the third a through-and-through gunshot wound of the upper part of the esophagus. PMID:7234137

  3. Laparoscopic repair in children with traumatic bladder perforation

    PubMed Central

    Karadag, Cetin Ali; Tander, Burak; Erginel, Basak; Demirel, Dilek; Bicakci, Unal; Gunaydin, Mithat; Sever, Nihat; Bernay, Ferit; Dokucu, Ali Ihsan

    2016-01-01

    Here, we report two patients with a traumatic intraperitoneal bladder dome rupture repaired by laparoscopic intracorporeal sutures. The first patient was a 3-year old boy was admitted with a history of road accident. He had a traumatic lesion on his lower abdomen and a pelvic fracture. Computed tomography (CT) scan revealed free intraabdominal fluid. The urethragram showed spreading contrast material into the abdominal cavity. Laparoscopic exploration revealed a 3-cm-length perforation at the top of the bladder. The injury was repaired in a two fold fashion. Post-operative follow-up was uneventful. The second case was a 3-year-old boy fell from the second floor of his house on the ground. He had traumatic lesion on his lower abdomen and a pelvic fracture. Due to bloody urine drainage, a cystography was performed and an extravasation from the dome of the bladder into the peritoneum was detected. On laparoscopy, a 3-cm long vertical perforation at the dome of the bladder was found. The perforation was repaired in two layers with intracorporeal suture technique. The post-operative course was uneventful. Laparoscopic repair of traumatic perforation of the bladder dome is a safe, effective and minimally invasive method. The cosmetic outcome is superior. PMID:27279407

  4. Role of endoscopic clipping in the treatment of oesophageal perforations

    PubMed Central

    Lázár, György; Paszt, Attila; Mán, Eszter

    2016-01-01

    With advances in endoscopic technologies, endoscopic clips have been used widely and successfully in the treatment of various types of oesophageal perforations, anastomosis leakages and fistulas. Our aim was to summarize the experience with two types of clips: The through-the-scope (TTS) clip and the over-the-scope clip (OTSC). We summarized the results of oesophageal perforation closure with endoscopic clips. We processed the data from 38 articles and 127 patients using PubMed search. Based on evidence thus far, it can be stated that both clips can be used in the treatment of early (< 24 h), iatrogenic, spontaneous oesophageal perforations in the case of limited injury or contamination. TTS clips are efficacious in the treatment of 10 mm lesions, while bigger (< 20 mm) lesions can be treated successfully with OTSC clips, whose effectiveness is similar to that of surgical treatment. However, the clinical success rate is significantly lower in the case of fistulas and in the treatment of anastomosis insufficiency. Tough prospective randomized multicentre trials, which produce the largest amount of evidence, are still missing. Based on experience so far, endoscopic clips represent a possible therapeutic alternative to surgery in the treatment of oesophageal perforations under well-defined conditions. PMID:26788259

  5. CHARACTERIZATION OF CLEAN AND FOULED PERFORATED MEMBRANE DIFFUSERS

    EPA Science Inventory

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

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

    PubMed

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

    2012-02-01

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

  7. Lower extremity muscle perforator flaps for lower extremity reconstruction.

    PubMed

    Hallock, Geoffrey G

    2004-10-01

    A true muscle perforator flap is distinguished by the requisite intramuscular dissection of its musculocutaneous perforator to capture the same musculocutaneous territory but with total exclusion of the muscle, and thereby results in minimal functional impairment. Adhering to this definition, several lower extremity donor sites now are available, each with specific attributes especially useful for consideration in the treatment of lower extremity defects. In this author's experience over the past two decades, 20 lower extremity muscle perforator flaps using multiple donor sites proved advantageous for lower extremity coverage problems as either a local pedicled flap or as a microsurgical tissue transfer. Significant complications occurred in 30 percent of flaps (six of 20) in that further intervention was required. Venous insufficiency and bulkiness were found to be the major inherent shortcomings. However, giant flaps, lengthy and large-caliber vascular pedicles, and the possibility for combined flaps were important assets. The choice of a lower extremity muscle perforator flap for lower extremity reconstruction limited the surgical intervention and morbidity to a single body region. PMID:15457022

  8. Role of endoscopic clipping in the treatment of oesophageal perforations.

    PubMed

    Lázár, György; Paszt, Attila; Mán, Eszter

    2016-01-10

    With advances in endoscopic technologies, endoscopic clips have been used widely and successfully in the treatment of various types of oesophageal perforations, anastomosis leakages and fistulas. Our aim was to summarize the experience with two types of clips: The through-the-scope (TTS) clip and the over-the-scope clip (OTSC). We summarized the results of oesophageal perforation closure with endoscopic clips. We processed the data from 38 articles and 127 patients using PubMed search. Based on evidence thus far, it can be stated that both clips can be used in the treatment of early (< 24 h), iatrogenic, spontaneous oesophageal perforations in the case of limited injury or contamination. TTS clips are efficacious in the treatment of 10 mm lesions, while bigger (< 20 mm) lesions can be treated successfully with OTSC clips, whose effectiveness is similar to that of surgical treatment. However, the clinical success rate is significantly lower in the case of fistulas and in the treatment of anastomosis insufficiency. Tough prospective randomized multicentre trials, which produce the largest amount of evidence, are still missing. Based on experience so far, endoscopic clips represent a possible therapeutic alternative to surgery in the treatment of oesophageal perforations under well-defined conditions. PMID:26788259

  9. Methotrexate-Induced Nasal Septal Perforation.

    PubMed

    Kaminska, Edidiong Ntuen; Sansaricq, Freda; Petronic-Rosic, Vesna

    2016-01-01

    A 58-year-old woman with a 31-year history of Hailey-Hailey (HH) disease that was refractory to treatment with mycophenolate mofetil, cyclosporine, dapsone, sulfasalazine, topical/oral antibiotics, and topical/oral steroids presented for alternative treatment options. Active erythematous, malodorous, eroded, and crusted plaques were present in the axillae, inframammary region, groin, and back (Figure 1). The patient had an undulant course, with acute exacerbations and partial remissions. During a 3-year period, she was prescribed oral methotrexate at a dose of 10 mg to 15 mg per week with daily oral folic acid (1 mg) supplementation, except on the day she took methotrexate. Oral clarithromycin and prednisone were also used intermittently for antibacterial and anti-inflammatory effects. PMID:27319962

  10. Endoscopic retrograde cholangiopancreatography-related perforations: Diagnosis and management

    PubMed Central

    Vezakis, Antonios; Fragulidis, Georgios; Polydorou, Andreas

    2015-01-01

    Endoscopic retrograde cholangiopancreatography (ERCP) has become an important therapeutic modality for biliary and pancreatic disorders. Perforation is one of the most feared complications of ERCP and endoscopic sphincterotomy. A MEDLINE search was performed from 2000-2014 using the keywords “perforation”, “ERCP” and “endoscopic sphincterotomy”. All articles including more than nine cases were reviewed. The incidence of ERCP-related perforations was low (0.39%, 95%CI: 0.34-0.69) with an associated mortality of 7.8% (95%CI: 3.80-13.07). Endoscopic sphincterotomy was responsible for 41% of perforations, insertion and manipulations of the endoscope for 26%, guidewires for 15%, dilation of strictures for 3%, other instruments for 4%, stent insertion or migration for 2% and in 7% of cases the etiology was unknown. The diagnosis was made during ERCP in 73% of cases. The mechanism, site and extent of injury, suggested by clinical and radiographic findings, should guide towards operative or non-operative management. In type I perforations early surgical repair is indicated, unless endoscopic closure can be achieved. Patients with type II perforations should be treated initially non-operatively. Non-operative treatment includes biliary stenting, fasting, intravenous fluid resuscitation, nasogastric drainage, broad spectrum antibiotics, percutaneous drainage of fluid collections. Non-operative treatment was successful in 79% of patients with type II injuries, with an overall mortality of 9.4%. Non-operative treatment was sufficient in all patients with type III injuries. Surgical technique depends on timing, site and size of defect and clinical condition of the patient. In conclusion, diagnosis is based on clinical suspicion and clinical and radiographic findings. Whilst surgery is usually indicated in patients with type I injuries, patients with type II or III injuries should be treated initially non-operatively. A minority of them will finally require surgical

  11. Use of self-expanding covered stent and negative pressure wound therapy to manage late rectal perforation after injury from an improvised explosive device: a case report.

    PubMed

    Ozer, M Tahir; Coskun, Ali K; Sinan, Huseyin; Saydam, Mehmet; Akay, Emin O; Peker, Subutay; Ogunc, Gokhan; Demirbas, Sezai; Peker, Yusuf

    2014-06-01

    Blast injuries, caused by explosions accompanied by high-pressure waves, produce tissue damage in the acute period, followed in the later period by circulatory disorders due to vascular endothelial damage and related tissue necrosis. Blunt rectal perforation is rare and difficult to diagnose. In the acute period following blast pelvic injuries, the main objectives are to stop bleeding, minimise contamination and preserve the patient's life. The patient in this report had major vascular injuries, severe pelvic injury and, in the later period, rectal perforation because of vascular endothelial damage caused by the blast effect. Our aim was to treat the patient conservatively because of his poor general condition. We placed a self-expanding covered stent (SECS) into the rectum and then applied negative pressure wound therapy (NPWT; V.A.C.® Therapy, KCI) to the pelvic region and perirectal area. At the end of the treatment, the rectal perforation was closed, and the patient was discharged with healing. In this article, we discuss the novel use of an SECS with NPWT and review related literature. PMID:24851734

  12. Feline perforating dermatitis resembling human reactive perforating collagenosis: clinicopathological findings and outcome in four cases.

    PubMed

    Albanese, Francesco; Tieghi, Chiara; De Rosa, Luigi; Colombo, Silvia; Abramo, Francesca

    2009-08-01

    The clinicopathological findings of perforating dermatitis in two young and two adult cats are described. In all cases, the lesions were characterized by single or multiple papules and plaques, 0.5-3.0 cm in diameter, each containing a central, firm, exophytic, cone-shaped, yellow-orange keratotic plug, tightly adherent to the underlying skin. Removal of the protruding material was associated with bleeding and left the ulcerated surface exposed. In one case, the lesions showed a linear configuration and identical lesions occurred on the suture sites following biopsy. Histopathologically, the diagnosis was straightforward because of the presence of vertically orientated collagen bundles extruded from ulcerated, concave-shaped invaginations of the skin. In two cases, vitamin C administration failed to resolve the disease. In two cases, methyl-prednisolone acetate was used to manage relapsing episodes and vitamin C helped to reduce glucocorticoid requirements. In one case, treatment with methyl-prednisolone acetate only appeared to be curative. The fourth case was lost to follow-up immediately after the diagnosis. PMID:19659539

  13. Endoscopic and Clinical Factors Affecting the Prognosis of Colorectal Endoscopic Submucosal Dissection-Related Perforation

    PubMed Central

    Kang, Dong-Uk; Choi, Yunsik; Lee, Ho-Su; Lee, Hyo Jeong; Park, Sang Hyoung; Yang, Dong-Hoon; Yoon, Soon Man; Kim, Kyung-Jo; Ye, Byong Duk; Myung, Seung-Jae; Yang, Suk-Kyun; Kim, Jin-Ho; Byeon, Jeong-Sik

    2016-01-01

    Background/Aims Although colorectal endoscopic submucosal dissection (ESD)-related perforation is not uncommon, the factors affecting clinical outcomes after perforation have not been investigated. This study was designed to investigate the factors influencing the clinical course of ESD-related colon perforation. Methods Forty-three patients with colorectal ESD-related perforation were evaluated. The perforations were classified as endoscopic or radiologic perforations. The patients’ medical records and endoscopic pictures were analyzed. Results The clinical outcomes were assessed by the duration of nil per os, intravenous antibiotics administration, and hospital stays, which were 2.7±1.5, 4.9±2.3, and 5.1±2.3 days, respectively. Multivariate analyses revealed that a larger tumor size, ESD failure, specific endoscopists, and abdominal pain were independently related to a poorer outcome. The time between perforation and clipping was 15.8±25.4 minutes in the endoscopic perforation group. The multivariate analysis of this group indicated that delayed clipping, specific endoscopists, and abdominal pain were independently associated with poorer outcomes. Conclusions Tumor size, ESD failure, abdominal pain, and the endoscopist were factors that affected the clinical outcomes of patients with colorectal ESD-related perforation. The time between the perforation and clipping was an additional factor influencing the clinical course of endoscopic perforation. Decreasing this time period may improve outcomes. PMID:26780090

  14. The rate of glove perforations in orthopaedic procedures: single versus double gloving. A prospective study.

    PubMed

    Chan, K Y; Singh, V A; Oun, B H; To, B H Se

    2006-12-01

    Glove perforation during surgery has always been a matter of concern as it increases the infection rate and the risk of transmission of blood borne diseases. To determine the common causes, the site and the awareness of glove perforations in orthopaedic surgery, a prospective study was conducted to assess the rate of glove perforation during 130 consecutive orthopaedic operations. All gloves worn by the surgical team were assessed after the surgery using the water-loading test. A total of 1452 gloves were tested, and the rate of perforation was 3.58%. Most of these perforations (61.5%) were unnoticed. The main surgeons had the most perforations (76.9%), followed by first assistants (13.5%) and second assistants (9.6%). Most perforations occurred at the non-dominant hand. The commonest site of perforation was the index finger followed by the thumb. Shearing force with instruments accounted for 45% of the noticed perforations. Majority of these occurred during nailing procedures (33%) and internal fixation without the use of wires (19%). Our rate of glove perforation is similar to other series. Most of them went unnoticed and were mainly due to shearing injuries rather than perforation by sharps. Therefore, there is an increased risk of contamination and break in asepsis during surgery. PMID:17605178

  15. Management of acute upside-down stomach

    PubMed Central

    2013-01-01

    Background Upside-down stomach (UDS) is characterized by herniation of the entire stomach or most gastric portions into the posterior mediastinum. Symptoms may vary heavily as they are related to reflux and mechanically impaired gastric emptying. UDS is associated with a risk of incarceration and volvulus development which both might be complicated by acute gastric outlet obstruction, advanced ischemia, gastric bleeding and perforation. Case presentation A 32-year-old male presented with acute intolerant epigastralgia and anterior chest pain associated with acute onset of nausea and vomiting. He reported on a previous surgical intervention due to a hiatal hernia. Chest radiography and computer tomography showed an incarcerated UDS. After immediate esophago-gastroscopy, urgent laparoscopic reduction, repair with a 360° floppy Nissen fundoplication and insertion of a gradually absorbable GORE® BIO-A®-mesh was performed. Conclusion Given the high risk of life-threatening complications of an incarcerated UDS as ischemia, gastric perforation or severe bleeding, emergent surgery is indicated. In stable patients with acute presentation of large paraesophageal hernia or UDS exhibiting acute mechanical gastric outlet obstruction, after esophago-gastroscopy laparoscopic reduction and hernia repair followed by an anti-reflux procedure is suggested. However, in cases of unstable patients open repair is the surgical method of choice. Here, we present an exceptionally challenging case of a young patient with a giant recurrent hiatal hernia becoming clinically manifest in an incarcerated UDS. PMID:24228771

  16. Spontaneous Bacterial Peritonitis due to Actinomyces Mimicking a Perforation of the Proximal Jejunum

    PubMed Central

    Eenhuis, Louise L.; de Lange, Marleen E.; Samson, Anda D.; Busch, Olivier R.C.

    2016-01-01

    Patient: Female, 42 Final Diagnosis: Spontaneous pelvic-abdominal peritonitis due to actinomyces Symptoms: Abdominal distension • abdominal pain • acute abdomen • fever • intermenstrual bleeding • nausea • sepsis • septic shock Medication: — Clinical Procedure: — Specialty: Surgery Objective: Unusual clinical course Background: Pelvic-abdominal actinomycosis is a rare chronic condition caused by an anaerobic, gram-negative rod-shaped commensal bacterium of the Actinomyces species. When Actinomyces becomes pathogenic, it frequently causes a chronic infection with granulomatous abscess formation with pus. Due to diversity in clinical and radiological presentation, actinomycosis can easily be mistaken for several other conditions. Peritonitis without preceding abscess formation caused by Actinomyces species has been described in only few cases before in literature. Case report: We report a case of spontaneous pelvic-abdominal peritonitis with presence of pneumoperitoneum and absence of preceding abscesses due to acute actinomycosis mimicking a perforation of the proximal jejunum in a 42-year-old female with an intra-uterine contraceptive device in place. Explorative laparotomy revealed 2 liters of odorless pus but no etiological explanation for the peritonitis. The intra-uterine contraceptive device was removed. Cultivation showed growth of Actinomyces turicensis. The patient was successfully treated with penicillin. Conclusions: In the case of primary bacterial peritonitis or lower abdominal pain without focus in a patient with an intrauterine device in situ, Actinomyces should be considered as a pathogen. PMID:27561364

  17. A Rare Case of Perforated Descending Colon Cancer Complicated with a Fistula and Abscess of Left Iliopsoas and Ipsilateral Obturator Muscle

    PubMed Central

    Cacurri, Alban; Trastulli, Stefano; Desiderio, Jacopo; Pressi, Eleonora; Giovannelli, Giorgio; Parisi, Amilcare

    2014-01-01

    Perforation of descending colon cancer combined with iliopsoas abscess and fistula formation is a rare condition and has been reported few times. A 67-year-old man came to our first aid for an acute pain in the left iliac fossa, in the flank, and in the ipsilateral thigh. Ultrasonography and computed tomography revealed a left abdominal wall, retroperitoneal, and iliopsoas abscess that also involved the ipsilateral obturator muscle. It proceeded with an exploratory laparotomy that showed a tumor of the descending colon adhered and perforated in the retroperitoneum with abscess of the iliopsoas muscle on the left-hand side, with presence of a fistula and liver metastases. A left hemicolectomy with drainage of the broad abscess was performed. Pathologic report findings determined adenocarcinoma of the resected colon. PMID:24744948

  18. Acute Appendicitis Secondary to Acute Promyelocytic Leukemia

    PubMed Central

    Rodriguez, Eduardo A.; Lopez, Marvin A.; Valluri, Kartik; Wang, Danlu; Fischer, Andrew; Perdomo, Tatiana

    2015-01-01

    Patient: Female, 43 Final Diagnosis: Myeloid sarcoma appendicitis Symptoms: Abdominal pain • chills • fever Medication: — Clinical Procedure: Laparoscopic appendectomy, bone marrow biopsy Specialty: Gastroenterology and Hepatology Objective: Rare disease Background: The gastrointestinal tract is a rare site for extramedullary involvement in acute promyelocytic leukemia (APL). Case Report: A 43-year-old female with no past medical history presented complaining of mild abdominal pain, fever, and chills for the past day. On examination, she was tachycardic and febrile, with mild tenderness of her right lower quadrant and without signs of peritoneal irritation. Laboratory examination revealed pancytopenia and DIC, with a fibrinogen level of 290 mg/dL. CT of the abdomen showed a thickened and hyperemic appendix without perforation or abscess, compatible with acute appendicitis. The patient was given IV broad-spectrum antibiotics and was transfused with packed red blood cells and platelets. She underwent uncomplicated laparoscopic appendectomy and bone marrow biopsy, which revealed neo-plastic cells of 90% of the total bone marrow cellularity. Flow cytometry indicated presence of 92.4% of immature myeloid cells with t (15: 17) and q (22: 12) mutations, and FISH analysis for PML-RARA demonstrated a long-form fusion transcript, positive for APL. Appendix pathology described leukemic infiltration with co-expression of myeloperoxidase and CD68, consistent with myeloid sarcoma of the appendix. The patient completed a course of daunorubicin, cytarabine, and all trans-retinoic acid. Repeat bone marrow biopsy demonstrated complete remission. She will follow up with her primary care physician and hematologist/oncologist. Conclusions: Myeloid sarcoma of the appendix in the setting of APL is very rare and it might play a role in the development of acute appendicitis. Urgent management, including bone marrow biopsy for definitive diagnosis and urgent surgical intervention

  19. Parenchymal Guidewire Perforation during ERCP: An Unappreciated Injury

    PubMed Central

    Rabie, M. Ezzedien; Al Faris, Saad; Nasser, Ali; Shahir, Abdul Aziz; Al Mahdi, Yasser; Youssef Al Asmari, Mansour

    2015-01-01

    ERCP is attended with certain complications, the majority of which are well known to the medical community. Other less-known complications also exist. Guidewire injury to the hepatic or pancreatic parenchyma represents one of the much less appreciated, albeit preventable, complications. In this report, we present the clinical course of three patients who sustained guidewire perforation of the pancreatic or hepatic parenchyma. In one patient, the clinical deterioration was confidently attributed to guidewire perforation of the pancreatic parenchyma. Conservative treatment was successful and unnecessary emergency surgery was thus avoided. In the other two, in whom the cause of the clinical deterioration was unclear, an emergency surgery was performed. Guidewire injury to the hepatic parenchyma was then confirmed which needed only intraperitoneal drainage, with successful outcome. PMID:26693377

  20. Apparatus and method for sealing perforated well casing

    DOEpatents

    Blount, Curtis G.; Benham, Robert A.; Brock, Jerry L.; Emerson, John A.; Ferguson, Keith R.; Scheve, Donald F.; Schmidt, Joseph H.; Schuler, Karl W.; Stanton, Philip L.

    1997-01-01

    Perforations and other openings in well casings, liners and other conduits may be substantially blocked or sealed to prevent fluid flow between the casing or liner interior and an earth formation by placing a radially expansible sleeve adjacent the perforations or openings and urging the sleeve into forcible engagement with the casing or inner wall using an explosive charge. An apparatus including a radially contracted sleeve formed by a coiled plate member or a tubular member having flutes defined by external and internal folds, may be deployed into a well casing or liner through a production or injection tubing string and on the end of a flexible cable or coilable tubing. An explosive charge disposed on the apparatus and within the sleeve may be detonated to urge the sleeve into forcible engagement with the casing inner wall.

  1. Apparatus and method for sealing perforated well casing

    DOEpatents

    Blount, C.G.; Benham, R.A.; Brock, J.L.; Emerson, J.A.; Ferguson, K.R.; Scheve, D.F.; Schmidt, J.H.; Schuler, K.W.; Stanton, P.L.

    1997-03-25

    Perforations and other openings in well casings, liners and other conduits may be substantially blocked or sealed to prevent fluid flow between the casing or liner interior and an earth formation by placing a radially expansible sleeve adjacent the perforations or openings and urging the sleeve into forcible engagement with the casing or inner wall using an explosive charge. An apparatus including a radially contracted sleeve formed by a coiled plate member or a tubular member having flutes defined by external and internal folds, may be deployed into a well casing or liner through a production or injection tubing string and on the end of a flexible cable or coilable tubing. An explosive charge disposed on the apparatus and within the sleeve may be detonated to urge the sleeve into forcible engagement with the casing inner wall. 17 figs.

  2. Impalement injury by glass shard with delayed colonic perforation

    PubMed Central

    Rosat, Adriá; Sánchez, Juan Manuel; Chocarro, Cristina; Barrera, Manuel

    2015-01-01

    A 66-year-old man experienced a traumatic injury after a fall on top of a glass tea table, which caused some superficial lacerations all around the body. He was examined in the emergency room by a physician. The physician could not feel any foreign body upon wound exploration and sutured the laceration. Fourteen months after the injury, he developed progressive abdominal pain. On emergency room and abdominal x-ray showed a foreign body, which a CT scan revealed as an intraabdominal glass shard. The glass presumably impaled his abdominal wall as a result of his previous traumatic injury. The patient underwent laparotomy, which revealed a large glass (16x1cm) perforating the transverse colon. It was extracted and the perforation closed with a lineal stapler. There was no need of bowel resection and the patient was discharged home nine days after the intervention. PMID:26587176

  3. [Perforating injuries of the eyes caused by rotating steel brushes].

    PubMed

    Höh, H; Krannig, H J

    1990-03-01

    Three cases of perforating lamellating injuries to the eyes are described which illustrate the hazards of using rotating wire brushes. All three patients were home handymen who failed to take the customary safety precautions. In one case the eye injury was partially due to an inappropriate combination of tools (a low-speed wire brush used with a high-speed drill). In view of the constantly increasing popularity of DIY work tool manufacturers, social insurance funds, private insurance companies and public institutions are called upon to help reduce the frequency of accidents in the DIY sector through appropriate design, organizational measures and publicity campaigns. Practical proposals are outlined in this paper. Perforating eye injuries caused by wire brushes can easily be overlooked. Thorough ophthalmological examination is therefore essential, and a diagnostic intervention may be required. PMID:2342318

  4. Reverse Radial Artery Flap Perforator Anatomy and Clinical Applications.

    PubMed

    White, Colin P; Steve, Anna K; Buchel, Edward W; Hayakawa, Thomas E; Morris, Steven F

    2016-09-01

    The pedicled reverse radial forearm flap is a well-known option for the treatment of a variety of soft tissue wounds including dorsal hand wounds. We document the number, emerging diameter, length from origin, course, and location of all perforators of the radial artery in a series of 6 fresh human cadavers after whole body lead oxide and gelatin injection to confirm and comprehensively document the anatomy of the radial artery perforators. This data provide an anatomic basis for a modification to the reversed radial forearm flap used to decrease venous congestion in the postoperative period. Two case reports are presented to provide clinical demonstration of the importance of this modification. PMID:26678105

  5. Microanatomy of the perforators of the anterior communicating artery complex.

    PubMed

    Camuscu, H; Dujovny, M; Abd el-Bary, T; Beristain, X; Viñas, F C

    1997-12-01

    We describe the microanatomy of the perforating arteries arising from the anterior communicating artery complex (5 mm distal of the anterior cerebral artery, the anterior communicating artery, and 5 mm proximal of the distal anterior cerebral artery). Thirteen unfixed human brains were used in this study. The origin and number of perforators are described, as is the site of brain penetration, and results are correlated with previous studies. The hemodynamics of blood flow in relation to the formation of an anterior communicating artery aneurysm and different surgical approaches are mentioned. The neuropsychological outcome after aneurysm clipping with regards to the pattern of blood supply from the anterior cerebral artery complex is also discussed. PMID:9427956

  6. Radiographic Diagnosis of Intestinal Perforation in Early Infancy

    PubMed Central

    Parker, Jacob J.; Mikity, Victor G.

    1966-01-01

    Records of 25 patients with intestinal perforation in early infancy who were treated at the Los Angeles County General Hospital in a period of 15 years were reviewed. Sixteen had roentgen evidence of pneumoperitoneum, and nine did not. The mortality rate was 94 per cent in the group with pneumoperitoneum, 78 per cent in the other, and 88 per cent overall. Multiple sites in the gastrointestinal tract were involved, and the causes of the lesions were diverse and frequently obscure. Prematurity, obstetrical and iatrogenic complications, and congenital anomalies were factors often associated with intestinal perforation. Roentgen features appeared to offer the best hope for diagnosis and appropriate treatment. ImagesFigure 1.Figure 2.Figure 3.Figure 4.Figure 5. PMID:5909251

  7. Multiple Small Intestine Perforations after Organophosphorous Poisoning: A Case Report.

    PubMed

    Mahajan, Rubina Khullar; Rajan, Sudha Jasmine; Peter, John Victor; Suryawanshi, Mayur Keshav

    2016-03-01

    Organophosphate poisoning has significant gastrointestinal manifestations including vomiting, diarrhea, cramps and increased salivation. We report an uncommon gastrointestinal complication of multiple small intestinal perforations following organophosphorus poisoning. A 28-year old male presented after ingesting dichlorvos mixed with alcohol. Following the initial cholinergic symptoms, the patient developed severe shock with fever, attributed to aspiration pneumonia. Despite appropriate antibiotics, shock was persistent. Over the next 24-hours, he developed abdominal distension, loose stools and high nasogastric aspirates. Computed tomography showed pneumoperitonium. Exploratory laparotomy revealed six perforations in the jejunum and ileum. The involved portion of the bowel was resected and re-anastomosed, following which only 80-cm of small bowel was left. Postoperatively, shock resolved over 72-hours. However, over the next few days, patient developed features of anastomotic leak. Since only a small portion of the small bowel was preserved, a conservative approach was adopted. He deteriorated further and finally succumbed to the illness. PMID:27134898

  8. Preservation of Hand Function Using Muscle Perforator Flaps

    PubMed Central

    2008-01-01

    Adequate soft tissue coverage is imperative after any interventions performed to maximize or preserve hand function. Although this can most simply be achieved by primary closure or a skin graft if possible, often a vascularized flap will be preferable, especially if a later secondary procedure is planned. Even moderately sized skin deficits of the upper extremity, and especially if involving the hand itself, can be better covered using a free tissue transfer. Many reasonable options in this regard are available. Muscle perforator flaps, as a relatively new variant of a fasciocutaneous flap, have unique attributes, including availability, diversity, accessibility, large size, and lengthy vascular pedicle, and since no muscle need be included, donor site function is preserved. As is shown here in a series of nine muscle perforator flaps in eight patients, these represent yet another alternative that should be considered if selection of a free flap is indicated to maintain hand function. PMID:18780005

  9. Nasal septum perforation in patient with pyoderma gangrenosum

    PubMed Central

    Maia, Camilla Bezerra da Cruz; Felix, Felippe; Paes, Vania; de Azevedo, Julia Alves; Grangeiro, Eliza Raquel Negrão; Riccio, Jonatah Lucas N.; Rito, Helen Cruz

    2012-01-01

    Summary Introduction: The cocaine is obtained from the leaves of the coca (Erythroxylon coca). It can be used in many ways, but the most common is the drug inhalation. The Cocaine also causes vasoconstriction at nasal mucous membrane and its chronic use can cause necrosis and nasal septum perforation. Pyoderma gangrenosum is an uncommon idiopathic disease characterized by ulcerations, usually observed on the legs. Its diagnosis is most common an exclusion of others diseases. So far, there is no specific treatment based on evidence by randomized controlled trials. Objective: Describe the rare association between Pyoderma gangrenosum and cocaine. Case Report: E. A., 27-year-old woman with destruction of nasal septum and palate who has been using a big amount of cocaine, been necessary note the difference from which disease cause de damage. Final Comments: Also there are only three cases of Pyoderma gangrenosum complicated with nasal septum perforation in cocaine users. PMID:25991946

  10. Study of a new railgun configuration with perforated sidewalls

    SciTech Connect

    Zhang, J.; Kim, K.; King, T.L. )

    1993-01-01

    A new railgun configuration with perforated sidewalls is investigated. The motivation for this new configuration is the desire to minimize the detrimental effects of inertial and viscous drag at high velocities caused by the debris from the projectile and the gun wall trapped in the plasma armature. The test has been done on a 1.2 m long railgun with a 3.2-mm-diameter bore. Results for hydrogen pellet acceleration show that at high currents the perforated railgun outperforms the unperforated one. Combined with a newly designed cryogenic pellet generator and the first stage gas gun, a solid hydrogen pellet velocity of 2.46 km/s has been achieved on the 1.2-m railgun.

  11. Magnetic resonance angiography in perforator flap breast reconstruction

    PubMed Central

    Levine, Joshua L.

    2016-01-01

    Magnetic resonance angiography (MRA) is an extremely useful preoperative imaging test for evaluation of the vasculature of donor tissue to be used in autologous breast reconstruction. MRA has sufficient spacial resolution to reliably visualize 1 mm perforating vessels and to accurately locate vessels in reference to a patient’s anatomic landmarks without exposing patients to ionizing radiation or iodinated contrast. The use of a blood pool contrast agent and the lack of radiation exposure allow multiple studies of multiple anatomic regions in one examination. The following article is a detailed description of our MRA protocol developed with our radiologists with examples that illustrate the utility of MRA in perforator flap breast reconstruction. PMID:27047787

  12. Multiple Small Intestine Perforations after Organophosphorous Poisoning: A Case Report

    PubMed Central

    Rajan, Sudha Jasmine; Peter, John Victor; Suryawanshi, Mayur Keshav

    2016-01-01

    Organophosphate poisoning has significant gastrointestinal manifestations including vomiting, diarrhea, cramps and increased salivation. We report an uncommon gastrointestinal complication of multiple small intestinal perforations following organophosphorus poisoning. A 28-year old male presented after ingesting dichlorvos mixed with alcohol. Following the initial cholinergic symptoms, the patient developed severe shock with fever, attributed to aspiration pneumonia. Despite appropriate antibiotics, shock was persistent. Over the next 24-hours, he developed abdominal distension, loose stools and high nasogastric aspirates. Computed tomography showed pneumoperitonium. Exploratory laparotomy revealed six perforations in the jejunum and ileum. The involved portion of the bowel was resected and re-anastomosed, following which only 80-cm of small bowel was left. Postoperatively, shock resolved over 72-hours. However, over the next few days, patient developed features of anastomotic leak. Since only a small portion of the small bowel was preserved, a conservative approach was adopted. He deteriorated further and finally succumbed to the illness. PMID:27134898

  13. Over-the-scope clips in the treatment of gastrointestinal tract iatrogenic perforation: A multicenter retrospective study and a classification of gastrointestinal tract perforations

    PubMed Central

    Mangiavillano, Benedetto; Caruso, Angelo; Manta, Raffaele; Di Mitri, Roberto; Arezzo, Alberto; Pagano, Nico; Galloro, Giuseppe; Mocciaro, Filippo; Mutignani, Massimiliano; Luigiano, Carmelo; Antonucci, Enrico; Conigliaro, Rita; Masci, Enzo

    2016-01-01

    AIM: To determine the outcome of the management of iatrogenic gastrointestinal tract perforations treated by over-the-scope clip (OTSC) placement. METHODS: We retrospectively enrolled 20 patients (13 female and 7 male; mean age: 70.6 ± 9.8 years) in eight high-volume tertiary referral centers with upper or lower iatrogenic gastrointestinal tract perforation treated by OTSC placement. Gastrointestinal tract perforation could be with oval-shape or with round-shape. Oval-shape perforations were closed by OTSC only by suction and the round-shape by the “twin-grasper” plus suction. RESULTS: Main perforation diameter was 10.1 ± 4.3 mm (range 3-18 mm). The technical success rate was 100% (20/20 patients) and the clinical success rate was 90% (18/20 patients). Two patients (10%) who did not have complete sealing of the defect underwent surgery. Based upon our observations we propose two types of perforation: Round-shape “type-1 perforation” and oval-shape “type-2 perforation”. Eight (40%) out of the 20 patients had a type-1 perforation and 12 patients a type-2 (60%). CONCLUSION: OTSC placement should be attempted after perforation occurring during diagnostic or therapeutic endoscopy. A failed closure attempt does not impair subsequent surgical treatment. PMID:27152138

  14. Psoas tunnel perforation-an unreported complication of hip arthroscopy.

    PubMed

    Degen, Ryan M; O'Sullivan, Eilish; Sink, Ernest L; Kelly, Bryan T

    2015-10-01

    The utilization of hip arthroscopy is rapidly increasing due to improved arthroscopic techniques and training, better recognition of pathology responsible for non-arthritic hip pain and an increasing desire for minimally invasive procedures. With increasing rates of arthroscopy, associated complications are also being recognized. We present a series of six patients who experienced psoas tunnel perforation during anchor insertion from the distal anterolateral portal during labral repair. All patients underwent prior hip arthroscopy and labral repair and presented with persistent symptoms at least partly attributable to magnetic resonance imaging (MRI)-documented psoas tunnel perforation. Their clinical records, operative notes and intra-operative photographs were reviewed. All patients presented with persistent pain, both with an anterior impingement test and resisted hip flexion. MRI imaging demonstrated medial cortical perforation with anchors visualized in the psoas tunnel, adjacent to the iliopsoas muscle. Four patients have undergone revision hip arthroscopy, whereas two have undergone periacetabular osteotomies. All patients had prominent anchors in the psoas tunnel removed at the time of surgery, with varying degrees of concomitant pathology appropriately treated during the revision procedure. Care must be utilized during medial anchor placement to avoid psoas tunnel perforation. Although this complication alone was not the sole cause for revision in each case, it may have contributed to their poor outcome and should be avoided in future cases. This can be accomplished by using a smaller anchor, inserting the anchor from the mid-anterior portal and checking the drill hole with a nitinol wire prior to anchor insertion. PMID:27011849

  15. Traumatic Cardiac Injury: Ventricular Perforation Caught on CT

    PubMed Central

    Dong, Paul; Evans, Scott

    2016-01-01

    Myocardial rupture is a rare imaging diagnosis given its clinical severity and high mortality. Early findings should be promptly communicated to the trauma service to ensure immediate intervention. We present a rare case of blowout perforation of the right ventricle which was prospectively diagnosed on computed tomography (CT) leading to emergent operative repair. The patient subsequently survived and was discharged after a lengthy hospital course. PMID:27382496

  16. Metastatic Adenocarcinoma of Unknown Origin Presenting as Small Bowel Perforation

    PubMed Central

    Alkabie, Samir; Bello, Brian; Martinez, Roberto F.; Geis, W. Peter

    2015-01-01

    Metastatic malignant tumors that originate from occult primaries are defined as “cancers of unknown origin.” We herein present the case of a 59-year-old man who presented with small bowel perforation secondary to metastatic adenocarcinoma of an unknown primary site. Imaging exhibited two pulmonary nodules, neither of which was dominant, along with mediastinal and retroperitoneal lymphadenopathy. Immunohistochemical profiling of the small bowel biopsy specimens revealed the tumor was most likely pulmonary in origin. PMID:26425638

  17. Effect of narcotic premedication of scintigraphic evaluation of gallbladder perforation

    SciTech Connect

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

    1985-01-01

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

  18. Temperature Driven Annealing of Perforations in Bicellar Model Membranes

    SciTech Connect

    Nieh, Mu-Ping; Raghunathan, V.A.; Pabst, Georg; Harroun, Thad; Nagashima, K; Morales, H; Katsaras, John; Macdonald, P

    2011-01-01

    Bicellar model membranes composed of 1,2-dimyristoylphosphatidylcholine (DMPC) and 1,2-dihexanoylphosphatidylcholine (DHPC), with a DMPC/DHPC molar ratio of 5, and doped with the negatively charged lipid 1,2-dimyristoylphosphatidylglycerol (DMPG), at DMPG/DMPC molar ratios of 0.02 or 0.1, were examined using small angle neutron scattering (SANS), {sup 31}P NMR, and {sup 1}H pulsed field gradient (PFG) diffusion NMR with the goal of understanding temperature effects on the DHPC-dependent perforations in these self-assembled membrane mimetics. Over the temperature range studied via SANS (300-330 K), these bicellar lipid mixtures exhibited a well-ordered lamellar phase. The interlamellar spacing d increased with increasing temperature, in direct contrast to the decrease in d observed upon increasing temperature with otherwise identical lipid mixtures lacking DHPC. {sup 31}P NMR measurements on magnetically aligned bicellar mixtures of identical composition indicated a progressive migration of DHPC from regions of high curvature into planar regions with increasing temperature, and in accord with the 'mixed bicelle model' (Triba, M. N.; Warschawski, D. E.; Devaux, P. E. Biophys. J.2005, 88, 1887-1901). Parallel PFG diffusion NMR measurements of transbilayer water diffusion, where the observed diffusion is dependent on the fractional surface area of lamellar perforations, showed that transbilayer water diffusion decreased with increasing temperature. A model is proposed consistent with the SANS, {sup 31}P NMR, and PFG diffusion NMR data, wherein increasing temperature drives the progressive migration of DHPC out of high-curvature regions, consequently decreasing the fractional volume of lamellar perforations, so that water occupying these perforations redistributes into the interlamellar volume, thereby increasing the interlamellar spacing.

  19. [Intestinal perforation by Angiostrongylus costaricensis. A report of 2 cases].

    PubMed

    Sánchez, G A

    1992-05-01

    Two cases of abdominal angiostronylosis with terminal ileum perforation are reported. The first two cases diagnosed in Panama of a well established eosinophilic granulomatous process which affects mostly children in Costa Rica. The parasite Angiostrongylus costaricensis has been demonstrated in cases with a geographic range, from Mexico down to Brazil. The parasite has been found in rodents in Panama (Sigmodon hispidus and Rattus rattus) with an still pending further epidemiological and serological studies in order to determine the true disease morbidity. PMID:1620898

  20. Unusual perforated appendicitis within umbilical hernia: CT findings.

    PubMed

    Arnáiz, J; Ortiz, A; Marco de Lucas, E; Piedra, T; Jordá, J; Arnáiz, A M; Pagola, M A

    2006-01-01

    We present the first imaging report of perforated appendicitis in an umbilical hernia. Computed tomography demonstrated a gas-forming abscess within an umbilical hernia and the cecum was found inside the hernial sac, with an inner relation to the abscess. Computed tomographic findings suggested appendicitis as possible diagnosis, which was confirmed at surgery. Physicians must consider appendicitis within the differential diagnosis of an abdominal abscess located near to the cecum, even at an unexpected location. PMID:16465570

  1. Diagnostic value of procalcitonin for acute complicated appendicitis

    PubMed Central

    Yamashita, Hiromasa; Yuasa, Norihiro; Takeuchi, Eiji; Goto, Yasutomo; Miyake, Hideo; Miyata, Kanji; Kato, Hideki; Ito, Masafumi

    2016-01-01

    ABSTRACT A rapid and reliable test for detection of complicated appendicitis would be useful when deciding whether emergency surgery is required. We investigated the clinical usefulness of procalcitonin for identifying acute complicated appendicitis. We retrospectively analyzed 63 patients aged ≥15 years who underwent appendectomy without receiving antibiotics before admission and had preoperative data on the plasma procalcitonin level (PCT), body temperature (BT), white blood cell count (WBC), neutrophil / lymphocyte ratio (N/L ratio), and C-reactive protein level (CRP). Patients were classified into 3 groups: group A (inflammatory cell infiltration of the appendix with intact mural architecture), group B (inflammatory cell infiltration with destruction of mural architecture, but without abscess or perforation), and group C (macroscopic abscess and/or perforation). For identifying destruction of mural architecture, the diagnostic accuracy of PCT was similar to that of BT or CRP. However, the diagnostic accuracy of PCT was highest among the five inflammatory indices for identifying abscess and/or perforation, with the positive predictive value of PCT for abscess and/or perforation being higher than that of CRP (73% vs. 48%). Univariate analysis of the predictors of abscess and/or perforation revealed that a plasma PCT level ≥0.46 ng/mL had the highest odds ratio (30.3 [95% confidence interval: 6.5–140.5] versus PCT <0.46 ng/mL). These findings indicate that procalcitonin is a useful marker of acute appendicitis with abscess and/or perforation. PMID:27019529

  2. Surgical Audit of Patients with Ileal Perforations Requiring Ileostomy in a Tertiary Care Hospital in India

    PubMed Central

    Verma, Hemkant; Pandey, Siddharth; Sheoran, Kapil Dev; Marwah, Sanjay

    2015-01-01

    Introduction. Ileal perforation peritonitis is a frequently encountered surgical emergency in the developing countries. The choice of a procedure for source control depends on the patient condition as well as the surgeon preference. Material and Methods. This was a prospective observational study including 41 patients presenting with perforation peritonitis due to ileal perforation and managed with ileostomy. Demographic profile and operative findings in terms of number of perforations, site, and size of perforation along with histopathological findings of all the cases were recorded. Results. The majority of patients were male. Pain abdomen and fever were the most common presenting complaints. Body mass index of the patients was in the range of 15.4–25.3 while comorbidities were present in 43% cases. Mean duration of preoperative resuscitation was 14.73 + 13.77 hours. Operative findings showed that 78% patients had a single perforation; most perforations were 0.6–1 cm in size and within 15 cm proximal to ileocecal junction. Mesenteric lymphadenopathy was seen in 29.2% patients. On histopathological examination, nonspecific perforations followed by typhoid and tubercular perforations respectively were the most common. Conclusion. Patients with ileal perforations are routinely seen in surgical emergencies and their demography, clinical profile, and intraoperative findings may guide the choice of procedure to be performed. PMID:26247059

  3. [Problems in the Treatment of Stage Ⅲ Colorectal Cancer with Perforation].

    PubMed

    Onozawa, Hisashi; Kumamoto, Kensuke; Matsuzawa, Takeaki; Ishiguro, Toru; Sobajima, Jun; Fukuchi, Minoru; Kumagai, Youichi; Ishibashi, Keiichiro; Mochiki, Erito; Ishida, Hideyuki

    2015-11-01

    We retrospectively investigated clinical outcome and treatment strategies in Stage Ⅲcolorectal cancer patients who underwent emergency surgery because of tumor-related perforation. We compared the clinical outcome of 6 patients (perforation group) who underwent emergency surgery for colonic perforation due to Stage Ⅲ colorectal cancer with 12 matched patients (matching group) who underwent elective colorectal surgery, between April 1998 and March 2012. Patients in the perforation group underwent colostomy procedures more frequently (p=0.02), had longer operative times (p=0.02), and more bleeding (p=0.04) than those in the matching group. There was no significant difference between the groups in terms of the introduction rate of chemotherapy, recurrence rate, or recurrence pattern. The 3-year disease-free survival rate was 44% in the perforation group and 81% in the matching group, resulting in no significant differences between these groups (p=0.28). The 3-year disease-free survival rates in the perforation and the matching groups were 44% and 81%, respectively (p=0.07). The 3-year overall survival rates in the perforation and the matching groups were 17% and 81%, respectively (p<0.01). The 3-year overall survival rate of patients who received adjuvant chemotherapy was 50% in the perforation group and 88%in the matching group (p=0.03). We concluded that patients with perforated Stage Ⅲ colorectal cancer had a significantly poorer prognosis compared with patients with non-perforated Stage Ⅲ colorectal cancer. PMID:26805325

  4. Intercostal artery perforator propeller flap for reconstruction of trunk defects following sarcoma resection.

    PubMed

    Zang, Mengqing; Yu, Shengji; Xu, Libin; Zhao, Zhenguo; Zhu, Shan; Ding, Qiang; Liu, Yuanbo

    2015-06-01

    Trunk defects following soft tissue sarcoma resection are usually managed by myocutaneous flaps or free flaps. However, harvesting muscle will cause functional morbidities and some trunk regions lack reliable recipient vessels. The intercostal arteries give off multiple perforators, which distribute widely over the trunk and can supply various pedicle flaps. Our purpose is to use various intercostal artery perforator propeller flaps for trunk oncologic reconstruction. Between November 2013 and July 2014, nine intercostal artery perforator propeller flaps were performed in seven patients to reconstruct the defects following sarcoma resection in different regions of the trunk, including the back, lumbar, chest, and abdomen. Two perforators from intercostal arteries were identified for each flap using Doppler ultrasound probe adjacent to the defect. The perforator with visible pulsation was chosen as the pedicle vessel. An elliptical flap was raised and rotated in a propeller fashion to repair the defects. There were one dorsal intercostal artery perforator flap, four dorsolateral intercostal artery perforator flaps, three lateral intercostal artery perforator flaps, and one anterior intercostal artery perforator flap. The mean skin paddle dimension was 9.38 cm in width (range 6-14 cm) and 21.22 cm in length (range 13-28 cm). All intercostal artery perforator flaps survived completely, except for marginal necrosis in one flap harvested close to the previous flap donor site. The intercostal artery perforator propeller flap provides various and valuable options in our reconstructive armamentarium for trunk oncologic reconstruction. To our knowledge, this is the first case series of using intercostal artery perforator propeller flaps for trunk oncologic reconstruction and clinical application of dorsolateral intercostal artery perforator flaps. PMID:25801799

  5. Management of an iatrogenic radial artery perforation: a case report.

    PubMed

    Buturak, Ali; Demirci, Yasemin; Dağdelen, Sinan

    2013-06-01

    A 73-year-old female patient underwent transradial coronary angiography with stable angina and signs of significant myocardial ischemia revealed by exercise stress test. After insertion of a 6F radial sheath into the right radial artery and intra-arterial administration of heparin plus verapamil, the hydrophilic guidewire could not be advanced under fluoroscopic guidance. Immediately afterwards, radial angiography was performed, which displayed a radial artery perforation with significant contrast extravasation. The perforated segment was crossed meticulously with the same guidewire after additional vasodilator drug administration. Afterwards, a 5F TIG catheter was advanced to the axillary artery and held in place for 20 minutes with application of external compression with a sphygmomanometer cuff at the level of systolic blood pressure. The same maneuver was again performed following cuff deflation and completion of coronary angiography with the 5F catheter. Final angiography displayed complete sealing of the perforation without a need for neutralization of heparin. External compression was continued for two hours, and after documentation of normal triphasic radial artery flow by Doppler ultrasound (DUS), the radial sheath was removed. The patient was discharged the following day with no evidence of hand ischemia and well-palpable radial artery pulse. DUS demonstrated normal radial artery flow one month later. This unusual complication was managed successfully with a simple and easily applicable technique that can be performed in such cases. PMID:23760121

  6. Micro-mechanical modeling of perforating shock damage

    SciTech Connect

    Swift, R.P.; Krogh, K.E.; Behrmann, L.A.; Halleck, P.M.

    1997-11-17

    Shaped charge jet induced formation damage from perforation treatments hinders productivity. Manifestation of this damage is in the form of grain fragmentation resulting in fines that plug up pore throats along with the breakdown of inter-grain cementation. The authors use the Smooth Particle Hydrodynamic (SPH) computational method as a way to explicitly model, on a grain pore scale, the dynamic interactions of grains and grain/pores to calculate the damage resulting from perforation type stress wave loading. The SPH method is a continuum Lagrangian, meshless approach that features particles. Clusters of particles are used for each grain to provide representation of a grain pore structure that is similar to x-ray synchrotron microtomography images. Numerous damage models are available to portray fracture and fragmentation. In this paper the authors present the results of well defined impact loading on a grain pore structure that illustrate how the heterogeneity affects stress wave behavior and damage evolution. The SPH approach easily accommodates the coupling of multi-materials. Calculations for multi-material conditions with the pore space treated as a void, fluid filled, and/or clay filled show diverse effects on the stress wave propagation behavior and damage. SPH comparisons made with observed damage from recovered impacted sandstone samples in gas gun experiments show qualitatively the influence of stress intensity. The modeling approach presented here offers a unique way in concert with experiments to define a better understanding of formation damage resulting from perforation completion treatments.

  7. Hybrid silencers with micro-perforated panels and internal partitions.

    PubMed

    Yu, Xiang; Cheng, Li; You, Xiangyu

    2015-02-01

    A sub-structuring approach, along with a unit cell treatment, is proposed to model expansion chamber silencers with internal partitions and micro-perforated panels (MPPs) in the absence of internal flow. The side-branch of the silencer is treated as a combination of unit cells connected in series. It is shown that, by connecting multiple unit cells with varying parameters, the noise attenuation bandwidth can be enlarged. With MPPs, the hybrid noise attenuation mechanism of the silencer is revealed. Depending on the size of the perforation hole, noise attenuation can be dominated by dissipative, reactive, or combined effects together. For a broadband sound absorption, the hole size, together with the perforation ratio and other parameters, can be optimized to strike a balance between the dissipative and reactive effect, for ultimately achieving the desired noise attenuation performance within a prescribed frequency region. The modular nature of the proposed formulation allows doing this in a flexible, accurate, and cost effective manner. The accuracy of the proposed approach is validated through comparisons with finite element method and experiments. PMID:25698027

  8. Perforated plates for cryogenic regenerators and method of fabrication

    DOEpatents

    Hendricks, J.B.

    1994-03-29

    Perforated plates having very small holes with a uniform diameter throughout the plate thickness are prepared by a [open quotes]wire drawing[close quotes] process in which a billet of sacrificial metal is disposed in an extrusion can of the plate metal, and the can is extruded and restacked repeatedly, converting the billet to a wire of the desired hole diameter. At final size, the rod is then sliced into wafers, and the wires are removed by selective etching. This process is useful for plate metals of interest for high performance regenerator applications, in particular, copper, niobium, molybdenum, erbium, and other rare earth metals. Er[sub 3]Ni, which has uniquely favorable thermophysical properties for such applications, may be incorporated in regions of the plates by providing extrusion cans containing erbium and nickel metals in a stacked array with extrusion cans of the plate metal, which may be copper. The array is heated to convert the erbium and nickel metals to Er[sub 3]Ni. Perforated plates having two sizes of perforations, one of which is small enough for storage of helium, are also disclosed. 10 figures.

  9. Perforated plates for cryogenic regenerators and method of fabrication

    DOEpatents

    Hendricks, John B.

    1994-01-01

    Perforated plates (10) having very small holes (14) with a uniform diameter throughout the plate thickness are prepared by a "wire drawing" process in which a billet of sacrificial metal is disposed in an extrusion can of the plate metal, and the can is extruded and restacked repeatedly, converting the billet to a wire of the desired hole diameter. At final size, the rod is then sliced into wafers, and the wires are removed by selective etching. This process is useful for plate metals of interest for high performance regenerator applications, in particular, copper, niobium, molybdenum, erbium, and other rare earth metals. Er.sub.3 Ni, which has uniquely favorable thermophysical properties for such applications, may be incorporated in regions of the plates by providing extrusion cans (20) containing erbium and nickel metals in a stacked array (53) with extrusion cans of the plate metal, which may be copper. The array is heated to convert the erbium and nickel metals to Er.sub.3 Ni. Perforated plates having two sizes of perforations (38, 42), one of which is small enough for storage of helium, are also disclosed.

  10. Acute Bronchitis

    MedlinePlus

    ... or though physical contact (for example, on unwashed hands). Being exposed to tobacco smoke, air pollution, dusts, vapors, and fumes can also cause acute bronchitis. Less often, bacteria can also cause acute bronchitis. To diagnose acute ...

  11. Cystitis - acute

    MedlinePlus

    Uncomplicated urinary tract infection; UTI - acute; Acute bladder infection; Acute bacterial cystitis ... control. Menopause also increases the risk for a urinary tract infection. The following also increase your chances of having ...

  12. Epstein–Barr Virus-Positive T/NK-Cell Lymphoproliferative Disorders Manifested as Gastrointestinal Perforations and Skin Lesions

    PubMed Central

    Xiao, Hai-Juan; Li, Ji; Song, Hong-Mei; Li, Zheng-Hong; Dong, Mei; Zhou, Xiao-Ge

    2016-01-01

    Abstract Systemic Epstein–Barr virus (EBV)-positive T-cell lymphoproliferative disorders (LPDs) of childhood is a highly aggressive EBV-positive T/natural killer (NK)-cell LPD, which emerges in the background of chronic active EBV infection (CAEBV) or shortly after primary acute EBV infection. The clinical presentations of CAEBV are varied; patients with atypical manifestations are easily misdiagnosed. We described a 14-year-old boy suffering from digestive disorders and intermittent fever for 1 year and 9 months, whose conditions worsened and skin lesions occurred 2 months before hospitalization. He was diagnosed as inflammatory bowel diseases (IBD) and treated accordingly. His other clinical features, hepatosplenomegaly, lymphadenopathy, anemia, hypoalbuminemia, and elevated inflammatory marks, were found in hospitalization. The boy suffered from repeatedly spontaneous intestinal perforations shortly after hospitalization and died of intestinal hemorrhea. The pathological results of intestine and skin both showed EBV-positive T/NK-cell LPD (lymphoma stage). There are rare studies reporting gastrointestinal perforations in EBV-positive T/NK-cell LPD, let alone repeatedly spontaneous perforations. Based on the clinical features and pathological results of this patient, the disease progressed from CAEBV (T-cell type) to systemic EBV-positive T-cell LPD of childhood (lymphoma). Not all the patients with CAEBV could have unusual patterns of anti-EBV antibodies. However, the presence of high EBV loads (EBV-encoded early small ribonucleic acid (RNA) (EBER) in affected tissues and/or EBV deoxyribonucleic acid (DNA) in peripheral blood) is essential for diagnosing CAEBV. Maybe because of his less common clinical features for CAEBV and negative anti-EBV antibodies, the boy was not diagnosed correctly. We should have emphasized the test for EBER or EBV-DNA. Meanwhile, for the IBD patients whose manifestations were not typical, and whose conditions were not improved by

  13. Prognostic Scoring Indicator in Evaluation of Clinical Outcome In Intestinal Perforations

    PubMed Central

    Ahuja, Ashish; Pal, Ravinder

    2013-01-01

    Introduction: Acute generalised peritonitis coming forth due to underlying intestinal perforation is a critical & life-threatening medical condition. It is a common surgical emergency most of the times across the world. Misleading data on crude morbidity and mortality due to the condition usually contaminates substantially the very purpose of medical audit. Thus, early prognostic evaluation is not only desirable but mandate to much extent. High-risk patients require timely & aggressive treatment especially in severe peritonitis & to select them reasonably well, evaluation through prognostic scoring is an approach of choice. Well sought after & reasonably reliable APACHE II scoring system is used for the purpose & scores are correlated well to accentuate & measure the various factors needed for better management of condition. Material and Methods: The study was conducted over the period of 18 months (Jan 2010 to June 2011) on 50 patients with confirmed diagnosis of intestinal perforation. APACHE II score was calculated and correlated with their symptoms & clinical outcomes regarding morbidity and mortality. Results: APACHE II score correlated well with the outcome of the study, showing score affects of two major aspects in the treatment outcome & management.1.) APACHE II score of less than 10 included 30 low risk group patients discharged in a satisfactory gratifying manner. Three out of four in high risk group with APACHE II score >20, shown adverse outcomes. 2.)Mean ICU stay of 9.75 days was found in patients with APACHE II score 20 or more compared to those with mean ICU stay of 0.13 days in patients with APACHE II score 10 or less. Conclusion: Acute generalized peritonitis being life–threatening medical emergency requires careful consideration in its management that needs to be economically viable, acceptably feasible and outcome oriented with better allocation & utilization of ICU resources that needs meticulous case analysis & prioritization. This present

  14. Coronary artery perforation in patients undergoing percutaneous coronary intervention: a single-centre report.

    PubMed

    Georgiadou, Panagiota; Karavolias, George; Sbarouni, Eftihia; Adamopoulos, Stamatis; Malakos, John; Voudris, Vassilis

    2009-01-01

    The present study reports the incidence, management and clinical outcome of coronary perforations in 5 of 2991 patients (0.1%) undergoing percutaneous coronary intervention, with non-debulking (percutaneous transluminal coronary angioplasty and stent) techniques. There was 1 type I, 1 type II and 3 type III perforations. One perforation was guidewire related, 2 perforations occurred after stent deployment and two occurred during stent-post dilatation with balloons. Restoration was obtained by prolong balloon inflation in three cases. Subsequent cardiac tamponade occurred in 2 patients, requiring pericardiocentesis. One patient died in the cath lab. due to electromechanical dissociation. At follow-up, 3 out of 4 patients were asymptomatic and one had bypass surgery for restenosis. Treatment of coronary perforation requires rapid detection, angiographic classification, and immediate occlusion of perforation site, pericardiocentesis, haemodynamic support and reversal of heparin anticoagulation. PMID:19742353

  15. Unusual presentation of a perforated appendicitis in a four-year-old girl - a case report from Yazd, Iran

    PubMed Central

    Afrand, Mohammadhosain; Modaresi, Vajiheh

    2014-01-01

    Difficulties in the early diagnosis of appendicitis, particularly in children, often lead to complications, such as perforation of the appendix, within 36 hours of the onset of symptoms. A four-year-old girl presented to the Emergency Department at Shohadaye Kargar Hospital in Yazd (a city in central Iran) in February 2013 with a history of chronic abdominal pain that began 20 days before admission. Her physical examination revealed a low-grade fever, conjunctivitis, dysuria with malodorous urine, and a mass in right, lower quadrant without localized tenderness in that area. Intestinal intussusception was suggested as the most likely diagnosis, and a laparotomy was performed. The appendix was perforated and an appendicular abscess had caused intestinal obstruction. The rarity of this case, with its unusual presentation and findings, which included unexplained chronic pain, necessitated an immediate operation that revealed the acute presentation of a mechanical obstruction of the intestine. Appendicitis must be kept in the differential diagnosis of any child who presents with chronic abdominal pain. In conclusion, chronic abdominal pain in children is not always of functional origin, and discerning the correct diagnosis can be very challenging. Therefore, clinicians should think broadly since multi-disciplinary input may be inevitable. PMID:25763147

  16. An atypical presentation of small bowel obstruction and perforation secondary to sporadic synchronous intra-abdominal desmoid tumours

    PubMed Central

    Abdalla, Sala; Wilkinson, Michelle; Wilsher, Mark; Uzkalnis, Aleksandras

    2016-01-01

    Introduction Desmoid tumours (DTs) are rare, soft tissue tumours which account for 0.03% of all neoplasms. They are characteristically locally invasive but do not metastasize. There is frequent association with females of reproductive age, a history of abdominal surgery or trauma and a family history of fibromatoses. Intra-abdominal DTs are infrequently sporadic and more commonly associated with inherited disorders such as familial adenomatous polyposis (FAP), attenuated FAP and Gardener’s syndrome. Presentation of case The authors report a rare case of small bowel obstruction and perforation secondary to sporadic, synchronous intra-abdominal DTs in a 54-year old man with atypical symptoms and no risk factors or family history. Discussion Intra-abdominal DTs have a worse prognosis as they can cause intestinal bleeding, obstruction and perforation. Due to the rarity of these tumours there are no clear guidelines on their management and this is instead based on small case series from specialist centres. In the non-acute setting patients with sporadic intra-abdominal DTs should be managed in a specialist sarcoma unit by a multidisciplinary team. In the presence of FAP or other polyposis syndromes patients with DTs should be managed at a specialist colorectal unit. Emergent presentations require emergency surgery in suitable candidates. Conclusion In non-emergency presentations of DTs, it is essential to exclude FAP, AFAP and other hereditary polyposis syndromes since this affects treatment and subsequent follow-up. PMID:26866881

  17. Effect of H2 antagonists on outcome of simple closure for perforated duodenal ulcer.

    PubMed

    Koh, K B; Chang, K W

    1992-10-01

    The treatment of perforated duodenal ulcer is controversial. Since the advent of H2 antagonists, the number of ulcer operations has declined tremendously. We wanted to find out if the addition of a H2 antagonist after simple closure of a perforated duodenal ulcer would change the outcome and therefore reviewed 46 patients treated in this fashion. Our results show that this is a safe and effective way of treating patients with perforated duodenal ulcer. PMID:1360708

  18. The Houdini effect--an unusual case of blunt abdominal trauma resulting in perforative appendicitis.

    PubMed

    O'Kelly, F; Lim, K T; Hayes, B; Shields, W; Ravi, N; Reynolds, J V

    2012-03-01

    We present a unique case of perforative appendicitis that occurred in an adult following blunt abdominal trauma. This case represents the first such reported case from Ireland. It also represents a modern practical example of Laplace's theory of the effect of increased pressure on colonic wall tension leading to localized perforation, and serves to highlight not only the importance in preoperative imaging for blunt abdominal trauma, but also the importance of considering appendiceal perforation. PMID:22558817

  19. Perforation of the colon and rectum--a newly recognized complication of CT colonography.

    PubMed

    Sosna, Jacob; Sella, Tamar; Bar-Ziv, Jacob; Libson, Eugene

    2006-04-01

    CT colonography (CTC) and conventional colonoscopy may have similar efficacy for detection of polyps > 6 mm. Perforation of the colon and rectum is a relatively rare, but potentially morbid complication of CTC, especially in symptomatic patients. Older age and underlying concomitant colon pathology increase the risk of perforation. This review describes the incidence, clinical features, and management of colon perforations at CTC, a study that was considered risk-free until recently. PMID:16623370

  20. Binge Eating Leading to Acute Gastric Dilatation, Ischemic Necrosis and Rupture -A Case Report.

    PubMed

    Dewangan, Manish; Khare, Manish Kumar; Mishra, Sumanta; Marhual, Jogesh Chandra

    2016-03-01

    Acute gastric dilatation is a rarely encountered clinical scenario in our day to day practice. This is very rapidly progressing condition and can lead to ischemic necrosis and perforation/rupture of the stomach. It could be fatal if not timely intervened. We report such a case of a 17-year-old, otherwise healthy boy, who presented with pain and distension of abdomen following binge eating episode after 24 hours of prolonged fasting. On exploration, stomach was dilated with necrosis and perforation at fundus near greater curvature. He was managed with excision of all the devitalized area and primary repair with feeding jejunostomy. The case is presented due to its rarity. Acute gastric dilatation (AGD) leading to ischemic necrosis and perforation because of binge eating episode in an otherwise healthy person is an exceptional occurrence with only few cases reported in literature. The clinician should be aware of this condition for prompt and appropriate management. PMID:27134932

  1. Binge Eating Leading to Acute Gastric Dilatation, Ischemic Necrosis and Rupture –A Case Report

    PubMed Central

    Khare, Manish Kumar; Mishra, Sumanta; Marhual, Jogesh Chandra

    2016-01-01

    Acute gastric dilatation is a rarely encountered clinical scenario in our day to day practice. This is very rapidly progressing condition and can lead to ischemic necrosis and perforation/rupture of the stomach. It could be fatal if not timely intervened. We report such a case of a 17-year-old, otherwise healthy boy, who presented with pain and distension of abdomen following binge eating episode after 24 hours of prolonged fasting. On exploration, stomach was dilated with necrosis and perforation at fundus near greater curvature. He was managed with excision of all the devitalized area and primary repair with feeding jejunostomy. The case is presented due to its rarity. Acute gastric dilatation (AGD) leading to ischemic necrosis and perforation because of binge eating episode in an otherwise healthy person is an exceptional occurrence with only few cases reported in literature. The clinician should be aware of this condition for prompt and appropriate management. PMID:27134932

  2. Repair of chronic tympanic membrane perforations using applications of hyaluronan or rice paper prostheses.

    PubMed

    Laurent, C; Söderberg, O; Anniko, M; Hartwig, S

    1991-01-01

    A controlled randomized study was performed in 60 patients with 64 chronic, dry tympanic membrane (TM) perforations. The perforations were randomly allocated to either resection of the perforation rim and instillation of 1% hyaluronan (Healon; HYA) in the perforation gap once daily for 7 days (33 ears) or resection of the perforation margin and application of a sterile rice paper prosthesis (31 ears). The treatment effect was documented by TM photography and morphometric measurements of the perforation area. The hearing was assessed with puretone and high-frequency audiometry. After 2 months, 5 of the HYA-treated perforations (15%) and 4 of the rice-paper-treated TMs (13%) were healed. After 1 year, 18 perforations (9 in each treatment group) were healed. In neither group were there any persistent adverse effects on hearing. It is noteworthy that 28% (18/64) of the chronic, long-standing TM perforations could be repaired by these technically simple and time-saving methods. Both procedures should be considered as easy first-choice alternatives to myringoplasty in selected cases. PMID:2008293

  3. Neonatal Sigmoid Colon Perforation: A Rare Occurrence in Low Anorectal Malformation and Review of the Literature.

    PubMed

    Parelkar, Sandesh V; Kapadnis, Satish P; Sanghvi, Beejal V; Joshi, Prashant B; Mundada, Dinesh D; Oak, Sanjay N

    2016-06-01

    Gastrointestinal perforation in neonates with anorectal malformation (ARM) is extremely uncommon. Delayed patient presentation is an important causative factor. A 2.5-kg neonate presented 72 hours after birth with abdominal distention and absent anal opening with meconium pearls. An abdominal X-ray revealed the presence of free gas. After adequate resuscitation patient underwent surgery. Closure of the sigmoid colon perforation with a proximal diverting loop colostomy with anoplasty was done. The literature reveals only two cases of sigmoid colon perforation with low ARM. Ours is the third case, in whom repair of the perforation and correction of the ARM was managed successfully at the same time. PMID:24231113

  4. Radiological evidence of subcutaneous emphysema leading to a diagnosis of retroperitoneal perforated diverticulum

    PubMed Central

    Sivarajah, Vernon; Jones, Christopher; Pittathankal, Antony

    2013-01-01

    INTRODUCTION This case report outlines the investigation and management of a young patient presenting with left iliac fossa pain and sepsis. A CT was performed which was initially reported as not showing a perforation, however closer analysis provided evidence of subcutaneous emphysema in the anterior abdominal wall. This evidence justified urgent operative intervention. We review the evidence with regard to this presentation. PRESENTATION OF CASE A previously fit 24-year-old male presented with left iliac fossa pain and features of sepsis. A CT provided subtle but distinctive evidence of retroperitoneal perforation secondary to diverticulitis, in the form of surgical emphysema in the anterior abdominal wall. In view of this, urgent operation was considered justified on suspicion of visceral perforation. A diverticular perforation was confirmed intra-operatively, and a sigmoid colectomy with primary anastomosis was performed, together with a covering ileostomy. The patient made a good post-operative recovery. DISCUSSION Diverticular disease and its complications are becoming more common in a younger age group, in whom perforation may present late or may not be suspected. In this context special attention must be paid to any radiological evidence of perforation. CONCLUSION Surgical emphysema in the abdominal wall is an indicator of retroperitoneal perforation, and its presence should be excluded before the possibility of perforation is dismissed. This may be of especial value in younger age groups amongst whom perforation may be less clinically obvious. PMID:23598175

  5. Esophageal stent placement as a therapeutic option for iatrogenic esophageal perforation in children

    PubMed Central

    Ahmad, Alsafadi; Wong Kee Song, Louis M.; Absah, Imad

    2016-01-01

    Iatrogenic esophageal perforation (IEP) is a potentially serious adverse event of interventional endoscopy. The approach to IEP varies from surgical repair for large perforations to conservative treatment for small contained perforations. We report a case of an 18-month-old girl with congenital esophageal stenosis suffering a large esophageal perforation after a trial of stricture dilatation, which was successfully managed by the placement of fully covered stent. Hence, in selected cases, esophageal stent placement is a feasible alternative to invasive surgery in managing IEP. PMID:27144142

  6. Multidetector-row Computed Tomographic Angiography in the Planning of the Local Perforator Flaps

    PubMed Central

    Sliesarenko, Sergii V.

    2015-01-01

    Background: The perforator vessels are highly variable in number, localization types, hemodynamic specifications, and the anatomical interactions with other structures. For these reasons, the identification of the best perforator before the operation is very important for the choice of the main feed vessel and the design of the perforator flap. Methods: The authors retrospectively analyzed all cases in which multiple detector computed tomography (MDCT) with 3-dimensional (3D) image reconstruction was used in the preoperative planning in preparation for the reconstruction with local perforator flaps, which took place between July 2012 and December 2014 in the hospital. Results: A total of 24 people were examined and underwent operations with 26 reconstructions using local perforator flaps. All perforators, which were identified during the MDCT with 3D reconstruction examination, were located intraoperationally without any errors. Conclusions: The preoperative MDCT with 3D reconstruction investigations of the topographic anatomical specifics of the perforator vessel on which the formation of the flap feed pedicle is planned allow for the fast and precise identification of the perforation at the preoperative stage while minimizing the amount of injury caused to the perforator during the operation and decrease the operation time. PMID:26495229

  7. Colonic perforation after stent placement for malignant colorectal obstruction--causes and contributing factors.

    PubMed

    Datye, Arundhati; Hersh, Jeff

    2011-05-01

    Self-expanding metal stents (SEMS) are used to manage malignant colorectal obstruction. Colonic perforation is the most worrisome complication from colonic stenting. We reviewed causes and contributing factors of perforation with colonic stent placement in patients with malignant colorectal obstruction. Articles from both English and foreign language publications were identified from Medline. Data were collected on causes, timing, treatment and mortality related to perforation. A total of 2287 patients from 82 articles were included in this analysis, which showed an overall perforation rate of 4.9%. Perforation rates for palliation and bridge to surgery (BTS) were not significantly different (4.8% vs. 5.4%, p = 0.66); over 80% occurred within 30 days of stent placement (half during or within one day of the procedure). The mortality rate related to perforation was 0.8% per stented patient, but the mortality of patients experiencing perforation was 16.2%. There was no significant difference (p = 0.78) in the mortality rates between the palliation and the BTS group and concomitant chemotherapy, steroids, and radiotherapy are risk factors of perforation. The overall perforation related mortality is far less than that of patients undergoing emergency surgery for bowel obstruction. PMID:20929424

  8. [Efficacy of Postoperative Chemotherapy in Stage Ⅳ Colorectal Cancer with Perforation].

    PubMed

    Onozawa, Hisashi; Kumamoto, Kensuke; Matsuzawa, Takeaki; Ishiguro, Toru; Sobajima, Jun; Fukuchi, Minoru; Kumagai, Youichi; Ishibashi, Keiichiro; Mochiki, Erito; Ishida, Hideyuki

    2015-11-01

    The clinical outcome and efficacy of postoperative chemotherapy in patients with Stage Ⅳ colorectal cancer with perforation were investigated. We compared the clinical outcomes between 11 patients with Stage Ⅳ colorectal cancer (perforation group), who underwent emergency surgery for colonic perforation between September 2005 and March 2012, and 22 matched patients (matching group) who underwent elective colorectal surgery during the same period. The colostomy rate in the perforation group was significantly higher than that of the matching group: patients with perforation received stoma construction surgery more frequently (p<0.01). Seven patients (64%) in the perforation group received postoperative chemotherapy, while 20 patients (91%) in the matching group received chemotherapy (p=0.15). Oxaliplatin-based chemotherapy was administered to all patients in both groups. There was no difference in the median relative dose intensity of oxaliplatin between these groups (p=0.37). No significant difference was observed between the cumulative 3-year overall survival rate in the perforation group and that of the matching group (35% and 54%, respectively; p=0.35). Moreover, the 3-year overall survival rates of patients who received oxaliplatin-based chemotherapy were 51%in the perforation group and 57% in the matching group (p=0.74). Our results suggest that postoperative oxaliplatin-based chemotherapy may improve the prognosis of patients with Stage Ⅳ colorectal cancer with perforation. PMID:26805324

  9. Perforated second trimester appendicitis with abdominal compartment syndrome managed with negative pressure wound therapy and open abdomen

    PubMed Central

    Turnock, Adam R.; Fleischer, Brian P.; Carney, Martin J.; Vanderlan, Wesley B.

    2016-01-01

    Abdominal compartment syndrome (ACS) is a known complication of laparotomy; however, the literature is lacking in regards to treatment of this entity in pregnant patients. We present a case of acute perforated appendicitis in a second trimester primagravida, complicated by gangrenous necrosis of the contiguous bowel with subsequent development of ACS and intra-abdominal sepsis. This was treated with a novel approach, using non-commercial negative pressure wound therapy and open abdomen technique. Gestational integrity was preserved and the patient went on to experience a normal spontaneous vaginal delivery. At 5 years post-delivery the patient has had no surgical complications and her baby has met all developmental milestones. PMID:27302498

  10. Perforated second trimester appendicitis with abdominal compartment syndrome managed with negative pressure wound therapy and open abdomen.

    PubMed

    Turnock, Adam R; Fleischer, Brian P; Carney, Martin J; Vanderlan, Wesley B

    2016-01-01

    Abdominal compartment syndrome (ACS) is a known complication of laparotomy; however, the literature is lacking in regards to treatment of this entity in pregnant patients. We present a case of acute perforated appendicitis in a second trimester primagravida, complicated by gangrenous necrosis of the contiguous bowel with subsequent development of ACS and intra-abdominal sepsis. This was treated with a novel approach, using non-commercial negative pressure wound therapy and open abdomen technique. Gestational integrity was preserved and the patient went on to experience a normal spontaneous vaginal delivery. At 5 years post-delivery the patient has had no surgical complications and her baby has met all developmental milestones. PMID:27302498

  11. The role of perforators in chronic venous insufficiency.

    PubMed

    O'Donnell, T F

    2010-02-01

    The treatment of incompetent calf perforating veins (ICPVs) has been ascribed an important role in the therapeutic strategy for reducing superficial venous hypertension in patients with advanced chronic venous insufficiency (C4-C6). Since the open approach to ligation of ICPVs was developed by Linton over 70 years ago, there has been an evolution toward less invasive techniques with lower morbidity. This paper will review the evidence for interruption of ICPVs through a series of systematic analyses of (1) subfascial endoscopic perforating surgery (SEPS) and (2) percutaneous thermal ablation techniques (PAPS). The effectiveness and morbidity of each approach will be discussed as well as the strength of evidence supporting that technique. While there are numerous case series that suggest that SEPS is beneficial for ulcer healing and for the prevention of ulcer recurrence, the sole two RCTs that have compared either open division or SEPS for ICPVs have failed to show a statistical advantage for ICPV ablation. The results of these studies are clouded by the inclusion of patients who received concomitant treatment of their great saphenous vein (GSV). The evidence for PAPS is based on a few (n = 5) case series in peer-reviewed journals, which are limited by small patient populations, limited follow-up, and a focus on surrogate outcomes (occlusion of the perforator) rather than clinical or functional outcomes. Moreover, most of these series were carried out in patients with mild disease. Sclerotherapy of ICPVs, by either liquid or foam, shows promise, but requires greater evidence. Our current approach for limbs with C4-C6 disease is to treat the GSV first and limit treatment of ICPVs to those with high volume flow and large-diameter ICPVs. [corrected] PMID:20118341

  12. Perforation of gastric cancer - what should the surgeon do?

    PubMed Central

    Ignjatovic, Nebojsa; Stojanov, Dragan; Djordjevic, Miodrag; Ignjatovic, Jelena; Stojanov, Daniela Benedeto; Milojkovic, Bobana

    2016-01-01

    Perforation represents a rare and severe complication of gastric cancer (GC) with a large hospital mortality (8-82%). The aim of this study is to evaluate the clinical-pathological features in patients with perforated gastric cancer (PGC) and to advise the surgical treatment options. A total of 11 patients with PGC were retrospectively reviewed among 376 consecutive cases of GC operated. The clinical-pathological features including tumor stage, survival, and the type of treatment were observed. The perforation was more frequent in stage III (8 patients) and in stage IV (3 patients), but none of the cases in stage I and II GC were observed. All the patients had serosal invasion and lymph node metastasis. Limited lymphadenectomy (D0, D1) was performed in 5 patients, and extended lymphadenectomy (D2, D3) in 3 patients. Emergency gastrectomy was performed in 8 (72.8%) patients, subtotal gastrectomy in 5 (45.5%), and total gastrectomy in 3 (27.2%) cases. Three (27.2%) patients were treated by simple closure with omental patch. The overall 30-day mortality rate was 46%. The survival rate was higher among the patients who underwent curative resection (75.77±68.88 days) than in those who underwent simple closure with omental patch (18.00±24.43 days). The difference between the treatments in these groups was significant (p < 0.05). PGC required surgical emergency. Curative resection improved long-term survival in the patients with potentially curable gastric malignancy. Unsuccessful outcomes after PGC could be attributed to the poor condition of the patients and the advanced disease stage.

  13. Esophgeal Perforation and Bilateral Empyema Following Endoscopic EsophyX Transoral Incisionless Fundoplication.

    PubMed

    Edriss, Hawa; El-Bakush, Amal; Nugent, Kenneth

    2014-11-01

    Transoral incisionless fundoplication (TIF) has been used for endoscopic treatment of gastroesophageal reflux disease (GERD). TIF using the EsophyX device system (EndoGastric Solutions) was designed to create a full-thickness valve at the gastroesophageal junction through the insertion of multiple fasteners; it improves GERD, reduces proton pump inhibitor use, and improves quality of life. Although TIF is effective in select patients, a significant subset of patients undergoing TIF develop persistent or recurrent GERD symptoms and may need antireflux surgery to control the GERD symptoms. We now report a 48-year-old man with chronic GERD unresponsive to medical management. He underwent TIF complicated by esophageal perforation and developed mediastinitis, left pneumothorax, bilateral pleural effusions, and acute respiratory failure. He required chest tube placement and bilateral decortication for treatment of nonresolving empyemas. Additional postmarketing studies are required to assess the safety, efficacy, and clinical outcomes of this novel procedure, and patients undergoing this procedure need close postprocedural follow-up. PMID:25505723

  14. Spontaneous Bacterial Peritonitis due to Actinomyces Mimicking a Perforation of the Proximal Jejunum.

    PubMed

    Eenhuis, Louise L; de Lange, Marleen E; Samson, Anda D; Busch, Olivier R C

    2016-01-01

    BACKGROUND Pelvic-abdominal actinomycosis is a rare chronic condition caused by an anaerobic, gram-negative rod-shaped commensal bacterium of the Actinomyces species. When Actinomyces becomes pathogenic, it frequently causes a chronic infection with granulomatous abscess formation with pus. Due to diversity in clinical and radiological presentation, actinomycosis can easily be mistaken for several other conditions. Peritonitis without preceding abscess formation caused by Actinomyces species has been described in only few cases before in literature. CASE REPORT We report a case of spontaneous pelvic-abdominal peritonitis with presence of pneumoperitoneum and absence of preceding abscesses due to acute actinomycosis mimicking a perforation of the proximal jejunum in a 42-year-old female with an intra-uterine contraceptive device in place. Explorative laparotomy revealed 2 liters of odorless pus but no etiological explanation for the peritonitis. The intra-uterine contraceptive device was removed. Cultivation showed growth of Actinomyces turicensis. The patient was successfully treated with penicillin. CONCLUSIONS In the case of primary bacterial peritonitis or lower abdominal pain without focus in a patient with an intra-uterine device in situ, Actinomyces should be considered as a pathogen. PMID:27561364

  15. Colonic obstruction and perforation related to heavy Trichuris trichiura infestation.

    PubMed Central

    Bahon, J; Poirriez, J; Creusy, C; Edriss, A N; Laget, J P; Dei Cas, E

    1997-01-01

    Heavy Trichuris trichiura infestation is rare in developed countries, and complications requiring surgical intervention have been described rarely in human trichuriasis. A case of colonic obstruction and perforation related to heavy whip-worm infection is described in an 84 year old woman. The woman was admitted to hospital because of a chest infection. Two days after admission she suffered nausea and vomiting followed a day later by bowel stoppage. Laparotomy indicated intestinal obstruction by a tumour. A partial right sided ileocolectomy was performed. Pathological examination of the resected bowel revealed heavy infestation with T trichiura causing a pseudotumour following a proliferative inflammatory response. Images PMID:9306948

  16. [Non perforating trabecular surgery with reticulated hyaluronic acid implant].

    PubMed

    Robe-Collignon, N J; Collignon-Brach, J D

    2000-01-01

    Non perforating trabecular surgery (NPTS) with reticulated hyaluronic acid implant (Skgel) allows aqueous humor to leave anterior chamber through a thin trabeculo-Descemet's membrane into a sclerocorneal space filled with Skgel implant and then via the outflow physiological channels. Good intraocular pressure results are obtained with less or without external filtration decreasing the incidence of per- and postoperative complications found after trabeculectomy. This surgery is actually only indicated for primary open angle glaucoma, the trabeculectomy still remaining the gold standard procedure for the other glaucoma cases. PMID:11262887

  17. Radiant heat test of Perforated Metal Air Transportable Package (PMATP).

    SciTech Connect

    Gronewald, Patrick James; Oneto, Robert; Mould, John; Pierce, Jim Dwight

    2003-08-01

    A conceptual design for a plutonium air transport package capable of surviving a 'worst case' airplane crash has been developed by Sandia National Laboratories (SNL) for the Japan Nuclear Cycle Development Institute (JNC). A full-scale prototype, designated as the Perforated Metal Air Transport Package (PMATP) was thermally tested in the SNL Radiant Heat Test Facility. This testing, conducted on an undamaged package, simulated a regulation one-hour aviation fuel pool fire test. Finite element thermal predictions compared well with the test results. The package performed as designed, with peak containment package temperatures less than 80 C after exposure to a one-hour test in a 1000 C environment.

  18. Extended thoracodorsal artery perforator flap for breast reconstruction.

    PubMed

    Angrigiani, Claudio; Rancati, Alberto; Escudero, Ezequiel; Artero, Guillermo

    2015-12-01

    A total of 45 patients underwent partial or total autologous breast reconstruction after skin-sparing mastectomy, skin-reducing mastectomy, and quadrantectomy using a thoracodorsal artery perforator (TDAP) flap. The detailed surgical technique with its variations is explained in this report. The propeller, flip-over, conventional perforator, and muscle-sparing flaps have been described and evaluated. The flaps were partially or completely de-epithelialized. The conventional TDAP can be enlarged or "extended" as the traditional latissimus dorsi musculocutaneous (LD-MC) flap by incorporating the superior and inferior fat compartments. It can be referred to as the "extended TDAP flap". This technique augments the flap volume. In addition, this flap can serve as a scaffold for lipofilling to obtain autologous breast reconstruction in medium to large cases. There were two complete failures due to technical errors during flap elevation. Distal partial tissue suffering was observed in four flaps. These flaps were longer than usual; they reached the midline of the back. It is advisable to discard the distal medial quarter of the flap when it is designed up to the midline to avoid steatonecrosis or fibrosis. A retrospective analysis of the 39 flaps that survived completely revealed a satisfactory result in 82% of the cases. The main disadvantage of this procedure is the final scar. The TDAP flap is a reliable and safe method for partial or total breast autologous reconstruction. PMID:26645006

  19. Simulation of air velocity in a vertical perforated air distributor

    NASA Astrophysics Data System (ADS)

    Ngu, T. N. W.; Chu, C. M.; Janaun, J. A.

    2016-06-01

    Perforated pipes are utilized to divide a fluid flow into several smaller streams. Uniform flow distribution requirement is of great concern in engineering applications because it has significant influence on the performance of fluidic devices. For industrial applications, it is crucial to provide a uniform velocity distribution through orifices. In this research, flow distribution patterns of a closed-end multiple outlet pipe standing vertically for air delivery in the horizontal direction was simulated. Computational Fluid Dynamics (CFD), a tool of research for enhancing and understanding design was used as the simulator and the drawing software SolidWorks was used for geometry setup. The main purpose of this work is to establish the influence of size of orifices, intervals between outlets, and the length of tube in order to attain uniformity of exit flows through a multi outlet perforated tube. However, due to the gravitational effect, the compactness of paddy increases gradually from top to bottom of dryer, uniform flow pattern was aimed for top orifices and larger flow for bottom orifices.

  20. Tensile strength of randomly perforated aluminum plates: Weibull distribution parameters

    NASA Astrophysics Data System (ADS)

    Klein, Claude A.

    2008-07-01

    Recently, Yanay and collaborators [J. Appl. Phys. 101, 104911 (2007)] addressed issues regarding the fracture strength of randomly perforated aluminum plates subjected to tensile loads. Based on comprehensive measurements and computational simulations, they formulate statistical predictions for the tensile strength dependence on the hole density but conclude that their data are inadequate for the purpose of deriving the strength distribution function. The primary purpose of this contribution is to demonstrate that, on dividing the totality of applicable data into seven "bins" of comparable population, the strength distribution of perforated plates of similar hole density obeys a conventional two-parameter Weibull model. Furthermore, on examining the fracture stresses as recorded in the vicinity of the percolation threshold, we find that the strength obeys the expression σo(P -Pth)β with Pth≃0.64 and β ≃0.4. In this light, and taking advantage of percolation theory, we formulate equations that specify how the two Weibull parameters (characteristic strength and shape factor) depend on the hole density. This enables us to express the failure probability as a function of the tensile stress, over the entire range of hole densities, i.e., P =0.02 up to the percolation threshold.

  1. Complication of endoscopic tattooing: a case report of covered perforation

    PubMed Central

    FALCO, N.; FONTANA, T.; TUTINO, R.; LICARI, L.; RASPANTI, C.; MASCOLINO, A.; MELFA, I.; SCERRINO, G.; SALAMONE, G.; GULOTTA, G.

    2016-01-01

    Aim Laparoscopy is considered a good approach in treatment of colorectal neoplastic diseases; the endoscopic tattooing is then recommended (Evidence Level III and grade of recommendation A) to mark a lesion or a polypectomy site for intraoperative identification. We describe the case of perforation after tattoing treated conservatively. Case report 63 years old woman, underwent colonoscopy for lipoma tattooing with India ink SPOT® solution kit and saline test. Immediately after the procedure the patient has been referred the appearance of colic epi-mesogastric pain and fever; Computed Tomography (CT) without MDC identified an irregular thickening of transverse colon with some microbubbles compatible with focal peritonitis. Initial paralytic ileus was present too. The blood count and metabolic panel examinations reveal a neutrophil leucocytosis (WBC: 11.000/mmc, 80% neutrophils). Results On the base of WSES sepsis severity score and recent literature patient was treated conservatively with total parenteral nutrition, and intravenous antibiotic therapy. After the resolution of fever and reactivation of peristalsis. The discharge occurred after six days with no early complications. Conclusion India ink tattooing with SPOT® solution kit and saline test represent the first choice. It is a feasible technique although perforation is a possible complication. It may need an immediately surgical operation but in most cases a conservative management is a good and safe tool even if surgery may be attempted too. PMID:27381693

  2. Double esophageal perforation by ingested foreign body: Endoscopic and surgical approach. A case report.

    PubMed Central

    Ugenti, I.; Digennaro, R.; Martines, G.; Caputi Iambrenghi, O.

    2015-01-01

    Introduction Esophageal perforation in adults is most frequently caused by ingested foreign bodies. They can migrate through the esophageal wall, damaging the nearby organs such as the aorta or the trachea, with fatal outcome. After the diagnosis, the viable treatments for extracting the foreign body and repairing the perforation are several. The appropriate treatment, may be endoscopic, surgical or combined, depending on the level of the perforation, on the co-morbidities of the patient and on the available resources. Presentation of case This paper describes a case of a 68 years old patient with a double EP caused by a meat-bone that perforated the thoracic esophageal wall, approaching the aorta on the left side and the azygos vein on the right side. Discussion Because of the double transfixion and the position near the aorta and the azygos, it was not possible to remove safely the bone during the endoscopy. The management required a combined endoscopic and surgical approach. This way it was possible to detect easily the location of the perforation, to remove safely the foreign body, to repair the perforation both from the outside and from the inside, and to place the nasogastric tube under direct vision. Conclusion Even when the type of esophageal perforation requires surgical treatment, the simultaneous use of endoscopy proved to be an advantage in order to extract the foreign body safely, to perform a double repair of the perforation and to place the nasogastric tube under direct vision. PMID:26551553

  3. The Role of Muscle Flaps for Salvage of Failed Perforator Free Flaps

    PubMed Central

    2015-01-01

    Background: Despite the most heroic efforts, sometimes free flaps fail. Perforator free flaps are not invincible and can suffer the same fate. The real challenge is how to decide what is the next best choice for achieving the desired outcome. Methods: Over the past decade, 298 free perforator flaps were used in our institution. Total failure occurred in 16 patients, and partial failure requiring a second free flap occurred in an additional 6 patients for a true success rate of 93%. All failures had some form of secondary vascularized tissue transfer, which included the use of muscle flaps in 9 (41%) different patients. Results: Initial flap salvage after a failed perforator free flap was attempted with 12 perforator and 5 muscle free flaps as well as 1 perforator and 2 muscle local flaps. These were not all successful, with loss of 3 muscle free flaps and 3 perforator flaps. Tertiary free flap coverage was successful in 3 cases using 2 muscle flaps and 1 perforator free flap. Local fasciocutaneous flaps or primary wound closure was used in the remaining individuals. Conclusions: Microsurgical tissue transfers can be the most rewarding and at the same time the most challenging reconstructive endeavor. Persistence in achieving the desired outcome can require multiple steps. Perforator flaps are an important asset to obtain this goal. However, muscle flaps can still be a useful alternative, and the message is that they should not be overlooked as sometimes a viable option. PMID:26893989

  4. Perforation of the Papilla of Vater in Wire-Guided Cannulation

    PubMed Central

    Maruoka, Naotaka

    2016-01-01

    Background. WGC in ERCP is considered a safe technique, although rare complications can occur. One unique complication of WGC is the perforation of the papilla of Vater by the guidewire. Subjects and Methods. Of 2032 patients who underwent ERCP at our department between January 2010 and December 2014, we selected 208 patients who underwent WGC for naïve papilla as subjects. A detailed examination of patients in whom a perforation occurred was conducted, and risk factors for perforations were investigated. Results. The perforation was observed in 7 of 208 patients (3.4%). All patients recovered with conservative treatment without the need for surgery. The perforation rate was significantly higher in the patients with juxtapapillary duodenal diverticula than those without diverticula (12.5% versus 0.6%, p < 0.001). Cannulation of the bile duct was ultimately achieved in 5 of 7 patients; PSP was performed for 4 of these patients. Conclusion. Caution must be exercised when dealing with patients who have a juxtapapillary duodenal diverticula because they are at higher risk of perforations. Because these are small perforations made by a wire, most of them heal with conservative treatment. However, perforations can make cannulation difficult, and PSP may be useful for deep cannulation. PMID:27446851

  5. Double perforators-based superior gluteal artery propeller flap for reconstruction of lumbar defects.

    PubMed

    Onyekwelu, Obi; Kosutic, Damir

    2016-01-01

    Wide local excision of skin cancer in the lumbar area is a challenge to reconstruct. We report on the successful use of a two perforators-based superior gluteal artery perforator propeller flap, for the reconstruction of a lumbar defect. PMID:27583268

  6. Double Sigmoid colon perforation due to migration of a biliary stent.

    PubMed

    Malgras, B; Pierret, C; Tourtier, J-P; Olagui, G; Nizou, C; Duverger, V

    2011-10-01

    Migration of pancreatico-biliary stents is a rare event, usually benign, but which can lead to severe complications such as digestive tube perforation. We report the case of a patient with double sigmoid perforation due to distal migration of a biliary stent placed to decompress a pancreatic head carcinoma. PMID:22075561

  7. Double perforators-based superior gluteal artery propeller flap for reconstruction of lumbar defects

    PubMed Central

    Onyekwelu, Obi; Kosutic, Damir

    2016-01-01

    Abstract Wide local excision of skin cancer in the lumbar area is a challenge to reconstruct. We report on the successful use of a two perforators-based superior gluteal artery perforator propeller flap, for the reconstruction of a lumbar defect. PMID:27583268

  8. Appendicular mass complicating acute appendicitis in a patient with dengue fever.

    PubMed

    Low, Y N; Cheong, B M K

    2016-04-01

    Abdominal pain with dengue fever can be a diagnostic challenge. Typically, pain is localised to the epigastric region or associated with hepatomegaly. Patients can also present with acute abdomen. We report a case of a girl with dengue fever and right iliac fossa pain. The diagnosis of acute appendicitis was made only after four days of admission. An appendicular mass and a perforated appendix was noted during appendectomy. The patient recovered subsequently. Features suggestive of acute appendicitis are persistent right iliac fossa pain, localised peritonism, persistent fever and leucocytosis. Repeated clinical assessment is important to avoid missing a concurrent diagnosis like acute appendicitis. PMID:27326951

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

    PubMed Central

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

    2014-01-01

    AIM: To investigate the causes and intraoperative detection of endoscopic retrograde cholangiopancreatography (ERCP)-related perforations to support immediate or early diagnosis. METHODS: Consecutive patients who underwent ERCP procedures at our hospital between January 2008 and June 2013 were retrospectively enrolled in the study (n = 2674). All procedures had been carried out using digital fluoroscopic assistance with the patient under conscious sedation. For patients showing alterations in the gastrointestinal anatomy, a short-type double balloon enteroscope had been applied. Cases of perforation had been identified by the presence of air in or leakage of contrast medium into the retroperitoneal space, or upon endoscopic detection of an abdominal cavity related to the perforated lumen. For patients with ERCP-related perforations, the data on medical history, endoscopic findings, radiologic findings, diagnostic methods, management, and clinical outcomes were used for descriptive analysis. RESULTS: Of the 2674 ERCP procedures performed during the 71-mo study period, only six (0.22%) resulted in perforations (male/female, 2/4; median age: 84 years; age range: 57-97 years). The cases included an endoscope-related duodenal perforation, two periampullary perforations related to endoscopic sphincterotomy, two periampullary perforations related to endoscopic papillary balloon dilation, and a periampullary or bile duct perforation secondary to endoscopic instrument trauma. No cases of guidewire-related perforation occurred. The video endoscope system employed in all procedures was only able to immediately detect the endoscope-related perforation; the other five perforation cases were all detected by subsequent digital fluoroscope applied intraoperatively (at a median post-ERCP intervention time of 15 min). Three out of the six total perforation cases, including the single case of endoscope-related duodenal injury, were surgically treated; the remaining three cases were

  10. Acute Abdominal Pain Secondary to Chilaiditi Syndrome

    PubMed Central

    Pan, Andrew S.; Lopez, Michael A.; Buicko, Jessica L.; Lopez-Viego, Miguel

    2013-01-01

    Chilaiditi syndrome is a rare condition occurring in 0.025% to 0.28% of the population. In these patients, the colon is displaced and caught between the liver and the right hemidiaphragm. Patients' symptoms can range from asymptomatic to acute intermittent bowel obstruction. Diagnosis is best achieved with CT imaging. Identification of Chilaiditi syndrome is clinically significant as it can lead to many significant complications such as volvulus, perforation, and bowel obstruction. If the patient is symptomatic, treatment is usually conservative. Surgery is rarely indicated with indications including ischemia and failure of resolution with conservative management. PMID:23936720

  11. Long-term epicardial ventricular pacing from endocardial bipolar pacemaker lead: perforation of right atrial wall.

    PubMed Central

    Lees, D A; Green, G D

    1977-01-01

    One of the hazards of endocardial cardiac pacing is that the pacemaker lead may perforate the myocardial wall or interventricular septum although the incidence of such perforations is believed to be small. This paper describes what is believed to be a unique case in which a pacemaker lead perforated the atrial wall at implantation (or possibly shortly afterwards) and yet gave satisfactory right ventricular epicardial pacing for more than five years. The perforation was discovered during a routine postmortem examination but earlier lateral x-ray examinations would probably have identified the abnormal position of the electrodes. Moreover, the present implantation technique would not have allowed perforation of the atrial wall at implantation to go undetected. Images PMID:882955

  12. Iatrogenic oesophageal perforation during placement of an endoscopic vacuum therapy device

    PubMed Central

    Halliday, Edwin; Patel, Anant; Hindmarsh, Andrew; Sujendran, Vijay

    2016-01-01

    Endoscopic vacuum-assisted closure (VAC) is increasingly being used as a means of managing perforations or anastomotic leaks of the upper gastrointestinal (GI) tract. Published outcomes are favourable, with few mentions of complications or morbidity. We present a case in which the management of a gastric perforation with endoscopic vacuum therapy was complicated by cervical oesophageal perforation. The case highlights the risks of such endoscopic therapeutic procedures and is the first report in the literature to describe significant visceral injury during placement of a VAC device for upper GI perforation. Iatrogenic oesophageal perforation is an inherent risk to upper GI endoscopy and the risk increases in therapeutic endoscopic procedures. Complications may be reduced by management under a multidisciplinary team in a centre with specialist upper GI services. There is no doubt that the endoscopic VAC approach is becoming established practice, and training in its use must reflect its increasingly widespread adoption. PMID:27470015

  13. Successful stenting of four spontaneous oesophageal perforations in a single patient during a 3-year period

    PubMed Central

    Sundbom, Magnus; Hedberg, Jakob

    2016-01-01

    Spontaneous oesophageal perforation, a rare condition associated with high mortality due to mediastinitis and multi-organ failure, can be treated surgically or with endoscopic stents. We present a case of four right-sided oesophageal perforations during a 3-year period in a single patient, all successfully stented. The 51-year-old Caucasian male had his first oesophageal perforation in 2012, which was successfully treated with a fully covered endoscopic stent. No residual pathology was seen at stent removal. Two years later, the patient was successfully treated with stents twice for recurrent perforations. The fourth spontaneous perforation at the same site occurred this fall, and again endoscopic treatment was successful. The patient does not report any squeals. In spite of the successful outcome, we would like to emphasize the need for close surveillance and readiness for definitive surgical treatment. PMID:27154748

  14. Experimental study of the turbulent field behind a perforated vortex generator

    NASA Astrophysics Data System (ADS)

    Habchi, C.; Lemenand, T.; Della Valle, D.; Al Shaer, A.; Peerhossaini, H.

    2015-07-01

    The influence of the wake vortex arising behind a perforated tab on the mixing process in heat exchangers and chemical reactors is analyzed. The preliminary step of this study, i.e., investigation of the turbulent field generated by a single perforated tab, is presented here. For this aim, laser Doppler velocimetry measurements are conducted downstream from a perforated trapezoidal vortex generator placed in a wind tunnel. It is shown that two shear layers are generated by the tab. The first shear layer is located at the upper edge of the tab, and the other is ejected from the perforation edges. These shear layers are characterized by high turbulent kinetic energy levels, which are profitable for meso-mixing enhancement. Finally, a spectral study shows that the turbulent macro-scale is nearly the same for typical locations in the shear layers shed from the tab and perforation edges.

  15. [SUBFASCIAL ENDOSCOPIC PERFORATOR VEIN SURGERY IN THE TREATMENT OF SEVERE VARICOSE VEINS].

    PubMed

    Tabuchi, Atsushi; Masaki, Hisao; Tanemoto, Kazuo

    2015-05-01

    Surgical treatment of severe varicose veins (CEAP classification : C4b-C6) should involve not only interruption of incompetent superficial veins to prevent venous regurgitation due to valve incompetence but also interruption of incompetent perforator veins. Subfascial endoscopic perforator vein surgery (SEPS) is performed via a small skin incision and involves interruption of perforator veins by the insertion of an endoscope into the subfascial space. SEPS produces good surgical outcomes: it is accurate in detecting and transecting perforator veins; has a low frequency of surgical wound complications; prevents lipodermatosclerosis and formation of pigmented skin lesions; and is minimally invasive compared with Linton's operation. Thus, SEPS is an excellent procedure for patients with incompetent perforator veins. SEPS has been covered by the Japanese national health insurance system since April 2014, and it is expected that SEPS will be further developed and become more widespread in use. PMID:26281656

  16. Shape-based 3D vascular tree extraction for perforator flaps

    NASA Astrophysics Data System (ADS)

    Wen, Quan; Gao, Jean

    2005-04-01

    Perforator flaps have been increasingly used in the past few years for trauma and reconstructive surgical cases. With the thinned perforated flaps, greater survivability and decrease in donor site morbidity have been reported. Knowledge of the 3D vascular tree will provide insight information about the dissection region, vascular territory, and fascia levels. This paper presents a scheme of shape-based 3D vascular tree reconstruction of perforator flaps for plastic surgery planning, which overcomes the deficiencies of current existing shape-based interpolation methods by applying rotation and 3D repairing. The scheme has the ability to restore the broken parts of the perforator vascular tree by using a probability-based adaptive connection point search (PACPS) algorithm with minimum human intervention. The experimental results evaluated by both synthetic and 39 harvested cadaver perforator flaps show the promise and potential of proposed scheme for plastic surgery planning.

  17. [Undetected hypopharyngeal perforation with deep neck abscess and mediastinitis due to transesophageal echocardiography].

    PubMed

    Eichhorn, K W G; Bley, T A; Ridder, G J

    2003-11-01

    Hypopharyngeal perforation is a rare but dangerous complication caused by diagnostic procedures. If there is any suspicion of perforation of the upper airways and/or upper digestive tract, immediate diagnostic and therapeutic procedures are indicated. Possible complications of a hypopharyngeal perforation are deep neck infection with subsequent mediastinitis and haemorrhage from major cervical vessels, both of which have high mortality rates. We present the case of a 65 year old male patient with perforation of the hypopharynx after transesophageal echocardiography which was unrecognized for more than 1 week. Clinical symptoms of hypopharyngeal perforation may initially be unspecific. Esophagography (Gastrografin administration) and computed tomography as well as esophagoscopy are needed to certify the diagnosis and to evaluate the extent of the lesion. Pathological findings as well as diagnostic and therapeutic needs are demonstrated and discussed. PMID:14605709

  18. Sealing Ability of MTA Used in Perforation Repair of Permanent Teeth; Literature Review

    PubMed Central

    Baroudi, Kusai; Samir, Samah

    2016-01-01

    There were several materials used to seal different types of perforation defects. MTA is one of these restorative materials that is considered the most effective, biocompatible, non-toxic, and non-irritant; promote bone healing and cementum regeneration. The objective of this article was to review and summarize the sealing ability of MTA compared with the other materials used for sealing different types of root perforations of permanent teeth. A literature search was conducted using Medline, accessed via the National Library of Medicine Pub Med from 2005 to 2015 searching for articles related to sealing ability of MTA. This study found that factors affecting prognosis are the size, site of the perforation and time elapsed as well as the repair material. MTA is an important filling material to be used for sealing different types of perforations when perforated sites sealed immediately with MTA. PMID:27347231

  19. Sealing Ability of MTA Used in Perforation Repair of Permanent Teeth; Literature Review.

    PubMed

    Baroudi, Kusai; Samir, Samah

    2016-01-01

    There were several materials used to seal different types of perforation defects. MTA is one of these restorative materials that is considered the most effective, biocompatible, non-toxic, and non-irritant; promote bone healing and cementum regeneration. The objective of this article was to review and summarize the sealing ability of MTA compared with the other materials used for sealing different types of root perforations of permanent teeth. A literature search was conducted using Medline, accessed via the National Library of Medicine Pub Med from 2005 to 2015 searching for articles related to sealing ability of MTA. This study found that factors affecting prognosis are the size, site of the perforation and time elapsed as well as the repair material. MTA is an important filling material to be used for sealing different types of perforations when perforated sites sealed immediately with MTA. PMID:27347231

  20. Spontaneous gallbladder perforation in a child secondary to a gallbladder cyst: a rare presentation and review of literature.

    PubMed

    Badru, F; Litton, T; Puckett, Y; Bansal, S; Guzman, M; Vane, D; Villalona, G A

    2016-06-01

    Spontaneous gallbladder perforation is rare in children. The etiology of gallbladder perforation varies greatly and is often unknown. Identified causes include infection, congenital, stones or choledochal cysts. Presently there are only five reported cases of spontaneous gallbladder perforation in children in the English literature. As such, the optimal method of diagnosis and management remains controversial. We report the case of a 2-year-old girl who presented with peritonitis secondary to spontaneous gallbladder perforation. PMID:27062138

  1. Acute Bronchitis

    MedlinePlus

    Bronchitis is an inflammation of the bronchial tubes, the airways that carry air to your lungs. It ... chest tightness. There are two main types of bronchitis: acute and chronic. Most cases of acute bronchitis ...

  2. Role of uterine forces in intrauterine device embedment, perforation, and expulsion

    PubMed Central

    Goldstuck, Norman D; Wildemeersch, Dirk

    2014-01-01

    Background The purpose of this study was to examine factors that could help reduce primary perforation during insertion of a framed intrauterine device (IUD) and to determine factors that contribute in generating enough uterine muscle force to cause embedment and secondary perforation of an IUD. The objective was also to evaluate the main underlying mechanism of IUD expulsion. Methods We compared known IUD insertion forces for “framed” devices with known perforation forces in vitro (hysterectomy specimens) and known IUD removal forces and calculated a range of possible intrauterine forces using pressure and surface area. These were compared with known perforation forces. Results IUD insertion forces range from 1.5 N to 6.5 N. Removal forces range from 1 N to 5.8 N and fracture forces from 8.7 N to 30 N depending upon device. Measured perforation forces are from 20 N to 54 N, and calculations show the uterus is capable of generating up to 50 N of myometrial force depending on internal pressure and surface area. Conclusion Primary perforation with conventional framed IUDs may occur if the insertion pressure exceeds the perforation resistance of the uterine fundus. This is more likely to occur if the front end of the inserter/IUD is narrow, the passage through the cervix is difficult, and the procedure is complex. IUD embedment and secondary perforation and IUD expulsion may be due to imbalance between the size of the IUD and that of the uterine cavity, causing production of asymmetrical uterine forces. The uterine muscle seems capable of generating enough force to cause an IUD to perforate the myometrium provided it is applied asymmetrically. A physical theory for IUD expulsion and secondary IUD perforation is given. PMID:25143756

  3. Comparing Gray and White Mineral Trioxide Aggregate as a Repair Material for Furcation Perforation: An in Vitro Dye Extraction Study

    PubMed Central

    Patel, Kiran; Baba, Suheel Manzoor; Jaiswal, Shikha; Venkataraghavan, Karthik; Jani, Mehul

    2014-01-01

    Introduction: Furcation perforation can have a negative impact on the prognosis of the affected tooth by compromising the attached apparatus. Hence these perforations require immediate repair. A variety of materials have been suggested for repair, of that MTA is the most promising material. The purpose of this study was to compare the ability of Gray and White MTA to seal furcation perforations using a dye extraction method under spectrophotometer. Materials and Methods: A total of 60 permanent mandibular molars were randomly divided into four experimental groups of 15 samples each as follows: Group A: Perforation repaired with White MTA. Group B: Perforation repaired with Gray MTA. Group C: Perforation left unsealed (positive). Group D: without perforation (negative). Dye extraction was performed using full concentration nitric acid. Dye absorbance was measured at 550 nm using spectrophotometer. The data analyzed using one-way-Anova Ratio and Unpaired t-test showing statistically significance difference among the groups. Result: It was seen that Group D samples without perforation showed least absorbance followed by Group A (perforation repaired with White MTA) and Group B (perforation repaired with Gray MTA). Group C (perforation left unsealed) showed highest absorbance. Conclusion: The White and Gray Mineral Trioxide Aggregate performed similarly as a furcation perforation repair material. There was no significant difference between the Gray MTA and White MTA. PMID:25478452

  4. Filling and shielding for postoperative gastric perforations of endoscopic submucosal dissection using polyglycolic acid sheets and fibrin glue

    PubMed Central

    Takimoto, Kengo; Hagiwara, Akeo

    2016-01-01

    Background and study aims: Many medical institutions in Japan perform endoscopic mucosal dissection (ESD) to treat early gastric cancer. Perforations can occur during ESD, and clipping has been reported as useful for treating small pinhole perforations. However, it is often difficult to close postoperative perforations because they usually have large diameters, and the muscle layer around the perforated region is often fragile, so additional open surgery is the only currently used method to treat large perforations and delayed perforations. Another method for large perforation is needed to treat perforations endoscopically. Ono et al. reported a case in which a postoperative perforation was closed using a polyglycolic acid (PGA) sheet and fibrin glue. In addition, it has been used by the authors’ group to repair duodenal injuries that occur during ESD. We report 3 cases in which PGA sheets and fibrin glue were successfully used to repair postoperative gastric perforations endoscopically. This method is simple, safe, and effective, and is a new way to treat large perforations and delayed perforations that occur following ESD. PMID:27556075

  5. Oculocerebral perforating trauma by foreign objects: diagnosis and surgery.

    PubMed

    Scarfo, G B; Mariottini, A; Palma, L

    1990-01-01

    Two unusual cases of perforating oculocerebral trauma by foreign bodies treated surgically are reported. Both were caused by industrial accidents. In the first a nail shot from a nail gun ricocheted off the target and crossed the right eyeball and the posterior wall of the orbit, lodging in the homolateral temporal lobe. In the second case a metal fragment expelled by an agricultural machine penetrated the left maxillary sinus, crossed the floor of the orbit, the eyeball and the roof of the orbit and lodged in the homolateral frontal lobe. After accurate neuroradiological examination the patients were operated using simultaneous transcranial and transorbital access. In our opinion this is the only approach which can minimize the risk of infection which is so dangerous in this type of trauma. The functional and aesthetic results, which were very satisfactory in both cases, seem to confirm the correctness of this approach. PMID:2092091

  6. The influence of the target strength model on computed perforation

    SciTech Connect

    Reaugh, J.E.

    1993-06-01

    The authors used an axi-symmetric, two-dimensional Eulerian computer simulation program to simulate the penetration of a tungsten rod with length to diameter ratio L/D = 10 into a thick steel target, and the same rod into finite steel plates of thicknesses between 0.9 and 1.3 L. They compare the perforation limit with the semi-infinite penetration depth at the same velocity (the excess thickness) when the model for target strength is constant yield stress, and when the model incorporates work hardening and thermal softening. The authors also compare their computed results with available experimental results, which show an excess thickness of about 1 rod diameter.

  7. Perforation of HY-100 steel plates with long rod projectiles

    SciTech Connect

    Hanchak, S.J.; Altman, B.S.; Forrestal, M.J.

    1993-07-01

    The authors conducted perforation experiments with 4340 steel, rod projectiles and HY-100 steel, target plates at striking velocities between 80 and 370 m/s. Projectiles were machined to nominally 30-mm-diameter and 281-mm-length so they could be launched from a 30-mm-powder gun without sabots. The target plates were rigidly clamped at 305-mm diameter and had a nominal thickness of 10.2 mm. In addition to measuring striking and residual projectile velocities, they obtained back surface framing camera data that showed clearly the plate deformation and plug ejection process. An Imacon 792 camera provided up to 20 frames per experiment with an interframe time duration of 10 {mu}s. The modeling work is in progress, but they present a beam model that exhibits the features observed in the experiments.

  8. Shock wave strength reduction by passive control using perforated plates

    NASA Astrophysics Data System (ADS)

    Doerffer, Piotr; Szulc, Oskar

    2007-05-01

    Strong, normal shock wave, terminating a local supersonic area on an airfoil, not only limits aerodynamic performance but also becomes a source of a high-speed impulsive helicopter noise. The application of a passive control system (a cavity covered by a perforated plate) on a rotor blade should reduce the noise created by a moving shock. This article covers the numerical implementation of the Bohning/Doerffer transpiration law into the SPARC code and includes an extended validation against the experimental data for relatively simple geometries of transonic nozzles. It is a first step towards a full simulation of a helicopter rotor equipped with a noise reducing passive control device in hover and in forward flight conditions.

  9. Skin friction on a flat perforated acoustic liner

    NASA Technical Reports Server (NTRS)

    Boldman, D. R.; Brinich, P. F.

    1976-01-01

    The report concerns the measurement of friction coefficients of a typical perforated acoustic liner installed in the side of a wind tunnel. The results are compared with measured friction coefficients of a smooth hard wall for the same mean flow velocities in a wind tunnel. At a velocity of 61 m/sec, an increase in the local skin coefficient of only a few percent was observed, but at the highest velocity of 213 m/sec an increase of about 20% was obtained. This velocity is a realistic velocity for turbo-machinery components utilizing such liners, so a loss in performance is to be expected. Some tests were also performed to see if changes in the mean boundary layer induced by imposed noise would result in friction increase, but only at low velocity levels was such an increase in friction noted.

  10. Endoscopic vacuum therapy for esophageal perforations and leakages

    PubMed Central

    Möschler, Oliver; Nies, Christoph; Mueller, Michael K.

    2015-01-01

    Background and study aims: Injuries to the esophageal wall, such as perforations and anastomotic leaks, are serious complications of surgical and endoscopic interventions. Since 2006, a new treatment has been introduced, in the form of endoscopically placed vacuum sponge therapy. Patients and methods: Between April 2012 and October 2014, 10 patients (5 men and 5 women) aged 57 to 94 years were treated at our institution using endoscopic vacuum therapy (EVT) in the upper gastrointestinal tract. Results: The defect in the esophageal wall was successfully closed in seven of the 10 patients (70 %). No severe complications occurred. Conclusions: EVT is a valuable tool for management of defects in the esophageal wall and should be considered as a treatment option for patients with this condition. PMID:26716111

  11. Mechanical seal having a single-piece, perforated mating ring

    DOEpatents

    Khonsari, Michael M.; Somanchi, Anoop K.

    2007-08-07

    A mechanical seal (e.g., single mechanical seals, double mechanical seals, tandem mechanical seals, bellows, pusher mechanical seals, and all types of rotating and reciprocating machines) with reduced contact surface temperature, reduced contact surface wear, or increased life span. The mechanical seal comprises a rotating ring and a single-piece, perforated mating ring, which improves heat transfer by controllably channeling coolant flow through the single-piece mating ring such that the coolant is in substantially uniform thermal contact with a substantial portion of the interior surface area of the seal face, while maintaining the structural integrity of the mechanical seal and minimizing the potential for coolant flow interruptions to the seal face caused by debris or contaminants (e.g., small solids and trash) in the coolant.

  12. Fatal rectal perforation following boar-to-boar mounting.

    PubMed

    Ulrich, R; Philipp, U; Buck, B C; Distl, O; Beineke, A

    2012-11-01

    Although abnormal sexual behavior, including boar-to-boar mounting with anal penetration, is recognized in pubescent pigs, reports of the pathologic consequences are scarce. A 7-month-old male minipig, housed with age-matched males, died within 1 day of the onset of lethargy and reluctance to rise. At necropsy, 2 rectal tears were identified as the cause for fibrinous peritonitis, and spermatozoa were identified in the pelvic and peritoneal cavity by light and transmission electron microscopy. According to DNA typing results, using 11 porcine microsatellites, the intraperitoneal semen was from at least 2 pen mates. The prohibition of castration of fattening pigs, implemented or planned in multiple European countries, could increase the risk of rectal perforation in co-housed pigs. PMID:22390881

  13. Abdominal perforator vs. muscle sparing flaps for breast reconstruction

    PubMed Central

    Wu, Liza C.

    2015-01-01

    Abdominally based free flaps have become the mainstay for women that desire to use their own tissue as a means of breast reconstruction after mastectomy. As the techniques have evolved, significant effort has been invested in finding the best means of minimizing morbidity to the abdominal donor site while ensuring a viable reconstructed breast that is aesthetically pleasing. This manuscript reviews and compares the muscle sparing free transverse rectus abdominis myocutaneous (MsfTRAM), the deep inferior epigastric artery perforator (DIEP), and the superficial inferior epigastric artery (SIEA) flaps, regarding flap success rate, operative times, abdominal donor site morbidity and residual functionality, hospital lengths of stay and associated costs, impact of co-morbid conditions, and resilience after adjuvant radiation treatment. PMID:26161306

  14. Abdominal perforator vs. muscle sparing flaps for breast reconstruction.

    PubMed

    Butler, Paris D; Wu, Liza C

    2015-06-01

    Abdominally based free flaps have become the mainstay for women that desire to use their own tissue as a means of breast reconstruction after mastectomy. As the techniques have evolved, significant effort has been invested in finding the best means of minimizing morbidity to the abdominal donor site while ensuring a viable reconstructed breast that is aesthetically pleasing. This manuscript reviews and compares the muscle sparing free transverse rectus abdominis myocutaneous (MsfTRAM), the deep inferior epigastric artery perforator (DIEP), and the superficial inferior epigastric artery (SIEA) flaps, regarding flap success rate, operative times, abdominal donor site morbidity and residual functionality, hospital lengths of stay and associated costs, impact of co-morbid conditions, and resilience after adjuvant radiation treatment. PMID:26161306

  15. Perforated monolayers. Progress report, July 1, 1990--December 31, 1992

    SciTech Connect

    Regen, S.L.

    1992-12-01

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

  16. Scaled Long Rod Perforation Experiments Using Multiple Diagnostics

    NASA Astrophysics Data System (ADS)

    Cross, Daniel; Proud, William

    2011-06-01

    A series of angled small-scale reverse ballistic long rod experiments were conducted using mild steel rods (6 mm dia., 90 mm long) against both 3 mm and 6 mm rolled homogeneous armour (RHA) plates at 30°. The impact velocity was varied from 450-780 m s-1 and the response of the system monitored by laser velocimetry, strain gauges and high-speed photography. This provided insight into the flexing of the rod during impact, the acceleration of the rear of the rod and the global penetration process. This experimental series involved ricochet, near-ricochet and full perforation, and so allows the sensitivity of the differing diagnostic outputs for these processes to be compared.

  17. Duodenal perforation as result of blunt abdominal trauma in childhood.

    PubMed

    Hartholt, Klaas Albert; Dekker, Jan Willem T

    2015-01-01

    Blunt abdominal trauma may cause severe intra-abdominal injuries, while clinical findings could be mild or absent directly after the trauma. The absence of clinical findings could mislead physicians into underestimating the severity of the injury at the primary survey, and inevitably leads to a delay in the diagnosis. The Blunt Abdominal Trauma in Children (BATiC) score may help to identify children who are at a high risk for intra-abdominal injuries in an early stage and requires additional tests directly. A case of a 10-year-old girl with a duodenal perforation after a blunt abdominal trauma is presented. A delay in diagnosis may lead to an increased morbidity and mortality rate. A low admission threshold for children with abdominal pain after a blunt trauma is recommended. PMID:26698210

  18. Superior gluteal artery perforator flap in bilateral breast reconstruction.

    PubMed

    Werdin, Frank; Peek, Alberto; Martin, Nicolas C S; Baumeister, Steffen

    2010-01-01

    The incidence of bilateral breast reconstruction is increasing particularly due to genetic counseling and the option for bilateral prophylactic mastectomies. The decision to undergo a prophylactic mastectomy depends on the achievable outcomes of breast reconstruction. The free superior gluteal artery perforator flap (sGAP) flap is one option for autologous bilateral reconstruction which has rarely been reported.All bilateral sGAP flaps performed in the department of plastic surgery at the Behandlungszentrum Vogtareuth over a period of 4.5 years were retrospectively analyzed for indication, success rate, and complications.Thirty sGAP flaps were performed for bilateral breast reconstruction. The average age of the 15 women was 42 years and the average body mass index was 20.8. Indications for breast reconstruction were predominantly prophylactic mastectomies (60%). Indication for a sGAP flap was either a thin patient with insufficient abdominal tissue or a 2-staged bilateral reconstruction. 83% of the breast reconstructions were performed secondarily and 93% in 2 stages. The average operating time was 7 hours 12 minutes. Twenty-nine flaps (97%) were successful. Complications were fat necrosis (n = 3), hematoma (n = 3), and breast seroma (n = 1). Donor site complications were seroma (n = 8), infection (n = 1), and wound dehiscence (n = 1).Our results with bilateral breast reconstruction with the sGAP flap show cosmetically appealing results with high success and low complication rates on the breast. However, seromas on the donor site occurred in 27%. In addition, the sGAP flap is a technically demanding and time consuming operation. We recommend the sGAP flap when the abdomen has not enough tissue bulk to perform a deep inferior epigastric perforator flap or for a 2-staged bilateral reconstruction. This is often the case in women with a hereditary high risk of breast cancer who often present as young and slim patients. PMID:20010408

  19. Scoring Systems for Outcome Prediction of Patients with Perforation Peritonitis

    PubMed Central

    Litake, Manjusha Madhusudhan

    2016-01-01

    Introduction Peritonitis continues to be one of the major infectious problems confronting a surgeon. Mannheim Peritonitis Index (MPI), Physiological and Operative Severity Score for en Umeration of Mortality (POSSUM) and Morbidity and sepsis score of Stoner and Elebute have been devised for risk assessment and for prediction of postoperative outcome. Aim The aim of this study was to find the accuracy of these scores in predicting outcome in terms of mortality in patients undergoing exploratory laprotomy for perforation peritonitis. Materials and Methods The prospective study was carried out in 100 diagnosed cases of perforation at our centre in a single unit over a period of 21 months from December 2012 to August 2014. Study was conducted on all cases of peritonitis albeit primary, tertiary, iatrogenic and those with age less than 12 years were excluded from the study. All the relevant data were collected and three scores were computed from one set of data from the patient. The main outcome measure was survival of the patient. The Receiver Operator Characteristics (ROC) curves were obtained for the three scores. Area Under the Curves (AUC) was calculated. Sensitivity and specificity were calculated at a cut off point obtained from the ROC curves. Results POSSUM had an AUC of 0.99, sepsis score had an AUC of 0.98 and MPI had an AUC of 0.95. The cut off point score of 51 for POSSUM had an accuracy of 93.8 and positive predictive value of 70.5, the score of 29 for MPI had an accuracy of 82.8 and positive predictive value of 46 and the score of 22 for sepsis score had an accuracy of 95.9 and positive predictive value of 86.67. Conclusion POSSUM score was found to be superior in prediction of mortality as compared to sepsis score of Stoner and Elebute and MPI. POSSUM and MPI over predicted mortality in some cases. None of these scores are strictly preoperative. PMID:27134924

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

    PubMed Central

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

    2014-01-01

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

  1. CT angiographic evaluation of perforators in the lower limb and their reconstructive implication

    PubMed Central

    Bhattacharya, Visweswar; Agrawal, Neeraj K.; Chaudhary, Gurab R.; Arvind, Srivastava; Bhattacharya, Siddharth

    2012-01-01

    Background: The perforator flaps evolved on the knowledge of the vascular tree from the main vascular trunk up to the subdermal plexus. Therefore, we thought that it's necessary to map the whole vascular arcade by CT angiography. The aim of this study is to evaluate the perforators and the whole vascular tree of the lower limb by peripheral CT angiography with 3D reconstruction and intraoperative evaluation. This study helps in designing flaps of different constituents based on the selected perforators. Materials and Methods: Twenty patients having lower limb defects were selected. CT angiography was done using a non-ionic iodinated contrast media injected through the antecubital vein. The lower limbs were imaged using volume rendering CT scan machine. Three dimensional reconstructions were made. The whole arterial tree, along with the perforators, were mapped. Findings of the audio-Doppler were correlated with the CT angiographic observations. Further these evaluations were confirmed by intraoperative findings. Results: The three dimensional CT angiographic reconstruction with bone and soft tissue provided advanced knowledge of this vascular network. It delineated the main vessel, the perforators, their caliber, distance from fixed bony landmarks and course up to the subdermal plexus. These findings were confirmed during dissection of the proposed flap. The perforators were mainly musculocutaneous in the proximal leg and septocutaneous distally. Conclusions: The vascular details visualized by this technique made advancement over the existing methods namely color Doppler, audio Doppler, two dimensional angiography etc. It improved the understanding of perforator flaps and their successful clinical application. PMID:23450763

  2. Efficacy of the Ovesco Clip for Closure of Endoscope Related Perforations

    PubMed Central

    Angsuwatcharakon, Phonthep; Prueksapanich, Piyapan; Kongkam, Pradermchai; Rattanachu-ek, Thawee; Sottisuporn, Jaksin; Rerknimitr, Rungsun

    2016-01-01

    Aim. To study the efficacy and other treatment outcomes of Ovesco clip closure of iatrogenic perforation. Methods. Retrospective study from 3 tertiary-care hospitals in Thailand. Patients with iatrogenic perforation who underwent immediate endoscopic closure by Ovesco clip were included. Patients' demographic data, perforation size, number of Ovesco clips used, fasting day, length of hospital stay, success rates, and complication rate were recorded. Technical success was defined as closure achievement during endoscopic procedure and clinical success was defined as the patient can be discharged without the need of additional surgical or radiological intervention. Results. There were 6 iatrogenic perforations in 2 male and 4 female patients. The median age was 59 years (range 39–78 years). The locations of perforation were 5 duodenal walls and 1 rectosigmoid junction. The median perforation size was 13 mm (range 10–40 mm). The technical success was 100% and the clinical success was 83.3%. The success rates per locations were 100% in colon and 80% in duodenum, respectively. The median fasting time was 5 days (range 1–10 days) and the median length of hospital stay was 10 days (range 2–22 days). There was no mortality in any. Conclusion. Ovesco clip seems to be an effective and safe tool for a closure of iatrogenic perforation. PMID:27293368

  3. The emergency room diagnosis of gastrointestinal tract perforation: the role of CT.

    PubMed

    Borofsky, Samuel; Taffel, Myles; Khati, Nadia; Zeman, Robert; Hill, Michael

    2015-06-01

    Computed tomography (CT) plays an important role in the evaluation of patients presenting to the emergency department with a suspected spontaneous gastrointestinal tract (GIT) perforation. Prospective identification of the site of perforation helps the emergency department physician plan the appropriate treatment in a potentially unstable patient. The purpose of this pictorial essay is to review the CT approach a radiologist should take when evaluating the patient with suspected perforation in the emergent setting. A series of patients presenting to the emergency department with surgically proven GIT perforations were retrospectively reviewed, and key images were obtained. For the purposes of this review, the anatomy of the abdominal cavity in relation to sites of GIT perforation will be discussed. CT findings of perforation will be described, including free intraperitoneal/extraperitoneal air, bowel wall discontinuity, and localized inflammatory changes. The use of a bone window setting to increase the free air conspicuity will be emphasized. The mimics of pneumoperitoneum will be demonstrated, including pneumothorax, pneumomediastinum, and venous air. Using a systematic approach, CT can precisely determine the presence and site of a gastrointestinal perforation in a majority of patients. This greatly assists the surgeon in planning the correct surgical approach. PMID:25417073

  4. Descriptive anatomy of the dominant septal perforators using Dual Source Coronary CT Angiography.

    PubMed

    Brinjikji, Waleed; Harris, Scott R; Froemming, Adam T; Christensen, Kevin N; Lachman, Nirusha; Araoz, Philip A

    2010-01-01

    Although clinical outcomes for septal ablation in treating left ventricular outflow tract obstructions are generally favorable, a variety of complications have been reported including a high incidence of right bundle branch block. These complications may be attributed to anatomic variability of the dominant septal perforator. We used Dual Source CT Coronary Angiography (DS-CTA) to determine the location of the termination point of the dominant septal perforator as well as the distance of the termination point from the mitral annulus in patients undergoing DS-CTA. One-hundred-fourteen DS-CTA scans were retrospectively reviewed by two observers by consensus. The left ventricle was divided into anterior wall, anterioseptum, and inferioseptum. For each segment, the myocardium was divided into three layers (1) right ventricular side, (2) mid portion, and (3) left ventricular side. The zone of termination of the dominant septal perforator was identified as well as the distance of the termination point from the mitral annulus. The dominant septal perforator terminated in the right ventricular side of the anterioseptum in 86 of the 118 visualized terminations (73%) and in the left ventricular anterior wall in 6 visualized terminations (5%). On average, the dominant septal perforator terminated 26.3 +/- 8.6 mm from the mitral annulus. In the majority of cases, the dominant septal perforator terminates in the right ventricular side of anterioseptum. In addition, there is great variability in the distribution of the termination point of the dominant septal perforator from the mitral annulus. PMID:19918876

  5. Bowel Perforation in Premature Infants with Necrotizing Enterocolitis: Risk Factors and Outcomes

    PubMed Central

    Yu, Lingling; Tian, Jianmei; Zhao, Xingli; Cheng, Ping; Chen, Xiaoqian; Yu, Yun; Ding, Xiaochun; Zhu, Xueping; Xiao, Zhihui

    2016-01-01

    We aim to determine risk factors and clinical outcomes for bowel perforation in premature infants with NEC. We analyzed clinical data of 57 cases of premature infants with NEC at our NICU between January 2010 and December 2012. Based on the presence of bowel perforation, we divided these infants into two groups: perforated NEC group (n = 10) and nonperforated NEC group (n = 47). We compared general information, clinical characteristics, and laboratory findings between groups. The perforated NEC group, compared to the nonperforated NEC group, had significantly lesser gestational age, lower birth weight, higher prevalence of apnea, mechanical ventilation, sepsis and shock, lower blood pH, higher levels of blood glucose, abnormal WBC count and thrombocytopenia, and elevated CRP (all P < 0.05). Moreover, the perforated NEC group had significantly longer durations of fasting and TPN usage, higher incidences of EUGR and cholestasis, longer duration of antibiotics, higher frequency of advanced antibiotics use, and poorer prognosis than the nonperforated NEC group (all P < 0.05). Bowel perforation in premature infants with NEC was associated with multiple risk factors. Early identification of some of these risk factors in premature infants with NEC may help implement early intervention to reduce the incidence of bowel perforation and thereby improve the prognosis. PMID:27375739

  6. Frequency of glove perforation and the protective effect of double gloves in gynecological surgery.

    PubMed

    Murta, Eddie F C; Silva, Cléber S; Júnior, Odilon R A

    2003-06-01

    The purposes of this prospective study were to verify the frequency of glove perforation during gynecological operations and to evaluate the efficacy of double gloving in preventing damage to the inner glove. From May 2000 to May 2001, three house staff and 12 residents were asked to place their used gloves in bags labeled with the following information: procedure performed, presence of a recognized glove perforation, and role in operating team (surgeon, first or second assistant, and instrumentalist). All glove sets were tested using the method of water pression. Damaged gloves were excluded from that analysis. In all, 35 and 51 operations were utilized with single and double gloves, respectively. There were 240 single gloves and 792 double gloves tested. Perforation occurred in 10.4% of the single gloves and 9.8% of the outer double gloves. There were no cases of perforation in the inner double gloves. In cases of operating time that lasted more than 2 h, 56% of the surgeries that used single gloves had perforation vs 58.5% of the double gloves. The first assistant had the major risk for glove perforation with the use of single or double gloves. The indicator finger of the non-dominant hand was the major risk for perforation. In conclusion, we recommend double gloving in all gynecological surgery to reduce the risk of contracting blood-borne diseases. PMID:12768294

  7. Laparoscopic treatment of gastric and duodenal perforation in children after blunt abdominal trauma.

    PubMed

    Tytgat, S H A J; Zwaveling, S; Kramer, W L M; van der Zee, D C

    2012-09-01

    Minimal invasive surgery has not yet gained wide acceptation for the care of patients that sustained an abdominal trauma. We describe the complete laparoscopic surgical treatment of two patients after a single blunt abdominal trauma. One patient sustained a handle bar injury and presented with a gastric perforation. The other sustained a duodenal rupture by falling on a sharp edge of a table. The patients were assessed and treated laparoscopically. The perforations were identified and closed. Both patients had an uneventful postoperative recovery. Therapeutic laparoscopic treatment of patients with upper gastrointestinal perforation is feasible. We would recommend this approach to experienced laparoscopic surgeons in hemodynamically stable patients. PMID:21129741

  8. Method for improving the electrostatics perforation pattern using power controlled discharges

    NASA Astrophysics Data System (ADS)

    Garzón, C.; Miranda, E.; Martínez-Cisneros, C.; Alonso, J.; García-García, J.

    2011-06-01

    The aims of this work are to show the influence of adding a series resistance at the output of a discharge generator circuit and to point out that this component can be used to control the spark energy in electrostatic perforation systems. Analysis of the experimental results reveals that there exists a close connection between the resistor value and the obtained perforation pattern both in hole density and size. The use of a series resistor has a strong influence on the material porosity, which is an important industrial parameter for assessing the pattern perforation quality.

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

    PubMed Central

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

    2014-01-01

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

  10. Surgical management for large chest keloids with internal mammary artery perforator flap.

    PubMed

    Xue, Dan; Qian, Huan

    2016-01-01

    Therapy for large symptomatic keloids is often plagued with complicated reconstruction manner and recurrence. This article reports a rare treatment combination for a chest keloid with internal mammary artery perforator flap reconstruction and radiation therapy. We excised the keloid and covered the defect with an internal mammary artery perforator flap. Immediate electron-beam irradiation therapy was applied on the second postoperative day. There was no sign of recurrence over the follow-up period of 18 months. The combination of internal mammary artery perforator flap and immediate radiation therapy is useful when faced with chest keloids of similar magnitude and intractability. PMID:26982790

  11. Localized intestinal perforations as a potential complication of brain hypothermic therapy for perinatal asphyxia.

    PubMed

    Nishizaki, Naoto; Maiguma, Atsuko; Obinata, Kaoru; Okazaki, Tadaharu; Shimizu, Toshiaki

    2016-08-01

    Brain hypothermic therapy (BHT) is becoming a frequently used standard of care for perinatal asphyxia. Although cardiovascular side effects, coagulation disorders, renal impairment, electrolyte abnormalities, impaired liver function, opportunistic infections, and skin lesions are well-known adverse effects of BHT in newborns, little information is available on the clinical features of intestinal perforation-related BHT. We herein report a case of therapeutic brain cooling for perinatal asphyxia complicated by localized intestinal perforation. In practice, the neonatologist should be aware that intestinal perforation in an infant with perinatal asphyxia is possible, particularly following BHT. PMID:26445344

  12. Severe Hypokalaemia, Hypertension, and Intestinal Perforation in Ectopic Adrenocorticotropic Hormone Syndrome

    PubMed Central

    Karacaer, Cengiz; Açikgöz, Seyyid Bilal; Aydemir, Yusuf; Tamer, Ali

    2016-01-01

    Ectopic adrenocorticotropic hormone (ACTH) syndrome is a rare cause of the Cushing’s syndrome. The occurrence of the ectopic ACTH syndrome presenting with severe hypokalaemia, metabolic alkalosis, and hypertension has been highlighted in case reports. However, presentation with lower gastrointestinal perforation is not known. We report the case of a 70-year-old male patient with severe hypokalaemia, metabolic alkalosis, hypertension, and colonic perforation as manifestations of an ACTH-secreting small cell lung carcinoma. Ectopic ACTH syndrome should be kept in mind as a cause of hypokalaemia, hypertension, and intestinal perforation in patients with lung carcinoma. PMID:26894113

  13. Surgical management for large chest keloids with internal mammary artery perforator flap*

    PubMed Central

    Xue, Dan; Qian, Huan

    2016-01-01

    Therapy for large symptomatic keloids is often plagued with complicated reconstruction manner and recurrence. This article reports a rare treatment combination for a chest keloid with internal mammary artery perforator flap reconstruction and radiation therapy. We excised the keloid and covered the defect with an internal mammary artery perforator flap. Immediate electron-beam irradiation therapy was applied on the second postoperative day. There was no sign of recurrence over the follow-up period of 18 months. The combination of internal mammary artery perforator flap and immediate radiation therapy is useful when faced with chest keloids of similar magnitude and intractability. PMID:26982790

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

    PubMed

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

    2014-01-01

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

  15. “Cat Scratch Colon” and Cecal Barotrauma perforation during colonoscopy using CO2 insufflation

    PubMed Central

    Cox, Kristen; Fang, John C

    2014-01-01

    Cecal perforation due to barotrauma is an increasingly recognized complication of colonoscopy when using room air for insufflation. CO2 is increasingly being utilized for insufflation due to more rapid absorption compared to ambient air and results in reduced post-procedural pain and flatulence. Use of CO2 is thought to protect against barotrauma injury, and use of CO2 during endoscopy has not previously been reported to cause barotrauma perforation during colonoscopy. We present a case of cecal perforation secondary to barotrauma during routine screening colonoscopy with CO2. PMID:27489654

  16. A rare case of duodenal ulcer perforation accompanied by Boerhaave syndrome

    PubMed Central

    Rokicki, Wojciech; Rokicki, Marek

    2015-01-01

    Esophageal perforation is the fastest progressing and the most life-threatening disruption of gastrointestinal tract continuity. It must be regarded as an emergency condition that requires early diagnosis as well as very aggressive and rapid implementation of treatment in order to avoid serious complications and death. Methods of treatment for spontaneous esophageal perforation continue to be a matter of controversy. However, all authors emphasize that ultimate success depends largely on the time taken to establish the diagnosis. The authors of this study describe a rare case of duodenal ulcer perforation accompanied by Boerhaave syndrome. PMID:26702287

  17. Cell perforation mediated by plasmonic bubbles generated by a single near infrared femtosecond laser pulse.

    PubMed

    Boutopoulos, Christos; Bergeron, Eric; Meunier, Michel

    2016-01-01

    We report on transient membrane perforation of living cancer cells using plasmonic gold nanoparticles (AuNPs) enhanced single near infrared (NIR) femtosecond (fs) laser pulse. Under optimized laser energy fluence, single pulse treatment (τ = 45 fs, λ = 800 nm) resulted in 77% cell perforation efficiency and 90% cell viability. Using dark field and ultrafast imaging, we demonstrated that the generation of submicron bubbles around the AuNPs is the necessary condition for the cell membrane perforation. AuNP clustering increased drastically the bubble generation efficiency, thus enabling an effective laser treatment using low energy dose in the NIR optical therapeutical window. PMID:26199220

  18. Treatment of an endodontic perforation with a restoration and a root coverage gingival graft.

    PubMed

    Harris, R J

    1995-07-01

    This case report describes the treatment of a perforation on the facial surface of the maxillary right central incisor made during endodontic therapy. Treatment of this highly visible area required a creative approach to therapy. The perforation was repaired with an amalgam restoration. A connective tissue with partial thickness double pedicle graft was used to replace missing periodontal structures, cover the exposed root surface, and obscure from view, as much as possible, the amalgam restoration placed in the perforation. This unconventional therapy is offered as a possible treatment option when few or no other acceptable options exist. PMID:7562357

  19. Self-propelling, self-locating colonoscope

    NASA Technical Reports Server (NTRS)

    Fazer, R. E.

    1979-01-01

    Articulated instrument moves by air actuated bladder, while defining position by ultrasonic or RF signals. Device allows optical inspection of large bowel from cecum to rectum with minimal discomfort or risk to patient.

  20. Minocycline Improves Functional Outcomes, Memory Deficits, and Histopathology after Endovascular Perforation-Induced Subarachnoid Hemorrhage in Rats

    PubMed Central

    Sherchan, Prativa; Lekic, Tim; Suzuki, Hidenori; Hasegawa, Yu; Rolland, William; Duris, Kamil; Zhan, Yan; Tang, Jiping

    2011-01-01

    Abstract Subarachnoid hemorrhage (SAH) results in significant long-lasting cognitive dysfunction. Therefore, evaluating acute and long-term outcomes after therapeutic intervention is important for clinical translation. The aim of this study was to use minocycline, a known neuroprotectant agent, to evaluate the long-term benefits in terms of neurobehavior and neuropathology after experimental SAH in rats, and to determine which neurobehavioral test would be effective for long-term evaluation. SAH was induced by endovascular perforation in adult male Sprague-Dawley rats (n=118). The animals were treated with intraperitoneal injection of minocycline (45 mg/kg or 135 mg/kg) or vehicle 1 h after SAH induction. In the short-term, animals were euthanized at 24 and 72 h for evaluation of neurobehavior, brain water content, and matrix metalloproteinase (MMP) activity. In the long-term, neurobehavior was evaluated at days 21–28 post-SAH, and histopathological analysis was done at day 28. High-dose but not low-dose minocycline reduced brain water content at 24 h, and therefore only the high-dose regimen was used for further evaluation, which reduced MMP-9 activity at 24 h. Further, high-dose minocycline improved spatial memory and attenuated neuronal loss in the hippocampus and cortex. The rotarod, T-maze, and water maze tests, but not the inclined plane test, detected neurobehavioral deficits in SAH rats at days 21–28. This study demonstrates that minocycline attenuates long-term functional and morphological outcomes after endovascular perforation-induced SAH. Long-term neurobehavioral assessments using the rotarod, T-maze, and water maze tests could be useful to evaluate the efficacy of therapeutic intervention after experimental SAH. PMID:22013966

  1. Comparison of gastric and other bowel perforations in preterm infants: a review of 20 years' experience in a single institution

    PubMed Central

    Lee, Do Kyung; Shim, So Yeon; Cho, Su Jin; Lee, Sun Wha

    2015-01-01

    Purpose In this study, we aimed to review the clinical presentation of preterm infants with gastrointestinal perforations and compare the clinical features of gastric perforation with other intestinal perforations. Methods The medical records of preterm neonates with pneumoperitoneum, admitted to the neonatal intensive care unit (NICU) between January 1994 and December 2013, were retrospectively reviewed. Results Twenty-one preterm infants underwent exploratory laparotomy to investigate the cause of the pneumoperitoneum. The sample consisted of five patients (23.8%) with gastric perforation and 16 patients (76.2%) with intestinal perforation. No statistical differences were found in the birth history and other perinatal factors between the two groups. Underlying necrotizing enterocolitis, bilious vomiting, and paralytic ileus preceding the perforation were statistically more common in the intestinal perforation group. All preterm infants with gastric perforation survived to discharge; however, six preterm infants with intestinal perforation expired during treatment in the NICU. In the gastric perforation group, sudden pneumoperitoneum was the most common finding, and the mean age at diagnosis was 4.4±1.7 days of life. The location and size of the perforations varied, and simple closure or partial gastrectomy was performed. Conclusion Patients with gastric perforation did not have a common clinical finding preceding the perforation diagnosis. Although mortality in previous studies was high, all patients survived to discharge in the present study. When a preterm infant aged less than one week presents with sudden abdominal distension and pneumoperitoneum, gastric perforation should first be excluded. Prompt exploratory laparotomy will increase the survival rates of these infants. PMID:26388893

  2. Acute nephritic syndrome

    MedlinePlus

    Glomerulonephritis - acute; Acute glomerulonephritis; Nephritis syndrome - acute ... Acute nephritic syndrome is often caused by an immune response triggered by an infection or other disease. Common causes ...

  3. Peritonitis with small bowel perforation caused by a fish bone in a healthy patient.

    PubMed

    Choi, Yonghoon; Kim, Gyuwon; Shim, Chansup; Kim, Dongkeun; Kim, Dongju

    2014-02-14

    Perforation of the gastrointestinal tract by ingested foreign bodies is extremely rare in otherwise healthy patients, accounting for < 1% of cases. Accidentally ingested foreign bodies could cause small bowel perforation through a hernia sac, Meckel's diverticulum, or the appendix, all of which are uncommon. Despite their sharp ends and elongated shape, bowel perforation caused by ingested fish bones is rarely reported, particularly in patients without intestinal disease. We report a case of 57-year-old female who visited the emergency room with periumbilical pain and no history of underlying intestinal disease or intra-abdominal surgery. Abdominal computed tomography and exploratory laparotomy revealed a small bowel micro-perforation with a 2.7-cm fish bone penetrating the jejunal wall. PMID:24587641

  4. An unusual and fatal case of upper gastrointestinal perforation and bleeding secondary to foreign body ingestion.

    PubMed

    Barranco, Rosario; Tacchella, Tiziana; Lo Pinto, Sara; Bonsignore, Alessandro; Ventura, Francesco

    2016-07-01

    We report a fatal case of gastrointestinal perforation and hemorrhage secondary to the ingestion of a foreign body. While engaged in an amateur futsal competition, an apparently healthy young man suddenly collapsed and his respiration ceased. Autopsy revealed a 3-mm circular perforation on the gastric wall fundus with a significant amount of clotted blood within the gastric lumen. On inspection, a foreign body consisting of a bristle-like hair, later identified via electron microscopy to be a cat vibrissa, i.e. a whisker, was found along the perforation margin. Thus, the inadvertent ingestion of fine, sharp objects (even a cat whisker) can lead to gastric perforation and bleeding, which might prove fatal under given circumstances. PMID:27183326

  5. Ultrasound and Perforated Viscus; Dirty Fluid, Dirty Shadows, and Peritoneal Enhancement

    PubMed Central

    Shokoohi, Hamid; S. Boniface, Keith; M. Abell, Bruce; Pourmand, Ali; Salimian, Mohammad

    2016-01-01

    Early detection of free air in the peritoneal cavity is vital in diagnosis of life-threatening emergencies, and can play a significant role in expediting treatment. We present a series of cases in which bedside ultrasound (US) in the emergency department accurately identified evidence of free intra-peritoneal air and echogenic (dirty) free fluid consistent with a surgical final diagnosis of a perforated hollow viscus. In all patients with suspected perforated viscus, clinicians were able to accurately identify the signs of pneumoperitoneum including enhanced peritoneal stripe sign (EPSS), peritoneal stripe reverberations, and focal air collections associated with dirty shadowing or distal multiple reflections as ring down artifacts. In all cases, hollow viscus perforation was confirmed surgically. It seems that, performing US in patients with suspected perforated viscus can accurately identify presence of intra-peritoneal echogenic or “dirty” free fluid as well as evidence of free air, and may expedite patient management.

  6. A case of perforating injury of eyeball and traumatic cataract caused by acupuncture.

    PubMed

    Shuang, Han; Yichun, Kong

    2016-04-01

    Perforating globe injury is the leading cause of monocular blindness and vision loss. A 58-year-old male was injured by acupuncture needle during acupuncture treatment for his cerebral infarction. To the best of our knowledge, this is the first case report of perforating injury of the eyeball and traumatic cataract caused by acupuncture. The patient was hospitalized due to diagnosis of perforating ocular injury, traumatic cataract, and corneal and iris perforating injury. Moreover, he had to accept treatments of phacoemulsification, anterior vitrectomy along with intraocular lens implantation in the sulcus to improve his visual acuity. As acupuncture therapy has been widely performed for various diseases and achieved highly approval, the aim of this report is to remind acupuncturists operating accurately to avoid unnecessary injury during the treatment process, or the cure can also become the weapon. PMID:27221689

  7. Transfixing cardiac injury with perforations in stomach, diaphragm and lung: unusual scenario in penetrating trauma

    PubMed Central

    Karigyo, Carlos Junior Toshiyuki; Fan, Otavio Goulart; Yoshida, Marcelo Miyazaki; Menescal, Roberto Jonathas; Tarasiewich, Marcos Jose

    2014-01-01

    A 23-year-old man suffered a penetrating injury caused by a metallic fragment thrown from a grass-cutting tool, resulting in perforating injuries in the stomach, diaphragm, heart, and lungs. PMID:24896170

  8. Ultrasound and Perforated Viscus; Dirty Fluid, Dirty Shadows, and Peritoneal Enhancement.

    PubMed

    Shokoohi, Hamid; S Boniface, Keith; M Abell, Bruce; Pourmand, Ali; Salimian, Mohammad

    2016-01-01

    Early detection of free air in the peritoneal cavity is vital in diagnosis of life-threatening emergencies, and can play a significant role in expediting treatment. We present a series of cases in which bedside ultrasound (US) in the emergency department accurately identified evidence of free intra-peritoneal air and echogenic (dirty) free fluid consistent with a surgical final diagnosis of a perforated hollow viscus. In all patients with suspected perforated viscus, clinicians were able to accurately identify the signs of pneumoperitoneum including enhanced peritoneal stripe sign (EPSS), peritoneal stripe reverberations, and focal air collections associated with dirty shadowing or distal multiple reflections as ring down artifacts. In all cases, hollow viscus perforation was confirmed surgically. It seems that, performing US in patients with suspected perforated viscus can accurately identify presence of intra-peritoneal echogenic or "dirty" free fluid as well as evidence of free air, and may expedite patient management. PMID:27274522

  9. Experimental investigation of sound absorption properties of perforated date palm fibers panel

    NASA Astrophysics Data System (ADS)

    Elwaleed, A. K.; Nikabdullah, N.; Nor, M. J. M.; Tahir, M. F. M.; Zulkifli, R.

    2013-06-01

    This paper presents the sound absorption properties of a natural waste of date palm fiber perforated panel. A single layer of the date palm fibers was tested in this study for its sound absorption properties. The experimental measurements were carried out using impedance tube at the acoustic lab, Faculty of Engineering, Universiti Kebangsaan Malaysia. The experiment was conducted for the panel without air gap, with air gap and with perforated plate facing. Three air gap thicknesses of 10 mm, 20 mm and 30 mm were used between the date palm fiber sample and the rigid backing of the impedance tube. The results showed that when facing the palm date fiber sample with perforated plate the sound absorption coefficient improved at the higher and lower frequency ranges. This increase in sound absorption coincided with reduction in medium frequency absorption. However, this could be improved by using different densities or perforated plate with the date palm fiber panel.

  10. Spontaneous Perforation of Common Bile Duct: A Rare Presentation of Gall Stones Disease

    PubMed Central

    Udayakumara, Edippuli Arachchige Don; Somathilaka, Upul; Huruggamuwa, Milinda

    2016-01-01

    Background. Spontaneous perforation of the extrahepatic biliary system is a rare presentation of gall stones. Very few cases of bile duct perforation have been reported in adults. It is rarely suspected or correctly diagnosed preoperatively. Case Presentation. A 66-year-old female presented at the surgical emergency with 3 days' history of severe upper abdominal pain with distension and repeated episodes of vomiting, as she had evidence of generalized peritonitis and underwent an exploratory laparotomy. A single 0.5 cm × 0.5 cm free perforation was present on the anterolateral surface of the common bile duct at the junction of cystic duct. A cholecystectomy and the CBD exploration were performed. Conclusion. Spontaneous perforation of the extrahepatic bile duct is a rare but important presentation of gall stones in adults. Therefore, awareness of the clinical presentation, expert ultrasound examination, and surgery are important aspects in the management. PMID:27433361

  11. Perforating Granuloma Annulare — An Unusual Subtype of a Common Disease

    PubMed Central

    Alves, João; Barreiros, Hugo; Bártolo, Elvira

    2014-01-01

    Perforating granuloma annulare (GA) is a rare subset of GA with an unknown etiology and chronic course. Herein, we report the case of 72 year-old women with a 3-month history of a post-traumatic, persistent, erythematous and exudative plaque located on her left leg. Differential diagnosis included mycobacterial infection, subcutaneous mycosis, perforating dermatoses, pyoderma and squamous cell carcinoma. The histopathology was highly suggestive of a perforating GA. The patient was treated with betamethasone dipropionate cream applied once daily and a complete resolution of the lesion was observed in three weeks. Despite being a very rare subtype of a common disease, perforating granuloma annulare has clinical and histopathological characteristic features that facilitate the differential diagnosis, avoiding unnecessary procedures and inadequate and potentially more invasive treatments.

  12. Delayed presentation of uterine perforation with ovary migration after dilatation and curettage.

    PubMed

    Su, Shili; Tao, Guowei; Dong, Baihua; Shi, Linlin; Dong, Jianchun

    2015-01-01

    We present a rare but serious uterine perforation. A 31-year-old woman was referred to our department for hyperechogenic mass in uterus on ultrasonography after Dilation and curettage (D&C) for the adherent placenta and retained products of conception. Transvaginal ultrasound examination showed that a mass with several follicles measuring 35×29 mm was seen emanating from the right posterior wall of the uterine cavity, and there was absence of the myometrial tissue. A hysteroscopy and laparoscopy showed a uterine perforation with ovary incarceration. The ovary was rehabilitated, and the uterine perforation site was incised. D&C can not be performed when delayed presentation of uterine perforation with migration of an extrauterine organ is suspected, particularly, some of them are asymptomatic after a difficult intrauterine operation. PMID:26131247

  13. Linear and radial flow targets for characterizing downhole flow in perforations

    SciTech Connect

    Deo, M. ); Tariq, S.M. ); Halleck, P.M. )

    1989-08-01

    Two types of sandstone targets are commonly used to test flow efficiency of shaped-charge jet perforations: linear targets, in which flow enters only the unperforated end of the cylindrical sample, and radial targets, in which flow enters through the end and sides of the sample. To determine which of these targets best represents downhole conditions, the flow distribution along the length of a perforation has been studied by three-dimensional (3D) finite-element analyses. Linear and radial laboratory targets have been compared with downhole perforations under varying conditions. For ideal perforations, the low-shot-density (LSD) case is adequately represented by the radial target, while the high-shot-density (HSD) case falls between the two targets. With realistic crushed and damaged zones, the HSD closely matches the linear target, and the LSD case falls between the two targets.

  14. Common bile duct perforation sealed with a metal fully-covered stent.

    PubMed

    García-Cano, Jesús; Ferri-Bataller, Ramón; Gómez-Ruiz, Carmen Julia

    2016-08-01

    A common bile duct perforation due to sphincteroplasty is reported. It was managed by temporary insertion of a metal fully covered stent with good outcomes. Images from the procedure are provided. PMID:27554382

  15. Cyanoacrylate repair of laser in situ keratomileusis corneal flap perforation by a snake bite.

    PubMed

    Korn, Bobby S; Korn, Tommy S

    2005-11-01

    A 30-year-old man who had laser in situ keratomileusis (LASIK) for myopia 1 year earlier developed a corneal perforation in the left eye from a boa constrictor. The patient presented to the emergency room, and a small corneal perforation just outside the visual axis was diagnosed within the LASIK flap. Cyanoacrylate adhesive was used to close the corneal perforation. The patient went on to full visual recovery with an uncorrected visual acuity of 20/20. This is the first reported case of a penetrating corneal injury from a serpent in an eye that had LASIK. Cyanoacrylate may be used to repair small traumatic corneal perforations with a favorable visual outcome in eyes that have had LASIK. PMID:16412943

  16. Direct Visualization of the Perforant Pathway in the Human Brain with Ex Vivo Diffusion Tensor Imaging

    PubMed Central

    Augustinack, Jean C.; Helmer, Karl; Huber, Kristen E.; Kakunoori, Sita; Zöllei, Lilla; Fischl, Bruce

    2010-01-01

    Ex vivo magnetic resonance imaging yields high resolution images that reveal detailed cerebral anatomy and explicit cytoarchitecture in the cerebral cortex, subcortical structures, and white matter in the human brain. Our data illustrate neuroanatomical correlates of limbic circuitry with high resolution images at high field. In this report, we have studied ex vivo medial temporal lobe samples in high resolution structural MRI and high resolution diffusion MRI. Structural and diffusion MRIs were registered to each other and to histological sections stained for myelin for validation of the perforant pathway. We demonstrate probability maps and fiber tracking from diffusion tensor data that allows the direct visualization of the perforant pathway. Although it is not possible to validate the DTI data with invasive measures, results described here provide an additional line of evidence of the perforant pathway trajectory in the human brain and that the perforant pathway may cross the hippocampal sulcus. PMID:20577631

  17. Large Gastric Perforation in Carmi Syndrome: A Morbid Complication in a Rare Association

    PubMed Central

    Krishnan, L; Kuruvila, S

    2012-01-01

    The association between epidermolysis bullosa (EB) and congenital pyloric atresia (CPA) named Carmi Syndrome is rare. We report unusual and morbid complication of gastric perforation resulting in peritonitis in a preterm neonate born with Carmi Syndrome. PMID:26023416

  18. A case of perforating injury of eyeball and traumatic cataract caused by acupuncture

    PubMed Central

    Shuang, Han; Yichun, Kong

    2016-01-01

    Perforating globe injury is the leading cause of monocular blindness and vision loss. A 58-year-old male was injured by acupuncture needle during acupuncture treatment for his cerebral infarction. To the best of our knowledge, this is the first case report of perforating injury of the eyeball and traumatic cataract caused by acupuncture. The patient was hospitalized due to diagnosis of perforating ocular injury, traumatic cataract, and corneal and iris perforating injury. Moreover, he had to accept treatments of phacoemulsification, anterior vitrectomy along with intraocular lens implantation in the sulcus to improve his visual acuity. As acupuncture therapy has been widely performed for various diseases and achieved highly approval, the aim of this report is to remind acupuncturists operating accurately to avoid unnecessary injury during the treatment process, or the cure can also become the weapon. PMID:27221689

  19. Severe mitral regurgitation due to anterior mitral leaflet perforation after surgical treatment of discrete subaortic stenosis.

    PubMed

    Ozyuksel, Arda; Yildirim, Ozgur; Onsel, Ibrahim; Bilal, Mehmet Salih

    2014-01-01

    Congenital subvalvular aortic stenosis may be associated with anomalies of the mitral valve. In this case, we present a patient with severe mitral valve regurgitation due to a perforation in the anterior mitral leaflet detected 4 months after an operation for relief of subaortic stenosis. A 10-year-old male patient who was operated for subvalvular aortic stenosis in another clinic was admitted to our hospital, and transthoracic echocardiography revealed severe mitral valve regurgitation due to a defect that was demonstrated at the anterior valve leaflet. The perforated area at the mitral valve zone A1 was repaired with a PTFE patch. The patient was successfully operated for the mitral valve perforation and the postoperative course was uneventful. In our case, the perforation in the anterior mitral leaflet implies a possible implementation of inappropriate surgical technique which necessitated a second surgical intervention after the initial operation. PMID:24859561

  20. Severe mitral regurgitation due to anterior mitral leaflet perforation after surgical treatment of discrete subaortic stenosis

    PubMed Central

    Ozyuksel, Arda; Yildirim, Ozgur; Onsel, Ibrahim; Bilal, Mehmet Salih

    2014-01-01

    Congenital subvalvular aortic stenosis may be associated with anomalies of the mitral valve. In this case, we present a patient with severe mitral valve regurgitation due to a perforation in the anterior mitral leaflet detected 4 months after an operation for relief of subaortic stenosis. A 10-year-old male patient who was operated for subvalvular aortic stenosis in another clinic was admitted to our hospital, and transthoracic echocardiography revealed severe mitral valve regurgitation due to a defect that was demonstrated at the anterior valve leaflet. The perforated area at the mitral valve zone A1 was repaired with a PTFE patch. The patient was successfully operated for the mitral valve perforation and the postoperative course was uneventful. In our case, the perforation in the anterior mitral leaflet implies a possible implementation of inappropriate surgical technique which necessitated a second surgical intervention after the initial operation. PMID:24859561

  1. Damping parameter study of a perforated plate with bias flow

    NASA Astrophysics Data System (ADS)

    Mazdeh, Alireza

    role of LES for research studies concerned with damping properties of liners is limited to validation of other empirical or theoretical approaches. This research has shown that LES can go beyond that and can be used for performing parametric studies to characterize the sensitivity of acoustic properties of multi--perforated liners to the changes in the geometry and flow conditions and be used as a tool to design acoustic liners. The conducted research provides an insightful understanding about the contribution of different flow and geometry parameters such as perforated plate thickness, aperture radius, porosity factors and bias flow velocity. While the study agrees with previous observations obtained by analytical or experimental methods, it also quantifies the impact from these parameters on the acoustic impedance of perforated plate, a key parameter to determine the acoustic performance of any system. The conducted study has also explored the limitations and capabilities of commercial tool when are applied for performing simulation studies on damping properties of liners. The overall agreement between LES results and previous studies proves that commercial tools can be effectively used for these applications under certain conditions.

  2. Acute abdominal complications following hip surgery.

    PubMed

    Deleanu, B; Prejbeanu, R; Vermesan, D; Haragus, H; Icma, I; Predescu, V

    2014-01-01

    Hip surgeries are some of the most common and successful orthopedic procedures. Although rarely, abdominal complications do occur and are associated with unfavorable outcomes.We aimed to identify and describe the severe abdominal complications that appear in patients under-going elective or traumatic hip surgery. A four year retrospective electronic database research identified 408 elective primary hip replacements,51 hip revisions and 1040 intra and extracapsular proximal femur fractures. Out of these, three males and 4 females between 64 - 84 years old were identified to have developed acute abdominal complications: perforated acute ulcer (3),acute cholecystitis (2), volvulus (1), toxic megacolon with peritonitis (1) and acute colonic pseudo-obstruction (1).Complications debuted 3 - 10 days after index orthopedic surgery. Acute perioperative abdominal complications are rarely encountered during orthopedic surgery. When these do occur, they do so almost exclusively in patients with hippathology, comorbidities and most often lead to life threatening situations. We thus emphasize the need for early identification and appropriate management by both orthopedic and general surgery doctors in order to improve patient safety. PMID:24742414

  3. Free anterolateral thigh flap raised on musculocutaneous perforators of rectus femoris muscle.

    PubMed

    Ehtesham-ul-Haq; Aslam, Ayesha; Hameed, Shahid; Ahmad, Rao Saood; Majid, Abdul; Waqas, Muhammad

    2011-08-01

    The anterolateral thigh flap (ALTF) has been in wide clinical use for the last two decades, its major disadvantage has been its variable anatomy. We are presenting a case in which no substantial perforators were found to be arising from either the lateral septum of thigh or Vastus Laterlis muscle. In this case, instead of raising another flap, we used the same skin paddle raised on the musculocutaneous perforators of rectus femoris muscle. PMID:21798144

  4. Rectal impalement with bladder perforation: A review from a single institution

    PubMed Central

    Bachir Benjelloun, EI; Ahallal, Youness; Khatala, Khalid; Souiki, Tarik; Kamaoui, Iman; Taleb, Khalid Ati

    2013-01-01

    Context: Impalement injuries of the rectum with bladder perforation have been rarely reported. Such lesions have been associated with increased postoperative morbidity. A well-conducted preoperative evaluation of the lesions tends to prevent such complications. Aims: To increase awareness about patients with rectal impalement that involve bladder injuries and to examine the significance of thorough clinical examination and complementary investigation for these patients’ management. Materials and Methods: Retrospectively, we identified three patients with rectal impalement and bladder perforation treated in University Hospital Hassan II, Fez, Morocco. We recorded the symptoms, subsequent management, and further follow-up for each patient. All available variables of published cases were reviewed and analyzed. Results: Evident urologic symptoms were present in only one patient. Bladder perforation was suspected in two other patients on the basis of anterior rectal perforation in digital exam. Retrograde uroscanner could definitely confirm the diagnosis of bladder perforation. Fecal and urine diversion was the basis of the treatment. No postoperative complications were noted. We have reviewed 14 previous reports. They are presented mainly with urine drainage through the rectum. Radiologic investigation (retrograde cystography and retrograde uroscanner) confirmed bladder perforation in 10 patients (71.4%). Unnecessary laparotomy was performed in six patients (42.8%). Fecal diversion and urinary bladder decompression using urethral catheter were the most performed procedures in bladder perforation [6/14 patients (42.8%)]. No specific postoperative complications were reported. Conclusions: A high index of clinical suspicion is required to make the diagnosis of bladder perforation while assessing patients presenting with rectal impalement. Meticulous preoperative assessment is the clue of successful management. PMID:24311904

  5. The Distally Based Dorsal Metatarsal Artery Perforator Flap: Vascular Study and Clinical Implications.

    PubMed

    van Alphen, Nick A; Laungani, Alexis T; Christner, Jodie A; Lachman, Nirusha; Carlsen, Brian T; Saint-Cyr, Michel

    2016-05-01

    Background Intrinsic flaps based on the dorsal metacarpal arteries are useful for coverage of dorsal hand, finger, and thumb defects. The purpose of this study was to explore the anatomy of the dorsal metatarsal arteries (DMtAs) in the foot to help define their clinical utility. We observed the size and numbers of distal perforators from the DMtAs and quantified the vascular perfusion pattern of the DMtA perforator across the skin. Methods Ten fresh cadaver feet were injected with latex and dissected to assess the size and number of distal perforators from the DMtAs. Five DMtA perforator flaps were injected with methylene blue to visualize and quantify the vascular territory of the skin flap to understand the clinical possibilities. In addition, a clinical case is described and shown. Results Ten fresh cadaver feet were dissected. The first DMtA was absent in two specimens and the second, third, or fourth DMtA was absent in one specimen each. The available DMtAs had between two and five cutaneous perforators supplying the skin (average, 3.7 perforators per DMtA). The largest perforators to the skin were always seen in the distal half of the DMtA and ranged from 0.4 to 0.8 mm (average, 0.5 mm). Methylene blue injections showed an average flap surface of 21.6 × 47.6 mm. Conclusion This cadaveric study demonstrates the usefulness of the DMtA perforator flap. The flap is a valuable addition to the arsenal of flaps to cover the dorsum of the toe, webspace, or defects exposing tendons on the distal dorsum of the foot. PMID:26165886

  6. A Simple Analytical Formula for the Leakage Flux Through a Perforated Aquitard.

    PubMed

    Bonte, Matthijs; Zaadnoordijk, Willem Jan; Maas, Kees

    2015-01-01

    In this methods note, we present a simple analytical formula to quantify the steady-state leakage flux (Q) over a perforated aquitard. The flux depends on the aquitard thickness (D), the radius of the perforation (R), the hydraulic conductivity of the material inside the perforation (kfill ), the conductivities of the overlying and underlying aquifers (k1 and k2 , respectively), and the head difference between the two aquifers (ΔH): [Formula: see text]. This equation assumes an aquitard separating two homogeneous and infinite aquifers (R ≪ aquifer thickness) in which radial flow to and from the perforation occurs, with no other recharge or discharge boundaries near the perforation. The flux through a perforation in a hypothetical case study with D = 10 m, k1  = 10 m/d, k2  = 20 m/d, R = 0.072 m, and ΔH = 1 m ranges between less than 1 mL/d if the hole is backfilled with bentonite (k(fill ) = 10(-4)  m/d), to several liters per day if the perforation is backfilled with sand from the overlying aquifer (k(fill)  = 10 m/d), to several m(3) /d if the perforation forms an open conduit (k(fill)  = 10(5)  m/d). The leakage fluxes calculated with this model agree well with those calculated using a numerical model (MODFLOW). PMID:25040493

  7. Imaging scatterometry and microspectrophotometry of lycaenid butterfly wing scales with perforated multilayers

    PubMed Central

    Wilts, Bodo D.; Leertouwer, Hein L.; Stavenga, Doekele G.

    2008-01-01

    We studied the structural as well as spatial and spectral reflectance characteristics of the wing scales of lycaenid butterfly species, where the scale bodies consist of perforated multilayers. The extent of the spatial scattering profiles was measured with a newly built scatterometer. The width of the reflectance spectra, measured with a microspectrophotometer, decreased with the degree of perforation, in agreement with the calculations based on multilayer theory. PMID:18782721

  8. An Experimentally Validated Numerical Modeling Technique for Perforated Plate Heat Exchangers

    PubMed Central

    Nellis, G. F.; Kelin, S. A.; Zhu, W.; Gianchandani, Y.

    2010-01-01

    Cryogenic and high-temperature systems often require compact heat exchangers with a high resistance to axial conduction in order to control the heat transfer induced by axial temperature differences. One attractive design for such applications is a perforated plate heat exchanger that utilizes high conductivity perforated plates to provide the stream-to-stream heat transfer and low conductivity spacers to prevent axial conduction between the perforated plates. This paper presents a numerical model of a perforated plate heat exchanger that accounts for axial conduction, external parasitic heat loads, variable fluid and material properties, and conduction to and from the ends of the heat exchanger. The numerical model is validated by experimentally testing several perforated plate heat exchangers that are fabricated using microelectromechanical systems based manufacturing methods. This type of heat exchanger was investigated for potential use in a cryosurgical probe. One of these heat exchangers included perforated plates with integrated platinum resistance thermometers. These plates provided in situ measurements of the internal temperature distribution in addition to the temperature, pressure, and flow rate measured at the inlet and exit ports of the device. The platinum wires were deposited between the fluid passages on the perforated plate and are used to measure the temperature at the interface between the wall material and the flowing fluid. The experimental testing demonstrates the ability of the numerical model to accurately predict both the overall performance and the internal temperature distribution of perforated plate heat exchangers over a range of geometry and operating conditions. The parameters that were varied include the axial length, temperature range, mass flow rate, and working fluid. PMID:20976021

  9. Neurodevelopmental Outcomes of Extremely Low Birth Weight Infants with Spontaneous Intestinal Perforation or Surgical Necrotizing Enterocolitis

    PubMed Central

    Wadhawan, Rajan; Oh, William; Hintz, Susan R; Blakely, Martin L; Das, Abhik; Bell, Edward F.; Saha, Shampa; Laptook, Abbot R.; Shankaran, Seetha; Stoll, Barbara J.; Walsh, Michele C.; Higgins, Rosemary D.

    2013-01-01

    Objective To determine if extremely low birth weight infants with surgical necrotizing enterocolitis have a higher risk of death or neurodevelopmental impairment and neurodevelopmental impairment among survivors (secondary outcome) at 18–22 months corrected age compared to infants with spontaneous intestinal perforation and infants without necrotizing enterocolitis or spontaneous intestinal perforation. Study Design Retrospective analysis of the Neonatal Research Network very low birth weight registry, evaluating extremely low birth weight infants born between 2000–2005. The study infants were designated into 3 groups: 1) Spontaneous intestinal perforation without necrotizing enterocolitis; 2) Surgical necrotizing enterocolitis (Bell's stage III); and 3) Neither spontaneous intestinal perforation nor necrotizing enterocolitis. Multivariate logistic regression analysis was performed to evaluate the association between the clinical group and death or neurodevelopmental impairment, controlling for multiple confounding factors including center. Results Infants with surgical necrotizing enterocolitis had the highest rate of death prior to hospital discharge (53.5%) and death or neurodevelopmental impairment (82.3%) compared to infants in the spontaneous intestinal perforation group (39.1% and 79.3%) and no necrotizing enterocolitis/no spontaneous intestinal perforation group (22.1% and 53.3%; p<0.001). Similar results were observed for neurodevelopmental impairment among survivors. On logistic regression analysis, both spontaneous intestinal perforation and surgical necrotizing enterocolitis were associated with increased risk of death or neurodevelopmental impairment (adjusted OR 2.21, 95% CI: 1.5, 3.2 and adjusted OR 2.11, 95% CI: 1.5, 2.9 respectively) and neurodevelopmental impairment among survivors (adjusted OR 2.17, 95% CI: 1.4, 3.2 and adjusted OR 1.70, 95% CI: 1.2, 2.4 respectively). Conclusions Spontaneous intestinal perforation and surgical necrotizing

  10. Protection Device Made of a Modified Syringe for Muscle Protection During Cranial Perforation: Technical Note.

    PubMed

    Matano, Fumihiro; Mizunari, Takayuki; Koketsu, Kenta; Fujiki, Yu; Kubota, Asami; Kobayashi, Shiro; Murai, Yasuo; Morita, Akio

    2016-05-01

    In neurosurgical procedures, avoiding damage of surrounding tissues such as muscle and periosteum during a craniotomy is important for esthetic and other reasons. We devised a protection tool by using an amputated syringe barrel to cover the perforating drill and protect temporal muscle damage. This device made it possible to prevent damage to surrounding tissues, such as the muscle and periosteum, during cranial perforation. This method could be useful as it is cost-effective, simple, and versatile. PMID:26773982

  11. A novel method for endoscopic perforation management by using abdominal exploration and full-thickness sutured closure

    PubMed Central

    Kumar, Nitin; Thompson, Christopher C.

    2016-01-01

    Background Perforation of the GI tract during endoscopy can result in significant morbidity and mortality. Early recognition and immediate management of endoscopic perforation are essential to optimize outcome. Larger perforations, defects with complex geometry, and those complicated by leakage of luminal contents have traditionally required surgical management. Objective To assess the feasibility of a new method for managing complex perforations that incorporates abdominal exploration and endoscopic sutured closure. Design Case series. Setting Tertiary care center. Patients Two patients with large, complicated perforations and peritoneal contamination. Interventions Endoscopic exploration of abdomen with angiocatheter placement under direct visualization, management of leaked luminal contents, and full-thickness sutured defect closure. Results Endoscopic abdominal exploration through the perforation site allowed safe placement of an angiocatheter for management of pneumoperitoneum, inspection for injury that may warrant surgical management, and removal of leaked luminal contents. Endoscopic sutured closure allowed safe and robust perforation management. Repair of gastrojejunal anastomotic perforation required 2 sutures and 63 minutes. Repair of gastric perforation required 4 sutures and 48 minutes. Patients had successful endoscopic defect closure confirmed by an upper GI series and were discharged 1 day later. Limitations Report of a new method in 2 patients performed at tertiary care center. Conclusions We demonstrate successful management of complex perforations with peritoneal contamination by incorporating endoscopic exploration and sutured closure with standard treatment measures. Traditional practice would have directed these patients to surgical management, which introduces additional morbidity and cost. A means for safe and broad implementation of these techniques should be evaluated. PMID:24721517

  12. Acute sacroiliitis.

    PubMed

    Slobodin, Gleb; Rimar, Doron; Boulman, Nina; Kaly, Lisa; Rozenbaum, Michael; Rosner, Itzhak; Odeh, Majed

    2016-04-01

    The purpose of this study was to review the data on the etiology, risk factors, clinical presentations, and diagnosis of acute sacroiliitis. A Pubmed search utilizing the indexing term "acute sacroiliitis" was conducted and the data pertinent to the aim of the review was extracted and organized in accordance with the preplanned structure of the manuscript. The diagnosis of acute sacroiliitis is often challenging because of both the relative rarity of this presentation and diverse character of acute sacroiliac pain, frequently mimicking other, more prevalent disorders. Technetium bone scintigraphy can localize the disease process to the sacroiliac joint, while computed tomography or magnetic resonance imaging can be used for the detailed characterization and the extent of the disease as well as the diagnosis of complications. Pyogenic sacroiliitis is by far the most common cause of acute sacroiliitis. Brucellosis, acute sacroiliitis in the course of reactive arthritis, and crystalline-induced sacroiliitis frequently imitate pyogenic sacroiliitis. Acute sacroiliitis can rarely be also related to hematological malignancies or treatment with isotretinoin. Awareness to the possibility of acute sacroiliitis and a thorough physical examination are the necessary prerequisites to its timely diagnosis, while the appropriate laboratory and imaging studies should confirm the precise diagnosis and direct the appropriate treatment strategy. PMID:26847855

  13. Experimental study of dissolved oxygen transport by regular waves through a perforated breakwater

    NASA Astrophysics Data System (ADS)

    Yin, Zegao; Yu, Ning; Liang, Bingchen; Zeng, Jixiong; Xie, Shaohua

    2016-02-01

    The perforated breakwater is an environmentally friendly coastal structure, and dissolved oxygen concentration levels are an important index to denote water quality. In this paper, oxygen transport experiments with regular waves through a vertical perforated breakwater were conducted. The oxygen scavenger method was used to reduce the dissolved oxygen concentration of inner water body with the chemicals Na2SO3 and CoCl2. The dissolved oxygen concentration and wave parameters of 36 experimental scenarios were measured with different perforated arrangements and wave conditions. It was found that the oxygen transfer coefficient through wave surface, K1 a 1, is much lower than the oxygen transport coefficient through the perforated breakwater, K2 a 2. If the effect of K1 a 1 is not considered, the dissolved oxygen concentration computation for inner water body will not be greatly affected. Considering the effect of a permeable area ratio a, relative location parameter of perforations δ and wave period T, the aforementioned data of 30 experimental scenarios, the dimensional analysis and the least squares method were used to derive an equation of K2 a 2 (K2 a 2=0.0042 a 0.5 δ 0.2 T -1). It was validated with 6 other experimental scenarios data, which indicates an approximate agreement. Therefore, this equation can be used to compute the DO concentration caused by the water transport through perforated breakwater.

  14. Nonsurgical treatment of 8 cases with esophageal perforations caused by ESD

    PubMed Central

    Zhong, Henggao; Ma, Limei; Zhang, Yin; Shuang, Jinquan; Qian, Yun; Sheng, Yu; Wang, Xiang; Miao, Lin; Fan, Zhining

    2015-01-01

    Background: Esophageal perforation is a serious, but rare complication of high mortality following the endoscopic submucosal dissection (ESD) procedure. The aim of this study is to evaluate the efficacy and safety of nonsurgical treatment of esophageal perforations caused by ESD based on our clinical experience. Methods: From January 2009 to November 2013, 8 patients were diagnosed with endoscopic perforation of the esophagus caused by ESD in our center. All cases were treated with nonsurgical measures, such as metallic clips, conservative treatment alone and therapeutic drainage. Results: The places of perforation were closured by metallic clips immediately in 4 patients. Two patients were cured with conservative treatment alone. Therapeutic drainage with large-bore tube thoracostomy was applied in another 2 patients who had empyema following esophageal perforation. All of the patients were treated nonsurgically, and recovered well. Conclusion: Esophageal perforation caused by ESD can be detected and treated timely, and nonsurgical treatment seems to be a feasible and effective option for clinicians. PMID:26885139

  15. FBG Sensor for Contact Level Monitoring and Prediction of Perforation in Cardiac Ablation

    PubMed Central

    Ho, Siu Chun Michael; Razavi, Mehdi; Nazeri, Alireza; Song, Gangbing

    2012-01-01

    Atrial fibrillation (AF) is the most common type of arrhythmia, and is characterized by a disordered contractile activity of the atria (top chambers of the heart). A popular treatment for AF is radiofrequency (RF) ablation. In about 2.4% of cardiac RF ablation procedures, the catheter is accidently pushed through the heart wall due to the application of excessive force. Despite the various capabilities of currently available technology, there has yet to be any data establishing how cardiac perforation can be reliably predicted. Thus, two new FBG based sensor prototypes were developed to monitor contact levels and predict perforation. Two live sheep were utilized during the study. It was observed during operation that peaks appeared in rhythm with the heart rate whenever firm contact was made between the sensor and the endocardial wall. The magnitude of these peaks varied with pressure applied by the operator. Lastly, transmural perforation of the left atrial wall was characterized by a visible loading phase and a rapid signal drop-off correlating to perforation. A possible pre-perforation signal was observed for the epoxy-based sensor in the form of a slight signal reversal (12–26% of loading phase magnitude) prior to perforation (occurring over 8 s). PMID:22368507

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

    PubMed Central

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

    2014-01-01

    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

  17. Pedicled-perforator (propeller) flaps in lower extremity defects: a systematic review.

    PubMed

    Gir, Phanette; Cheng, Angela; Oni, Georgette; Mojallal, Ali; Saint-Cyr, Michel

    2012-11-01

    Pedicled-perforator (propeller) flaps for lower extremity reconstruction have gained popularity due to minimal donor site morbidity, relatively simple surgical technique, and replacement of tissue using "like-by-like" principles. We reviewed and analyzed the clinical use of these flaps in regards to patient age and gender, etiology and location of the defect, size and type of flap, arc of rotation, and complications to determine the reliability of this technique. A systematic review of the PubMed database using search terms to include perforator, pedicled, and propeller flaps in the lower extremity. Data from 15 case series provided 186 cases of pedicled-perforator (propeller) flaps for analysis using Chi-square tests. The Peroneal Artery Perforator (PAP) flaps and Posterior Tibial Artery Perforator (PTAP) flaps were the most frequently used flaps. The overall complication rate was 25.8% and the failure rate was 1.1%. No significant differences were found in complication rate related to age, gender, etiology or location of the defect, type or size of the flap. The most common complications were partial flap loss and venous congestion (11.3 and 8.1%). Pedicled-perforator flaps appear to be a reliable and safe procedure for the coverage soft tissue defects of the lower extremity based on favorable results reported in the literature. PMID:22715046

  18. Fatigue response of perforated titanium for application in laminar flow control

    NASA Technical Reports Server (NTRS)

    Johnson, W. Steven; Miller, Jennifer L.; Newman, Jr., James

    1996-01-01

    The room temperature tensile and fatigue response of non-perforated and perforated titanium for laminar flow control application was investigated both experimentally and analytically. Results showed that multiple perforations did not affect the tensile response, but did reduce the fatigue life. A two dimensional finite element stress analysis was used to determine that the stress fields from adjacent perforations did not influence one another. The stress fields around the holes did not overlap one another, allowing the materials to be modeled as a plate with a center hole. Fatigue life was predicted using an equivalent MW flow size approach to relate the experimental results to microstructural features of the titanium. Predictions using flaw sizes ranging from 1 to 15 microns correlated within a factor of 2 with the experimental results by using a flow stress of 260 MPa. By using two different flow stresses in the crack closure model and correcting for plasticity, the experimental results were bounded by the predictions for high applied stresses. Further analysis of the complex geometry of the perforations and the local material chemistry is needed to further understand the fatigue behavior of the perforated titanium.

  19. Vessel wall perforation mechanism of the excimer laser-assisted non-occlusive anastomosis technique.

    PubMed

    Bremmer, Jochem; van Doormaal, Tristan P C; Verweij, Bon H; van der Zwan, Albert; Tulleken, Cornelius A F; Verdaasdonk, Rudolf

    2016-08-01

    The excimer laser assisted non-occlusive anastomosis (ELANA) technique is used to make anastomoses on intracerebral arteries. This end-to-side anastomosis is created without temporary occlusion of the recipient artery using a 308-nm excimer laser with a ring-shaped multi-fiber catheter to punch an opening in the arterial wall. Over 500 patients have received an ELANA bypass. However, the vessel wall perforation mechanism of the laser catheter is not known exactly and not 100 % successful. In this study, we aimed to understand the mechanism of ELANA vessel perforation using specialized imaging techniques to ultimately improve its effectiveness. High-speed imaging, high-contrast imaging, and high-sensitivity thermal imaging were used to study the laser wall perforation mechanism and reveal the mechanical and thermal effects involved. In vitro, rabbit arteries were exposed with the special designed laser catheter in a setup representative for the clinical setting, in which blood was replaced with a transparent UV absorbing liquid for visualization. We observed that laser vessel wall perforation was caused by explosive vapor bubbles tearing through the vessel wall, mostly within the first 20 of the total 200 pulses. Thermal effects were minimal. Unsymmetrical tension in the vessel wall inducing migration of the flap during laser exposure was observed in case of unsuccessful wall perforations. The laser wall perforation mechanism in the ELANA technique is primarily mechanical. Symmetric tension in the recipient vessel wall is essential and should be trained by neurosurgeons. PMID:27220531

  20. Fatigue response of perforate titanium for application in laminar flow control

    SciTech Connect

    Miller, J.L.; Newman, J.C. Jr.; Johnson, W.S.

    1997-12-01

    The room temperature tensile and fatigue response of non-perforated and perforated titanium for laminar flow control application was investigated both experimentally and analytically. Results showed that multiple perforations did not affect the tensile response, but did reduce the fatigue life. A two-dimensional finite element stress analysis was used to determine that the stress fields from adjacent perforations did not influence one another. The stress fields around the holes did not overlap one another, allowing the material to be modeled as a plate with a center hole. Fatigue life was predicted using an equivalent initial flaw size approach to relate the experimental results to microstructural features of the titanium. Predictions using flaw sizes ranging from 1 to 15 {micro}m correlated within a factor of 2 with the experimental results by using a flow stress of 260 MPa. By using two different flow stresses in the crack closure model and correcting the plasticity, the experimental results were bounded by the predictions for high gross section stresses. Further analysis of the complex perforation geometry and the local material chemistry is needed to further understand the fatigue behavior of the perforated titanium.