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Sample records for intraperitoneal bladder perforation

  1. Spontaneous Intraperitoneal Bladder Perforation Associated with Urothelial Carcinoma with Divergent Histologic Differentiation, Diagnosed by CT Cystography.

    PubMed

    Lee, Jee Han; You, Hyun Wook; Lee, Choong-Hyun

    2010-04-01

    Spontaneous bladder perforation is a very rare event. Prompt diagnosis of this injury is very important, particularly with intraperitoneal perforation, because mortality increases if surgical repair is delayed. Previous studies have reported that plain cystography is the primary modality of imaging study rather than relatively insensitive computed tomography (CT) when bladder perforation is suspected. We report here a rare case of spontaneous intraperitoneal perforation of the bladder associated with urothelial carcinoma with divergent histologic differentiation, as diagnosed with CT cystography.

  2. An unusual cause of abdominal distension: intraperitoneal bladder perforation secondary to intermittent self-catheterisation.

    PubMed

    Martin, Jennifer; Convie, Liam; Mark, David; McClure, Mark

    2015-02-25

    We report a strikingly unusual case of traumatic intraperitoneal perforation of an augmented bladder from clean intermittent self-catheterisation (CISC), which presented a unique diagnostic challenge. This case describes a 48-year-old T1 level paraplegic, who had undergone clamshell ileocystoplasty for detrusor overactivity, presenting with abdominal distension, vomiting and diarrhoea. Initial investigations were suggestive of disseminated peritoneal malignancy with ascitic fluid collections, but the ascitic fluid was found to be intraperitoneal urine from a perforation of the urinary bladder. This was associated with an inflammatory response in the surrounding structures causing an appearance of colonic thickening and omental disease. Although the diagnostic process was complex due to this patient's medical history, the treatment plan initiated was non-operative, with insertion of an indwelling urinary catheter and radiologically guided drainage of pelvic and abdominal collections. Overdistension perforations of augmented urinary bladders have been reported, but few have described perforation from CISC.

  3. Intraperitoneal explosion following gastric perforation.

    PubMed

    Mansfield, Scott K; Borrowdale, Roderick

    2014-04-01

    The object of this study is to report a rare case of explosion during laparotomy where diathermy ignited intraperitoneal gas from a spontaneous stomach perforation. Fortunately, the patient survived but the surgeon experienced a finger burn. A literature review demonstrates other examples of intraoperative explosion where gastrointestinal gases were the fuel source. Lessons learned from these cases provide recommendations to prevent this potentially lethal event from occurring.

  4. Bladder perforation by ventriculoperitoneal shunt.

    PubMed

    Miranda, Marcelo Eller; de Sousa, Mariana Bueno; Tatsuo, Edson Samesima; Quites, Lucas Viana; Giannetti, Alexandre Varella

    2016-12-01

    Bladder perforation by ventriculoperitoneal shunt is a rare complication that has been describe in 19 cases in prior literature. This work describes the case of a 4-month-old baby who presented with extrusion of the distal catheter through the urethra. The patient underwent a laparotomy; the catheter was cut close to the bladder wall and repositioned into the peritoneal cavity. The bladder wall was sutured, and the remaining distal portion of the catheter was removed through the urethra. Based on this single experience and a literature review, the authors classified the clinical signs and symptoms of bladder perforation by the ventriculoperitoneal shunt catheter. Finally, the authors propose a more conservative approach for this rare complication.

  5. Spontaneous Urinary Bladder Perforation: An Unusual Presentation of Diabetes Mellitus☆

    PubMed Central

    Kabarriti, Abdo E.; Ramchandani, Parvati; Guzzo, Thomas J.

    2014-01-01

    Spontaneous urinary bladder perforation is a rare event, which requires immediate medical attention due to its extremely high morbidity and mortality. We report a case of a 36-year-old man who presented with acute-onset abdominal pain without any inciting events. His glucose level at the time of presentation was 1107 mg/dL. On initial abdominal imaging, it was believed that he had a large pelvic mass likely originating from the bladder. On further workup at our hospital, it was discovered that he had an intraperitoneal perforation after which he underwent an exploratory laparotomy and a cystorrhaphy. PMID:26955559

  6. 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

  7. 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.

  8. Perforated intraperitoneal intrauterine contraceptive devices: diagnosis, management, and clinical outcomes.

    PubMed

    Kho, Kimberly A; Chamsy, Dina J

    2014-01-01

    To describe a series of intraperitoneal perforated intrauterine contraception devices (IUDs) and to discuss associated findings, methods for diagnosis, and management of this complication. Retrospective review of surgical database between 1998 and 2012 (Canadian Task Force classification II-2). University medical center. Thirty-seven women with a perforated IUD in the intraperitoneal cavity. Nineteen copper IUDs (51%), 17 levonorgestrel-releasing IUDs (LNG-IUDs) (46%), and 1 Lippes loop (3%) were identified. Twenty women (54%) had abdominal pain, 16 (43%) had no symptoms, and 1 (3%) was found to have strings protruding from her anus. Twenty-six women (70%) underwent laparoscopy to remove the IUD, and 6 (16%) underwent hysteroscopy along with laparoscopy. Conversion to laparotomy was required in 4 patients (11%). Two IUDs (5%) caused full-thickness rectouterine fistulas that required laparotomy for repair. Dense adhesions were found in 21 women (57%); and of those, 15 (71%) were associated with a copper IUD. Copper IUDs were significantly more likely than LNG-IUDs to be associated with dense adhesions (p = .02). Perforated IUDs can be asymptomatic or cause short-term and long-term symptoms. Long-term complications include abscess and fistula formation. Copper IUDs cause a greater inflammatory process than do LNG-IUDs. Even if asymptomatic, we advocate prompt removal of all IUDs that perforate into the peritoneal cavity once they are identified. Laparoscopic surgical removal of an intraperitoneal IUD is a safe and preferred method. Copyright © 2014 AAGL. Published by Elsevier Inc. All rights reserved.

  9. Urosepsis complicated by a spontaneous bladder perforation.

    PubMed

    Lutwak, Nancy; Dill, Curt

    2011-11-08

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

  10. Delayed Diagnosis of Iatrogenic Bladder Perforation in a Neonate

    PubMed Central

    Perez, Jose A.; Rich, Mark A.; Swana, Hubert S.

    2016-01-01

    Iatrogenic bladder injuries have been reported in the neonate during umbilical artery/vein catheterization, voiding cystourethrogram, urinary catheterizations, and overwhelming hypoxic conditions. Patients with iatrogenic bladder perforations can present with acute abdomen indicating urinary peritonitis, septic-uremic shock, or subtle symptoms like abdominal distension, pain, hematuria, uremia, electrolyte imbalances, and/or difficulty urinating. The following neonatal case report of perforated bladder includes a review of the signs, symptoms, diagnostic tools, and management of bladder injury in neonates. PMID:27747129

  11. An unusual cause of death: spontaneous urinary bladder perforation.

    PubMed

    Limon, Onder; Unluer, Erden Erol; Unay, Fulya Cakalagaoglu; Oyar, Orhan; Sener, Aslı

    2012-11-01

    Spontaneous urinary bladder perforation is a rare and life-threatening condition similar to traumatic and iatrogenic perforation. The connection with the underlying bladder damage due to previous radiotherapy, inflammation, malignancy, obstruction, or other causes can be found in almost all cases. The symptoms are often nonspecific, and misdiagnosis is common. Here, we present a case of spontaneous urinary bladder perforation due to bladder necrosis in a diabetic woman. She presented to the emergency department with abdominal pain. Exploratory laparotomy was performed by surgeons and revealed necrosis of the anterior and lateral walls of the urinary bladder. Microscopic examination revealed necrotic changes throughout the bladder wall. Ghost-like cellular outlines were compatible with coagulative necrosis. Clusters of bacteria were also present in some necrobiotic tissues. Malignant cells were not present. It appears probable that the infection was due to local interference with the blood supply (arterial, capillary, or venous) combined with the systemic metabolic upset that led to the bladder condition. In our case, we observed partial necrosis of the bladder rather than distortion of the entire blood supply to the bladder as consequences of the microvascular effects of diabetes. Urinary bladder perforation must be considered in the differential diagnosis of patients presenting with free fluid in the abdomen/peritonitis, decreased urine output, and hematuria, and in whom increased levels of urea/creatinine are detected in serum and/ or peritoneal fluid aspirate.

  12. [Bladder rupture caused by spontaneous perforation of an infected urachal cyst].

    PubMed

    Maruschke, M; Kreutzer, H J; Seiter, H

    2003-06-01

    Anomalies of the fetal urachus are rare. Normally, the postnatal urachus presents as a fibrous band extending from the bladder to the umbilicus. Urachal cysts may occur in postnatal life. Spontaneous perforation of urachal cysts is a very rare condition, which clinically may not be distinguishable from other acute abdominal conditions. We report a case of a 63-year-old male with a history of recurrent urinary tract infections and a bladder rupture caused by a spontaneous perforation of an infected urachal cyst. The symptomatology showed abdominal rigidity and pain, a palpable mass in the lower abdomen, and hematuria. Laboratory findings showed leukocytosis and an increased CRP level. The bladder rupture was confirmed by cystography. Bacteriologic examination identified Proteus vulgaris, Corynebacterium species, and Klebsiella pneumoniae. Most of the published cases in the literature report about intraperitoneal perforation of infected urachal cysts. In the present case, we found a spontaneous perforation of an infected urachal cyst leading to an extraperitoneal bladder rupture with an extraperitoneal limitation of the infection. The definitive therapy was complete surgical excision including a cuff of the bladder, drainage, and systemic broad-spectrum and local application of antibiotics. The further course was uneventful.

  13. Fluid extravasation caused by bladder perforation during bipolar transurethral resection using saline solution -a case report-.

    PubMed

    Park, Sun-Kyung; Cho, Woo-Jin; Choi, Yun-Suk

    2013-08-01

    Transurethral resection of the prostate is the gold standard in the operative management of benign prostatic hyperplasia. Bipolar transurethral resection of the prostate using saline solution is a safe technique and reduces the risk of transurethral resection syndrome. This report discusses a rare complication of bipolar transurethral resection of the prostate: the extravasation of 0.9% saline solution into intraperitoneal and retroperitoneal cavities due to bladder perforation, resulting in respiratory difficulties.

  14. Preoperative cystoscopy is beneficial in selection of patients for laparoscopic repair of intraperitoneal bladder rupture.

    PubMed

    Yee, David S; Kalisvaart, Jonathan F; Borin, James F

    2007-10-01

    Intraperitoneal bladder rupture usually is caused by blunt external trauma to a distended bladder. Although such injuries generally necessitate a formal laparotomy, advances in minimally invasive surgery have allowed successful laparoscopic repair. We describe our preoperative evaluation and laparoscopic technique in a case of isolated intraperitoneal bladder rupture secondary to trauma.

  15. Spontaneous bladder perforation: a rare complication of tuberculosis.

    PubMed

    Kong, Christopher Ho Chee; Ali, Siti Aishah Md; Singam, Praveen; Hong, Goh Eng; Cheok, Lee Boon; Zainuddin, Zulkifli Md

    2010-09-01

    Spontaneous bladder perforation secondary to tuberculosis (TB) is very rare. Only three cases have been reported so far in the literature. Due to its rarity, the diagnosis of spontaneous bladder perforation is often missed. Confirmation of TB via culture takes a long time and starting empirical treatment for TB is necessary. We relate our experience with a young woman who presented with clinical features of a perforated appendix and was only diagnosed with bladder perforation during laparotomy. She also had distal right ureteral stricture and left infundibular stenosis. The provisional diagnosis of TB was attained via typical histopathological features and a positive Mantoux test. She was started empirically on anti-TB treatment and recovered without any complications. Urine culture after 6 weeks confirmed the diagnosis of TB.

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

    PubMed

    Wieloch, Maria; Bazylińska, Kamila; Ziemniak, Piotr

    2013-12-01

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

  17. Bladder perforation during sling procedures: diagnosis and management of injury.

    PubMed

    Israfil-Bayli, F; Bulchandani, S; Parsons, M; Jackson, S; Toozs-Hobson, P

    2014-05-01

    Midurethral slings are an effective and minimally invasive treatment for stress urinary incontinence. One of the most common intraoperative complications is bladder perforation, complicating between 2 and 10% of all operations, and on average 4.7%. It is usually corrected during surgery, with repositioning of the trocars. The purpose of this video is to demonstrate a method of replacing the trocars under direct vision. This video exhibits a bladder perforation during insertion of a retropubic midurethral sling (Advantage Fit; Boston Scientific) and gives a step-by step guide to the removal and repositioning of the sling under direct visualisation. Repositioning of the trocars under direct vision in cases of bladder perforation may have numerous advantages. It may prevent damage to the urethra, possibly reduce the risk of postoperative infection and may be beneficial for trainees.

  18. Laparoscopic repair of intra-abdominal bladder perforation in preschool children

    PubMed Central

    Deshpande, Aniruddh V.; Michail, Peter; Gera, Parshotam

    2017-01-01

    Intraperitoneal bladder rupture is uncommon in very young children, but its incidence may increase with increasing use of seat and lap belts. To the best of our knowledge, there are no prior reports of laparoscopic repair of this injury in children. We describe two recent cases and discuss useful technical points that facilitate a successful laparoscopic repair. Both our patients were preschool age girls who sustained seat and lap belt injuries. Contrast computed tomography scan suggested a large amount of free peritoneal fluid and cystogram confirmed intraperitoneal bladder perforation (isolated injury). The injury was repaired using delayed absorbable sutures and intracorporeal suturing (continuous in 1, interrupted in 1) using a 3 port laparoscopic technique. Meticulous peritoneal lavage was carried out to minimise urinary peritonitis and the bladder as well as the peritoneal cavity were drained. Check cystograms (day 7) revealed no leaks. Young girls appear to be at risk of intraperitoneal bladder injuries following lap belt injuries. After exclusion of life-threatening injuries and concurrent abdominal injuries which need rapid control or preclude pneumoperitoneum, a laparoscopic repair can be safely performed. PMID:27143696

  19. Spontaneous intraperitoneal rupture of the bladder in association with transitional cell carcinoma.

    PubMed Central

    Budd, J. S.

    1988-01-01

    A 79 year old woman presented with generalized peritonitis and was subsequently found to have a perforated bladder secondary to a tumour. This is a rare occurrence and a difficult diagnosis to make preoperatively. PMID:3174533

  20. Necrotizing fasciitis following gall-bladder perforation.

    PubMed

    Rehman, A; Walker, M; Kubba, H; Jayatunga, A P

    1998-10-01

    Necrotizing fasciitis continues to carry a very high mortality and prolonged morbidity. Gallstones have previously not been reported as a cause of this condition. We report a patient who presented with gallbladder perforation leading to necrotizing fasciitis of the anterior abdominal wall. The only organism isolated was Escherichia Coli, cultured from necrotic issue.

  1. Spontaneous perforation of acalculous gall bladder presenting as acute abdomen.

    PubMed

    Goenka, Usha; Majumder, Shounak; Banerjee, Pinaki; Kapoor, Nisha; Nandi, Subhabrata; Sethy, Pradeepta K; Goenka, Mahesh K

    2012-10-01

    Acute abdominal pain is commonly encountered in the emergency department (ED), but a diagnosis of gall bladder perforation (GBP) is rarely considered in the absence of predisposing factors. This article will highlight the risk factors, diagnosis, and management of GBP, a rare but potentially life-threatening biliary pathology. A 73-year-old diabetic man presented to the ED with a 12-h history of severe upper abdominal pain. He was hemodynamically stable, but abdominal examination showed distention, guarding, and diffuse tenderness. Abdominal X-ray study showed mildly distended small bowel loops without any air-fluid levels. Abdominal sonography revealed mild ascites and pericholecystic fluid collection but no gall bladder calculi. Laboratory reports documented a white blood cell count of 13,700/mm(3) and elevated serum amylase of 484 IU/L. A contrast-enhanced computed tomography (CT) scan of the abdomen suggested discontinuity of the gall bladder wall along with fluid accumulation in the pericholecystic, perihepatic, right subphrenic, and right paracolic spaces. In view of the possibility of spontaneous GBP developing as a complication of acute acalculous cholecystitis, laparotomy was planned. At surgery, several liters of bile-stained peritoneal fluid were aspirated and inspection of the gall bladder revealed a perforation at the fundus. After cholecystectomy, the patient had an uneventful recovery. The diagnosis of spontaneous gall bladder perforation should be considered in elderly patients presenting to the ED with symptoms and signs of peritonitis even in the absence of pre-existing gall bladder disease. Abdominal CT scan is an invaluable tool for the diagnosis, and early surgical intervention is usually life-saving. Copyright © 2012 Elsevier Inc. All rights reserved.

  2. Posttraumatic Haematuria with Pseudorenal Failure: A Diagnostic Lead for Intraperitoneal Bladder Rupture

    PubMed Central

    Vagholkar, Suvarna

    2016-01-01

    Bladder rupture is a very morbid injury following blunt or penetrating lower abdominal trauma. Prompt diagnosis is crucial to initiate optimal treatment. Intraperitoneal bladder rupture is associated with haematuria and biochemical features of renal failure. Cystogram is diagnostic. Immediate open surgical repair is the main stay of treatment. A case of intraperitoneal rupture diagnosed preoperatively by the presence of haematuria and pseudorenal failure is presented to highlight the association of posttraumatic haematuria and pseudorenal failure in such injuries. PMID:27547477

  3. Intra-peritoneal duodenal perforation caused by delayed migration of endobiliary stent: a case report.

    PubMed

    Bharathi, Ramanathan Saranga; Rao, Pankaj P; Ghosh, Kunal

    2008-12-01

    Endoscopic biliary stenting is an accepted modality of palliation of malignant biliary obstructions. Delayed stent migration causing intra-peritoneal perforation of duodenum, is a rare life threatening complication. Proximal adhesion of stent to the tumor is believed to increase the intensity of distal trauma produced by the intra-duodenal segment, preventing its adaptation to intestinal peristalsis and causing perforation. Low bacterial load and containment of leak by gut and omentum blunts the clinical features. Unexplained abdominal discomfort in stented patients should alert the clinician to its possibility, irrespective of the delay between stent placement and onset of symptoms. Early diagnosis and treatment is desirable but aggressive surgical management with gastro-biliary diversion, tube duodenostomy, antibiotics, bowel rest and parenteral alimentation followed by distal alimentation, may make up for the delay in those presenting late. A case of 7 days old intra-peritoneal duodenal perforation following delayed migration (3 months) of endobiliary stent presenting with atypical features is reported. Stent's distal end was protruding through the duodenum with its proximal end in CBD. Mortality, fistulization, abscesses and sepsis are known complications but were not observed in our case. Much of the management can be done minimally invasively, if recognized early.

  4. Perineal Bull Gore with Urinary Bladder Perforation and Pneumoperitoneum

    PubMed Central

    R, Santhosh; Barad, Arun Kumar; Ghalige, Hemanth Sureshwara; K, Sridartha; Sharma M, Birkumar

    2013-01-01

    Animal related injuries are frequently reported in India and other countries, where bulls are used for sporting events as well as in places where farming and livestock rearing is practised. The presentation is, many times, atypical and misleading as well. They have unique mechanics of injury. The patterns of the injury are reviewed. An intra-peritoneal urinary bladder injury which is caused by a perineal bull gore with a pneumoperitoneum is unusual and it has not been reported in the literature which was reviewed. We are reporting a successfully treated 25 years old male patient from the slopes of the southern district of Manipur, India, who had presented 40 hours after he was injured. The identification and prompt exploration, keeping in mind the mechanics of bull goring, helps the surgeons to adequately deal such atypical injuries, for optimal outcomes. PMID:23814738

  5. Rare cause of acute surgical abdomen with free intraperitoneal air: Spontaneous perforated pyometra. A report of 2 cases

    PubMed Central

    Lim, Siew Fung; Lee, Song Liang; Chiow, Adrian Kah Heng; Foo, Chek Siang; Wong, Andrew Siang Yih; Tan, Su-Ming

    2012-01-01

    Summary Background: The acute abdomen accounts for up to 40% of all emergency surgical hospital admissions and a large proportion are secondary to gastrointestinal perforation. Studies have shown the superiority of the abdominal CT over upright chest radiographs in demonstrating free intraperitoneal air. Spontaneous perforated pyometra is a rare cause of the surgical acute abdomen with free intraperitoneal air. Only 38 cases have been reported worldwide. Case Report: We report 2 cases of spontaneously perforated pyometra in our hospital’s general surgery department. Both underwent exploratory laparotomy: one had a total hysterectomy and bilateral salpingo-oophorectomy, while the other had an evacuation of the uterine cavity, primary repair of uterine perforation and a peritoneal washout. A literature search was conducted and all reported cases reviewed in order to describe the clinical presentations and management of the condition. Of the 40 cases to date, including 2 of our cases, the most common presenting symptoms were abdominal pain (97.5%), fever (37.5%) and vomiting (25.0%). The main indication for exploratory laparotomy was pneumoperitoneum (97.5%). Conclusions: Pyometra is an unusual but serious condition in elderly women presenting with an acute abdomen. A high index of suspicion is needed to make the appropriate diagnosis. PMID:23569488

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

    PubMed

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

    2010-07-01

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

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

    PubMed

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

    2014-01-01

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

  8. Management of gall bladder perforation evaluation on ultrasonography: report of six rare cases with review of literature.

    PubMed

    Singal, Rikki; Mittal, Amit; Gupta, Samita; Singh, Bir; Jain, Parul

    2011-11-14

    Perforation of the gall bladder with cholecystohepatic communication is a rare cause of liver abscess. We are reporting here six rare cases of gall bladder perforation with variable clinical presentations. Most patients presented with right hypochondrium pain and fever but two patients presented with only pain in the abdomen. Ultrasonography (USG) and Computed Tomography (CT) were used for diagnosis. The patients were also successfully treated. There was a gall bladder perforation with cholecystohepatic communication, leading to liver abscess formation in most cases on USG and CT. The final diagnosis was confirmed on surgery. The perforation of the gall bladder which leads to liver abscess is a rare complication of acute, chronic or empyema gall bladder. USG and CT scans are the most important diagnostic tool in diagnosing this rare complication. In the set up, where advanced options are not available, the only treatment of choice is the conservative one or surgery, according to the status of the patients.

  9. Long-term complications following bladder augmentations in patients with spina bifida: bladder calculi, perforation of the augmented bladder and upper tract deterioration

    PubMed Central

    2016-01-01

    Background We desire to review our experience with bladder augmentation in spina bifida patients followed in a transitional and adult urologic practice. This paper will specifically focus on three major complications: bladder calculi, the most frequent complication found following bladder augmentation, perforation of the augmentation, its most lethal complication and finally we will address loss of renal function as a direct result of our surgical reconstructive procedures. Methods We reviewed a prospective data base maintained on patients with spina bifida followed in our transitional and adult urology clinic from 1986 to date. Specific attention was given to patients who had developed bladder calculi, sustained a spontaneous perforation of the augmented bladder or had developed new onset of renal scarring or renal insufficiency (≥ stage 3 renal failure) during prolonged follow-up. Results The development of renal stones (P<0.05) and symptomatic urinary tract infections (P<0.0001) were found to be significantly reduced by the use of high volume (≥240 mL) daily bladder wash outs. Individuals who still developed bladder calculi recalcitrant to high volume wash outs were not benefited by the correction of underlying metabolic abnormalities or mucolytic agents. Spontaneous bladder perforations in the adult patient population with spina bifida were found to be directly correlated to substance abuse and noncompliance with intermittent catheterization, P<0.005. Deterioration of the upper tracts as defined by the new onset of renal scars occurred in 40% (32/80) of the patients managed by a ileocystoplasty and simultaneous bladder neck outlet procedure during a median follow-up interval 14 years (range, 8–45 years). Development of ≥ stage 3 chronic renal failure occurred within 38% (12/32) of the patients with scarring i.e., 15% (12/80) of the total patient population. Prior to the development of the renal scarring, 69% (22/32) of the patients had been noncompliant

  10. Patient with perforation caused by emphysematous cholecystitis who showed flare on the skin of the right dorsal lumbar region and intraperitoneal free gas.

    PubMed

    Kanehiro, Tetsuya; Tsumura, Hiroaki; Ichikawa, Toru; Hino, Yuji; Murakami, Yoshiaki; Sueda, Taijiro

    2008-01-01

    We report an 84-year-old man with perforation caused by emphysematous cholecystitis who showed flare on the skin of the right dorsal lumbar region and intraperitoneal free gas. The patient was admitted for abdominal pain, abdominal swelling, and consciousness disorder 18 days after the onset. Abdominal computed tomography (CT) revealed emphysema in the gallbladder and a small amount of intraperitoneal free gas. Intraoperative findings suggested gangrenous cholecystitis. The gallbladder wall was perforated, and an abscess involving the right subphrenic region, the periphery of the liver and gallbladder, and the right paracolonic groove, was detected. The flare on the body surface may have reflected abscess formation in the right abdominal cavity. Emphysematous cholecystitis induces necrosis and perforation in many patients, and immediate strategies such as emergency surgery are important.

  11. Fish bone migration to the urinary bladder after rectosigmoid colon perforation.

    PubMed

    Cho, Min-Kyung; Lee, Moon-Soo; Han, Hyun-Young; Woo, Seung Hyo

    2014-06-14

    Fish bones are the most common foreign objects leading to bowel perforation. Most cases are confined to the extraluminal space without penetration of an adjacent organ. However, abscess formation due to the perforation of the rectosigmoid colon by a fish bone can lead to the penetration of the urinary bladder and may subsequently cause the fish bone to migrate into the urinary bladder. In the presented case, a 42-year-old female was admitted for lower abdominal pain. The computed tomography (CT) demonstrated a 5 cm pelvic abscess containing a thin and curvilinear foreign body. After conservative management, the patient was discharged. After 1 mo, the subject developed a mechanical ileus. Surgery had to be delayed due to her hyperthyroidism. Migration of the foreign body to the urinary bladder was shown on additional CT. A Yellowish fish bone 3.5 cm in size was removed through intra-operative cystoscopy. The patient was discharged 8 d after the operation without any unexpected event.

  12. Unusual presentation of direct intraperitoneal metastases complicated with massive ascites from plasmacytoid variant of bladder cancer and adenocarcinoma of colon

    PubMed Central

    Shao, Yu-Hua; Kao, Chien-Chang; Tang, Shou-Hung; Cha, Tai-Lung; Tsao, Chih-Wei; Meng, En; Yu, Dah-Shyong; Sun, Guang-Huan; Wu, Sheng-Tang

    2017-01-01

    Abstract Background: Plasmacytoid urothelial carcinoma (PUC) is a distinct variant of urinary bladder cancer, with a high propensity for invasion and poor prognosis. These tumors occur most commonly in male patients with the age of reported cases ranging from 46 to 87 years. Case report: We present a case of a 74-year-old male patient having massive ascites and bilateral lower leg edema. Colonoscopy showed a 3-cm lesion in the sigmoid colon and an edematous nonpapillary tumor was found by cystoscopy in the bladder. Histopathology analysis of the biopsies showed adenocarcinoma of colon and PUC of bladder. The diagnosis of PUC with peritoneal carcinomatosis was then confirmed by immunohistochemical stain. Conclusion: The diagnostic dilemmas of the unusual variant of urothelial malignancy, the origin of peritoneal metastasis, and its clinical impact are discussed in the present case. PMID:28207504

  13. Comparative Evaluation of Ultrasonography and Cross-sectional Imaging in Determining Gall Bladder Perforation in Accordance to Niemeier’s Classification

    PubMed Central

    Sanyal, Shantiranjan; Sharma, Barun Kumar; Boruah, D.R.

    2016-01-01

    Introduction Gall Bladder (GB) perforation, a rare but dreaded complication of acute cholecystitis and is associated with high mortality rate. Early detection of acute cases of GB perforation reduces the risk of biliary peritonitis and hence the associated mortality and morbidity. Aim The purpose of the study was to make a comparative evaluation of the role of Cross-sectional imaging in GB perforation with base line investigation like sonography. Finally both modalities were compared in determining the type of perforation according to Niemeier’s classification. Materials and Methods We retrospectively evaluated the Ultrasonography (USG), Computed Tomography (CT) and Magnetic Resonance Imagings (MRI) findings in patients of GB perforation with surgical correlation. Results We evaluated 17 patients of GB perforations over a time period of one year. USG was done in all patients. As cross-sectional modality only CT scan was done in 14 patients and MRI scan was done in four patients. Both CT and MRI scans were done in one patient. Conclusion Cross-sectional imaging must not be delayed in suspected cases of GB perforations because it helps in establishing a quicker diagnosis, detecting complications and also helps in decision making related to management thereby reducing the morbidity and mortality associated with this condition. PMID:27656526

  14. Laparoscopic reconstruction of an iatrogenic perforation of the neovagina and urinary bladder by a neovaginal dilator in a patient with Mayer-Rokitansky-Küster-Hauser syndrome.

    PubMed

    Khoder, Wael Y; Stief, Christian G; Burgmann, Maximiliane; Burges, Alexander

    2015-07-01

    Mayer-Rokitansky-Küster-Hauser syndrome (MRKH) is a rare genital aplasia syndrome. Patients with MRKH regularly dilate their neovagina with vaginal dilatators. A 23-year-old MRKH syndrome patient came to our department complaining of a lost vaginal dilator, which she had inserted 2 days previously. She had no bleeding or abdominal pain, but did have occasional urine loss. She had a history of abdominal exploration for an acute abdomen and the creation of a neovagina at the age of 16. An abdominal CT scan located the dislocated dilator intravesically. After diagnostic laparoscopy, the dilator was removed through the vesico-neovaginal perforation. The vagina was closed and covered by a pedicled peritoneal flap, followed by closure of the urinary bladder. An omental J-flap was then fixed between the vagina and bladder. The operative time was 185 min, with no significant blood loss, injuries or need for conversion/revision. The indwelling catheter was removed 7 days later after cystography, followed by normal micturition and an adequate bladder capacity. Vaginal dilation and sexual activity was resumed 1 month postoperatively. Follow-up was uneventful. Laparoscopic vaginal dilator removal with immediate repair of the perforation of the neovagina and the urinary bladder directly after an acute trauma in a patient with MRKH syndrome may be a management option. It is a feasible, safe and viable operation in the hands of experienced laparoscopists.

  15. Rare Presentation of Gall Bladder Tuberculosis in a Non Immuno-Compromised Patient.

    PubMed

    Kumar, Pawan; Hazrah, Priya; Taneja, Anil; Ahuja, Arvind; Sharma, Deborshi

    2015-04-24

    The gall bladder is least common intra-abdominal organ to be involved by tuberculosis. It is either part of systemic miliary tuberculosis or abdominal tuberculosis. Isolated gall bladder tuberculosis is even rarer, can presents either as calculus or acalculus cholecystitis. Gall bladder tuberculosis presenting as a localized perforation with a sinus formation into anterior abdominal wall is unreported complication in a non immuno-compromised person. A 48-year old female presented with a gradually increasing swelling in right hypochondrium. Abdominal ultrasound showed superficial collection over right hypochondrium with intraperitoneal extension. Computed tomography showed localized gall bladder perforation with extension to the abdominal wall. Patient underwent emergency exploration and cholecystectomy with excision of sinus tract and drainage of abdominal wall abscess. Histopathological examination showed granulomatous cholecystitis suggestive of tuberculosis of gall bladder with extension into the sinus tract. She had an uneventful recovery and was treated with 6-month antitubercular therapy after surgery.

  16. Occult bladder injury after laparoscopic appendicectomy.

    PubMed

    Lad, Meher; Duncan, Sarah; Patten, Darren K

    2013-11-22

    Minimally invasive procedures have revolutionised surgery by reducing pain and the length of hospital stay for patients. These are not simple procedures and training in laparoscopic surgery is an arduous process. Meticulous preparation prior to surgery is paramount to prevent complications. We report a rare complication involving a 35-year-old patient who underwent a laparoscopic appendicectomy for a perforated appendix. Two days after surgery the patient experienced redness and swelling in the lower abdominal region and oliguria. A delayed computer tomography (CT) scan revealed contrast leakage around the bladder spreading within the peritoneal cavity consistent with an intraperitoneal bladder perforation. She underwent urinary catheterisation for 6 days. A follow-up CT cystogram showed no evidence of leakage into the peritoneal cavity. This case highlights the need for thorough preparation prior to laparoscopic surgery and careful manipulation of instruments during routine procedures to minimise the risk of serious patient complications such as the aforementioned.

  17. Gastrointestinal perforation

    MedlinePlus

    Intestinal perforation; Perforation of the intestines; Gastric perforation; Esophageal perforation ... Perforation of the intestine or other organs causes the contents to leak into the abdomen. This causes a severe infection called peritonitis . Symptoms ...

  18. [Treatment of large postoperative hernias using intraperitoneal meshes].

    PubMed

    Trojanowski, Piotr; Witczak, Witold; Najdecki, Marek; Stanowski, Edward

    2007-05-01

    Most common hernias among men and women are inguinal hernias (75-80%) and postoperative (incisional) hernias (8-10%). Management of large incisional hernias (hernia gate bigger than 10 cm) both primary and recurrent could be an encounter for a surgeon. In surgical repair of large hernia use of synthetic materials (mesh) is being prefered. Using mesh can significantly decrease recurrence rate (<10%), compare to operations without synthetic grafts where risk of recurrence can reach 50%. One of the methods of surgical treatment of large abdominal hernias is intraperitoneal placing of implants. For such purpose complex meshes (multi-layered) should be used to prevent adhesion of the mesh to the intestines and avoid dangerous complications such as migration of the mesh through the tissues, perforation of the urine bladder, small and large intestine, forming fistulas and blocking intestines. Presentation of own experience in dealing with patients with large postoperative abdominal hernias using composite meshes: Bard--Composix Mesh, Parietex--Composite Sofradim and Proceed Ethicon. Since 2003 to 2006 were performed 7 surgical repairs of large abdominal hernia via an open aproach. 3 male, 4 female, average age 47 years old. Every hernia gate was wider than 15 cm. Bard mesh was used three times, Sofradim and Ethicon two times. Mesh was implanted without tension with single sutures and overlap of more than 5 cm from the edge of the hernia gate. Mesh was separated from intestines with greater momentum if it was possible. Anticoagulant and antibiotic preventive therapies were applied as a rule. Average time of operation was 140 minutes; average time of postoperative hospitalization was 8 days. Only one case was complicated with seroma which was treated with transcutaneous punctures with good result. (1) Surgical treatment of large abdominal hernia using composite mesh (intraperitoneal). in selected cases has good results. (2) The limiting factor of using presented method is

  19. Esophageal perforation

    MedlinePlus

    ... or caustic chemicals, such as household cleaners, disk batteries, and battery acid Trauma or injury to the chest and ... surgery. Surgery will depend on the location and size of the perforation. If surgery is needed, it ...

  20. [Esophageal perforations].

    PubMed

    Manso, L C; Milheiro, A; Castro e Sousa, F

    1994-04-01

    The opportunity of having successfully treated a patient with intrathoracic perforation of the Oesophagus and many surgical complications, led us to review the literature on the subject. We then discussed the advantages and disadvantages of the various technical options, concluding that immediate Oesophagectomy is the best solution for this type of perforation, with several hours of evolution and serious mediastinite, to reduce surgical complications and mortality.

  1. Spontaneous pneumoperitoneum and other nonsurgical causes of intraperitoneal free gas.

    PubMed Central

    Williams, N. M.; Watkin, D. F.

    1997-01-01

    Intraperitoneal free gas seen radiologically as air under the diaphragm nearly always indicates a perforated abdominal viscus that requires surgical intervention. Rarely, however, the presence of a pneumoperitoneum may not indicate an intra-abdominal perforation and thus may not require laparotomy. Such a situation is termed spontaneous or nonsurgical pneumoperitoneum. In this review, we explore the aetiological mechanisms and the pathophysiology of the appearance of intra-abdominal free gas. An appreciation of the condition and its likely aetiological factors should improve awareness and possibly reduce the imperative to perform an emergency laparotomy on an otherwise well patient with an unexplained pneumoperitoneum. Images Figure 1 Figure 2 PMID:9373590

  2. Stercolith perforation.

    PubMed

    Yasin, Malik M Amjad; Nasreen, Ghazala; Rathore, Farooq Azam; Malik, Sikandar Ali

    2012-07-01

    A 62-year-old diabetic bed ridden woman, presented to the emergency department with symptoms suggestive of peritonitis. She had been taking oral laxatives and enemas to relieve her chronic constipation for last 6 years. Hard impacted stools and pelvic tenderness were found on digital rectal examination. Her X-ray abdomen showed soft tissue shadows in the colon but there was no gas under the diaphragm on chest X-ray. Sonography found free fluid in pelvis. She was resuscitated, and her hyperglycemia was controlled by use of regular insulin as per sliding scale. Operative findings revealed free fluid in pelvis and very hard faecalomas lying free in peritoneal cavity. There was a 2 x 3 cm perforation at the anterior wall of the recto-sigmoid junction. Peritoneal toilet was carried out followed by Hartmann's procedure. Histopathology of perforation side showed no evidence of malignancy.

  3. Perforated monolayers

    SciTech Connect

    Regen, S.L.

    1992-01-01

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

  4. Systemic Toxicity of Intraperitoneal Vancomycin

    PubMed Central

    Kumar, Teerath; Teo, Iris

    2016-01-01

    Intraperitoneal vancomycin is used for empiric treatment of peritoneal dialysis peritonitis. It is dosed intermittently and a high systemic concentration is often achieved. Despite this, there are very few reports of systemic toxicity from intraperitoneal vancomycin. We report the course of a patient who developed a drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome after three weeks of intraperitoneal vancomycin. We review the literature and conclude that this is the first ever reported case of DRESS syndrome from intraperitoneal vancomycin. PMID:27840751

  5. Bladder Health

    MedlinePlus

    ... organ, much like a balloon, that stores urine. Pelvic floor muscles help hold urine in the bladder. The ... the bathroom more often. The bladder wall and pelvic floor muscles may weaken. Weak bladder wall muscles may ...

  6. Bladder Management

    MedlinePlus

    ... Catheterization • Urinary Tract Infections: Indwelling (Foley) Catheter Bladder Management [ Download this pamphlet: "Bladder Management" - (PDF, 499KB) ] The ... and medication or surgery may be helpful. Bladder Management Foley or Suprapubic Catheter A tube is inserted ...

  7. Bladder cancer

    MedlinePlus

    Transitional cell carcinoma of the bladder; Urothelial cancer ... In the United States, bladder cancer often starts from the cells lining the bladder. These cells are called transitional cells. These tumors are classified by the way ...

  8. Bladder Cancer

    MedlinePlus

    ... schistosomiasis) is a common cause of bladder infections. Adenocarcinoma. Adenocarcinoma begins in cells that make up mucus-secreting glands in the bladder. Adenocarcinoma of the bladder is rare in the United ...

  9. Bladder biopsy

    MedlinePlus

    Biopsy - bladder ... A bladder biopsy can be done as part of a cystoscopy . Cystoscopy is a telescopic examination of the inside of the ... informed consent form before you have a bladder biopsy. In most cases, you are asked to urinate ...

  10. Bladder Diseases

    MedlinePlus

    ... frequent, urgent urination Bladder cancer Doctors diagnose bladder diseases using different tests. These include urine tests, x- ... National Institute of Diabetes and Digestive and Kidney Diseases

  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. 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

  13. Icodextrin and intraperitoneal inflammation.

    PubMed

    Moriishi, Misaki; Kawanishi, Hideki

    2008-06-01

    The peritoneum is impaired by exposure to biocompatible dialysis solutions. Because icodextrin peritoneal dialysis fluid (PDF) is made from cornstarch, a possibility that it induces intraperitoneal inflammation has been reported. In the present study, patients on glucose PDF were switched to icodextrin PDF and then switched back to glucose PDF. Icodextrin PDF-induced intraperitoneal inflammation was investigated based on changes in peritoneal permeability and inflammatory reactions. The subjects were 7 stable peritoneal dialysis patients (4 men, 3 women), with a mean age of 59.1 +/- 3.8 years (range: 55.2 - 64.6 years). The mean duration of peritoneal dialysis was 58.3 +/- 27.4 months (range: 34.3 - 97.7 months), and the cause of end-stage renal disease was chronic glomerulonephritis in all patients. For the overnight dwell, glucose PDF was changed to icodextrin PDF, and the patients returned to glucose PDF 30 months later. To evaluate peritoneal permeability, a peritoneal equilibrium test (PET) was performed, and dialysate-to-plasma (D/P) ratios of creatinine (Cr), beta(2)-microglobulin (beta2M), albumin, immunoglobulin G (IgG), and alpha(2)-macroglobulin (alpha2M) were measured in the overnight dialysate and serum. As markers of inflammation and fibrinolysis or coagulation, interleukin-6 (IL-6) and fibrinogen degradation products (FDPs) were measured in overnight effluent. The evaluations were made every 6 months for 36 months. A significant elevation in FDP levels was detected in overnight effluent 6 months after the switch to icodextrin PDF, and IL-6 levels tended to increase. The D/P ratios of Cr, beta2M, and albumin were also significantly increased, and the D/P ratios of IgG and alpha2M tended to increase. The D/P ratio of Cr as measured by PET was slightly increased, but the elevation was not significant. In 5 patients, after icodextrin PDF was switched back to glucose PDF at 30 months, the D/P ratios of Cr, beta2M, albumin, IgG, and alpha2M in overnight

  14. Intraperitoneal therapy for peritoneal cancer

    PubMed Central

    Lu, Ze; Wang, Jie; Wientjes, M Guillaume; Au, Jessie L-S

    2011-01-01

    Cancers originating from organs in the peritoneal cavity (e.g., ovarian, pancreatic, colorectal, gastric and liver) account for approximately 250,000 new cancer cases annually in the USA. Peritoneal metastases are common owing to locoregional spread and distant metastases of extraperitoneal cancers. A logical treatment is intraperitoneal therapy, as multiple studies have shown significant targeting advantage for this treatment, including significant survival benefits in stage III, surgically debulked ovarian cancer patients. However, the clinical use of intraperitoneal therapy has been limited, in part, by toxicity, owing to the use of indwelling catheters or high drug exposure, by inadequate drug penetration into bulky tumors (>1 cm) and by the lack of products specifically designed and approved for intraperitoneal treatments. This article provides an overview on the background of peritoneal metastasis, clinical research on intraperitoneal therapy, the pharmacokinetic basis of drug delivery in intraperitoneal therapy and our development of drug-loaded tumor-penetrating microparticles. PMID:21062160

  15. Prevention of ventriculoperitoneal shunt complications after intraperitoneal urological surgeries.

    PubMed

    Ikeda, Takashi; Akiyama, Sayaka; Kim, Woo Jin; Ito, Susumu; Yamazaki, Yuichiro

    2017-07-01

    To evaluate perioperative management for the prevention of postoperative shunt infection and malfunction after intraperitoneal urological surgery in patients with myelodysplasia and a ventriculoperitoneal shunt. From 2005 to 2015, 20 consecutive patients with myelodysplasia and a ventriculoperitoneal shunt who underwent intraperitoneal urological surgeries were managed with the same perioperative regimen. Intraperitoneal surgeries involved opening gastrointestinal tracts, including bladder augmentation by enterocystoplasty, creating continent catheterizable channels and Malone antegrade continent enema. We compared results with those from seven previous reports regarding postoperative shunt complications, surgical histories of previous shunt revisions, management of bacteriuria before surgery preoperative bowel preparation, antibiotic regimens, and duration of indwelling drain. Of 20 patients, 18 received prior shunt revisions, and 14 had positive urine culture before surgery that was managed with oral antibiotics. Thirteen patients underwent bladder augmentation with ileum, and one underwent augmentation with sigmoid colon. Nineteen patients underwent Malone antegrade continent enema using the appendix. All parenteral antibiotics were stopped on postoperative day 2.5. Mean duration of indwelling peritoneal drain was 2.7days. Mean follow-up period was 59.8months. Neither postoperative shunt infections nor intraperitoneal shunt malfunctions were recognized during follow-up period. This is the first study to evaluate postoperative ventriculoperitoneal shunt complications in patients with myelodysplasia who underwent intraperitoneal urological surgeries with a specific perioperative regimen. Shunt complications are greatly reduced by rigorous perioperative management, including preoperative control of bacteriuria, appropriate administration of prophylactic antibiotics, and early removal of intraperitoneal drains. The type of study: Case series with no comparison group

  16. Bladder tear during revision total hip arthroplasty.

    PubMed

    Grauer, Jonathan N; Halim, Andrea; Keggi, Kristaps J

    2014-08-01

    Total hip arthroplasty (THA) and revision total hip arthroplasty are among the most commonly performed orthopedic procedures. There are many reported complications of THA, but intrapelvic complications are a rare subset. Bladder injuries have infrequently been described in association with this common procedure. We present an unusual case of a bladder tear occurring intraoperatively during a revision THA. It is suspected that the patient's history of multiple prior hip procedures caused adhesions of the bladder to the pelvic floor and predisposed the bladder to injury during acetabular revision. Previous reports of bladder injury relating to THA have described thermal necrosis, component migration, and occasional direct perforation. There are no prior case reports describing bladder tears related to adhesions occurring intraoperatively during revision THA. This case report highlights the importance of surgeon awareness of an unusual complication. In this case, intraoperative and postoperative recognition of a hematuria diagnosis led to the appropriate treatment, and this patient had an acceptable outcome.

  17. Bladder Stones

    MedlinePlus

    ... the urine. The elements in urine can form crystals. These harden to create bladder stones. Bladder stones ... away from diets high in fat, salt, and sugar.Avoid smoking and illegal drugs. Your kidneys can ...

  18. 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.

  19. Bladder cancer.

    PubMed Central

    Leung, H. Y.; Griffiths, T. R.; Neal, D. E.

    1996-01-01

    Bladder cancer is the fourth most common cancer in England and Wales. The most common presenting symptom is macroscopic haematuria. The management options for superficial and invasive bladder cancer depend on the stage at presentation. Most superficial bladder cancers are managed by transurethral resection and cytoscopic follow-up. The prognosis for patients with invasive bladder cancer is less good. The role of chemical, radiotherapeutic and surgical intervention are discussed. PMID:9015464

  20. Spontaneous perforation of choledochal cyst: a case with unusual distribution of fluid in the retroperitoneal space.

    PubMed

    Tani, Chihiro; Nosaka, Shunsuke; Masaki, Hidekazu; Kuroda, Tatsuo; Honna, Toshiroh

    2009-06-01

    Images of perforated choledochal cysts typically show an intraperitoneal fluid collection. We report a case with, in addition to free intraperitoneal fluid, fluid collection in the right-side anterior pararenal and perirenal spaces. Surgery confirmed the presence of a perforation at the junction of the cystic duct and the common bile duct. This perforation may explain the biliary leakage extending into the free peritoneal space as well as into the anterior pararenal space and the hepatoduodenal ligament. Anterior pararenal and perirenal spaces communicate with the infrarenal space, and this may result in extension of the fluid into the perirenal space from the anterior pararenal space.

  1. Bladder injury secondary to obturator reflex is more common with plasmakinetic transurethral resection than monopolar transurethral resection of bladder cancer

    PubMed Central

    Ozer, Kutan; Gorgel, Sacit Nuri; Ozbek, Emin

    2015-01-01

    Introduction Transurethral resection (TUR) is the most common surgical technique for the diagnosis and initial treatment of bladder cancer. In this study, we evaluated two surgical techniques in terms of bladder injury due to obturator reflex in patients that underwent TUR for non-muscle invasive bladder cancer (NMIBC). Material and methods 93 patients who underwent TUR for bladder cancer were analyzed. Fifty patients underwent monopolar resection and 43 patients underwent plasmakinetic resection. Standard TUR were performed with conventional Storz monopolar resection using a U-shaped cutting loop, 120V cutting/80 V coagulation settings, 5% mannitol fluid was used for irrigation. For bipolar resection, an Olympus ESG-400 plasmakinetic loop bipolar device using a U-shaped cutting loop, 160V cutting/80V coagulation settings and normal saline for irrigation was used. Results In the monopolar resection group; obturator reflex was seen in 4 (8%) patients. Bladder perforation caused by the obturator reflex was seen in 4 (8%) patients, but hemorrhage and other major complications were not seen in this group. In the bipolar resection group; obturator reflex was seen in 15 (34%) patients. Bladder perforation caused by the obturator reflex was seen in 10 (23%) patients. Conclusions Bipolar transurethral resection of bladder tumor was not superior to monopolar resection with respect to obturator reflex and bladder perforation. We conclude that we do not yet have enough experience concerning the long-term complications and major complications associated with bipolar resection of bladder cancer. PMID:26568867

  2. Neurogenic Bladder

    PubMed Central

    Dorsher, Peter T.; McIntosh, Peter M.

    2012-01-01

    Congenital anomalies such as meningomyelocele and diseases/damage of the central, peripheral, or autonomic nervous systems may produce neurogenic bladder dysfunction, which untreated can result in progressive renal damage, adverse physical effects including decubiti and urinary tract infections, and psychological and social sequelae related to urinary incontinence. A comprehensive bladder-retraining program that incorporates appropriate education, training, medication, and surgical interventions can mitigate the adverse consequences of neurogenic bladder dysfunction and improve both quantity and quality of life. The goals of bladder retraining for neurogenic bladder dysfunction are prevention of urinary incontinence, urinary tract infections, detrusor overdistension, and progressive upper urinary tract damage due to chronic, excessive detrusor pressures. Understanding the physiology and pathophysiology of micturition is essential to select appropriate pharmacologic and surgical interventions to achieve these goals. Future perspectives on potential pharmacological, surgical, and regenerative medicine options for treating neurogenic bladder dysfunction are also presented. PMID:22400020

  3. Uterine perforation by intrauterine devices: a 16-year review.

    PubMed

    O'Brien, Paul A; Pillai, Sarah

    2017-07-24

    One of the major concerns with the insertion of intrauterine devices is uterine perforation. Though uncommon, it can be debilitating and result in failure of the device. In this article we review uterine perforation with intrauterine contraception (IUC) in a community clinic in the UK over a 16-year period. We prospectively collected data on uterine perforations for the years 2000-2015, reviewed associated factors and calculated the annual rate of perforation, estimating if this lay within the expected range of normal variation using statistical process control (SPC) analysis. We analysed the rates of perforation in relation to the time from delivery and to breastfeeding. We identified 30 uterine perforations in 22 795 IUC insertions over the 16 years of observation, with an annual rate ranging from 0 to 4.3 per 1000 insertions, and a mean annual rate of 1.3 per 1000 insertions (95% CI 0.9 to 1.9), which remain within the SPC limits. Twenty-eight of the perforations were in parous women, 87% of whom were within 18 weeks of delivery, peaking at 13 weeks postpartum. Twenty of these were in breastfeeding women. In 3/28 cases for which we have outcome data the device was adherent to or had perforated either the bladder or bowel. Our perforation rate is consistent with other studies. Most of our perforations were within 18 weeks of childbirth, earlier than in a recent major study. We cannot tell from our data if there is a true peak in perforations 3 months postpartum as that may be a time when a high proportion of insertions are done. © Faculty of Sexual and Reproductive Healthcare of the Royal College of Obstetricians and Gynaecologists (unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  4. Bladder Monitor

    NASA Technical Reports Server (NTRS)

    1993-01-01

    Diagnostic Ultrasound Corporation's Bladder Scan Monitor continuously records and monitors bladder fullness and alerts the wearer or caretaker when voiding is required. The sensor is held against the lower abdomen by a belt and connected to the monitor by a cable. The sensor obtains bladder volume data from sound waves reflecting off the bladder wall. The device was developed by Langley Research Center, the Ames Research Center and the NASA Technology Applications Team. It utilizes Langley's advanced ultrasound technology. It is licensed to the ARC for medical applications, and sublicensed to Diagnostics Ultrasound. Central monitoring systems are planned for the future.

  5. Nontraumatic terminal ileal perforation

    PubMed Central

    Wani, Rauf A; Parray, Fazl Q; Bhat, Nadeem A; Wani, Mehmood A; Bhat, Tasaduq H; Farzana, Fowzia

    2006-01-01

    Background There is still confusion and controversy over the diagnosis and optimal surgical treatment of non traumatic terminal ileal perforation-a cause of obscure peritonitis. Methods This study was a prospective study aimed at evaluating the clinical profile, etiology and optimal surgical management of patients with nontraumatic terminal ileal perforation. Results There were 79 cases of nontraumatic terminal ileal perforation; the causes for perforation were enteric fever(62%), nonspecific inflammation(26%), obstruction(6%), tuberculosis(4%) and radiation enteritis (1%). Simple closure of the perforation (49%) and end to side ileotransverse anastomosis(42%) were the mainstay of the surgical management. Conclusion Terminal ileal perforation should be suspected in all cases of peritonitis especially in developing countries and surgical treatment should be optimized taking various accounts like etiology, delay in surgery and operative findings into consideration to reduce the incidence of deadly complications like fecal fistula. PMID:16759405

  6. Management of endodontic perforations.

    PubMed

    Martin, L R; Gilbert, B; Dickerson, A W

    1982-12-01

    1. Perforations in the floor of the pulp chambers of molars offer an improved prognosis when treated aseptically and quickly. 2. Perforations in the apical third of the root canal, when made with a reamer or file that leaves 2 mm. or less of unfilled root canal space, have a good prognosis. 3. If a perforation, either mechanical or resorptive in etiology, occurs on the lingual surface and requires surgical management, prognosis is poor. 4. Recent advances in the use of calcium hydroxide to treat endodontic perforations show promise.

  7. Acute phlegmonous gastritis complicated by delayed perforation.

    PubMed

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

    2014-03-28

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

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

    PubMed

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

    2010-06-01

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

  9. Bladder cancer.

    PubMed

    Sanli, Oner; Dobruch, Jakub; Knowles, Margaret A; Burger, Maximilian; Alemozaffar, Mehrdad; Nielsen, Matthew E; Lotan, Yair

    2017-04-13

    Bladder cancer is a highly prevalent disease and is associated with substantial morbidity, mortality and cost. Environmental or occupational exposures to carcinogens, especially tobacco, are the main risk factors for bladder cancer. Most bladder cancers are diagnosed after patients present with macroscopic haematuria, and cases are confirmed after transurethral resection of bladder tumour (TURBT), which also serves as the first stage of treatment. Bladder cancer develops via two distinct pathways, giving rise to non-muscle-invasive papillary tumours and non-papillary (solid) muscle-invasive tumours. The two subtypes have unique pathological features and different molecular characteristics. Indeed, The Cancer Genome Atlas project identified genetic drivers of muscle-invasive bladder cancer (MIBC) as well as subtypes of MIBC with distinct characteristics and therapeutic responses. For non-muscle-invasive bladder cancer (NMIBC), intravesical therapies (primarily Bacillus Calmette-Guérin (BCG)) with maintenance are the main treatments to prevent recurrence and progression after initial TURBT; additional therapies are needed for those who do not respond to BCG. For localized MIBC, optimizing care and reducing morbidity following cystectomy are important goals. In metastatic disease, advances in our genetic understanding of bladder cancer and in immunotherapy are being translated into new therapies.

  10. Bladder hernia.

    PubMed

    Nicola, Massimiliano; De Luca, Francesco

    2006-06-01

    Bladder hernia is a rare condition, but crural herniation of the bladder into the scrotum is very rare. A case of bladder hernia presenting with urological symptoms is described. A 71-year-old man presented to the urological ward complaining for persistent frequency and nocturia associated with loss offorce and decrease of caliber of the urinary stream and the presence of a large mass of the right scrotum. An IVP (intra venous pyelography) showed a large herniation of the bladder through the right inguinal canal into the scrotum. An inguinal incision was made and a crural hernia was identified. The hernia sac, containing bowel and bladder, was dissectedfreefrom the spermatic cord and the testis and the hernia defect was repaired.

  11. Small bowel and colon perforation.

    PubMed

    Brown, Carlos V R

    2014-04-01

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

  12. Intraperitoneal pressure in peritoneal dialysis.

    PubMed

    Pérez Díaz, Vicente; Sanz Ballesteros, Sandra; Hernández García, Esther; Descalzo Casado, Elena; Herguedas Callejo, Irene; Ferrer Perales, Cristina

    2017-07-21

    The measure of intraperitoneal pressure in peritoneal dialysis is easy and provides clear therapeutic benefits. However it is measured only rarely in adult peritoneal dialysis units. This review aims to disseminate the usefulness of measuring intraperitoneal pressure. This measurement is performed in supine before initiating the drain of a manual exchange with "Y" system, by raising the drain bag and measuring from the mid-axillary line the height of the liquid column that rises from the patient. With typical values of 10-16 cmH2O, intraperitoneal pressure should never exceed 18 cmH2O. With basal values that depend on body mass index, it increases 1-3 cmH2O/L of intraperitoneal volume, and varies with posture and physical activity. Its increase causes discomfort, sleep and breathing disturbances, and has been linked to the occurrence of leaks, hernias, hydrothorax, gastro-esophageal reflux and enteric peritonitis. Less known and valued is its ability to decrease the effectiveness of dialysis significantly counteracting ultrafiltration and decreasing solute clearance to a smaller degree. Because of its easy measurement and potential utility, should be monitored in case of ultrafiltration failure to rule out its eventual contribution in some patients. Although not yet mentioned in the clinical practice guidelines for PD, its clear benefits justify its inclusion among the periodic measurements to consider for prescribing and monitoring peritoneal dialysis. Copyright © 2017 Sociedad Española de Nefrología. Published by Elsevier España, S.L.U. All rights reserved.

  13. 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.

  14. Idiopathic Neonatal Colonic Perforation

    PubMed Central

    Tuncer, Oğuz; Melek, Mehmet; Kaba, Sultan; Bulan, Keziban; Peker, Erdal

    2014-01-01

    Though the perforation of the colon in neonates is rare, it is associated with more than 50% mortality in high-risk patients. We report a case of idiopathic neonatal perforation of the sigmoid colon in an 8-day-old, healthy, male neonate without any demonstrable cause. PMID:26023477

  15. Spontaneous rupture of the gall bladder: an unusual forensic diagnosis.

    PubMed

    Dean, Dorothy E; Jamison, Jennifer M; Lane, Jason L

    2014-07-01

    Peritonitis secondary to spontaneous rupture/perforation of the gall bladder is a rare condition overall and is even less common in the forensic population. We report the case of a middle-aged man who died from generalized peritonitis from gall bladder perforation due to acute acalculous cholecystitis. This condition usually occurs in critical patients with systemic illness, and although the exact pathogenesis remains unclear, the development of acalculous cholecystitis appears to be multifactorial. Antemortem diagnosis is reliant upon clinical presentation, laboratory data, and radiologic studies. Surgery and appropriate antibiotics are mainstays of treatment; however, there is an emerging role for minimally invasive procedures. Histopathologic features show significant overlap with the calculous type. Although increasing numbers of acalculous cholecystitis have been diagnosed in the critically ill, the fatal presentation of a perforated gall bladder following an undiagnosed case of acute acalculous cholecystitis is unusual in a nonhospitalized and ambulatory man. © 2014 American Academy of Forensic Sciences.

  16. Intraperitoneal contrast agents for computed tomography

    SciTech Connect

    Stork, J.

    1985-08-01

    Intraperitoneal contrast agents have been used to diagnose mass lesions, adhesions, and hernias using conventional radiographic techniques. The use of intraperitoneal contrast agents in conjunction with computed tomography (CT) has been limited and is the subject of this report.

  17. Neurogenic bladder

    MedlinePlus

    ... cause skin to break down and lead to pressure sores Kidney damage if the bladder becomes too full, ... dysfunction; NBSD Patient Instructions Multiple sclerosis - discharge Preventing pressure ulcers Images Voiding cystourethrogram References Chapple CR, Osman NI. ...

  18. 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.

  19. 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.

  20. Bladder Cancer Advocacy Network

    MedlinePlus

    ... Grants Bladder Cancer Think Tank Bladder Cancer Research Network Bladder Cancer Genomics Consortium Get Involved Ways to ... RESEARCHERS Research Grants Bladder Cancer Think Tank Research Network Explore all research programs View all stories NEWSLETTER ...

  1. Prepacking perforations improves gravel packs

    SciTech Connect

    Hall, B.E.; Pace, J.R. )

    1990-05-21

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

  2. Complications after bladder augmentation in children.

    PubMed

    Molina, Carlos Augusto Fernandes; Lima, Gilson José de; Cassini, Marcelo Ferreira; Andrade, Murilo Ferreira de; Facincani, Inalda; Tucci Júnior, Silvio

    2016-01-01

    Bladder augmentation is an effective surgical procedure for increasing bladder capacity and reducing pressure on the urinary system. It is indicated for patients with anomalies such as spina bifida, myelomeningocele, urethral valve and bladder exstrophy, who progress with low tolerance of medication. This was a retrospective study conducted on pediatric patients submitted to bladder augmentation from 2000 to 2011. 34 patients aged 4 to 17 years were submitted to bladder augmentation, 30 of them with an ileal loop and 4 with a ureter.A continent urinary shunt was performed in 16 patients, the Mitrofanoff conduit was associated in 15, and the Macedo technique was used in one. Mean follow-up was 34.35 months (1 to 122 months). Mean creatinine was 1.5 ng/ml (0.4 to 7.5 ng/ml) preoperatively and 1.78 ng/ml postoperatively. Three patients required a renal transplant during follow-up. There was improvement or resolution of vesicoureteral reflux in 83.5% of the kidneys on the right and in 75% on the left. Bladder capacity increased, on average, from 152.5 ml to 410 ml. The main complications were vesical lithiasis in 3 patients and conduit perforation in one. Bladder augmentation showed good results in this series, preserving renal function in most of the patients.

  3. Periumbilical perforating pseudoxanthoma elasticum.

    PubMed

    Kumar, Piyush; Savant, Sushil S; Barkat, Rizwana

    2016-11-15

    A 50-year-old woman presented with a 2-year history of a yellowish plaque studded with red brown keratotic papules in the periumbilical region. Histopathological examination from the yellow plaque showed curled and granular elastic fibers in the mid and lower dermis. Histopathological examination from a keratotic papule showed pathological elastic fibers and dense chronic inflammatory cells around areas of perforation. Clinicopathological correlation established periumbilical perforating pseudoxanthoma elasticum as the final diagnosis.

  4. Treatment of stripping perforations.

    PubMed

    Allam, C R

    1996-12-01

    Strippings are problems that are frequent on thin and concave roots. Treatment and prognosis differ from that of a lateral root perforation because of the size, oval shape, and thin edges of the striping. We propose a two-step technique: an endodontic phase in which the root canal system is sealed with gutta-percha overflowing through the stripping perforation and a surgical second step that will allow elimination of this excess.

  5. Overactive Bladder.

    PubMed

    White, Nicola; Iglesia, Cheryl B

    2016-03-01

    Overactive bladder (OAB) is a condition affecting millions of individuals in the United States. Anticholinergics are the mainstay of treatment. Bladder botulinum toxin injections have shown an improvement in symptoms of OAB equivalent to anticholinergic therapy. Percutaneous tibial nerve stimulation can decrease symptoms of urinary frequency and urge incontinence. Sacral neuromodulation for refractory patients has been approved by the Food and Drug Administration for treatment of OAB, urge incontinence, and urinary retention. Few randomized, head-to-head comparisons of the different available alternatives exist; however, patients now have increasing options to manage their symptoms and improve their quality of life. Copyright © 2016 Elsevier Inc. All rights reserved.

  6. 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

  7. Bladder explosion during transurethral resection of prostate: Bladder diverticula as an additional risk factor

    PubMed Central

    Vincent, D. Paul

    2017-01-01

    Vesical explosion during transurethral resection of the prostate (TURP) is a very rare occurrence. Very few cases have been reported in the literature. The literature was reviewed pertaining to the etiology of bladder explosion during transurethral resection. The underlying mechanism for intravesical explosion is the generation and trapping of explosive gasses under the dome of the bladder which eventually detonates when it comes into contact with the cautery electrode during TURP. Various techniques have been suggested to prevent this dreaded complication. A 75-year-old male with chronic retention of urine underwent TURP. There was Grade 2 trilobar enlargement of the prostate. There were multiple diverticula with one large diverticulum in the dome of the bladder. During hemostasis, there was a loud pop sound and the bladder exploded. Lower midline laparotomy was performed and the intraperitoneal bladder rupture was repaired. He had an uneventful postoperative recovery, and he is asymptomatic at 6 months of follow-up. Even though all the precautions were taken to avoid this complication, bladder rupture was encountered. The presence of multiple diverticula is being suggested as an additional risk factor for this complication as the bladder is thinned out and also possibly due to trapping of air bubble within the diverticulum. In such cases where there are multiple bladder diverticula, the employment of a suprapubic trocar for continuous drainage of the air bubble, could well be a practical consideration. PMID:28216933

  8. Giant Intraperitoneal Multiloculated Pseudocyst in a Male

    PubMed Central

    2016-01-01

    Intraperitoneal pseudocysts are rare and may be difficult to differentiate from other malignant neoplasms. Reports of occurrences are mainly associated with long-term intraperitoneal catheter use, intraperitoneal catheter infections, or major pelvic surgery in females, although there are few reported incidences without prior trauma. We present a case of a male patient found to have a 19 × 15 × 9 cm intraperitoneal pseudocyst with other multiloculated areas and a history of a right inguinal hernia repair. After a thorough review of the literature, this is the first multiloculated nonpancreatic pseudocyst reported in a male patient. PMID:27022497

  9. 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

  10. 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.

  11. Explosion of the urinary bladder during transurethral resection of the prostate.

    PubMed

    Baldvinsdóttir, Bryndís; Gíslason, Thornorsteinn; Jónsson, Eiríkur

    2014-12-01

    Transurethral resection of the prostate (TURP) remains the gold standard for the surgical treatment of benign prostatic hyperplasia. Complications during the procedure are rare. An extremely rare complication is a rupture of the urinary bladder. This article reports a case where an explosion occurred during TURP, resulting in a large intraperitoneal rupture of the urinary bladder. The patient underwent emergency laparotomy to repair the bladder.

  12. Perforated diode neutron sensors

    NASA Astrophysics Data System (ADS)

    McNeil, Walter J.

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

  13. Gastrointestinal Tract Perforation: MDCT Findings according to the Perforation Sites

    PubMed Central

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

    2009-01-01

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

  14. [Drug related colonic perforation: Case report].

    PubMed

    Núñez-García, Edgar; Valencia-García, Luis César; Sordo-Mejía, Ricardo; Kajomovitz-Bialostozky, Daniel; Chousleb-Kalach, Alberto

    2016-01-01

    Acute pseudo-obstruction of the colon is a disorder characterised by an increase in intra-luminal pressure that leads to ischaemia and necrosis of the intestinal wall. The mechanism that produces the lesion is unknown, although it has been associated with: trauma, anaesthesia, or drugs that alter the autonomic nervous system. The pathophysiology of medication induced colon toxicity can progress to a perforated colon and potentially death. Present a case of a colonic pseudo-obstruction in a patient with polypharmacy as the only risk factor and to review the medical literature related to the treatment of this pathology. The case is presented of a 67 year old woman with colonic pseudo-obstruction who presented with diffuse abdominal pain and distension. The pain progressed and reached an intensity of 8/10, and was accompanied by fever and tachycardia. There was evidence of free intraperitoneal air in the radiological studies. The only risk factor was the use of multiple drugs. The colonic pseudo-obstruction progressed to intestinal perforation, requiring surgical treatment, which resolved the problem successfully. It is important to consider drug interaction in patients with multiple diseases, as it may develop complications that can be avoided if detected on time. Copyright © 2015 Academia Mexicana de Cirugía A.C. Published by Masson Doyma México S.A. All rights reserved.

  15. [Disorders of bladder compliance and neurogenic bladder].

    PubMed

    Chartier-Kastler, E; Comperat, E; Ruffion, A

    2007-05-01

    Bladder compliance is defined as the relationship between change in bladder volume and change in detrusor pressure (DV/DP). The pathophysiology of neurogenic disorders of bladder compliance is still poorly understood. Experimental reduction of blood flow in the bladder wall, bilateral hypogastric nerve section in rats, the study of spinalized rat bladders, and reduction of oestrogen impregnation show that these conditions induce loss of the viscoelastic properties of the bladder. With the arrival of new treatments active on afferent and/or efferent pathways or on the central nervous system, it is very important to improve our understanding of the pathophysiology of neurogenic disorders of bladder compliance. The reversibility of these disorders constitutes a major therapeutic challenge and their functional consequences constitute a crucial prognostic element of neurogenic bladder. Disorders of bladder compliance can be assessed clinically from two points of view: 1) The natural history of onset of these disorders in neurogenic bladder. Clinical experience demonstrates certain risk factors for the development of these disorders, such as the voiding mode (intermittent self-catheterization or by a carer versus indwelling catheter), the level of the spinal cord lesion (suprasacral versus sacral, incomplete versus complete, and cauda equina lesions), and the presence of myelomeningocele. 2) Data derived from conservative management of these disorders in patients with neurogenic bladder: urethral dilatation, various types of sphincterotomy, vesical denervation, alpha-blockers, sympatholytics, vanilloids (resiniferatoxin and capsaicin), intra-detrusor botulinum toxin and intrathecal baclofen have been shown to improve disorders of compliance of neurogenic bladder.

  16. Fishbone Perforated Appendicitis.

    PubMed

    Beh, Joey Chan Yiing; Uppaluri, Anandswaroop Srinivas; Koh, Beatrice Fang Ju; Cheow, Peng-Chung

    2016-07-01

    Ingested foreign bodies tend to pass through the gastrointestinal tract without incidence, and vast majority of cases do not need intervention. Rarely, these foreign bodies drop into the appendix and not likely to re-enter the normal digestive tract. We describe a case of a 72-year-old male patient who presented with right iliac fossa pain of 3-day duration. Clinical examination suggested classic acute appendicitis. Blood test results revealed leukocytosis. Computed tomography of the abdomen and pelvis showed evidence of acute appendicitis and a linear hyperdensity (foreign body) perforating the appendix. The patient was managed successfully with prompt laparoscopic appendectomy and removal of the foreign body which was confirmed to be a fish bone measuring about 10mm. While imaging diagnosis of fishbone in the appendix has been published, reports are few. To the best of the author's knowledge, fishbone induced perforated appendicitis has been described only in 2 cases (including this case) in the literature.

  17. 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

  18. Bladder volume-dependent excitatory and inhibitory influence of lumbosacral dorsal and ventral roots on bladder activity in rats.

    PubMed

    Sugaya, Kimio; de Groat, William C

    2007-08-01

    This study was undertaken to examine the role of the afferent and efferent pathways of the lumbosacral spinal nerve roots in the tonic control of bladder activity. Changes of isovolumetric bladder activity were recorded in 21 sympathectomized female rats under urethane anesthesia following transection of the dorsal (DRT) and ventral (VRT) lumbosacral spinal roots, and after intraperitoneal administration of hexamethonium. DRT altered the baseline intravesical pressure in a bladder volume-dependent manner in each animal. The percent change of baseline pressure after VRT following DRT was also dependent upon bladder volume. The percent change of baseline pressure after VRT alone was similarly dependent on bladder volume, but not after VRT followed by DRT. The percent change of baseline intravesical pressure (y)(-9 to +8 cm H(2)O, -56 to +46%) after DRT and VRT depended upon bladder volume (x)(y = 44.7 x -40.4) in all rats. Hexamethonium increased the amplitude of small myogenic bladder contractions after DRT and VRT. In conclusion, the bladder is tonically excited or inhibited by a local reflex pathway and by a parasympathetic reflex pathway that depends on connections with the lumbosacral spinal cord and the pelvic nerves. Both reflex mechanisms are influenced by bladder volume.

  19. Comparison of the efficacy and feasibility of laser enucleation of bladder tumor versus transurethral resection of bladder tumor: a meta-analysis.

    PubMed

    Yang, Huan; Wang, Ning; Han, Shanfu; Male, Musa; Zhao, Chenming; Yao, Daqiang; Chen, Zhiqiang

    2017-08-23

    The transurethral resection of bladder tumor (TURBT) remains the most widely used method in the surgical treatment of the non-muscle invasive bladder tumor (NMIBT). Despite its popularity, the laser technique has been widely used in urology as an alternative, via the application of transurethral laser enucleation of bladder tumor. The aim of the present study was to compare the efficacy and feasibility between transurethral laser enucleation and transurethral resection of bladder tumor. A systematic search of the following databases was conducted: PubMed, Wed of Science, Cochrane Library, EMBASE, Google scholar, and Medline. The search included studies up to the 1st of January 2017. The outcomes of interest that were used in order to assess the two techniques included operation time, catheterization time, hospitalization time, obturator nerve reflex, bladder perforation, bladder irritation, 24-month-recurrence rate, and the postoperative adjuvant intravesical chemotherapy. A total of 13 trials with 2012 participants were included, of which 975 and 1037 underwent transurethral laser enucleation and transurethral resection of bladder tumor, respectively. No significant difference was noted in the operation time between the two groups, although significant differences were reported for the variables catheterization time, hospitalization time, obturator nerve reflex, bladder perforation, bladder irritation, and 24-month-recurrence rate. In the mitomycin and epirubicin subgroups, no significant differences were observed in the laser enucleation and TURBT methods with regard to the 24-month-recurrence rate. The laser enucleation was superior to TURBT with regard to the parameters obturator nerve reflex, bladder perforation, catheterization time, hospitalization time, and 24-month-recurrence rate. Moreover, laser enucleation can offer a more accurate result of the tumor's pathological stage and grade.

  20. Radiologic diagnosis of gastrointestinal perforation.

    PubMed

    Rubesin, Stephen E; Levine, Marc S

    2003-11-01

    Perforations of the gastrointestinal tract have many causes. Holes in the wall of gastrointestinal organs can be created by blunt or penetrating trauma, iatrogenic injury, inflammatory conditions that penetrate the serosa or adventitia, extrinsic neoplasms that invade the gastrointestinal tract, or primary neoplasms that penetrate outside the wall of gastrointestinal organs. This article provides a radiologic approach for investigating the wide variety of gastrointestinal perforations. General principles about contrast agents and studies are reviewed, and then perforations in specific gastrointestinal organs are discussed.

  1. Pacemaker leads and cardiac perforation

    PubMed Central

    Prasad, Rachana; Andrews, Richard

    2017-01-01

    This case series highlights the rare but potentially life threatening complication of ventricular perforation caused by pacemaker leads and discusses appropriate investigations and management strategies. PMID:28321317

  2. 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

  3. Spontaneous rupture of urinary bladder: a case report and review.

    PubMed

    Albino, Giuseppe; Bilardi, Francesco; Gattulli, Domenico; Maggi, Pietro; Corvasce, Antonio; Marucco, Ettore Cirillo

    2012-12-01

    Spontaneous rupture of the bladder is a rare event. The clinical presentation shows the signs and symptoms of peritonitis, but the diagnosis is made at the operating table. This event is burdened with a high mortality rate. We present a case report of a 73-year-old man who came to our observation. He was a chronic carrier of urinary catheter, at least 7 times removed traumatically by himself. At the time of admission he showed drastic reduction in urine output, absence of hydronephrosis, normal functioning of the catheter, a tense and widely meteoric abdomen, the presence of air-fluid levels, normal kidneys, absence of free fluid in the abdomen. The CT showed a fluid collection of about 7 cm diameter between the bladder and rectum. The explorative laparotomy found a small fissuration of the posterior wall of the bladder. For his severe conditions, the patient died a few hours after surgery, in intensive care unit. Although it is a rare event, since 1980, 177 cases of spontaneous rupture of the bladder are reported in the literature. Their causes may be essentially divided into two groups: for increase of intravesical pressure; or for weakening of the bladder wall. In most cases, the spontaneous rupture of the bladder takes place in presence of a urothelial neoplasm or after radiation therapy of the pelvic organs. The etiology of spontaneous rupture of the bladder in our case does not relate to a bladder tumor or radiotherapy. It may have been caused by repeated episodes of acute retention of urine with extreme bladder distension up to 3 liters. It is not easy to think of a bladder perforation in patients presenting signs of peritonitis without a history of bladder cancer or pelvic radiotherapy. A CT with intravesical contrast medium could help the diagnostic orientation.

  4. Chemotherapy for intraperitoneal use: a review of hyperthermic intraperitoneal chemotherapy and early post-operative intraperitoneal chemotherapy

    PubMed Central

    McPartland, Sarah; Detelich, Danielle; Saif, Muhammad Wasif

    2016-01-01

    Peritoneal spread of tumors is a major problem in cancer management. Patients develop a marked deterioration in quality of life and shortened survival. This is in part due to bowel obstructions, marked ascites, and overall increase debilitation. Standard medical management has shown to be inadequate for the treatment of these problems. Surgery can palliate symptoms, however, it is unable to be complete at the microscopic level by a significant spillage of tumor cells throughout the abdomen. Chemotherapy can have some improvement in symptoms however it is short lived due to poor penetration into the peritoneal cavity. The role of intraperitoneal chemotherapy is to maximize tumor penetration and optimize cell death while minimizing systemic toxicity. Hyperthermic intraperitoneal chemotherapy (HIPEC) and early post-operative intraperitoneal chemotherapy (EPIC) are two treatment methods that serve this role and have been shown to improve survival. This review will discuss different chemotherapies used for both of these treatment options. PMID:26941983

  5. Subcutaneous Compared with Intraperitoneal KetamineXylazine for Anesthesia of Mice.

    PubMed

    Levin-Arama, Maya; Abraham, Lital; Waner, Trevor; Harmelin, Alon; Steinberg, David M; Lahav, Tal; Harlev, Mickey

    2016-11-01

    Mice are commonly anesthetized intraperitoneally with a ketamine-xylazine (KX) solution. Although this route of administration allows rapid uptake of the injected drugs, its disadvantages and potential risks include pain, peritoneal irritation, and perforation of an abdominal organ; some of the risks depend on the operator's experience. We compared the efficacy of intraperitoneal and subcutaneous administration of KX in HSD:ICR, BALB/cOlaHsd, and C57BL/6JOlaHsd mice in terms of time to onset and duration of surgical anesthesia, procedure safety, and mortality. Male and female mice (n = 20 each sex and strain) were anesthetized by using the same dose of intraperitoneal or subcutaneous KX. Time to onset and duration of immobilization and time to onset and duration of surgical anesthesia according to the pedal reflex differed significantly between strains. Within each strain, the durations of immobilization and surgical anesthesia were comparable between the routes of administration. The sex of the mouse but not the route of administration influenced whether surgical anesthesia was achieved. None of the subcutaneously-injected mice died. After intraperitoneal injections, 30% of the female mice died, compared with 3% of the male. In addition, fewer female mice achieved surgical anesthesia, suggesting a narrow therapeutic window for intraperitoneal KX in female mice. In conclusion, surgical anesthesia of mice with subcutaneous KX (K, 191.25 mg/kg; X, 4.25 mg/kg) seems to be safe, and the subcutaneous route is generally just as effective as the intraperitoneal route. The variability among mouse strains and between sexes requires further investigation to determine the optimal dosage.

  6. The sternocleidomastoid perforator flap.

    PubMed

    Avery, C M E

    2011-10-01

    The conventional pedicled sternocleidomastoid (SCM) flap has a poor arc of rotation, limited volume and precarious vascularity. This report describes a new technique for raising a SCM flap based on the perforating vessels of the superior thyroid vascular pedicle. The upper and lower attachments of the sternocleidomastoid muscle are divided. Four medically and/or surgically compromised patients have successfully undergone reconstruction of hemiglossectomy (1), partial glossectomy (1) and rim of mandible (2) defects for malignancy. The arc of rotation of the SCM flap is greatly increased and the potential applications for the flap expanded.

  7. AB138. Experience on thulium laser treatment in transurethral resection of bladder tumor

    PubMed Central

    Gan, Xiuguo; An, Ruihua

    2016-01-01

    Objective To study the safety and efficacy of thulium laser treatment of bladder cancer. Methods Thulium laser surgery system was used for the treatment of 45 cases of bladder cancer patients, including 33 cases of single tumor, 12 cases of multiple tumors. Tumor diameter were 5–25 mm. Tumor pathology were bladder transitional cell carcinoma, clinical stage at T1–T2. Results All the surgery was successfully completion. Operation time was 10–35 minutes. Blood loss was 0–5 mL. None of bladder has perforation, water intoxication, urinary leakage or postoperative bleeding. All of the patients had received immediate intravesical chemotherapy within 0.5 hours, and to maintain bladder chemotherapy. All had catheter indwelled 5 to 7 days. Patients were followed up 1 year, no recurrence of the surgical area. Conclusions Thulium laser surgery system for the transurethral treatment of bladder cancer within stage T2 is safe and effective.

  8. Fishbone Perforated Appendicitis

    PubMed Central

    Beh, Joey Chan Yiing; Uppaluri, Anandswaroop Srinivas; Koh, Beatrice Fang Ju; Cheow, Peng-Chung

    2016-01-01

    Ingested foreign bodies tend to pass through the gastrointestinal tract without incidence, and vast majority of cases do not need intervention. Rarely, these foreign bodies drop into the appendix and not likely to re-enter the normal digestive tract. We describe a case of a 72-year-old male patient who presented with right iliac fossa pain of 3-day duration. Clinical examination suggested classic acute appendicitis. Blood test results revealed leukocytosis. Computed tomography of the abdomen and pelvis showed evidence of acute appendicitis and a linear hyperdensity (foreign body) perforating the appendix. The patient was managed successfully with prompt laparoscopic appendectomy and removal of the foreign body which was confirmed to be a fish bone measuring about 10mm. While imaging diagnosis of fishbone in the appendix has been published, reports are few. To the best of the author’s knowledge, fishbone induced perforated appendicitis has been described only in 2 cases (including this case) in the literature. PMID:27761185

  9. CT cystography with multiplanar reformation for suspected bladder rupture: experience in 234 cases.

    PubMed

    Chan, David P N; Abujudeh, Hani H; Cushing, George L; Novelline, Robert A

    2006-11-01

    CT cystography has replaced conventional cystography in the evaluation of patients with suspected bladder rupture in most trauma centers. We performed this retrospective review to determine the accuracy of CT cystography and the role of multiplanar reformation in the diagnosis of bladder injury. The patient cohort was composed of trauma patients with clinically or CT-suspected bladder ruptures who were evaluated with CT cystography using two different MDCT scanners at our level 1 trauma center. The patients were identified through Folio, a radiology research tool software system. The CT cystography results were compared with the findings at surgery, clinical follow-up, or both. Between January 1, 2000, and December 31, 2004, 234 patients were examined in our level 1 trauma center with CT cystography. From the total of 234 examinations, 216 (92.3%) were interpreted as negative and 18 examinations (7.7%) were interpreted as positive. On the 18 positive examinations, 11 were extraperitoneal bladder rupture, five were intraperitoneal bladder rupture, and two were combined intraperitoneal and extraperitoneal bladder rupture. Surgical bladder exploration and repair were performed in nine of the 18 cases. Seven (77.8%) of the nine cases had operative findings consistent with the CT cystogram findings. The overall sensitivity and specificity of CT cystography in diagnosing bladder rupture were each 100%. For extraperitoneal bladder rupture, the sensitivity and specificity were 92.8% and 100%, respectively. For intraperitoneal rupture, the sensitivity and specificity were 100% and 99%, respectively. CT cystography is accurate for diagnosing bladder rupture. Sagittal and coronal multiplanar reformations may be helpful in identifying most sites of bladder rupture.

  10. Transrectal impalement of an incense stick in a child presenting as foreign body in the urinary bladder

    PubMed Central

    Singha Mahapatra, Rajkumar; Priyadarshi, Vinod; Sarma Madduri, Vijay kumar; Pal, Dilip Kumar

    2014-01-01

    The diversity of objects that can be found in the urinary bladder often surpasses the urologist's imagination and mostly they are introduced per urethrally. Impalement injuries of the rectum with bladder perforation have been rarely reported. A high index of clinical suspicion is required to make the diagnosis of bladder perforation while assessing patients presenting with rectal impalement. In this interesting case, a young male child presented with haematuria and dysuria. He had a history of accidentally sitting on an agarbatti (Indian incense stick) stand while playing, followed by perianal pain which subsided spontaneously. Next day he presented with haematuria and dysuria. Clinical examination was inconclusive. On thorough investigation, a linear echogenic foreign body was found in the urinary bladder. The child was operated and the foreign body (incense stick) was removed. This is the first reported case of rectal impalement injury with incense stick, migrated to the urinary bladder in a 2-year-old child. PMID:24925539

  11. Bladder sensation measures and overactive bladder.

    PubMed

    Rapp, David E; Neil, Nancy J; Govier, Fred E; Kobashi, Kathleen C

    2009-09-01

    We performed a prospective multicomponent study to determine whether subjective and objective bladder sensation instruments may provide data on sensory dysfunction in patients with overactive bladder. We evaluated 70 prospectively enrolled patients with urodynamics and questionnaires on validated urgency (Urgency Perception Score), general overactive bladder (Urogenital Distress Inventory) and quality of life (Incontinence Impact Questionnaire). We first sought a correlation between sensory specific (Urgency Perception Score) and quality of life questionnaire scores. We then assessed a correlation between sensory questionnaire scores and urodynamic variables, exploring the hypothesis that certain urodynamic parameters may be bladder sensation measures. We evaluated 2 urodynamic derivatives (first sensation ratio and bladder urgency velocity) to increase sensory finding discrimination. We noted a moderate correlation between the Urgency Perception Score (0.56) and the Urogenital Distress Inventory (0.74) vs the Incontinence Impact Questionnaire (each p <0.01). A weak negative correlation was seen between Urgency Perception Score and bladder capacity (-0.25, p <0.05). No correlation was noted for the other urodynamics parameters. First sensation ratio and bladder urgency velocity statistically significantly correlated with the Urgency Perception Score despite the lesser or absent correlation associated with the individual components of these derivatives. Bladder sensation questionnaires may be valuable to identify patients with sensory dysfunction and provide additional data not obtained in generalized symptom questionnaires. Urodynamic variables correlated with bladder sensation questionnaire scores and may be an objective method to assess sensory dysfunction.

  12. Post-Colonoscopy Colonic Perforation Presenting With Subcutaneous Emphysema: A Case Report.

    PubMed

    Khan, Muhammad; Ijaz, Muhammad; Bukhari, Sumera; Dirweesh, Ahmed; Christmas, Donald

    2017-04-01

    Colonoscopy is performed for both diagnostic and therapeutic indications. Although rare, associated complications can be quite serious. The frequency of these complications depends mainly on the skills of the physicians doing the procedure, and the diagnostic or therapeutic indications. Major complications include adverse anesthetic related events, aspiration pneumonia, bleeding, and colonic perforation. We present a rare case of a post-colonoscopy perforation presenting with subcutaneous emphysema and free mediastinal, and intra-peritoneal air. The patient was successfully managed conservatively with complete resolution of symptoms.

  13. Post-Colonoscopy Colonic Perforation Presenting With Subcutaneous Emphysema: A Case Report

    PubMed Central

    Khan, Muhammad; Ijaz, Muhammad; Bukhari, Sumera; Dirweesh, Ahmed; Christmas, Donald

    2017-01-01

    Colonoscopy is performed for both diagnostic and therapeutic indications. Although rare, associated complications can be quite serious. The frequency of these complications depends mainly on the skills of the physicians doing the procedure, and the diagnostic or therapeutic indications. Major complications include adverse anesthetic related events, aspiration pneumonia, bleeding, and colonic perforation. We present a rare case of a post-colonoscopy perforation presenting with subcutaneous emphysema and free mediastinal, and intra-peritoneal air. The patient was successfully managed conservatively with complete resolution of symptoms. PMID:28496537

  14. Snapshot in surgery: intraperitoneal encapsulated fat necrosis

    PubMed Central

    Oh, Han Boon; Arab, Nahlah; Teo, Lynette; Lieske, Bettina

    2015-01-01

    Key Clinical Message A 66-year-old man with rectal cancer was found to have an incidental ring-like lesion in the left rectovesical pouch. Histology revealed an encapsulated fat necrosis. Intraperitoneal encapsulated fat necroses are postulated to be a result of infarcted epiploic appendages resulting in a free-floating lesion. PMID:25767714

  15. Bladder function - neurological control

    MedlinePlus Videos and Cool Tools

    ... with urine, sensory nerves send impulses to the brain indicating that the bladder is full. The sensory ... cord to relay this information. In turn, the brain sends impulses back to the bladder instructing the ...

  16. A new approach for the management of bladder injury in retropubic slings: one side transobturator/ one side retropubic sling.

    PubMed

    Aksakal, Orhan Seyfi; Cavkaytar, Sabri; Kokanalı, Mahmut Kuntay; Tasdemir, Umit; Topcu, Hasan Onur; Doganay, Melike

    2014-11-01

    The aim of this study was to establish a new management modality for bladder perforation during retropubic slings. In 2013, among 102 retropubic slings, there were five bladder injuries. All procedures were performed by one of the fourth year residents under direct supervision of experienced surgeons. Bladder perforation was detected in cystoscopic examination. In the bladder perforated side, tape was retracted and placed by transobturator approach and the Foley catheter remained in place for seven days. Demographic features, preoperative urodynamic examination, and preoperative and postoperative life quality questionnaires (IIQ-7 and UDI-6) were recorded. The mean age of the patients was 44 ± 2.5 years and body mass index was 29.4 ± 1.7 kg/ m2. Mean parity was 2.8 ± 1.8 and all the patients delivered with vaginal route. None of the patients were in menopause. Of the five bladder perforations, 40%(2) occurred on the right side, 60%(3) on the left side. All the surgeons were right handed. All patients underwent other vaginal reconstructive procedures like anterior colporraphy and posterior colporraphy. None of the patients had previous anti-incontinence surgery. Mean follow-up was 10.2 ± 2.4 months. All patients had negative stress tests and improvement in IIQ-7 and UDI-6 at postoperative sixth month. There was no postoperative voiding dysfunction in any of the patients. If bladder perforation occurs in patients who undergo retropubic sling, the tape can be placed by transobturator approach in the bladder perforated side.

  17. Spontaneous Perforation of Pyometra

    PubMed Central

    Yildizhan, Begüm; Uyar, Esra; Şişmanoğlu, Alper; Güllüoğlu, Gülfem; Kavak, Zehra N.

    2006-01-01

    Pyometra is the accumulation of purulent material in the uterine cavity. Its reported incidence is 0.01−0.5% in gynecologic patients; however, as far as elderly patients are concerned, its incidence is 13.6% [3]. The most common cause of pyometra is malignant diseases of genital tract and the consequences of their treatment (radiotherapy). Other causes are benign tumors like leiomyoma, endometrial polyps, senile cervicitis, cervical occlusion after surgery, puerperal infections, and congenital cervical anomalies. Spontaneous rupture of the uterus is an extremely rare complication of pyometra. To our knowledge, only 21 cases of spontaneous perforation of pyometra have been reported in English literature since 1980. This paper reports an additional case of spontaneous uterine rupture. PMID:17093350

  18. Acquired reactive perforating collagenosis

    PubMed Central

    Fei, Chengwen; Wang, Yao; Gong, Yu; Xu, Hui; Yu, Qian; Shi, Yuling

    2016-01-01

    Abstract Background: Reactive perforating collagenosis (RPC) is a rare form of transepithelial elimination, in which altered collagen is extruded through the epidermis. There are 2 types of RPC, acquired RPC (ARPC) and inherited RPC, while the latter is extremely rare. Here we report on 1 case of ARPC. Methods: A 73-year-old female was presented with strongly itchy papules over her back and lower limbs for 3 months. She denied the history of oozing or vesiculation. A cutaneous examination showed diffusely distributed multiple well-defined keratotic papules, 4 to 10 mm in diameter, on the bilateral lower limbs and back as well as a few papules on her chest and forearm. Scratching scars were over the resolved lesions while Koebner phenomenon was negative. The patient had a history of type 2 diabetes for 15 years. Laboratory examinations showed elevated blood glucose level. Skin lesion biopsy showed a well-circumscribed area of necrosis filled with a keratotic plug. Parakeratotic cells and lymphocytic infiltration could be seen in the necrosed area. In dermis, sparse fiber bundles were seen perforating the epidermis. These degenerated fiber bundles were notarized as collagen fiber by elastic fiber stain, suggesting a diagnosis of RPC. Results: Then a diagnosis of ARPC was made according to the onset age and the history of diabetes mellitus. She was treated with topical application of corticosteroids twice a day and oral antihistamine once a day along with compound glycyrrhizin tablets 3 times a day. And the blood glucose was controlled in a satisfying range. Two months later, a significant improvement was seen in this patient. Conclusion: Since there is no efficient therapy to RPC, moreover, ARPC is considered to be associated with some systemic diseases, the management of the coexisting disease is quite crucial. The patient in this case received a substantial improvement due to the control of blood glucose and application of compound glycyrrhizin tablets. PMID

  19. Rett syndrome and gastric perforation.

    PubMed

    Shah, Malay B; Bittner, James G; Edwards, Michael A

    2008-04-01

    Rett Syndrome is associated with decreased peristaltic esophageal waves and gastric dysmotility, resulting in swallowing difficulties and gastric dilation. Rarely, gastric necrosis and perforation occur. Our case represents the third reported case of gastric necrosis and perforation associated with Rett Syndrome. A 31-year-old female after 11 hours of intermittent emesis and constant, sharp abdominal pain presented with evidence of multiorgan system failure including hypovolemic shock, metabolic acidosis, coagulopathy, and hepatorenal failure. A chest radiograph revealed intra-abdominal free air necessitating emergent laparotomy. During exploration, a severely dilated, thin-walled stomach with an area of necrosis and gross perforation was noted. Wedge resection of the necrotic tissue and primary closure were performed. Despite aggressive perioperative resuscitation and ventilation support, the patient died 3 hours postoperatively secondary to refractory shock and hypoxemia. Severe gastric dilation can occur with Rett Syndrome and may cause gastric necrosis and perforation. Prolonged elevated gastric pressures can decrease perfusion and may contribute to perforation. Timely decompression via percutaneous endoscopic or surgical gastrostomy could decrease the risk of perforation particularly when significant gastric distention is present. Consideration of gastric necrosis and perforation in patients with Rett Syndrome may lead to earlier intervention and decreased mortality.

  20. [Free perforation in Crohn's disease].

    PubMed

    Patti, R; Arcara, M; Daví, V; Leo, P; Di Vita, G

    2004-01-01

    Free perforation in abdominal cavity in patients with Crohn's disease is a rare entity as attested from the data reported in the literature. It is a very dangerous event and requires a surgical urgency management. The Authors reported two cases of free perforation, in patients with Crohn' disease, undergoing surgical operation in urgency. Analyzing pathogenesis, difficulty in diagnosis making and therapeutic choices, they underline that CT is very useful in the diagnosis, while resection of the perforated intestinal tract represent the best surgical treatment.

  1. Preventative effects of a HIF inhibitor, 17-DMAG on partial bladder outlet obstruction-induced bladder dysfunction.

    PubMed

    Iguchi, Nao; Dönmez, M İrfan; Malykhina, Anna P; Carrasco, Alonso; Wilcox, Duncan T

    2017-08-02

    Posterior urethral valves are the most common cause of partial bladder outlet obstruction (PBOO) in the pediatric population. Pathological changes in the bladder developed during PBOO are responsible for long-lasting voiding dysfunction in this population despite early surgical interventions. Increasing evidence showed PBOO induces an upregulation of Hypoxia inducible factors (HIFs) and their transcriptional target genes, and they play a role in pathophysiological changes in the obstructed bladders. We hypothesized that blocking HIF pathways can prevent PBOO-induced bladder dysfunction. PBOO was surgically created by ligation of the bladder neck in male C57BL/6J mice for 2 weeks. PBOO mice received intraperitoneal injection of either saline or 17-DMAG (Alvespimycin, 3mg/kg) every 48 h starting from day 1 post-surgery. Sham operated animals received injection of saline at the same schedule as PBOO mice and served as controls. The bladders were harvested after 2 weeks, and basal activity and evoked contractility of the detrusor smooth muscle (DSM) were evaluated in vitro Bladder function was assessed in vivo by void spot assay and cystometry in conscious, unrestrained mice. Results indicated the 17-DMAG treatment preserved DSM contractility, and partially prevented the development of detrusor over activity in obstructed bladders. In addition, PBOO caused a significant increase in the frequency of micturition which was significantly reduced by 17-DMAG treatment. The 17-DMAG treatment improved urodynamic parameters, including increases in the bladder pressure at micturition and non-void contractions observed in PBOO mice. These results demonstrate that treatment with 17-DMAG, a HIF inhibitor significantly alleviated PBOO-induced bladder pathology in vivo. Copyright © 2017, American Journal of Physiology-Renal Physiology.

  2. Ruptured Gall Bladder containing Stones following Blunt Trauma Abdomen: A Rare Presentation of Hemodynamic Instability.

    PubMed

    Goel, V; Kumar, N; Soni, N

    2015-01-01

    Gall bladder injuries are seen in 2% of patients undergoing laparotomy for blunt trauma abdomen. Isolated gall bladder injury is a rare event with associated presence of stones is even rarer. The associated visceral injuries lead to intraoperative identification in most cases. Here we present a case of 30 years old male with isolated gall bladder laceration following blunt abdominal trauma. The diagnosis of gallbladder perforation after blunt injury may be suspected in patients with signs of an acute abdomen and hypotension that is not explained by blood loss. Early suspicion and prompt exploration is imperative. Cholecystectomy is an adequate treatment for the condition.

  3. [Benign intraperitoneal metastatic leiomyomatosis: A case report].

    PubMed

    García, Paz; Errázuriz, Juan Ignacio; Fernández, Carlos; Arteaga, Eugenio

    2017-02-01

    Benign intraperitoneal metastatic leiomyomatosis is a rare benign disease that is observed when a leiomyoma is present in the peritoneal surface. Women who have undergone hysterectomy for leiomyomas are most commonly affected. Patients are usually asymptomatic at presentation, being frequently an incidental finding in imaging studies. Ultrasound and CT play an important role in the diagnosis. The lesions are histologically identical to their uterine counterparts. There are different theories about the pathogenesis of the disease, including peritoneal seeding after laparoscopic hysterectomy. Others support the hypothesis of multiple independent foci of smooth muscle proliferation. Treatment, as in uterine leiomyomatosis, is generally conservative. We report a 53-year-old hysterectomized woman with intraperitoneal leiomyomas detected in a routine physical examination as mobile abdominal masses who underwent successful laparoscopic resection.

  4. Avidin targeting of intraperitoneal tumor xenografts.

    PubMed

    Yao, Z; Zhang, M; Sakahara, H; Saga, T; Arano, Y; Konishi, J

    1998-01-07

    Lectins (proteins that bind specific sugar molecules on glycoproteins and glycolipids) are expressed at various levels on the surface of tumor cells. Conjugation of cytotoxic agents to glycoproteins recognized by lectins could be useful in the treatment of tumors. Avidin (a highly glycosylated, positively charged protein found in egg white) contains terminal N-acetylglucosamine and mannose residues that bind to some lectins. In this study, we tested the ability of avidin, labeled through conjugation to radioactive biotin (a B vitamin), to target intraperitoneal tumors. Biotin was radioactively labeled with 111In. Four tumor models (one ovarian, one lung, and two colon) were established in nude mice by intraperitoneal injection of cultured cancer cells. The following two approaches were used in the intraperitoneal administration of avidin: 1) radioactive biotin-avidin conjugates were injected and 2) avidin was injected 1-24 hours before the injection of radioactive biotin (avidin pretargeting; avidin-biotin conjugates formed in vivo). The distribution of injected radioactivity in the tissues of treated animals was assessed. Radiolabeled avidin localized highly and rapidly in the tumors. More than 50% of the administered dose of avidin-biotin conjugate accumulated per gram of tumor tissue 2 hours after injection; high tumor uptake of radioactivity was observed up to 24 hours after conjugate injection. In contrast, accumulation of radioactivity in normal tissues was low, yielding high tumor to nontumor ratios. With avidin pretargeting, accumulation of radioactivity in the liver, kidney, and spleen was reduced to a greater extent than that in the tumor, and tumor to nontumor ratios were increased. Avidin may be a promising vehicle for the delivery of radioisotopes, drugs, toxins, or therapeutic genes to intraperitoneal tumors.

  5. Abdominal metastases from colorectal cancer: intraperitoneal therapy

    PubMed Central

    Guend, Hamza; Patel, Sunil

    2015-01-01

    Patients with peritoneal metastasis from colorectal cancer represent a distinct subset with regional disease rather than systemic disease. They often have poorer survival outcomes with systemic chemotherapy. Optimal cytoreductive surgery and intraperitoneal chemotherapy (IPC) offers such patients a more directed therapy with improved survival. In this review, we discuss the diagnosis, evaluation and classification, as well as rational for treatment of peritoneal carcinomatosis (PC) secondary to colorectal cancer. PMID:26697203

  6. Neoadjuvant Intravesical Vaccine Therapy in Treating Patients With Bladder Carcinoma Who Are Undergoing Cystectomy

    ClinicalTrials.gov

    2014-12-22

    Bladder Adenocarcinoma; Bladder Squamous Cell Carcinoma; Bladder Urothelial Carcinoma; Recurrent Bladder Carcinoma; Stage I Bladder Cancer; Stage II Bladder Cancer; Stage III Bladder Cancer; Stage IV Bladder Cancer

  7. A suicide involving intraperitoneal injection of pentobarbital.

    PubMed

    Hangartner, Sarah; Steiner, Jasmin; Dussy, Franz; Moeckli, Regula; Gerlach, Kathrin; Briellmann, Thomas

    2016-09-01

    We present an unusual case of suicide by intraperitoneal injection of pentobarbital, an overdose of zolpidem and the intake of diazepam, ethanol and other psychoactive substances. The autopsy and specimen collection were conducted in a 10 to 18 h postmortem interval. The toxicological analysis revealed a significantly higher pentobarbital concentration in femoral blood compared to cardiac blood (36 vs. 15 mg/L). On the contrary, zolpidem and diazepam concentrations in cardiac blood (2700 and 590 µg/L) were found to be significantly higher than in femoral blood (1500 and 230 µg/L). These findings point to a postmortem redistribution with a distinct gradient from areas of high drug concentrations in the gastrointestinal tract (zolpidem and diazepam) and the injection site (pentobarbital) to peripheral tissue. Ethanol concentration was 0.95 ‰ which amplified the CNS depression. The choice of this unusual suicide method was associated with the deceased's former job as a veterinarian's assistant. In veterinary medicine, the intraperitoneal injection of a lethal dose of pentobarbital is quite commonly performed to euthanise small animals. Intraperitoneal injection is rare as route of administration in humans.

  8. Endoscopic closure of septal perforations.

    PubMed

    Alobid, Isam

    2017-05-26

    The management of septal perforations is a challenge for the surgeon. A wide variety of surgical techniques have been described, with different approaches. There is no scientific evidence to support a particular approach. The objective of this review is to present a practical guide on the technique of choice for each case of septal perforation. Inspection of the nasal mucosa, the size of the perforation, the location and especially the osteo-cartilaginous support, are the pillars of a successful surgery. For the sliding or rotating flaps of the mucosa of the septum it is essential to know in advance if the elevation of the mucopericondrio or mucoperiosteo of the septum is possible, otherwise the use of these flaps would not be indicated. The flaps of the lateral wall or nasal floor are the alternative. The pericranial flap may be indicated in total or near total perforations. The remnant of the nasal septum and status of osteo-cartilaginous support are the determining factors in the management of septal perforations. Each case should be evaluated individually and the approach chosen according to the size and location of the perforation, mucosal quality, personal history, previous surgery and the experience of the surgeon. Copyright © 2017 Elsevier España, S.L.U. and Sociedad Española de Otorrinolaringología y Cirugía de Cabeza y Cuello. All rights reserved.

  9. Gallbladder perforation by absorbable spiral tacker

    PubMed Central

    Wirsching, A; Vonlanthen, R

    2014-01-01

    Introduction Mesh fixation with tacker systems is common in laparoscopic and open hernia repair. Complications due to absorbable tackers are rare and have not been described in the literature. However, we report a case of gallbladder erosion due to tacker dislocation. Methods An open hernia repair was performed using an intraperitoneal onlay mesh for a recurrent parastomal hernia after two previous mesh repairs in a 67-year-old patient. Results On postoperative day 2, the patient was reoperated because of a dislocated tacker that eroded and perforated the fundus region of the gallbladder. Putatively, tacker dislocation occurred owing to imbalanced traction forces. Initially, the mesh was fixed with absorbable tackers around the stoma on the right and transmuscular suture fixation was carried out on the left abdominal side. On revision surgery, tension forces to the right were therefore neutralised by additional transmuscular sutures on the right side. Conclusions Absorbable tackers in open hernia repair provide a safe and effective mesh fixation if tension forces are carefully avoided. PMID:25245719

  10. Perforation of the gallbladder: a rare cause of acute abdominal pain.

    PubMed

    Ponten, Joep B; Selten, Jasmijn; Puylaert, Julien B C M; Bronkhorst, Maarten W G A

    2015-02-08

    An 82-year-old woman without any previous medical history arrived in the emergency department with severe pain in the entire abdomen since 5 h. Blood tests showed, apart from a CRP of 28 mg/l, no abnormalities. We decided to perform an abdominal ultrasound, which showed an easily compressible gallbladder, containing a small, mobile gallstone and free fluid in the abdomen. During ultrasound-guided punction of this fluid, bile is aspirated. We performed laparoscopy and confirmed a large amount of intraperitoneal bile. Upon inspecting the gallbladder a perforation is seen in the anti-hepatic side of the gallbladder. After performing a cholecystectomy, we opened the gallbladder and detected a dissection-like lesion, which provided access to the peritoneal cavity. The confirmed diagnosis was acute onset free perforation of the gallbladder. The perforation was probably caused by the small obstructing gallstone seen on ultrasound or by another small stone, which could not be visualized.

  11. Minimally invasive percutaneous cystostomy with ureteroscopic pneumatic lithotripsy for calculus in bladder diverticula

    PubMed Central

    GU, SI-PING; YOU, ZHI-YUAN; HUANG, YUNTENG; LU, YI-JIN; HE, CAOHUI; CAI, XIAO-DONG; ZHOU, XIAO-MING

    2013-01-01

    The aim of this study was to investigate the effectiveness of minimally invasive percutaneous cystostomy with ureteroscopic pneumatic lithotripsy for treating calculus in bladder diverticula. Percutaneous cystostomy with ureteroscopic pneumatic lithotripsy was performed on six elderly male patients with calculi in bladder diverticula, who could not be treated with transurethral ureteroscopic lithotripsy. The stones were successfully removed from all patients, with no complications such as bladder perforation, rupture, urethritis or cystitis. The surgery time was 15–60 min, with an average time of 32 min. Postoperative ultrasound or X-ray examination showed no stone residues and the bladder stoma healed well. No recurrent stones were detected in the follow-up of 3–24 months (average, 16 months). Minimally invasive percutaneous cystostomy with ureteroscopic pneumatic lithotripsy is a safe, efficient and easy treatment for calculus in bladder diverticula. This method provides a new clinical approach for lithotripsy and we suggest that it is worthy of wider use. PMID:23837044

  12. Thoracic osteophyte: rare cause of esophageal perforation.

    PubMed

    Rathinam, S; Makarawo, T; Norton, R; Collins, F J

    2010-01-01

    Esophageal perforation is a difficult problem in thoracic surgery. Esophageal perforations can be spontaneous, iatrogenic, or malignant. We report two cases of esophageal perforations caused by thoracic osteophytes and different management strategies leading to successful outcomes. An 80-year-old male presented with chest pain and dysphagia following a fall. On endoscopy, an esophageal perforation and foreign body was noted which was confirmed as a thoracic osteophyte on computed tomography scan. He was managed conservatively as he declined surgery. A 63-year-old male was admitted with dysphagia following a food bolus obstruction. Following esophagoscopy and dilatation, there was clinical and radiological evidence of perforation. During surgery, a thoracic osteophyte was identified as the cause of perforation. The perforation was closed in layers and the osteophyte was trimmed. Both patients recovered well. Thoracic osteophytes are a rare cause of esophageal perforations and a high index of suspicion is required in patients with osteoarthritis who present with esophageal perforations.

  13. Semianalytical productivity models for perforated completions

    SciTech Connect

    Karakas, M.; Tariq, S.M. )

    1991-02-01

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

  14. ACUTE PERFORATED APPENDICITIS IN CHILDHOOD—Analysis of Management, Including the Use of Hypothermia

    PubMed Central

    Brayton, Donald

    1956-01-01

    From an analysis of a recent series of 99 cases of acute perforated appendicitis in childhood several conclusions appeared valid. 1. The majority of infants and young children with acute perforated appendicitis do not exhibit the signs of localization of peritoneal irritation so characteristically seen in older children and adults. Hence if a history compatible with acute perforated appendicitis is present and there is evidence of peritoneal irritation on repeated examinations, patients of this age group may be assumed to have the disease and should be prepared and operated upon with minimal delay. Early operation after a maximum of several hours of preparation with parenteral hydration, nasogastric suction and antibiotics is the treatment of choice. 2. In nine patients in the present series with temperature and rapid pulse that did not fall to safe levels with the usual preoperative preparation, mild hypothermia appeared to reduce the risk of anesthesia and operation. 3. The use of intraperitoneal drains in children with acute perforated appendicitis is associated with a definite reduction in the incidence of postoperative intraperitoneal abscesses and with a probable reduction in the number of serious wound infections. PMID:13343013

  15. Mouse bladder wall injection.

    PubMed

    Fu, Chi-Ling; Apelo, Charity A; Torres, Baldemar; Thai, Kim H; Hsieh, Michael H

    2011-07-12

    Mouse bladder wall injection is a useful technique to orthotopically study bladder phenomena, including stem cell, smooth muscle, and cancer biology. Before starting injections, the surgical area must be cleaned with soap and water and antiseptic solution. Surgical equipment must be sterilized before use and between each animal. Each mouse is placed under inhaled isoflurane anesthesia (2-5% for induction, 1-3% for maintenance) and its bladder exposed by making a midline abdominal incision with scissors. If the bladder is full, it is partially decompressed by gentle squeezing between two fingers. The cell suspension of interest is intramurally injected into the wall of the bladder dome using a 29 or 30 gauge needle and 1 cc or smaller syringe. The wound is then closed using wound clips and the mouse allowed to recover on a warming pad. Bladder wall injection is a delicate microsurgical technique that can be mastered with practice.

  16. Biomatrices for bladder reconstruction.

    PubMed

    Lin, Hsueh-Kung; Madihally, Sundar V; Palmer, Blake; Frimberger, Dominic; Fung, Kar-Ming; Kropp, Bradley P

    2015-03-01

    There is a demand for tissue engineering of the bladder needed by patients who experience a neurogenic bladder or idiopathic detrusor overactivity. To avoid complications from augmentation cystoplasty, the field of tissue engineering seeks optimal scaffolds for bladder reconstruction. Naturally derived biomaterials as well as synthetic and natural polymers have been explored as bladder substitutes. To improve regenerative properties, these biomaterials have been conjugated with functional molecules, combined with nanotechology, or seeded with exogenous cells. Although most studies reported complete and functional bladder regeneration in small-animal models, results from large-animal models and human clinical trials varied. For functional bladder regeneration, procedures for biomaterial fabrication, incorporation of biologically active agents, introduction of nanotechnology, and application of stem-cell technology need to be standardized. Advanced molecular and medical technologies such as next generation sequencing and magnetic resonance imaging can be introduced for mechanistic understanding and non-invasive monitoring of regeneration processes, respectively.

  17. An Unusual Complication of Ventriculoperitoneal Shunt: Urinary Bladder Stone Case Report and Literature Review.

    PubMed

    Xu, Songtao; Sheng, Weixin; Qiu, Yufa; Wang, Jianguo

    2016-01-01

    Ventriculoperitoneal (V-P) shunt surgery is the most common technique used for the treatment of hydrocephalus. The migration of ventriculoperitoneal shunt to the bladder is rare. Only two cases have been previously reported in the literature. We report on a 38-year-old male who had hydrocephalus and V-P shunt for 12 years. Two years ago, he found himself with recurrent urinary tract infections, haematuria and urges incontinence, and then he was diagnosed with bladder perforation and merge stones. The patient had an abdominal operation to cut off and take out the shunt catheter, as well as a transurethral holmium laser lithotripsy. Bladder perforation and stones are rare examples of complications in V-P surgical procedures. Controlling the effective length of the terminal V-P shunt and modifying it appropriately can effectively reduce these complications.

  18. [Radiotherapy of bladder cancer].

    PubMed

    Riou, O; Chauvet, B; Lagrange, J-L; Martin, P; Llacer Moscardo, C; Charissoux, M; Lauche, O; Aillères, N; Fenoglietto, P; Azria, D

    2016-09-01

    Surgery (radical cystectomy) is the standard treatment of muscle-invasive bladder cancer. Radiochemotherapy has risen as an alternative treatment option to surgery as part as organ-sparing combined modality treatment or for patients unfit for surgery. Radiochemotherapy achieves 5-year bladder intact survival of 40 to 65% and 5-year overall survival of 40 to 50% with excellent quality of life. This article introduces the French recommendations for radiotherapy of bladder cancer: indications, exams, technique, dosimetry, delivery and image guidance.

  19. Is the Poly (L- Lactide- Co– Caprolactone) Nanofibrous Membrane Suitable for Urinary Bladder Regeneration?

    PubMed Central

    Kowalczyk, Tomasz; Warda, Karolina; Rasmus, Marta; Buchholz, Lukasz; Krzyzanowska, Sandra; Nakielski, Pawel; Chmielewski, Tomasz; Bodnar, Magdalena; Marszalek, Andrzej; Debski, Robert; Frontczak-Baniewicz, Malgorzata; Mikułowski, Grzegorz; Nowacki, Maciej; Kowalewski, Tomasz A.; Drewa, Tomasz

    2014-01-01

    The purpose of this study was to compare: a new five-layered poly (L–lactide–co–caprolactone) (PLC) membrane and small intestinal submucosa (SIS) as a control in rat urinary bladder wall regeneration. The five-layered poly (L–lactide–co–caprolactone) membrane was prepared by an electrospinning process. Adipose tissue was harvested from five 8-week old male Wistar rats. Adipose derived stem cells (ADSCs) were seeded in a density of 3×106 cells/cm2 onto PLC membrane and SIS scaffolds, and cultured for 5-7 days in the stem cell culture medium. Twenty male Wistar rats were randomly divided into five equal groups. Augmentation cystoplasty was performed in a previously created dome defect. Groups: (I) PLC+ 3×106ADSCs; (II) SIS+ 3×106ADSCs; (III) PLC; (IV) SIS; (V) control. Cystography was performed after three months. The reconstructed urinary bladders were evaluated in H&E and Masson's trichrome staining. Regeneration of all components of the normal urinary bladder wall was observed in bladders augmented with cell-seeded SIS matrices. The urinary bladders augmented with SIS matrices without cells showed fibrosis and graft contraction. Bladder augmentation with the PLC membrane led to numerous undesirable events including: bladder wall perforation, fistula or diverticula formation, and incorporation of the reconstructed wall into the bladder lumen. The new five-layered poly (L–lactide–co–caprolactone) membrane possesses poorer potential for regenerating the urinary bladder wall compared with SIS scaffold. PMID:25162451

  20. Is the poly (L- lactide- co- caprolactone) nanofibrous membrane suitable for urinary bladder regeneration?

    PubMed

    Pokrywczynska, Marta; Jundzill, Arkadiusz; Adamowicz, Jan; Kowalczyk, Tomasz; Warda, Karolina; Rasmus, Marta; Buchholz, Lukasz; Krzyzanowska, Sandra; Nakielski, Pawel; Chmielewski, Tomasz; Bodnar, Magdalena; Marszalek, Andrzej; Debski, Robert; Frontczak-Baniewicz, Malgorzata; Mikułowski, Grzegorz; Nowacki, Maciej; Kowalewski, Tomasz A; Drewa, Tomasz

    2014-01-01

    The purpose of this study was to compare: a new five-layered poly (L-lactide-co-caprolactone) (PLC) membrane and small intestinal submucosa (SIS) as a control in rat urinary bladder wall regeneration. The five-layered poly (L-lactide-co-caprolactone) membrane was prepared by an electrospinning process. Adipose tissue was harvested from five 8-week old male Wistar rats. Adipose derived stem cells (ADSCs) were seeded in a density of 3×10(6) cells/cm2 onto PLC membrane and SIS scaffolds, and cultured for 5-7 days in the stem cell culture medium. Twenty male Wistar rats were randomly divided into five equal groups. Augmentation cystoplasty was performed in a previously created dome defect. Groups: (I) PLC+ 3×10(6)ADSCs; (II) SIS+ 3×10(6)ADSCs; (III) PLC; (IV) SIS; (V) control. Cystography was performed after three months. The reconstructed urinary bladders were evaluated in H&E and Masson's trichrome staining. Regeneration of all components of the normal urinary bladder wall was observed in bladders augmented with cell-seeded SIS matrices. The urinary bladders augmented with SIS matrices without cells showed fibrosis and graft contraction. Bladder augmentation with the PLC membrane led to numerous undesirable events including: bladder wall perforation, fistula or diverticula formation, and incorporation of the reconstructed wall into the bladder lumen. The new five-layered poly (L-lactide-co-caprolactone) membrane possesses poorer potential for regenerating the urinary bladder wall compared with SIS scaffold.

  1. Management of a Case of Severe Pelvic Fracture Related Bladder Trauma

    PubMed Central

    Myers, Jeremy B.; Hotaling, James M.; Brant, William O.; Enniss, Toby M.

    2015-01-01

    A 62-year-old male was admitted after being struck by a bus. He sustained a severe pelvic fracture, sigmoid colon injury, and both intraperitoneal and extraperitoneal bladder injury. He underwent initial successful bladder repair. However, at 7 days post-operatively he manifested a leak from the repair and urine was evident coming from the pins of his pelvic external fixator. A repeat cystogram showed massive extravasation, which was managed by operative ligation of the lower ureters and placement of percutaneous nephrostomy tubes. He underwent ureteral reconstruction and colostomy reversal at 9 months. He has both bladder and bowel control. PMID:26793492

  2. Management of a Case of Severe Pelvic Fracture Related Bladder Trauma.

    PubMed

    Myers, Jeremy B; Hotaling, James M; Brant, William O; Enniss, Toby M

    2015-03-01

    A 62-year-old male was admitted after being struck by a bus. He sustained a severe pelvic fracture, sigmoid colon injury, and both intraperitoneal and extraperitoneal bladder injury. He underwent initial successful bladder repair. However, at 7 days post-operatively he manifested a leak from the repair and urine was evident coming from the pins of his pelvic external fixator. A repeat cystogram showed massive extravasation, which was managed by operative ligation of the lower ureters and placement of percutaneous nephrostomy tubes. He underwent ureteral reconstruction and colostomy reversal at 9 months. He has both bladder and bowel control.

  3. Posterior repair with perforated porcine dermal graft.

    PubMed

    Taylor, G Bernard; Moore, Robert D; Miklos, John R; Mattox, T Fleming

    2008-01-01

    To compare postoperative vaginal incision separation and healing in patients undergoing posterior repair with perforated porcine dermal grafts with those that received grafts without perforations. Secondarily, the tensile properties of the perforated and non-perforated grafts were measured and compared. This was a non-randomized retrospective cohort analysis of women with stage II or greater rectoceles who underwent posterior repair with perforated and non-perforated porcine dermal grafts (Pelvicol(TM) CR Bard Covington, GA USA). The incidence of postoperative vaginal incision separation (dehiscence) was compared. A secondary analysis to assess graft tensile strength, suture pull out strength, and flexibility after perforation was performed using standard test method TM 0133 and ASTM bending and resistance protocols. Seventeen percent of patients (21/127) who received grafts without perforations developed vaginal incision dehiscence compared to 7% (5/71) of patients who received perforated grafts (p = 0.078). Four patients with vaginal incision dehiscence with non-perforated grafts required surgical revision to facilitate healing. Neither tensile strength or suture pull out strength were significantly different between perforated and non-perforated grafts (p = 0.81, p = 0.29, respectively). There was no difference in the flexibility of the two grafts (p = 0.20). Perforated porcine dermal grafts retain their tensile properties and are associated with fewer vaginal incision dehiscences.

  4. 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

  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.

  6. [Development and current status of perforator flaps].

    PubMed

    Xu, Dachuan; Zhang, Shimin; Tang, Maolin; Ouyang, Jun

    2011-09-01

    To provide a comprehensive review for development and existing problems of the perforator flaps. The related home and abroad literature concerning perforator flaps was extensively reviewed. The perforator flaps are defined as the axial flaps nourished solely by small cutaneous perforating vessels (perforating arteries and veins), which are exclusively composed of skin and subcutaneous fat. The perforator flaps have the advantages as follows: less injury at donor site, less damage to the contour of the donor site, good reconstruction and appearance of the recipient site flexible design, and short time of postoperative recovery, which have been widely used in reconstructive surgery. The perforator flaps are the new development of the microsurgery, which usher an era of small axial flaps; However, the controversies of the definition, vascular classification, the nomenclature, and the clinical application of the perforator flaps still exist, which are therefore the hot spot for future study.

  7. Chemoimmunotherapy of implanted murine bladder cancer.

    PubMed

    Akaza, H; Crabtree, W N; Matheny, R B; Soloway, M S

    1983-03-01

    The unaltered incidence of recurrence of superficial bladder tumor after discontinuation of intravesical chemotherapy has prompted a search for effective adjuvant therapy. The technique of cauterization and implantation of tumor cells was performed in C3H/He mice to simulate the early stage of bladder cancer to evaluate a regimen of intravesical mitomycin C followed by the systemic immunopotentiator, levamisole. Mice received either normal saline (control), mitomycin C (MMC), levamisole (Leva), or MMC plus Leva. Chemotherapy was given intravesically on days 6 and 13. Immunotherapy was given intraperitoneally on days 7 and 14. All mice were sacrificed on day 21. In the treatment groups, the incidences of bladder tumor varied from 50 to 63 per cent whereas that of the control group was 91 per cent. An increase in spleen weight was observed in the treatment groups of Leva and MMC plus Leva as well as the control group but not observed in the group receiving MMC. Our study suggests that although Leva did not reduce the tumor incidence, an immunostimulator might be of benefit when used in conjunction with MMC.

  8. Spontaneous Perforation of Gallbladder: Case Report

    PubMed Central

    Sheoran, Satish Kumar; Sahai, Rajiv Nandan; Indora, Jagmohan; Biswal, Upender Chand

    2016-01-01

    The main cause of perforation of the gallbladder is cholecystitis with or without cholelithiasis. In old age, spontaneous perforation of gallbladder can be due to decrease in its blood supply, which can be due to atherosclerosis, focal vasospasm or localized vasculitis. Perforation of gallbladder is associated with high morbidity and mortality, if left untreated. Here we report a case of a 60-year-old male with perforation of gallbladder. PMID:27785327

  9. Stercoraceous perforation of the right colon.

    PubMed

    Lalla, R; Enquist, I; Oloumi, M; Velez, F J

    1989-01-01

    We have reported a case of stercoraceous perforation of the right colon with peritonitis. Stercoraceous perforation should be considered in patients with an acute condition of the abdomen, radiologic evidence of a perforated viscus, and a long-standing history of constipation. The condition is rare and has a high mortality. The treatment of choice is always surgical.

  10. Addressing ketamine bladder syndrome.

    PubMed

    Logan, Karen

    The rise in ketamine misuse means more health professionals will need to diagnose, refer and treat ketamine bladder syndrome. Prevention and raising awareness of the problem among multidisciplinary teams will help limit damage to the bladder as well as making treatment and management more effective.

  11. Biological effects on canine bladder by Nd:YAP laser

    NASA Astrophysics Data System (ADS)

    Zhang, Hui-Guo; Zhang, Mei-Jue; Zhu, Jing

    2005-07-01

    Objective: To observe the difference of biological effects on canine bladder by Nd:YAP laser with different power and different irradiation time. Methods: The canine bladder was irradiated with different power and different irradiation time. The effects of ablation and thermal coagulation in different laser settings were observed. The damage scale was evaluated macroscopically, with microscope and with electroscope. Results: The thermal coagulation effects is mostly and ablation effects is subordinate on the canine bladder by irradiation of Nd:YAP laser on. Pathology vision shows the thermal coagulation dose on perforation is 10W、6s;20W、4s;30W、3s;40W、2s;50-60W、1s;the dose of whole audience wear through is 10W、6s 20W、4s 30W、3s;40W、2s;50-60W、1s. Conclusions: The thermal coagulation effects is mostly and ablation effects is subordinate on biological effect of Nd:YAP laser on canine bladder. The better safety dose is power 10W、duration time less than 6s; power 20W、duration time less than 4s. power 30W、time less than 3s. power 40W、time less than 2s. The ablation and thermal coagulation effects of Nd:YAP laser on canine bladder is homocercal of power and time.

  12. Fishbone-induced perforated appendicitis.

    PubMed

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

    2015-05-20

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

  13. Effects of low energy shock wave therapy on inflammatory moleculars, bladder pain, and bladder function in a rat cystitis model.

    PubMed

    Wang, Hung-Jen; Lee, Wei-Chia; Tyagi, Pradeep; Huang, Chao-Cheng; Chuang, Yao-Chi

    2017-08-01

    Low energy shock wave (LESW) is known to facilitate tissue regeneration with analgesic and anti-inflammatory effects. We examined the effects of LESW on the expression of inflammatory molecules, pain behavior, and bladder function in a rat cystitis model. Control and experimental animals were injected with saline or cyclophosphamide (CYP; 75 mg/kg intraperitoneally) on day 1 and 4. After lower midline incision, the bladders were exposed to LESW (300 pulses, 0.12 mJ/mm(2) ) or sham operation on day 2. In study 1 (N = 12, 4 for each group), the nociceptive effects of CYP were evaluated for 30 min by behavioral assessment on day 4 one hour after CYP injection. In study 2 (N = 21, 7 for each group), continuous cystometry (CMG) was performed on day 8. The bladder was harvested after behavioral assessment or CMG for histology and Western blotting. CYP-induced upregulation of COX2 and IL6 expression, caused pain behavior (eye closing and hypolocomotion), and bladder inflammation was noted on days 4 and 8 along with bladder hyperactivity. LESW treatment reduced pain behavior and downregulated the NGF expression (33.3%, P < 0.05) on day 4 and IL6 (40.9%, P < 0.05). LESW treatment suppressed bladder overactivity (intercontraction interval 77.8% increase, P < 0.05) by decreasing inflammation and COX2 (38.6%, P < 0.05) expression and NGF expression (25.2%, P = 0.0812). CYP-induced bladder pain, inflammation, and overactivity involves activation of IL6, NGF, and COX2 expression. These changes are suppressed by LESW, indicating it as a potential candidate for relieving bladder inflammatory conditions and overactivity. © 2016 Wiley Periodicals, Inc.

  14. Surgically treated perforations of the gastrointestinal tract caused by ingested foreign bodies.

    PubMed

    Rodríguez-Hermosa, J I; Codina-Cazador, A; Sirvent, J M; Martín, A; Gironès, J; Garsot, E

    2008-09-01

    Intestinal perforation due to foreign body (FB) ingestion is rare (1%). We describe our experience in treating these lesions surgically. From 1995 to 2006, data were collected prospectively in 33 patients (18 women and 15 men; mean age 64 years) operated on for intestinal perforation due to an ingested FB. The type of object, preoperative diagnosis, perforation site, treatment, morbidity and mortality were reviewed. Foreign body ingestion was predominantly involuntary (88%). The mean time from ingestion to perforation was 10.4 days. The most frequently ingested objects were dietary FB (n = 21) and toothpicks (n = 6). The most frequent predisposing factors were dentures or an orthodontic appliance (73%). The most common preoperative diagnoses were acute abdomen of uncertain origin (n = 7), acute appendicitis (n = 7) and acute diverticulitis (n = 5). Pneumoperitoneum was observed in 10 cases. The diagnosis was reached during laparotomy in 30 (91%) cases. The most frequent perforation site was the colorectal region (n = 18, 54.5%), followed by the terminal ileum (n = 7, 21.2%); intraperitoneal perforation was the most common (n = 30, 91%). All cases had abdominal contamination and 22 (66.7%) had diffuse peritonitis. Treatment was always by surgery and antibiotics. Thirteen patients required a colostomy. Morbidity was 57.6% (n = 19) and mortality 6.1% (n = 2). Intestinal perforation by a foreign body is rare and normally affects the sigmoid colon, rectum or distal ileum. Dentures are a common risk factor. Patients are rarely aware of foreign body ingestion. Dietary FB and toothpicks are the most commonly ingested objects. Treatment consists of surgery and antibiotics. Appendicitis and acute diverticulitis should be considered in the differential diagnosis.

  15. Spontaneous perforation of the common bile duct in children

    SciTech Connect

    Haller, J.O.; Condon, V.R.; Berdon, W.E.; Oh, K.S.; Price, A.P.; Bowen, A.; Cohen, H.L. )

    1989-09-01

    The authors describe radiologic findings in five patients with spontaneous perforation of the common bile duct (a rare disorder). The patients were 5 weeks, 9 weeks, 3 months, 11 months, and 2 1/2 years old at presentation. The most common presenting complaints were jaundice and abdominal distention (due to ascites). Sonographic findings included ascites in three patients, a loculated fluid collection around the gallbladder in two patients, and both in one patient. The biliary tree was undilated in all patients. Results of hepatobiliary scintigraphy definitely demonstrated that intraperitoneal fluid originated from the biliary tract. Intraoperative cholangiography was used to confirm the diagnosis at surgery. All children were successfully treated with surgery. Recognition of these findings on sonograms and subsequent confirmation with scintigraphy are important to prevent delays in diagnosis of a potentially fatal condition.

  16. Mortality after bladder augmentation in children with spina bifida.

    PubMed

    Szymanski, Konrad M; Misseri, Rosalia; Whittam, Benjamin; Adams, Cyrus M; Kirkegaard, Jordan; King, Shelly; Kaefer, Martin; Rink, Richard C; Cain, Mark P

    2015-02-01

    Renal failure has been a leading cause of death for children with spina bifida. Although improvements in management have increased survival, current data on mortality are sparse. Bladder augmentation, a modern intervention to preserve renal function, carries risks of morbidity and mortality. We determined long-term mortality and causes of death in patients with spina bifida treated with bladder augmentation. We retrospectively reviewed the records of patients with spina bifida who underwent bladder augmentation between 1979 and 2013. Those born before 1972 or older than 21 years at augmentation were excluded. Demographic and surgical data were collected. Outcomes were obtained from medical records, death records and the Social Security Death Index. Fisher exact and Wilcoxon rank-sum tests and Kaplan-Meier plots were used for analysis. Of 888 patients in our bladder reconstruction database 369 with spina bifida met inclusion criteria. Median followup was 10.8 years. A total of 28 deaths (7.6%) occurred. The leading causes of mortality were nonurological infections (ventriculoperitoneal shunt related, decubitus ulcer fasciitis, etc) and pulmonary disease. Two patients (0.5%) died of renal failure. No patient died of malignancy or bladder perforation. Patients with a ventriculoperitoneal shunt had a higher mortality rate than those without a shunt (8.9% vs 1.5%, p = 0.04). Previously reported mortality rates of 50% to 60% in patients with spina bifida do not appear to apply in children who have undergone bladder augmentation. On long-term followup leading causes of death in patients with spina bifida after bladder augmentation were nonurological infections rather than complications associated with augmentation or renal failure. Copyright © 2015 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

  17. 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

  18. Origins of Bladder Cancer.

    PubMed

    Czerniak, Bogdan; Dinney, Colin; McConkey, David

    2016-05-23

    Bladder cancer, one of the most frequently occurring human cancers, develops via two tracks referred to as papillary and nonpapillary that correspond to clinically different forms of the disease. Most bladder cancers are chemically induced, with tobacco smoking being the leading risk factor. Recent advances in bladder cancer research have enhanced our understanding of the origin of this disease from urothelial progenitor cells via field effects along papillary/luminal and nonpapillary/basal pathways. Evident from the outset of the disease, the diversity of the luminal and basal pathways, together with cell lineage tracing studies, postulates the origin of molecularly distinct subtypes from different uroprogenitor cells. The molecular mechanisms initiating field effects involve a new class of genes referred to as forerunner (FR) genes that generally map around major tumor suppressors such as RB1. These genes are silenced, predominantly by hypermethylation and less frequently by mutations, and drive the expansion of intraurothelial preneoplastic cells. Different FR genes are involved in various molecular subtypes of bladder cancer and they sensitize the uroprogenitor cells to the development of luminal and basal bladder cancers in animal models. In human bladder cancer, luminal and basal forms have dissimilar clinical behavior and response to conventional and targeted chemotherapeutic manipulations. These new research developments hold the promise of expanding our armamentarium of diagnostic and treatment options for patients with bladder cancer and improving our ability to select patients most likely to respond to a specific therapy.

  19. 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.

  20. Neonatal and pediatric esophageal perforation.

    PubMed

    Rentea, Rebecca M; St Peter, Shawn D

    2017-04-01

    Esophageal perforation (EP) is a rare complication that is often iatrogenic in origin. In contrast with adult patients in whom surgical closure of the defect is preferred, nonoperative treatment has become a common therapeutic approach for EP in neonates and children. Principles of management pediatric EP includes rapid diagnosis, appropriate hemodynamic monitoring and support, antibiotic therapy, total parenteral nutrition, control of extraluminal contamination, and restoration of luminal integrity either through time or operative approaches. Copyright © 2017 Elsevier Inc. All rights reserved.

  1. Colonic perforation in Behcet's syndrome.

    PubMed

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

    2008-11-14

    A 17-year-old gentleman was admitted to our hospital for headache, the differential diagnosis of which included Behcet'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.

  2. Specific inhibition of ICAM-1 effectively reduces bladder inflammation in a rat model of severe non-bacterial cystitis

    PubMed Central

    Zhang, Xiang; He, Hongchao; Lu, Guoliang; Xu, Tianyuan; Qin, Liang; Wang, Xianjin; Jin, Xingwei; Liu, Boke; Zhao, Zhonghua; Shen, Zhoujun; Shao, Yuan

    2016-01-01

    The development and progression of bladder pain syndrome/interstitial cystitis (BPS/IC) is closely related to bladder inflammation. Intercellular adhesion molecule 1 (ICAM-1) is associated with bladder inflammation in BPS/IC. We investigated the effect of specific inhibition of ICAM-1 using an anti-ICAM-1 antibody (AIA) on bladder inflammation in a rat model of severe non-bacterial cystitis (NBC) resembling BPS/IC by evaluating the bladder inflammation grade, mast cell infiltration and related cytokines and receptors. We also compared the effects of AIA with the COX-2 inhibitor celecoxib and the neurokinin-1 receptor (NK1R) inhibitor aprepitant. Our NBC model was established by intraperitoneal injection of cyclophosphamide combined with intravesical protamine/lipopolysaccharide, which resulted in severe bladder inflammation and increased mast cell infiltration, similar to the pathological changes of BPS/IC. Inhibition of ICAM-1 by AIA significantly decreased the bladder inflammation grade and mast cell counts, which was accompanied by a reduction of purinergic receptors (P2X2/P2X3), prostaglandin E2, EP1/EP2 receptors, TNF-α, NK1R, and ICAM-1. Moreover, AIA showed superior effects to those of celecoxib and aprepitant treatment in improving the bladder inflammatory response. Our results suggest that ICAM-1 may play a critical role in bladder inflammation in severe NBC and may be used as a novel therapeutic target in non-bacterial bladder inflammation such as BPS/IC. PMID:27782122

  3. Ultrasound: Bladder (For Parents)

    MedlinePlus

    ... bladder area and images are recorded on a computer. The black-and-white images show the internal ... the images can be seen clearly on the computer screen. A technician (sonographer) trained in ultrasound imaging ...

  4. What Is Bladder Cancer?

    MedlinePlus

    ... bladder, which is called the urothelium or transitional epithelium . As the cancer grows into or through the ... in the inner layer of cells (the transitional epithelium) but have not grown into the deeper layers. ...

  5. Ultrasound: Bladder (For Parents)

    MedlinePlus

    ... bladder area and images are recorded on a computer. The black-and-white images show the internal ... the images can be seen clearly on the computer screen. A technician (sonographer) trained in ultrasound imaging ...

  6. Bladder Diseases - Multiple Languages

    MedlinePlus

    ... Supplements Videos & Tools You Are Here: Home → Multiple Languages → All Health Topics → Bladder Diseases URL of this page: https://medlineplus.gov/languages/bladderdiseases.html Other topics A-Z Expand Section ...

  7. The medial sural artery perforator free flap.

    PubMed

    Cavadas, P C; Sanz-Giménez-Rico, J R; Gutierrez-de la Cámara, A; Navarro-Monzonís, A; Soler-Nomdedeu, S; Martínez-Soriano, F

    2001-11-01

    The medial sural artery supplies the medial gastrocnemius muscle and sends perforating branches to the skin. The possible use of these musculocutaneous perforators as the source of a perforator-based free flap was investigated in cadavers. Ten legs were dissected, and the topography of significant perforating musculocutaneous vessels on both the medial and the lateral gastrocnemius muscles was recorded. A mean of 2.2 perforators (range, 1 to 4) was noted over the medial gastrocnemius muscle, whereas in only 20 percent of the specimens was a perforator of moderate size noted over the lateral gastrocnemius muscle. The perforating vessels from the medial sural artery clustered about 9 to 18 cm from the popliteal crease. When two perforators were present (the most frequent case), the perforators were located at a mean of 11.8 cm (range, 8.5 to 15 cm) and 17 cm (range, 15 to 19 cm) from the popliteal crease. A series of six successful clinical cases is reported, including five free flaps and one pedicled flap for ipsilateral lower-leg and foot reconstruction. The dissection is somewhat tedious, but the vascular pedicle can be considerably long and of suitable caliber. Donor-site morbidity was minimal because the muscle was not included in the flap. Although the present series is short, it seems that the medial sural artery perforator flap can be a useful flap for free and pedicled transfer in lower-limb reconstruction.

  8. 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.

  9. Perforated peptic ulcer - an update

    PubMed Central

    Chung, Kin Tong; Shelat, Vishalkumar G

    2017-01-01

    Peptic ulcer disease (PUD) affects 4 million people worldwide annually. The incidence of PUD has been estimated at around 1.5% to 3%. Perforated peptic ulcer (PPU) is a serious complication of PUD and patients with PPU often present with acute abdomen that carries high risk for morbidity and mortality. The lifetime prevalence of perforation in patients with PUD is about 5%. PPU carries a mortality ranging from 1.3% to 20%. Thirty-day mortality rate reaching 20% and 90-d mortality rate of up to 30% have been reported. In this review we have summarized the current evidence on PPU to update readers. This literature review includes the most updated information such as common causes, clinical features, diagnostic methods, non-operative and operative management, post-operative complications and different scoring systems of PPU. With the advancement of medical technology, PUD can now be treated with medications instead of elective surgery. The classic triad of sudden onset of abdominal pain, tachycardia and abdominal rigidity is the hallmark of PPU. Erect chest radiograph may miss 15% of cases with air under the diaphragm in patients with bowel perforation. Early diagnosis, prompt resuscitation and urgent surgical intervention are essential to improve outcomes. Exploratory laparotomy and omental patch repair remains the gold standard. Laparoscopic surgery should be considered when expertise is available. Gastrectomy is recommended in patients with large or malignant ulcer. PMID:28138363

  10. [Management of perforative gastroduodenal ulcer].

    PubMed

    Sovtsov, S A

    2015-01-01

    To study the immediate results of surgical treatment of patients with perforative gastroduodenal ulcer. It was analyzed immediate results of surgical treatment of 646 patients with perforative gastroduodenal ulcer. Ulcer suturing predominated as surgical technique (358 patients, 55.5%), in other observations there were different types of vagotomy (215 cases, 33.3%), partial gastrectomy in 73 (11.2%) patients. In early postoperative period 36 (5.62%)patients died, incidence of complications was 6.2%. Following aspects effect on choice of surgical techbique including laoarotomy or minimally invasive approach, conventional suturing, vagotomy, partial gastrectomy: 1. presence of shock or unstable hemodynamics; 2. life-threating comorbidities (ASA class 3 and higher); 3. degree of abdominal bacterial contamination; 4. pre-hospital duration of disease; 5. dimension and type of ulcer; 6. ulcerative history or intraoperative evidence of chronic ulcer. Implementation or absolute predominance of surgery of the same type (suturing of perforative ulcer) leads to great number of poor long-term results (up to 60-70%) and requires repeated interventions.

  11. Effects of coffee and caffeine on bladder dysfunction in streptozotocin-induced diabetic rats.

    PubMed

    Yi, Chao-Ran; Wei, Zhong-Qing; Deng, Xiang-Lei; Sun, Ze-Yu; Li, Xing-Rong; Tian, Cheng-Gong

    2006-08-01

    To explore the effects and mechanisms of caffeine and coffee on bladder dysfunction in streptozotocin-induced diabetic rats. Sprague-Dawley male rats were divided randomly into 4 groups: control, diabetes mellitus (DM), DM with coffee treatment, and DM with caffeine treatment. The diabetic rat was induced by intraperitoneal injection of streptozotocin (60 mg/kg). After 7 weeks of treatment with coffee and caffeine, cystometrogram, contractile responses to electrical field stimulation (EFS) and acetylcholine (ACh), and cyclic AMP (cAMP) concentration of the bladder body and base were measured. The bladder weight, volume threshold for micturition and post-void residual volume (PVR) in the diabetic rats were significantly higher compared to those in the control animals. Coffee or caffeine treatment significantly reduced the bladder weight, bladder capacity and PVR in the diabetic rats. DM caused significant decreases in cAMP concentration of the bladder and coffee and caffeine caused upregulation of cAMP content in the diabetic bladder. In addition, coffee and caffeine tended to normalize the altered detrusor contractile responses to EFS and ACh in the diabetic rats. These results indicate that caffeine and coffee may have beneficial effects on bladder dysfunction in the early stage of diabetes by increasing cAMP content in the lower urinary tract, recovering the micturition reflex and improving the detrusor contractility.

  12. Engineering functional bladder tissues.

    PubMed

    Horst, Maya; Madduri, Srinivas; Gobet, Rita; Sulser, Tullio; Milleret, Vinzent; Hall, Heike; Atala, Anthony; Eberli, Daniel

    2013-07-01

    End stage bladder disease can seriously affect patient quality of life and often requires surgical reconstruction with bowel tissue, which is associated with numerous complications. Bioengineering of functional bladder tissue using tissue-engineering techniques could provide new functional tissues for reconstruction. In this review, we discuss the current state of this field and address different approaches to enable physiologic voiding in engineered bladder tissues in the near future. In a collaborative effort, we gathered researchers from four institutions to discuss the current state of functional bladder engineering. A MEDLINE® and PubMed® search was conducted for articles related to tissue engineering of the bladder, with special focus on the cells and biomaterials employed as well as the microenvironment, vascularisation and innervation strategies used. Over the last decade, advances in tissue engineering technology have laid the groundwork for the development of a biological substitute for bladder tissue that can support storage of urine and restore physiologic voiding. Although many researchers have been able to demonstrate the formation of engineered tissue with a structure similar to that of native bladder tissue, restoration of physiologic voiding using these constructs has never been demonstrated. The main issues hindering the development of larger contractile tissues that allow physiologic voiding include the development of correct muscle alignment, proper innervation and vascularization. Tissue engineering of a construct that will support the contractile properties that allow physiologic voiding is a complex process. The combination of smart scaffolds with controlled topography, the ability to deliver multiple trophic factors and an optimal cell source will allow for the engineering of functional bladder tissues in the near future. Copyright © 2012 John Wiley & Sons, Ltd.

  13. Neuromodulation in neurogenic bladder

    PubMed Central

    Sanford, Melissa T.

    2016-01-01

    While neuromodulation is a well-established treatment option for patients with non-neurogenic overactive bladder and urinary retention, its applicability to the neurogenic bladder population has only recently been examined more in depth. In this article we will discuss the outcomes, contraindications, and special considerations of sacral and percutaneous tibial nerve stimulation (PTNS) in patients with neurogenic lower urinary tract dysfunction. PMID:26904417

  14. [A case of Crohn's disease developing bladder rupture 4 months after laparoscopic sigmoidectomy with partial cystectomy for vesicosigmoidal fistula].

    PubMed

    Masumori, Naoya; Tanaka, Toshiaki; Takeuchi, Motoi; Ichihara, Koji; Inoue, Ryuta; Shinkai, Nobuo; Maehana, Takeshi; Mizuno, Takahiro; Tabata, Hidetoshi; Hiyama, Yoshiki; Tsukamoto, Taiji

    2012-05-01

    A 32-year-old well-nourished man having a vesicosigmoidal fistula due to Crohn's disease received laparoscopic sigmoidectomy with partial cystectomy. The bladder wall was closed with an all-layer running suture and additional interrupted sutures using 2-0 Vicryl. Four months after surgery, the suture site on the bladder showed perforation to the abdominal cavity. Since the same event occurred again 6 months after surgery, open partial cystectomy was performed to repair the perforated site 8 months after the initial surgery. The perforated site showed a thinning bladder wall composed of normal urothelium, scar tissue and thin detrusor muscle. Non-caseating granuloma was not found in the specimen, even though it was slightly observed in the margin of the detrusor muscle resected in the initial surgery. Although it was possible that the persisting activity of Crohn's disease, subclinical impaired nutrition due to Crohn's disease or insufficient suturing of the bladder wall were involved in the bladder rupture, the definitive cause remains unknown.

  15. Intravesical therapy for overactive bladder.

    PubMed

    Evans, Robert J

    2005-11-01

    Overactive bladder and urgency incontinence are common conditions generally treated with oral anticholinergic therapy. Despite the development of new antimuscarinic agents, many patients do not tolerate or fail to respond to oral therapy. Intravesical instillation therapy can provide an alternative method of managing bladder overactivity. Intravesical instillation of anticholinergics such as oxybutynin and atropine can achieve cholinergic blockade without producing systemic side effects. Botulinum A toxin injected directly into the detrusor has been shown in preliminary studies to increase bladder capacity and decrease uncontrolled bladder contractility for up to 6 months. Intravesical local anesthetics such as lidocaine and bupivacaine block the conduction of unmyelinated C fibers and when administered into the bladder, lead to an increase in functional bladder capacity. Intravesical capsaicin and resiniferatoxin also affect afferent innervation by blocking C-fiber afferents, leading to decreased bladder contractility and increased bladder capacity. Intravesical instillation therapy can provide an alternative treatment for the management of overactive bladder.

  16. Single Center Experience With Hyperthermic Intraperitoneal Chemotherapy

    PubMed Central

    Kim, Woo Ram; Hur, Hyuk; Min, Byung Soh; Baik, Seung Hyuk; Lee, Kang Young

    2017-01-01

    Purpose Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) have been proposed for controlling peritoneal seeding metastasis in some kinds of cancers, including those of colorectal origin, but their safety and oncological benefits are subjects of debate. We present our early experience with those procedures. Methods Data were retrospectively collected from all patients with peritoneal carcinomatosis (PC) and pseudomyxoma peritonei (PMP) treated using CRS and HIPEC at Yonsei Cancer Center between July 2014 and July 2015. Short-term outcomes and risk factors for postoperative complications were analyzed. Results Twenty-three patients with PC (n = 18) and PMP (n = 5) underwent CRS and HIPEC. Median follow-up and age were 2 months and 54 years, respectively. The median peritoneal carcinomatosis index score was 15, and CC0-1 was achieved in 78.3% of all patients. The median operation time and bleeding loss were 590 minutes and 570 mL, respectively. Grade-IIIa/grade-IIIb complications occurred in 4.3% (n = 1)/26.1% (n = 6) of the patients within 30 days postoperatively, and no 30-day mortalities were reported. Factors related to postoperative complications with CRS and HIPEC were number of organ resection (P = 0.013), longer operation time (P < 0.001), and amount of blood loss (P = 0.003). All patients treated with cetuximab for recurred colorectal cancer had grade-III postoperative complication. Conclusion Our initial experience with CRS and HIPEC presented about 30% grade-III postoperative complications. Therefore, expert surgeons need to perform those procedures with great caution in selected patients who might benefit from it. PMID:28289659

  17. Spontaneous Bladder Rupture Masquerading as Pseudo-diverticulum.

    PubMed

    Raghavendran, M; Kumar, Kiran G; Venugopal, A; Prasad, Shiva; Venkatesh, H A

    2017-05-01

    Spontaneous bladder rupture is rare. Presentation is non-specific and in absence of history of trauma, radiation, inflammatory conditions and other leading causes, there is considerable diagnostic delay. Absence of clear cut diagnostic signs leads to increased morbidity and mortality. In many patients, omentum seals perforation, giving diverticular appearance in Cystogram. The objective of this case report is to highlight important specific diagnostic points in history and radiology which will help in clear, early diagnosis and treatment causing immense benefit to the patient. We would also like to highlight a specific radiological point to distinguish true from pseudo-diverticulum.

  18. Comparison of Monopolar and Bipolar Transurethral Resection of Non-Muscle Invasive Bladder Cancer.

    PubMed

    Balci, Melih; Tuncel, Altug; Keten, Tanju; Guzel, Ozer; Lokman, Utku; Koseoglu, Ersin; Aslan, Yilmaz; Atan, Ali

    2017-04-06

    We aimed to compare the safety and efficacy of monopolar and bipolar transurethral resection (TUR) of bladder tumors (TURBTs). A total of 240 patients who underwent TURBT were prospectively included in the study from May 2011 to May 2014. All patients with suspected bladder tumors were eligible for study inclusion. Those who refused consent and those undergoing routine restaging TURBT were excluded from analysis. Patients were divided on the basis of the monopolar arm and the bipolar arm. Study outcomes included the incidence of bladder perforation and obturator jerk, decrease in hemoglobin and sodium levels, rates of re-coagulation and blood transfusion, TUR syndrome, and operation time. The mean age of the patients was 62 ± 13.7 years. The incidence of obturator jerk and bladder perforation was greater in the bipolar arm. However, with a decrease in the hemoglobin and sodium levels, rates of re-coagulation and blood transfusion were greater in the monopolar arm. Statistical analysis did not show significant differences with regard to study outcomes between the groups. There was no case of TUR syndrome in the 2 arms. The residual tumors' rate was similar between the 2 groups. Our results showed that efficacy and safety of the monopolar and bipolar methods seems to be comparable in patients with bladder tumors. © 2017 S. Karger AG, Basel.

  19. Traumatic injury of the bladder and urethra

    MedlinePlus

    Injury - bladder and urethra; Bruised bladder; Urethral injury; Bladder injury; Pelvic fracture; Urethral disruption ... Types of bladder injuries include: Blunt trauma (such as a blow to the body) Penetrating wounds (such as bullet or stab wounds) The ...

  20. Complete endoscopic management of a retained bullet in the bladder.

    PubMed

    Friedman, Ariella A; Trinh, Quoc-Dien; Kaul, Sanjeev; Bhandari, Akshay

    2013-01-01

    A 25-year-old male gunshot victim presented at our institution with gross hematuria following Foley catheter insertion. Computed tomography and cystogram did not show a bladder perforation, but were notable for a left ischial fracture and the presence of a bullet within the bladder. After failed attempts at retrieving the bullet with a resectoscope and loop, as well as a cystoscope and stone crusher, a 26 French nephroscope was inserted transurethrally, and the bullet was successfully engaged and removed using a Perc NCircle (Cook Medical, Bloomington, IN) grasper. The extra-peritoneal injury was managed conservatively with catheter drainage. To our knowledge, this represents the first case of successful transurethral management of a retained intravesical bullet. Such an approach may benefit patients with retained intravesical bullets or other challenging intravesical foreign bodies and may be helpful in select circumstances to spare patients from more extensive surgeries.

  1. Intraperitoneal ropivacaine nebulization for pain management after laparoscopic cholecystectomy: a comparison with intraperitoneal instillation.

    PubMed

    Bucciero, Mario; Ingelmo, Pablo M; Fumagalli, Roberto; Noll, Eric; Garbagnati, Andrea; Somaini, Marta; Joshi, Girish P; Vitale, Giovanni; Giardini, Vittorio; Diemunsch, Pierre

    2011-11-01

    Studies evaluating intraperitoneal local anesthetic instillation for pain relief after laparoscopic procedures have reported conflicting results. In this randomized, double-blind study we assessed the effects of intraperitoneal local anesthetic nebulization on pain relief after laparoscopic cholecystectomy. Patients undergoing elective laparoscopic cholecystectomy were randomly assigned to receive either instillation of ropivacaine 0.5%, 20 mL after induction of the pneumoperitoneum, or nebulization of ropivacaine 1%, 3 mL before and after surgery. Anesthetic and surgical techniques were standardized. Degree of pain at rest and on deep breathing, incidence of shoulder pain, morphine consumption, unassisted walking time, and postoperative nausea and vomiting were evaluated at 6, 24, and 48 hours after surgery. Of the 60 patients included, 3 exclusions occurred for conversion to open surgery. There were no differences between groups in pain scores or in morphine consumption. No patients in the nebulization group presented significant shoulder pain in comparison with 83% of patients in the instillation group (absolute risk reduction -83, 95% CI -97 to -70, P<0.001). Nineteen (70%) patients receiving nebulization walked without assistance within 12 hours after surgery in comparison with 14 (47%) patients receiving instillation (absolute risk reduction -24, 95% CI -48 to 1, P=0.04). One (3%) patient in the instillation group vomited in comparison with 6 (22%) patients in the nebulization group (absolute risk reduction -19%, 95% CI -36 to -2, P=0.03). Intraperitoneal ropivacaine nebulization was associated with reduced shoulder pain and unassisted walking time but with an increased incidence of postoperative vomiting after laparoscopic cholecystectomy.

  2. Assessment of Hyperthermic Intraperitoneal Chemotherapy to Eradicate Intraperitoneal Free Cancer Cells1

    PubMed Central

    Ji, Zhonghe; Sun, Jianhua; Wu, Haitao; Zhang, Qian; Peng, Kaiwen; Li, Yan

    2016-01-01

    OBJECTIVE: To assess the effect of hyperthermic intraperitoneal chemotherapy (HIPEC) to eradicate intraperitoneal free cancer cells and to explore the feasibility of cytological cure for peritoneal carcinomatosis (PC). METHODS: The peritoneal lavage fluid (or ascites) from 50 PC patients was collected before and after intraoperative HIPEC, respectively, for conventional cytology test, and conventional and real-time quantitative reverse transcript polymerase chain reaction detecting carcinoembryonic antigen (CEA) mRNA and cytokeratin-20 (CK20) mRNA. The blood samples 3 days before and 7 days after intraoperative HIPEC were also collected for detecting the serum tumor markers, including CEA, carbohydrate antigen (CA) 125, and CA19-9. RESULTS: The positive rate of conventional cytology test before HIPEC versus after HIPEC was100.0% versus 22.0% (P = .000). The positive rates of CEA mRNA and CK20 mRNA before HIPEC versus after HIPEC were 100.0% versus 86.0% (P = .012) and 100.0% versus 96.0% (P = .495), respectively. Moreover, after HIPEC, 18 (36.0%) patients had a decline in CEA mRNA (P = .000), and 17 (34.0%) patients had a decline in CK20 mRNA (P = .000). The positive rates of serum CEA, CA125, and CA199 before HIPEC versus after HIPEC were 52.0% versus 28.0% (P = .014), 52.0% versus 44.0% (P = .423), and 40.0% versus 28.0% (P = .205), respectively. CONCLUSION: HIPEC could effectively eradicate intraperitoneal free cancer cells and partially achieve cytological cure for PC. PMID:26947877

  3. Freestyle Local Perforator Flaps for Facial Reconstruction.

    PubMed

    Lee, Jun Yong; Kim, Ji Min; Kwon, Ho; Jung, Sung-No; Shim, Hyung Sup; Kim, Sang Wha

    2015-01-01

    For the successful reconstruction of facial defects, various perforator flaps have been used in single-stage surgery, where tissues are moved to adjacent defect sites. Our group successfully performed perforator flap surgery on 17 patients with small to moderate facial defects that affected the functional and aesthetic features of their faces. Of four complicated cases, three developed venous congestion, which resolved in the subacute postoperative period, and one patient with partial necrosis underwent minor revision. We reviewed the literature on freestyle perforator flaps for facial defect reconstruction and focused on English articles published in the last five years. With the advance of knowledge regarding the vascular anatomy of pedicled perforator flaps in the face, we found that some perforator flaps can improve functional and aesthetic reconstruction for the facial defects. We suggest that freestyle facial perforator flaps can serve as alternative, safe, and versatile treatment modalities for covering small to moderate facial defects.

  4. Dimensions of stabident intraosseous perforators and needles.

    PubMed

    Ramlee, R A; Whitworth, J

    2001-09-01

    Problems can be encountered inserting intraosseous injection needles through perforation sites. This in vitro study examined the variability and size compatibility of Stabident intraosseous injection components. The diameters of 40 needles and perforators from a single Stabident kit were measured in triplicate with a toolmakers microscope. One-way ANOVA revealed that mean needle diameter (0.411 mm) was significantly narrower than mean perforator diameter (0.427 mm) (p < 0.001). A frequency distribution plot revealed that needle diameter followed a normal distribution, indicating tight quality control during manufacture. The diameter of perforators was haphazardly distributed, with a clustering of 15% at the lower limit of the size range. However on no occasion was the diameter of a perforator smaller than that of an injection needle. We conclude that components of the Stabident intraosseous anaesthetic system are size-compatible, but there is greater and more haphazard variability in the diameter of perforators than injection needles.

  5. Freestyle Local Perforator Flaps for Facial Reconstruction

    PubMed Central

    Kim, Ji Min; Kwon, Ho; Jung, Sung-No; Shim, Hyung Sup; Kim, Sang Wha

    2015-01-01

    For the successful reconstruction of facial defects, various perforator flaps have been used in single-stage surgery, where tissues are moved to adjacent defect sites. Our group successfully performed perforator flap surgery on 17 patients with small to moderate facial defects that affected the functional and aesthetic features of their faces. Of four complicated cases, three developed venous congestion, which resolved in the subacute postoperative period, and one patient with partial necrosis underwent minor revision. We reviewed the literature on freestyle perforator flaps for facial defect reconstruction and focused on English articles published in the last five years. With the advance of knowledge regarding the vascular anatomy of pedicled perforator flaps in the face, we found that some perforator flaps can improve functional and aesthetic reconstruction for the facial defects. We suggest that freestyle facial perforator flaps can serve as alternative, safe, and versatile treatment modalities for covering small to moderate facial defects. PMID:26236734

  6. The Other Bladder Syndrome: Underactive Bladder

    PubMed Central

    Miyazato, Minoru; Yoshimura, Naoki; Chancellor, Michael B

    2013-01-01

    Detrusor underactivity, or underactive bladder (UAB), is defined as a contraction of reduced strength and/or duration resulting in prolonged bladder emptying and/or a failure to achieve complete bladder emptying within a normal time span. UAB can be observed in many neurologic conditions and myogenic failure. Diabetic cystopathy is the most important and inevitable disease developing from UAB, and can occur silently and early in the disease course. Careful neurologic and urodynamic examinations are necessary for the diagnosis of UAB. Proper management is focused on prevention of upper tract damage, avoidance of overdistension, and reduction of residual urine. Scheduled voiding, double voiding, al-blockers, and intermittent self-catheterization are the typical conservative treatment options. Sacral nerve stimulation may be an effective treatment option for UAB. New concepts such as stem cell therapy and neurotrophic gene therapy are being explored. Other new agents for UAB that act on prostaglandin E2 and EP2 receptors are currently under development. The pharmaceutical and biotechnology industries that have a pipeline in urology and women’s health may want to consider UAB as a potential target condition. Scientific counsel and review of the current pharmaceutical portfolio may uncover agents, including those in other therapeutic fields, that may benefit the management of UAB. PMID:23671401

  7. Abdominal CT findings in small bowel perforation.

    PubMed

    Zissin, R; Osadchy, A; Gayer, G

    2009-02-01

    Small bowel perforation is an emergent medical condition for which the diagnosis is usually not made clinically but by CT, a common imaging modality used for the diagnosis of acute abdomen. Direct CT features that suggest perforation include extraluminal air and oral contrast, which are often associated with secondary CT signs of bowel pathology. This pictorial review illustrates the CT findings of small bowel perforation caused by various clinical entities.

  8. Holmium laser transurethral resection of bladder tumor: Our experience

    PubMed Central

    D’souza, Nischith; Verma, Ashish

    2016-01-01

    Purpose: To compare the safety and efficiency of conventional monopolar and holmium laser en bloc transurethral resection of bladder tumor (CM-TURBT and HoL-EBRBT) while managing primary nonmuscle-invasive bladder cancer. Materials and Methods: From January 2012 to October 2015, fifty patients with primary nonmuscle-invasive bladder cancer underwent endoscopic surgery. Among them, 27 patients underwent CM-TURBT and 23 patients underwent HoL-EBRBT. Clinical data, included preoperative, operative, and postoperative management and follow-up, were recorded. Results: Patient demographics and tumor characteristics in both groups were compared before surgery. There was no significant difference in operative duration among the groups. Compared with the CM-TURBT group, HoL-EBRBT group had less intraoperative and postoperative complications, including obturator nerve reflex (P < 0.01), bladder perforation (P < 0.01), as well as bleeding and postoperative bladder irritation (P < 0.01). There were no significant differences among the two groups in the transfusion rate and occurrence of urethral strictures. Patients in the HoL-EBRBT group had less catheterization and hospitalization time than those in the CM-TURBT group (P < 0.01), and there were no significant differences in each risk subgroup as well as the overall recurrence rate among the CM-TURBT and HoL-EBRBT groups. Conclusions: HoL-EBRBT might prove to be preferable alternatives to CM-TURBT management of nonmuscle-invasive bladder cancer. HoL-EBRBT however did not demonstrate an obvious advantage over CM-TURBT in tumor recurrence rate. PMID:28057988

  9. Laparoscopic management of a two staged gall bladder torsion

    PubMed Central

    Sunder, Yadav Kamal; Akhilesh, Sali Priyanka; Raman, Garg; Deborshi, Sharma; Shantilal, Mehta Hitesh

    2015-01-01

    Gall bladder torsion (GBT) is a relatively uncommon entity and rarely diagnosed preoperatively. A constant factor in all occurrences of GBT is a freely mobile gall bladder due to congenital or acquired anomalies. GBT is commonly observed in elderly white females. We report a 77-year-old, Caucasian lady who was originally diagnosed as gall bladder perforation but was eventually found with a two staged torsion of the gall bladder with twisting of the Riedel’s lobe (part of tongue like projection of liver segment 4A). This together, has not been reported in literature, to the best of our knowledge. We performed laparoscopic cholecystectomy and she had an uneventful post-operative period. GBT may create a diagnostic dilemma in the context of acute cholecystitis. Timely diagnosis and intervention is necessary, with extra care while operating as the anatomy is generally distorted. The fundus first approach can be useful due to altered anatomy in the region of Calot’s triangle. Laparoscopic cholecystectomy has the benefit of early recovery. PMID:26730287

  10. Laparoscopic management of a two staged gall bladder torsion.

    PubMed

    Sunder, Yadav Kamal; Akhilesh, Sali Priyanka; Raman, Garg; Deborshi, Sharma; Shantilal, Mehta Hitesh

    2015-12-27

    Gall bladder torsion (GBT) is a relatively uncommon entity and rarely diagnosed preoperatively. A constant factor in all occurrences of GBT is a freely mobile gall bladder due to congenital or acquired anomalies. GBT is commonly observed in elderly white females. We report a 77-year-old, Caucasian lady who was originally diagnosed as gall bladder perforation but was eventually found with a two staged torsion of the gall bladder with twisting of the Riedel's lobe (part of tongue like projection of liver segment 4A). This together, has not been reported in literature, to the best of our knowledge. We performed laparoscopic cholecystectomy and she had an uneventful post-operative period. GBT may create a diagnostic dilemma in the context of acute cholecystitis. Timely diagnosis and intervention is necessary, with extra care while operating as the anatomy is generally distorted. The fundus first approach can be useful due to altered anatomy in the region of Calot's triangle. Laparoscopic cholecystectomy has the benefit of early recovery.

  11. Management of Esophageal Perforation in Adults

    PubMed Central

    Kaman, Lileswar; Iqbal, Javid; Kundil, Byju; Kochhar, Rakesh

    2010-01-01

    Perforation of esophagus in the adult is a very morbid condition with high morbidity and mortality. The ideal treatment is controversial. The main causes for esophageal perforation in adults are iatrogenic, traumatic, spontaneous and foreign bodies. The morbidity and mortality rate is directly related to the delay in diagnosis and initiation of optimum treatment. The reported mortality from treated esophageal perforation is 10% to 25%, when therapy is initiated within 24 hours of perforation, but it could rise up to 40% to 60% when the treatment is delayed beyond 48 hours. Primary closure of the perforation site and wide drainage of the mediastinum is recommended if perforation is detected in less than 24 hours. Treatment option for delayed or missed rupture of esophagus is not very clear and is controversial. Recently a substantial number of patients with esophageal perforation are being managed by nonoperative measures. Patients with small perforations and minimal extraesophageal involvement may be better managed by nonoperative treatment Major prognostic factors determining mortality are the etiology and site of the injury, the presence of underlying esophageal pathology, the delay in diagnosis and the method of treatment. For optimum outcome for management of esophageal perforations in adults a multidisciplinary approach is needed. PMID:27942303

  12. Delayed lead perforation: a disturbing trend.

    PubMed

    Khan, Mohammed N; Joseph, George; Khaykin, Yaariv; Ziada, Khaled M; Wilkoff, Bruce L

    2005-03-01

    Delayed lead perforation (occurring more than 1 month after implantation) is a rare complication. Its pathophysiology and optimal management are currently unclear. Three cases of delayed lead perforation (6-10 month) were identified in patients with low-profile active fixation leads. All cases presented in a subacute fashion with pleuritic chest pain with confirmatory chest x-ray and device interrogation. Given the potential complications of a perforated lead, all cases had the lead extracted under TEE observation with cardiac surgery backup in the operating room. All patients tolerated extraction without complication. Based on these cases, we recommend a management scheme for patients who present with delayed lead perforation.

  13. Minimally invasive treatments for perforator vein insufficiency.

    PubMed

    Kuyumcu, Gokhan; Salazar, Gloria Maria; Prabhakar, Anand M; Ganguli, Suvranu

    2016-12-01

    Incompetent superficial veins are the most common cause of lower extremity superficial venous reflux and varicose veins; however, incompetent or insufficient perforator veins are the most common cause of recurrent varicose veins after treatment, often unrecognized. Perforator vein insufficiency can result in pain, skin changes, and skin ulcers, and often merit intervention. Minimally invasive treatments have replaced traditional surgical treatments for incompetent perforator veins. Current minimally invasive treatment options include ultrasound guided sclerotherapy (USGS) and endovascular thermal ablation (EVTA) with either laser or radiofrequency energy sources. Advantages and disadvantages of each modality and knowledge on these treatments are required to adequately address perforator venous disease.

  14. Minimally invasive treatments for perforator vein insufficiency

    PubMed Central

    Salazar, Gloria Maria; Prabhakar, Anand M.; Ganguli, Suvranu

    2016-01-01

    Incompetent superficial veins are the most common cause of lower extremity superficial venous reflux and varicose veins; however, incompetent or insufficient perforator veins are the most common cause of recurrent varicose veins after treatment, often unrecognized. Perforator vein insufficiency can result in pain, skin changes, and skin ulcers, and often merit intervention. Minimally invasive treatments have replaced traditional surgical treatments for incompetent perforator veins. Current minimally invasive treatment options include ultrasound guided sclerotherapy (USGS) and endovascular thermal ablation (EVTA) with either laser or radiofrequency energy sources. Advantages and disadvantages of each modality and knowledge on these treatments are required to adequately address perforator venous disease. PMID:28123979

  15. Bladder Control and Nerve Disease

    MedlinePlus

    ... the sphincter muscles relax to allow urine to pass through the urethra as the bladder contracts to ... contract at the same time, so urine cannot pass easily. Drug therapy for an uncoordinated bladder and ...

  16. Giant Intradiverticular Bladder Tumor

    PubMed Central

    Noh, Mohamad Syafeeq Faeez Md; Aziz, Ahmad Fuad Abdul; Ghani, Khairul Asri Mohd; Siang, Christopher Lee Kheng; Yunus, Rosna; Yusof, Mubarak Mohd

    2017-01-01

    Patient: Male, 74 Final Diagnosis: Giant intradiverticular bladder tumor with metastasis Symptoms: Hematuria Medication:— Clinical Procedure: — Specialty: Urology Objective: Rare disease Background: Intradiverticular bladder tumors are rare. This renders diagnosis of an intradiverticular bladder tumor difficult. Imaging plays a vital role in achieving the diagnosis, and subsequently staging of the disease. Case Report: A 74-year-old male presented to our center with a few months history of constitutional symptoms. Upon further history, he reported hematuria two months prior to presentation, which stopped temporarily, only to recur a few days prior to coming to the hospital. The patient admitted to having lower urinary tract symptoms. However, there was no dysuria, no sandy urine, and no fever. Palpation of his abdomen revealed a vague mass at the suprapubic region, which was non tender. In view of his history and the clinical examination findings, an ultrasound of the abdomen and computed tomography (CT) was arranged. These investigations revealed a giant tumor that seemed to be arising from a bladder diverticulum, with a mass effect and hydronephrosis. He later underwent operative intervention. Conclusions: Intradiverticular bladder tumors may present a challenge to the treating physician in an atypical presentation; thus requiring a high index of suspicion and knowledge of tumor pathophysiology. As illustrated in our case, CT with its wide availability and multiplanar imaging capabilities offers a useful means for diagnosis, disease staging, operative planning, and follow-up. PMID:28246375

  17. Adenocarcinoma of the urinary bladder.

    PubMed

    Dadhania, Vipulkumar; Czerniak, Bogdan; Guo, Charles C

    2015-01-01

    Adenocarcinoma is an uncommon malignancy in the urinary bladder which may arise primarily in the bladder as well as secondarily from a number of other organs. Our aim is to provide updated information on primary and secondary bladder adenocarcinomas, with focus on pathologic features, differential diagnosis, and clinical relevance. Primary bladder adenocarcinoma exhibits several different growth patterns, including enteric, mucinous, signet-ring cell, not otherwise specified, and mixed patterns. Urachal adenocarcinoma demonstrates similar histologic features but it can be distinguished from bladder adenocarcinoma on careful pathologic examination. Secondary bladder adenocarcinomas may arise from the colorectum, prostate, endometrium, cervix and other sites. Immunohistochemical study is valuable in identifying the origin of secondary adenocarcinomas. Noninvasive neoplastic glandular lesions, adenocarcinoma in situ and villous adenoma, are frequently associated with bladder adenocarcinoma. It is also important to differentiate bladder adenocarcinoma from a number of nonneoplastic lesions in the bladder. Primary bladder adenocarcinoma has a poor prognosis largely because it is usually diagnosed at an advanced stage. Urachal adenocarcinoma shares similar histologic features with bladder adenocarcinoma, but it has a more favorable prognosis than bladder adenocarcinoma, partly due to the relative young age of patients with urachal adenocarcinoma.

  18. Adenocarcinoma of the urinary bladder

    PubMed Central

    Dadhania, Vipulkumar; Czerniak, Bogdan; Guo, Charles C

    2015-01-01

    Adenocarcinoma is an uncommon malignancy in the urinary bladder which may arise primarily in the bladder as well as secondarily from a number of other organs. Our aim is to provide updated information on primary and secondary bladder adenocarcinomas, with focus on pathologic features, differential diagnosis, and clinical relevance. Primary bladder adenocarcinoma exhibits several different growth patterns, including enteric, mucinous, signet-ring cell, not otherwise specified, and mixed patterns. Urachal adenocarcinoma demonstrates similar histologic features but it can be distinguished from bladder adenocarcinoma on careful pathologic examination. Secondary bladder adenocarcinomas may arise from the colorectum, prostate, endometrium, cervix and other sites. Immunohistochemical study is valuable in identifying the origin of secondary adenocarcinomas. Noninvasive neoplastic glandular lesions, adenocarcinoma in situ and villous adenoma, are frequently associated with bladder adenocarcinoma. It is also important to differentiate bladder adenocarcinoma from a number of nonneoplastic lesions in the bladder. Primary bladder adenocarcinoma has a poor prognosis largely because it is usually diagnosed at an advanced stage. Urachal adenocarcinoma shares similar histologic features with bladder adenocarcinoma, but it has a more favorable prognosis than bladder adenocarcinoma, partly due to the relative young age of patients with urachal adenocarcinoma. PMID:26309895

  19. Cyanoacrylate glue for type iii lad perforation.

    PubMed

    Trehan, V K; Nigam, Arima

    2008-01-01

    Coronary artery perforation especially type III is a rare and catastrophic complication of percutaneous coronary intervention. It mandates emergency open heart surgery if hemostasis is not achieved promptly. We report a case of type III left anterior descending artery (LAD) perforation which was managed successfully with cyanoacrylate glue.

  20. High power laser perforating tools and systems

    SciTech Connect

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

    2014-04-22

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

  1. 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.

  2. 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.

  3. The incidence, spectrum and outcomes of traumatic bladder injuries within the Pietermaritzburg Metropolitan Trauma Service.

    PubMed

    Urry, R J; Clarke, D L; Bruce, J L; Laing, G L

    2016-05-01

    The purpose of this study is to provide a comprehensive overview of the incidence, spectrum and outcomes of traumatic bladder injury in Pietermaritzburg, South Africa, and to identify the current optimal investigation and management of patients with traumatic bladder injuries. The Pietermaritzburg Metropolitan Trauma Service (PMTS) trauma registry was interrogated retrospectively for all traumatic bladder injuries between 1 January 2012 and 31 October 2014. Of 8129 patients treated by the PMTS over the study period, 58 patients (0.7% or 6.5 cases per 1,000,000 population per year) had bladder injuries, 65% caused by penetrating trauma and 35% by blunt trauma. The majority (60%) were intraperitoneal bladder ruptures (IBRs), followed by 22% extraperitoneal bladder ruptures (EBRs). There was a high rate of associated injury, with blunt trauma being associated with pelvic fracture and penetrating trauma being associated with rectum and small intestine injuries. The mortality rate was 5%. Most bladder injuries were diagnosed at surgery or by computed tomography (CT) scan. All IBRs were managed operatively, as well as 38% of EBRs; the remaining EBRs were managed by catheter drainage and observation. In the majority of operative repairs, the bladder was closed in two layers, and was drained with only a urethral catheter. Most patients (91%) were managed definitively by the surgeons on the trauma service. Traumatic bladder rupture caused by blunt or penetrating trauma is rare and mortality is due to associated injuries. CT scan is the investigative modality of choice. In our environment IBR is more common than EBR and requires operative management. Most EBRs can be managed non-operatively, and then require routine follow-up cystography. Simple traumatic bladder injuries can be managed definitively by trauma surgeons. A dedicated urological surgeon should be consulted for complex injuries. Copyright © 2016 Elsevier Ltd. All rights reserved.

  4. [Soil evaporation under perforated plastic mulch].

    PubMed

    Li, Yi; Wang, Quanjiu; Wang, Wenyan; Shao, Ming'an

    2005-03-01

    In arid and semiarid regions of northwestern China, where evaporation exceeds precipitation, perforated plastic mulches are widely used to decrease soil water evaporation. To determine the effects of various perforated plastic mulches on soil water evaporation after irrigation, a soil column experiment was conducted, which consisted of six mulches with different perforated rates and four levels of irrigation, and the soil water evaporation from each soil column was measured. The results showed that with 100% perforated mulch, the cumulative evaporation was 2.8-48.5 times higher than that of the control, and increased with increasing irrigation amount. There was a linear relationship between cumulative evaporation and time, which followed the Gardner's theory of bare soil evaporation. A three-factor (evaporation time, perforated rate and irrigation amount) function of cumulative evaporation and the functions of relative cumulative evaporation and cumulative evaporation per unit hole area film were established, which fitted the observed data very well.

  5. The island thoracoacromial artery muscle perforator flap.

    PubMed

    Hallock, Geoffrey G

    2011-02-01

    Descriptions of muscle perforator flaps incorporating the same skin territory of almost all known musculocutaneous flaps reflect their versatility. The pectoralis major musculocutaneous flap is a proven "workhorse" flap, especially for head and neck reconstruction. Yet, the corresponding thoracoacromial artery muscle perforator flap has been relatively overlooked, with few clinical experiences reported, presumably because of the highly variable and diminutive perforators emanating from this source vessel. However, in certain circumstances, this can be another alternative as a local muscle perforator flap for the transfer of chest skin to adjacent defects. Two clinical examples using the island thoracoacromial artery perforator flap prove that this can sometimes be a viable option also for head and neck reconstruction.

  6. 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.

  7. [Methods for sealing of corneal perforations].

    PubMed

    Samoilă, O; Totu, Lăcrămioara; Călugăru, M

    2012-01-01

    A variety of corneal pathology can lead to corneal ulcers and perforations. A deep corneal ulcer may need surgical treatment to allow good volume restoration and reepithelisation. Corneal perforation must be sealed and when the perforation is large, the task of repairing the defect can be underwhelming. The elegant solution is the corneal transplant, but this is not always readily available, especially in undeveloped countries. We present here two cases with different solutions to seal the perforated cornea: the first one has a large peripheral defect and it is successfully sealed with scleral patch and the second one is central with small perforation and is successfully sealed with multilayered amniotic membrane. Both cases are followed for over 12 months and demonstrate good corneal restoration (both on clinical examination and corneal topography). Sclera and amniotic membrane can be used to seal corneal defects when corneal transplant is not readily available.

  8. [Intraperitoneal chemotherapy in the treatment of advanced ovarian cancer].

    PubMed

    Classe, J-M; Muller, M; Frenel, J-S; Berton Rigaud, D; Ferron, G; Jaffré, I; Gladieff, L

    2010-05-01

    The standard treatment for advanced ovarian cancer consist in complete surgical debulking and intravenous platin and taxane based chemotherapy. Despite research efforts, a lot of patients still die from peritoneal carcinomatosis. The aim of our work was to present the state of art about intraperitoneal chemotherapy. Intraperitoneal chemotherapy (IPC): three multi-institutional randomised trials showed that platin based IPC gave better results in term of overall and disease free survival when compared to standard intravenous treatment. Even so, IPC is not yet becoming a new international standard of treatment because a high rate of morbidity. Hyperthermic Intraperitoneal chemotherapy (HIPEC) represents an innovative alternative to IPC. HIPEC is based on a complete surgical debulking without any visible mass and an intraperitoneal chemotherapy with synergy of hyperthermia. Phase II trails have shown its feasibility. Randomised trials are needed to assess its efficiency in improving survival. Copyright 2010 Elsevier Masson SAS. All rights reserved.

  9. Postmenopausal overactive bladder

    PubMed Central

    2014-01-01

    Bladder storage symptoms have a severe impact on many areas as regards the quality of life including health-related, social, psychological and working functions. Pharmacotherapy of lower urinary tract stores (LUTS) has been developed to optimize neural control of the lower urinary tract in pathologic states. The bladder can be overactive or underactive. Overactive bladder (OAB) is highly prevalent and is associated with considerable morbidity, especially in aging population. Therefore, an effective treatment of OAB must result in a meaningful reduction in urinary symptoms. Pharmacotherapy for the OAB must be individualized based on the degree of bother, medication side-effect profile, concomitant comorbidities and current medication regimen. Antimuscarinic agents will continue to represent the current gold standard for the first-line pharmacological management of OAB. Alternatively to antimuscarinic therapy, β3-adrenergic receptor agonists, due to their efficacy and favorable adverse event profile, are a novel and attractive option of pharmacological treatment of overactive bladder symptoms. A combination of selective antimuscarinic and β3-adrenergic receptor agonists, agents with the different mechanism of action, gives a new treatment option for the patient with OAB according to its harms profile. A number of putative novel therapeutic agents is under clinical evaluations that may ultimately provide alternative or combination treatment options for OAB in the nearest future. PMID:26327873

  10. Urinary bladder xanthomatous cystitis

    PubMed Central

    Shah, Shrenik J.; Ajitsaria, Vineet; Singh, Vineet

    2017-01-01

    Xanthoma cystitis of urinary bladder is a rare entity and may present as an intravesical mass. A 38-year-old female presented with abdominal pain and imaging was done which was suggestive of a malignant mass with surrounding tissue infiltration. Partial cystectomy was performed, and histological examination of the mass showed xanthomatous cystitis. PMID:28197037

  11. [Atlas of skin perforator arteries of trunk and limbs - guide in the realization of perforator flaps].

    PubMed

    Boucher, F; Mojallal, A

    2013-12-01

    Since Harvey, anatomists and surgeons have developed better knowledge of skin vascularization. Descriptive anatomy evolved from the direct and indirect cutaneous arteries concept to that of skin perforator arteries. These skin perforator arteries have preferential locations or clusters. An atlas of skin perforator arteries allows identifying these clusters in relation to anatomical landmarks. A literature review was undertaken in order to find the characteristics of perforator arteries originating in the source arteries described by Taylor. This research allowed us to uncover 895 citations. We have selected from this abundant literature source only the articles that specifically treated the perforator arteries localization. All the data concerning the perforator arteries localization, their source artery, the caliber and territory, were analyzed and recorded. We described the perforators that were covered most frequently. The definition of these clusters is based on a work of collecting and synthesizing of anatomical, radiological and clinical data. The preferential territories or clusters of skin perforators were defined using simple anatomical landmarks. A synthesized iconography was imagined to allow easy and fast usage of the atlas. This atlas is a learning tool that helps realizing locoregional or free perforator flaps. It can form a "winning duo" with the acoustic Doppler in preoperatory design of a perforator flap. This duo is easily available, portable, easy to use, non-invasive and inexpensive. In conclusion, the precise localization of perforator arteries associated to adherence to the big principles and definitions of the perforator flaps will allow users to better understand the surface and orientation of the skin paddle that can be taken on one perforator artery. Copyright © 2013 Elsevier Masson SAS. All rights reserved.

  12. Intestinal perforation by an ingested foreign body*

    PubMed Central

    Nicolodi, Gabriel Cleve; Trippia, Cesar Rodrigo; Caboclo, Maria Fernanda F. S.; de Castro, Francisco Gomes; Miller, Wagner Peitl; de Lima, Raphael Rodrigues; Tazima, Leandro; Geraldo, Jamylle

    2016-01-01

    Objective To identify the computed tomography findings suggestive of intestinal perforation by an ingested foreign body. Materials and Methods This was a retrospective study of four cases of surgically proven intestinal perforation by a foreign body, comparing the computed tomography findings with those described in the literature. Results None of the patients reported having ingested a foreign body, all were over 60 years of age, three of the four patients used a dental prosthesis, and all of the foreign bodies were elongated and sharp. In all four patients, there were findings indicative of acute abdomen. None of the foreign bodies were identified on conventional X-rays. The computed tomography findings suggestive of perforation were thickening of the intestinal walls (in all four cases), increased density of mesenteric fat (in all four cases), identification of the foreign body passing through the intestinal wall (in three cases), and gas in the peritoneal cavity (in one case). Conclusion In cases of foreign body ingestion, intestinal perforation is more common when the foreign body is elongated and sharp. Although patients typically do not report having ingested such foreign bodies, the scenario should be suspected in elderly individuals who use dental prostheses. A computed tomography scan can detect foreign bodies, locate perforations, and guide treatment. The findings that suggest perforation are thickening of the intestinal walls, increased mesenteric fat density, and, less frequently, gas in the peritoneal cavity, often restricted to the point of perforation. PMID:27818542

  13. Spontaneous Gastric Perforation in Two Adolescents

    PubMed Central

    Akalonu, Amaka; Yasrebi, Mona; Rios, Zarela Molle

    2016-01-01

    Case series Patients: Female, 11 • Male, 15 Final Diagnosis: Spontaneous gastric perforation Symptoms: Abdominal pain • distention • vomiting • leukocytosis Medication: — Clinical Procedure: Both patients had surgery Specialty: Gastroenterology Objective: Rare etiology Background: Spontaneous gastric perforation is a rare clinical disorder. The majority of the available data have been reported in the neonatal age group. There are a few cases of spontaneous gastric perforation in preschool children. To our knowledge, there is no published information on spontaneous gastric perforation in older children and adolescents. Case Report: We describe the presentation and clinical course of two adolescent children who presented with spontaneous gastric perforation. Both children presented with acute onset abdominal pain, which progressively worsened. In both cases, the patient were taken urgently to the operating room after imaging studies had shown pneumoperitoneum. In both cases, surgery revealed gastric perforation with no obvious etiology, specifically no ulcer, inflammation, or other pathology. Conclusions: These two cases highlight the importance of including spontaneous gastric perforation, not just the typical duodenal/gastric ulcer, in the differential of a patient with severe abdominal pain and distension, who has imaging showing pneumoperitoneum. PMID:27686129

  14. 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

  15. Cystolithotomy during robotic radical prostatectomy: Single-stage procedure for concomitant bladder stones

    PubMed Central

    Tan, Gerald Y.; Sooriakumaran, Prasanna; Peters, David L.; Srivastava, Abhishek; Tewari, Ashutosh

    2012-01-01

    Asymptomatic concomitant vesical calculi are an occasional finding on routine radiologic staging and evaluation of patients with early prostate cancer. We report the first case of single-stage robotic cystolithotomy for multiple bladder stones in a 64-year-old man undergoing robotic-assisted radical prostatectomy, and discuss the approaches available for ensuring complete stone clearance in this unique setting. We show that concomitant bladder stone extraction during robotic-assisted radical prostatectomy is feasible and does not add significantly to operative time. This technique avoids the need to undergo additional general anesthetic procedures with potential complications such as bleeding, urethral stricture formation, and bladder perforation, prior to the prostatectomy. PMID:22557729

  16. Spontaneous cholecysto-cutaneous fistula complicating carcinoma of the gall bladder: a case report.

    PubMed

    Sodhi, Kuljinder; Athar, Mohd; Kumar, Vijay; Sharma, Inder D; Husain, Nuzhat

    2012-04-01

    Most cholecystocutaneous fistulas are postoperative complications of liver and biliary tract surgery or trauma. External biliary fistulas rarely occur spontaneously as a result of intrahepatic abscess (pyogenic or parasitic), necrosis or perforation of the gallbladder, or other inflammatory process involving the biliary tree. A cholecystocutaneous fistula as a presentation of an underlying cancer arising from the gall bladder is an extremely uncommon finding. Over the past 50 years fewer than 20 cases of spontaneous cholecystocutaneous fistulas have been described in the medical literature but so far there has been no published report of a cholecystocutaneous fistula arising from adenocarcinoma of gall bladder. We here report a case of a patient presenting with spontaneous cholecystocutaneous fistula from cancer of gall bladder.

  17. 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.

  18. Transpiration effects in perforated plate aerodynamics

    NASA Astrophysics Data System (ADS)

    Szwaba, R.; Ochrymiuk, T.

    2016-10-01

    Perforated walls find a wide use as a method of flow control and effusive cooling. Experimental investigations of the gas flow past perforated plate with microholes (110μm) were carried out. The wide range of pressure at the inlet were investigated. Two distinguishable flow regimes were obtained: laminar and turbulent regime.The results are in good agreement with theory, simulations and experiments on large scale perforated plates and compressible flows in microtubules. Formulation of the transpiration law was associated with the porous plate aerodynamics properties. Using a model of transpiration flow the “aerodynamic porosity” could be determined for microholes.

  19. Perforated membrane-type acoustic metamaterials

    NASA Astrophysics Data System (ADS)

    Langfeldt, F.; Kemsies, H.; Gleine, W.; von Estorff, O.

    2017-04-01

    This letter introduces a modified design of membrane-type acoustic metamaterials (MAMs) with a ring mass and a perforation so that an airflow through the membrane is enabled. Simplified analytical investigations of the perforated MAM (PMAM) indicate that the perforation introduces a second anti-resonance, where the effective surface mass density of the PMAM is much higher than the static value. The theoretical results are validated using impedance tube measurements, indicating good agreement between the theoretical predictions and the measured data. The anti-resonances yield high low-frequency sound transmission loss values with peak values over 25 dB higher than the corresponding mass-law.

  20. Perforated granulomatous colitis caused by Histoplasma capsulatum.

    PubMed

    Lee, S H; Barnes, W G; Hodges, G R; Dixon, A

    1985-03-01

    A 57-year-old man who presented with an acute abdomen and clinically was thought to have perforated colonic diverticulitis, was found to have transmural granulomatous inflammation and perforation of colon that was caused by Histoplasma capsulatum. Although involvement of any part of the gastrointestinal tract may occur with disseminated histoplasmosis, the complication of intestinal perforation requiring emergency surgery (particularly in the colon) is extremely rare and warrants this case report with discussion of the various clinicopathologic features of gastrointestinal histoplasmosis and the occurrence of primary intestinal histoplasmosis.

  1. Abdominal drainage to prevent intra-peritoneal abscess after open appendectomy for complicated appendicitis.

    PubMed

    Cheng, Yao; Zhou, Shiyi; Zhou, Rongxing; Lu, Jiong; Wu, Sijia; Xiong, Xianze; Ye, Hui; Lin, Yixin; Wu, Taixiang; Cheng, Nansheng

    2015-02-07

    Appendectomy, the surgical removal of the appendix, is performed primarily for acute appendicitis. Patients who undergo appendectomy for complicated appendicitis, defined as gangrenous or perforated appendicitis, are more likely to suffer from postoperative complications. The routine use of abdominal drainage to reduce postoperative complications after appendectomy for complicated appendicitis is controversial. To assess the safety and efficacy of abdominal drainage to prevent intra-peritoneal abscess after open appendectomy for complicated appendicitis. We searched The Cochrane Library (Issue 1, 2014), MEDLINE (1950 to February 2014), EMBASE (1974 to February 2014), Science Citation Index Expanded (1900 to February 2014), and Chinese Biomedical Literature Database (CBM) (1978 to February 2014). We included all randomised controlled trials (RCTs) that compared abdominal drainage and no drainage in patients undergoing emergency open appendectomy for complicated appendicitis. Two review authors identified the trials for inclusion, collected the data, and assessed the risk of bias independently. We performed the meta-analyses using Review Manager 5. We calculated the risk ratio (RR) for dichotomous outcomes (or a Peto odds ratio for very rare outcomes), and the mean difference (MD) for continuous outcomes with 95% confidence intervals (CI). We included five trials involving 453 patients with complicated appendicitis who were randomised to the drainage group (n = 228) and the no drainage group (n = 225) after emergency open appendectomies. All of the trials were at a high risk of bias. There were no significant differences between the two groups in the rates of intra-peritoneal abscess or wound infection. The hospital stay was longer in the drainage group than in the no drainage group (MD 2.04 days; 95% CI 1.46 to 2.62) (34.4% increase of an 'average' hospital stay). The quality of the current evidence is very low. It is not clear whether routine abdominal drainage has

  2. Determining the effect of intraperitoneal pethidine on postoperative pain.

    PubMed

    Jahromi, S Abbas Hosseini; Valami, S Massumeh Hosseini; Yaghoubi, Siamak

    2011-02-01

    The main problem in the postoperative period is pain relief. Adequate postoperative analgesia not only leads to patient's comfort but also decreases morbidity, nursing care and time of hospitalization. Determination of the effect of intraperitoneal pethidine on postoperative pain in women scheduled for elective tubal ligation was undertaken. In a double blind clinical trial study of 60 women, ASA I, 25-45 years old, were enrolled for elective tubal ligation in Kosar hospital in Qazvin, IRAN. Patients were randomly divided in two equal groups (30 each).One group received pethidine intraperitoneally and the other group received equal amount of placebo in the same region. The intensity of postoperative pain was evaluated by visual analogue scale (VAS) for about 8 hours. Incidence of nausea was also evaluated. Data was transformed to SPSS software. Then data analysis was performed by U-test. There was no significant statistical difference with regard to age, weight, and time of operation between the two groups. The mean score of pain was significantly lower in intraperitoneal pethidine group than placebo group but the incidence of nausea in the intraperitoneal pethidine group was more than in placebo group (P < 0.05). Thus, intraperitoneal pethidine decreases postoperative pain but increases postoperative nausea.

  3. Murine bladder wall biomechanics following partial bladder obstruction.

    PubMed

    Chen, Joseph; Drzewiecki, Beth A; Merryman, W David; Pope, John C

    2013-10-18

    Evaluation of bladder wall mechanical behavior is important in understanding the functional changes that occur in response to pathologic processes such as partial bladder outlet obstruction (pBOO). In the murine model, the traditional approach of cystometry to describe bladder compliance can prove difficult secondary to small bladder capacity and surgical exposure of the bladder. Here, we explore an alternative technique to characterize murine mechanical properties by applying biaxial mechanical stretch to murine bladders that had undergone pBOO. 5-6 week old female C57/Bl6 mice were ovariectomized and subjected to pBOO via an open surgical urethral ligation and sacrificed after 4 weeks (n=12). Age matched controls (n=6) were also analyzed. Bladders were separated based on phenotype of fibrotic (n=6) or distended (n=6) at the time of harvest. Biaxial testing was performed in modified Kreb's solution at 37°C. Tissue was preconditioned to 10 cycles and mechanical response was evaluated by comparing axial strain at 50kPa. The normal murine bladders exhibited anisotropy and were stiffer in the longitudinal direction. All mice showed a loss of anisotropy after 4 weeks of pBOO. The two phenotypes observed after pBOO, fibrotic and distended, exhibited less and more extensibility, respectively. These proof-of-principle data demonstrate that pBOO creates quantifiable changes in the mechanics of the murine bladder that can be effectively quantified with biaxial testing.

  4. Delayed jejunal perforation after laparoscopic cholecystectomy

    PubMed Central

    Browne, Ikennah L.; Dixon, Elijah

    2016-01-01

    Bowel perforation is a rare complication of laparoscopic cholecystectomy, which if left undiagnosed can have fatal consequences. In addition, isolated small bowel perforation is extremely rare and should be considered in patients presenting with sudden onset abdominal pain in the postoperative period. A 57-year-old male with symptomatic gallstones underwent urgent laparoscopic cholecystectomy and was discharged home on postoperative day (POD) 1 without complications. He presented to the emergency department on POD 11 complaining of sudden onset abdominal pain. A CT scan did not confirm a diagnosis and he was admitted for observation. On post admission day 2, he became significantly peritonitic and laparotomy revealed jejunal perforation. Bowel resection with hand-sewn anastomosis was completed and he was discharged on POD 10. Follow-up at 6 weeks revealed no further issues. We review the literature on small bowel perforation post laparoscopic cholecystectomy. PMID:26908534

  5. Esophageal perforation after fiberoptic variceal sclerotherapy.

    PubMed

    Perino, L E; Gholson, C F; Goff, J S

    1987-06-01

    Our experience and review of the literature suggests that perforation follows fiberoptic sclerotherapy at an incidence of 1-6% per patient. Perforation is delayed for 2-14 days after the procedure and is due to chemical necrosis of the esophageal wall. The risk of perforation is higher in Child's class C patients. The use of large volumes or high concentrations of sclerosant may increase the risk of perforation. To reduce this risk, we suggest a cautious approach to Child's class C patients, with no more than two sclerosis sessions during the first 2 weeks of treatment using less than or equal to 10 ml of 1.5% sodium tetradecyl sulfate per session.

  6. Successful endoscopic hemoclipping of an esophageal perforation.

    PubMed

    Sung, H Y; Kim, J I; Cheung, D Y; Cho, S H; Park, S-H; Han, J-Y; Kim, J K; Han, S W; Choi, K Y; Chung, I S

    2007-01-01

    We describe a case of esophageal perforation that resulted from a fishbone. A 71-year-old man had had a fishbone impacted in the lower esophagus for 2 days. At presentation, the bone was dislodged at endoscopy; one round opening in a deep ulceration was detected when the fishbone was removed. The perforation was closed by endoscopic hemoclipping, after the removal of the fishbone. A thoracic computed tomography revealed air around the esophagus, aorta and bronchus and the presence of a pleural effusion. These findings suggested mediastinal emphysema and mediastinitis due to the esophageal perforation after the removal of the fishbone. Esophagography revealed a focal esophageal defect and linear contrast leakage at the distal esophagus. The mediastinal emphysema and pleural effusion successfully resolved after the endoscopic hemoclip application and conservative management of the perforation.

  7. Endoscopic Management of Bladder Diverticula

    PubMed Central

    Pham, Khanh N.; Jeldres, Claudio; Hefty, Thomas; Corman, John M.

    2016-01-01

    A 50-year-old man with benign prostatic hyperplasia and urinary retention had a very large diverticulum on the posterior wall of the bladder. The patient was managed with transurethral resection of the prostate and endoscopic fulguration of the bladder diverticulum mucosa using the Orandi technique. There was near-complete resolution of the bladder diverticulum following endoscopic management, obviating the need for bladder diverticulectomy. The patient now empties his bladder, with a postvoid residual < 50 mL and the absence of urinary tract infection after 6-month follow-up. We report the successful treatment of a large bladder diverticulum with endoscopic fulguration to near-complete resolution. This minimally invasive technique is a useful alternative in patients unfit for a more extensive surgical approach. PMID:27601971

  8. Innovation in Bladder Cancer Immunotherapy.

    PubMed

    Grossman, H Barton; Lamm, Donald L; Kamat, Ashish M; Keefe, Stephen; Taylor, John A; Ingersoll, Molly A

    2016-10-01

    Bladder cancer is understudied despite its high prevalence and its remarkable response to immunotherapy. Indeed, funding for studies to explore mechanisms of tumor immunity and novel new therapeutics is disproportionately lower for bladder cancer in comparison with malignancies of the breast, prostate, or lung. However, the recent successes of checkpoint blockade therapy suggest that new therapeutic strategies are on the horizon for bladder cancer. Here, we give a perspective into the evolution of bladder cancer therapy, focusing on strategies to treat high-risk nonmuscle invasive disease, followed by a discussion of recent advances in the treatment of muscle invasive bladder cancer and their potential applicability to lower stage disease. Finally, we explore immunotherapeutic strategies, which have been demonstrated to be successful in the treatment of other malignancies, for their potential to treat and cure patients with nonmuscle and muscle invasive bladder cancer.

  9. Contemporary Management of Bladder Cancer

    PubMed Central

    Bell, David; Fradet, Yves

    1991-01-01

    Bladder cancer is currently the fifth most common cancer in Western society, and its incidence appears to be increasing. Important advances have recently occurred in both diagnostic and therapeutic approaches to bladder neoplasms. Presentation is not unique, and physician awareness is important to identify patients who are at risk for bladder neoplasia and consequently require further investigation. A diagnostic approach and contemporary management are discussed. ImagesFigure 1Figure 4 PMID:21229043

  10. Effects of electroacupuncture combined with bladder training on the bladder function of patients with neurogenic bladder after spinal cord injury

    PubMed Central

    Xia, Li-Ping; Fan, Fan; Tang, Ai-Ling; Ye, Wen-Qin

    2014-01-01

    Neurogenic bladder is a common complication of spinal cord injury and results in urinary bladder dysfunction through lost control of micturition, or urination. Although several treatment options exist, the efficacies of many of these treatments are unknown. In particular, electroacupuncture and bladder training have had some success as individual treatments. The aim of this study was to explore effects of electroacupuncture combined with bladder training on bladder function of patients with neurogenic bladder after spinal cord injury (SCI) above the sacral segment. Forty-two patients with neurogenic bladder after SCI were evenly divided into two groups (n=21) and given only bladder function training (control group) or electroacupuncture combined with bladder function training (treatment group). Urodynamic changes, IPSS score, and therapeutic efficacy were compared between groups pre- and post-treatment. After either treatment, patients had higher bladder volume and bladder compliance, but lower residual urine volume, bladder pressure, rectal pressure, and detrusor pressure, compared to pre-treatment (P<0.05). Compared to controls, treatment group patients had significantly increased bladder volume and bladder compliance, but significantly decreased residual urine volume, bladder pressure, rectal pressure, and detrusor pressure (P<0.05). Treatment group patients had lower IPSS scores post-treatment (P<0.05) and better therapeutic efficacy (P<0.05) than control group patients. Altogether, our results suggest that electroacupuncture combined with bladder function training can clinically improve bladder function of patients with neurogenic bladder after SCI above the sacral segment. PMID:24995093

  11. Modeling nasal physiology changes due to septal perforations.

    PubMed

    Cannon, Daniel E; Frank, Dennis O; Kimbell, Julia S; Poetker, David M; Rhee, John S

    2013-03-01

    To use computational fluid dynamics (CFD) technology to help providers understand (1) how septal perforations may alter nasal physiology and (2) how these alterations are influenced by perforation size and location. Computer simulation study. Facial plastic and reconstructive surgery clinic. With the aid of medical imaging and modeling software, septal perforations of 1 and 2 cm in anterior, posterior, and superior locations were virtually created in a nasal cavity digital model. The CFD techniques were used to analyze airflow, nasal resistance, air conditioning, and wall shear stress. Bilateral nasal resistance was not significantly altered by a septal perforation. Airflow allocation changed, with more air flowing through the lower-resistance nasal cavity. This effect was greater for anterior and posterior perforations than for the superior location. At the perforation sites, there was less localized heat and moisture flux and wall shear stress in superior perforations compared with those in anterior or posterior locations. For anterior perforations, a larger size produced higher wall shear and velocity, whereas in posterior perforations, a smaller size produced higher wall shear and velocity. Septal perforations may alter nasal physiology. In the subject studied, airflow allocation to each side was changed as air was shunted through the perforation to the lower-resistance nasal cavity. Anterior and posterior perforations caused larger effects than those in a superior location. Increasing the size of anterior perforations and decreasing the size of posterior perforations enhanced alterations in wall shear and velocity at the perforation.

  12. Mucosal perforators from the facial artery.

    PubMed

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

    2014-07-01

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

  13. Ventriculoperitoneal shunt perforations of the gastrointestinal tract.

    PubMed

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

    2015-07-01

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

  14. Biliary Stent Migration with Duodenal Perforation

    PubMed Central

    Yaprak, Muhittin; Mesci, Ayhan; Colak, Taner; Yildirim, Bulent

    2008-01-01

    Intestinal perforation from a migrated biliary stent is a known complication of endoscopic biliary stent placement. We present a case of stent migration and resultant duodenal perforation after stent placement for a malignant biliary stricture in a 52-year-old woman. We review the current literature on the diagnosis and management of stent migration and intestinal perforation after endoscopic stent placement for biliary strictures. A plain abdominal radiograph is necessary for early diagnosis of biliary stent migration. If a stent becomes lodged in the gastrointestinal tract, endoscopic or operative extraction of the stent is necessary to prevent subsequent intestinal perforation and peritonitis. Intestinal perforation secondary to biliary stent dislocation should be considered in all patients presenting with fever and abdominal pain after biliary stent insertion. Any abnormality that prevents stent migration through the intestinal tract such as gastroenterostomy, abdominal wall hernia, extensive adhesions or colonic divertucula may be a contraindication for insertion of a plastic biliary stent because of increased perforation risk. PMID:25610053

  15. [Diet in bladder cancer ethiopathogenesis].

    PubMed

    Radosavljević, V; Ilić, M; Janković, S; Djokić, M

    2005-01-01

    The aim of this paper is to show influence of different foods on bladder cancer appearance, as well as possible consequent ways of prevention. Consuption of food rich in animal fat and cholesterol, fried foods, especially several times used cookin oil for frying, processed meat with additives (nitrates, nitrites, azo-colourrs) can influence bladder cancer occurrence. Regularly, continous consumption of fermented milk products, which contains come types of milky--acids bacterias, is considered as protective factor in developing bladder cancer. Reports that fruit and vegetable are protective food items are pretty consistent. Data about mineral intake and bladder cancer are obscure.

  16. Regional but fatal: Intraperitoneal metastasis in gastric cancer

    PubMed Central

    Wei, Jia; Wu, Nan-Die; Liu, Bao-Rui

    2016-01-01

    Peritoneal carcinomatosis appears to be the most common pattern of metastasis or recurrence and is associated with poor prognosis in gastric cancer patients. Many efforts have been made to improve the survival in patients with peritoneal metastasis. Hyperthermic intraperitoneal chemotherapy remains a widely accepted strategy in the treatment of peritoneal dissemination. Several phase II-III studies confirmed that the combined cytoreducitve surgery and hyperthermic intraperitoneal chemotherapy resulted in longer survival in patients with peritoneal carcinomatosis. In addition, proper selection and effective regional treatment in patients with high risk of peritoneal recurrence after resection will further improve prognosis in local advanced gastric cancer patients. PMID:27672270

  17. Evidence for bladder urothelial pathophysiology in functional bladder disorders.

    PubMed

    Keay, Susan K; Birder, Lori A; Chai, Toby C

    2014-01-01

    Understanding of the role of urothelium in regulating bladder function is continuing to evolve. While the urothelium is thought to function primarily as a barrier for preventing injurious substances and microorganisms from gaining access to bladder stroma and upper urinary tract, studies indicate it may also function in cell signaling events relating to voiding function. This review highlights urothelial abnormalities in bladder pain syndrome/interstitial cystitis (BPS/IC), feline interstitial cystitis (FIC), and nonneurogenic idiopathic overactive bladder (OAB). These bladder conditions are typified by lower urinary tract symptoms including urinary frequency, urgency, urgency incontinence, nocturia, and bladder discomfort or pain. Urothelial tissues and cells from affected clinical subjects and asymptomatic controls have been compared for expression of proteins and mRNA. Animal models have also been used to probe urothelial responses to injuries of the urothelium, urethra, or central nervous system, and transgenic techniques are being used to test specific urothelial abnormalities on bladder function. BPS/IC, FIC, and OAB appear to share some common pathophysiology including increased purinergic, TRPV1, and muscarinic signaling, increased urothelial permeability, and aberrant urothelial differentiation. One challenge is to determine which of several abnormally regulated signaling pathways is most important for mediating bladder dysfunction in these syndromes, with a goal of treating these conditions by targeting specific pathophysiology.

  18. Perforation of the terminal ileum induced by blast injury: delayed diagnosis or delayed perforation?

    PubMed

    Paran, H; Neufeld, D; Shwartz, I; Kidron, D; Susmallian, S; Mayo, A; Dayan, K; Vider, I; Sivak, G; Freund, U

    1996-03-01

    Blast injuries are rare, and although blast-induced perforations of the bowel have been described in the past, the entity of a delayed perforation caused by an evolving injury has not been reported. We report three men injured by the explosion of a terrorist bombing in open air. They suffered primary blast injuries, which resulted in isolated perforations of the terminal ileum. They were operated at different times after the blast event. The resected specimens were examined under light microscopy. One patient was operated immediately, and had three perforations in the terminal ileum. In the other two patients, abdominal complaints appeared only 24 and 48 hours later. These two patients were found to have hematomas in the wall of the terminal ileum, and small perforations therein, with almost no contamination of the peritoneal cavity. On histological examination, there were small perforations with disruption of all intestinal layers. In the vicinity of the perforations, the mucosa was necrotic and disorganized. The submucosa showed edema and vascular thrombi, and at several points mucus was shown dissecting through the muscularis propria, thus creating minute microperforations. Because of the findings in these patients, we suggest a mechanism of evolving damage to the bowel wall and delayed perforation rather than delayed diagnosis, after blast injuries. We suggest that patients exposed to a significant blast should be watched carefully for at least 48 hours.

  19. Coronary perforation and covered stents: an update and review.

    PubMed

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

    2011-04-01

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

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

    PubMed

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

    2015-03-01

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

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

    PubMed Central

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

    2011-01-01

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

  2. Complete and partial uterine perforation and embedding following insertion of intrauterine devices. II. Diagnostic methods, prevention, and management.

    PubMed

    Zakin, D; Stern, W Z; Rosenblatt, R

    1981-08-01

    This paper discusses the various methods used to diagnose uterine perforation caused by an IUD. Radiography, or plain film, has a limited use in the diagnosis of uterine perforation since its usefulness depends on the radiopacity of the particular IUD; if the IUD appears on film, plain film does not allow one to conclude whether the device is in its proper position. Several modifications of plain film have been tried but all methods fall short of their goals. Hysterography permits the best diagnostic assessment since it allows the visualization of the entire uterine cavity so that the position of the IUD is immediately evident in cases of embedding and of perforation. Pelvic pneumography can differentiate between intraperitoneal or extraperitoneal locations of perforated IUDs; it can be enhanced by hysterosalpingography and can be done on an ambulatory basis. Ultrasonography simply determines the presence or absence of an IUD, but has the advantage of accurately demonstrating a concomitant pregnancy; the sonogram is not reliable if the IUD is surrounded by omentum or by loops of bowel; ultrasonography can be advantageously coupled with hysterography. Laparoscopy is still the method most used to diagnose uterine IUD perforation; when removal of the device is advisable laparotomy is usually carried out concomitantly; successful laparoscopy requires a skilled and experienced operator. Hysteroscopy is a new and extremely valuable technique which should not be chosen as a primary procedure because it carries a risk of complications. The best prevention of uterine perforation is a meticulous and well executed insertion technique, done only by an experienced operator and after a careful pelvic examination. Uterine size, consistency and position must be exactly known; IUD insertion is easier during or immediately after menstruation. Perforated IUDs should be removed even if considered innocuous, although this is a matter still debated by the specialists. Spontaneous IUD

  3. Intraperitoneal chemotherapy (IPC) for peritoneal carcinomatosis: review of animal models.

    PubMed

    Gremonprez, Félix; Willaert, Wouter; Ceelen, Wim

    2014-02-01

    The development of suitable animal models is essential to experimental research on intraperitoneal chemotherapy (IPC). This review of the English literature (MEDLINE) presents a detailed analysis of current animal models and gives recommendations for future experimental research. Special consideration should be given to cytotoxic drug dose and concentration, tumor models, and outcome parameters.

  4. Anesthesia with Intraperitoneal Propofol, Medetomidine, and Fentanyl in Rats

    PubMed Central

    Alves, Heber Nuno Castro; da Silva, Aura Luísa Maia; Olsson, Ingrid Anna S; Orden, José Manuel Gonzalo; Antunes, Luis Marques

    2010-01-01

    A safe and reliable method for anesthetizing rats has long been a leading concern of biomedical researchers. We recently found that the intraperitoneal administration of propofol combined with medetomidine and fentanyl is safe for mouse anesthesia. Here we studied whether the same combination could be used for general anesthesia in rats. We used male Wistar rats to test 10 combinations of propofol, medetomidine, and fentanyl administered intraperitoneally and reversed with intraperitoneal atipamezole 30 min after induction. The depth of anesthesia, induction time, loss of pedal withdrawal reflex, pulse rate, and respiratory rate were evaluated, along with the duration and quality of induction, surgical anesthesia, and recovery. The combination of propofol and medetomidine provided a predictable induction and sufficient hypnosis and muscle relaxation, but surgical anesthesia (loss of pedal withdrawal reflex) was difficult to achieve with this protocol. The addition of fentanyl increased analgesia, making it possible to achieve surgical anesthesia. In conclusion, combination of propofol (100 mg/kg), medetomidine (0.1 mg/kg), and fentanyl (0.1 mg/kg) is a safe and practical technique for intraperitoneal anesthesia in rats, providing a surgical window of 25 min and restraint for 30 min, with rapid recovery after administration of atipamezole. PMID:20819392

  5. Clipping prevents perforation in large, flat polyps

    PubMed Central

    Luba, Daniel; Raphael, Mona; Zimmerman, Dayna; Luba, Joseph; Detka, Jon; DiSario, James

    2017-01-01

    AIM To determine if prophylactic clipping of post-polypectomy endoscopic mucosal resection (EMR) mucosal defects of large, flat, right sided polyps prevents perforations. METHODS IRB approved review of all colonoscopies, and prospective data collection of grasp and snare EMR performed by 2 endoscopists between January 1, 2010 and March 31, 2014 in a community ambulatory endoscopy center. The study consisted of two phases. In the first phase, all right-sided, flat polyps greater than or equal to 1.2 cm in size were removed using the grasp and snare technique. Clipping was done at the discretion of the endoscopist. In the second phase, all mucosal defects were closed using resolution clips. Phase 2 of the study was powered to detect a statistically significant difference in perforation rate with 148 EMRs, if less than or equal to 2 perforations occurred. RESULTS In phase 1 of the study, 2121 colonoscopies were performed. Seventy-five patients had 95 large polyps removed. There were 4 perforations in 95 polypectomies (4.2%). The perforations occurred in polyps ranging in size from 1.5 cm to 2.5 cm. In phase 2, there were 2464 colonoscopies performed. One hundred and sixteen patients had 151 large polyps removed, and all mucosal defects were clipped. There were no perforations (P = 0.0016). There were no post-polypectomy hemorrhages in either phase. An average of 2.15 clips were required to close the mucosal defects. The median time to perform the polypectomy and clipping was 13 min, and the median procedure duration was 40 min. Five percent of all patients undergoing colonoscopy in our community based, ambulatory endoscopy center had flat, right sided polyps greater than or equal to 1.2 cm in size. CONCLUSION Prophylactic clipping of the mucosal resection defect of large, right-sided, flat polyps reduces the incidence of perforation. PMID:28360975

  6. A case of perforated sigmoid diverticulitis in which gram staining of ascitic fluid was useful for diagnosis.

    PubMed

    Tsuchida, Junko; Fujita, Shouhei; Kawano, Fumihiro; Tsukamoto, Ryoichi; Honjo, Kunpei; Naito, Shigetoshi; Ishiyama, Shun; Miyano, Shozo; Machida, Michio; Kitabatake, Toshiaki; Fujisawa, Minoru; Kojima, Kuniaki; Ogura, Kanako; Matsumoto, Toshiharu

    2014-01-01

    An 85-year-old woman was admitted to our hospital for steroid therapy for relapsing nephrotic syndrome. During hospitalization, she complained of sudden epigastric pain at night. Although there were signs of peritoneal irritation, CT showed a large amount of ascitic fluid, but no free intraperitoneal gas. Gram staining of ascitic fluid obtained by abdominal paracentesis showed Gram-negative rods, which raised a strong suspicion of gastrointestinal perforation and peritonitis. Therefore, emergency surgery was performed. Exploration of the colon showed multiple sigmoid diverticula, one of which was perforated. The patient underwent an emergency Hartmann's procedure. Imaging studies failed to reveal any evidence of gastrointestinal perforation, presenting a diagnostic challenge. However, a physician performed rapid Gram staining of ascitic fluid at night when laboratory technicians were absent, had a strong suspicion of gastrointestinal perforation, and performed emergency surgery. Gram staining is superior in rapidity, and ascitic fluid Gram staining can aid in diagnosis, suggesting that it should be actively performed. We report this case, with a review of the literature on the significance of rapid diagnosis by Gram staining.

  7. Immunotherapy for bladder cancer

    PubMed Central

    Fuge, Oliver; Vasdev, Nikhil; Allchorne, Paula; Green, James SA

    2015-01-01

    It is nearly 40 years since Bacillus Calmette–Guérin (BCG) was first used as an immunotherapy to treat superficial bladder cancer. Despite its limitations, to date it has not been surpassed by any other treatment. As a better understanding of its mechanism of action and the clinical response to it have evolved, some of the questions around optimal dosing and treatment protocols have been answered. However, its potential for toxicity and failure to produce the desired clinical effect in a significant cohort of patients presents an ongoing challenge to clinicians and researchers alike. This review summarizes the evidence behind the established mechanism of action of BCG in bladder cancer, highlighting the extensive array of immune molecules that have been implicated in its action. The clinical aspects of BCG are discussed, including its role in reducing recurrence and progression, the optimal treatment regime, toxicity and, in light of new evidence, whether or not there is a superior BCG strain. The problems of toxicity and non-responders to BCG have led to development of new techniques aimed at addressing these pitfalls. The progress made in the laboratory has led to the identification of novel targets for the development of new immunotherapies. This includes the potential augmentation of BCG with various immune factors through to techniques avoiding the use of BCG altogether; for example, using interferon-activated mononuclear cells, BCG cell wall, or BCG cell wall skeleton. The potential role of gene, virus, or photodynamic therapy as an alternative to BCG is also reviewed. Recent interest in the immune check point system has led to the development of monoclonal antibodies against proteins involved in this pathway. Early findings suggest benefit in metastatic disease, although the role in superficial bladder cancer remains unclear. PMID:26000263

  8. Medical management of overactive bladder

    PubMed Central

    Ubee, Sarvpreet S.; Manikandan, Ramaswamy; Singh, Gurpreet

    2010-01-01

    Overactive bladder (OAB), as defined by the International Continence Society, is characterized by a symptom complex including urinary urgency with or without urge incontinence, usually associated with frequency and nocturia. OAB syndrome has an incidence reported from six European countries ranging between 12-17%, while in the United States; a study conducted by the National Overactive Bladder Evaluation program found the incidence at 17%. In Asia, the prevalence of OAB is reported at 53.1%. In about 75%, OAB symptoms are due to idiopathic detrusor activity; neurological disease, bladder outflow obstruction (BOO) intrinsic bladder pathology and other chronic pelvic floor disorders are implicated in the others. OAB can be diagnosed easily and managed effectively with both non-pharmacological and pharmacological therapies. The first-line treatments are lifestyle interventions, bladder training, pelvic floor muscle exercises and anticholinergic drugs. Antimuscarinics are the drug class of choice for OAB symptoms; with proven efficacy, and adverse event profiles that differ somewhat. PMID:20877608

  9. Simple cyst of urinary bladder.

    PubMed

    Bo, Yang

    2014-07-01

    Simple cysts are rare in the urinary bladder and can pose a diagnostic dilemma to both the urologist and the histopathologist. No case study was found in the database of Elsevier Science Direct, Spring-Link, or PubMed. We present two cases of subserous cyst in the bladder and discuss the diagnosis and treatment of the condition. The cystic lesion at bladder dome was detected by radiologic examination and confirmed by cystoscopy. In case 1, transurethral resection was first performed which was followed by partial cystectomy; In case 2, the cyst was removed with the urachus using laparoscopic surgery. The patients recovered uneventfully and the histopathology showed cysts in subserous layer of urinary bladder. The bladder cyst should be distinguished from urachal tumor, and laparoscopic partial cystectomy is the preferred operative procedure.

  10. Feasibility of photoacoustic evaluations on dual-thermal treatment of ex vivo bladder tumors.

    PubMed

    Nguyen, Van Phuc; Oh, Junghwan; Park, Suhyun; Wook Kang, Hyun

    2017-04-01

    A variety of thermal therapeutic methods have been investigated to treat bladder tumors but often cause bowel injury and bladder wall perforation due to high treatment dosage and limited clinical margins. The objective of the current study is to develop a dual-thermal modality to deeply coagulate the bladder tumors at low thermal dosage and to evaluate therapeutic outcomes with high contrast photoacoustic imaging (PAI). High intensity focused ultrasound (HIFU) is combined with 532 nm laser light to enhance therapeutic depth during thermal treatments on artificial tumor-injected bladder tissue ex vivo. PAI is employed to identify the margins of the tumors pre- and post-treatments. The dual-thermal modality achieves 3- and 1.8-fold higher transient temperature changes and 2.2- and 1.5-fold deeper tissue denaturation than laser and HIFU, respectively. PAI vividly identifies the position of the injected tumor and entails approximately 7.9 times higher image contrast from the coagulated tumor as that from the untreated tumor. Spectroscopic analysis exhibits that both 740 nm and 760 nm attains the maximum photoacoustic amplitudes from the treated areas. The proposed PAI-guided dual-thermal treatments (laser and HIFU) treatments can be a feasible therapeutic modality to treat bladder tumors in a controlled and efficient manner. © 2017 Wiley-VCH Verlag GmbH & Co. KGaA, Weinheim.

  11. Colonoscopic Perforation in Inflammatory Bowel Disease

    PubMed Central

    Makkar, Rohit

    2013-01-01

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

  12. Basic Perforator Flap Hemodynamic Mathematical Model.

    PubMed

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

    2016-05-01

    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. 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. 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. 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.

  13. Perforation of Meckel's diverticulum with enteroliths.

    PubMed

    Nishikawa, Takeshi; Takei, Yoshiki; Tsuno, Nelson H; Maeda, Mamoru

    2012-08-01

    Perforation of Meckel's diverticulum with enteroliths is a rare complication. Here, we report a case of perforation of Meckel's diverticulum with enteroliths, which could be accurately diagnosed by the preoperative computed tomography (CT). A 46-year-old man with acute onset of severe abdominal pain, and a localized muscle guarding in the right hypochondrium, had a solitary stone detected in the right abdomen by the radiography. The abdominal CT revealed a saclike outpouching of the small intestine, containing air/fluid levels and an enterolith, with surrounding free air and mesenteric inflammatory change in the right paraumbilical area. He was diagnosed as the perforation of Meckel's diverticulum with enterolith, and the emergency operation was indicated. The perforated Meckel's diverticulum was identified approximately 90 cm proximal to the ileocecal valve. The diverticulum was transected at the base, and removed. The patient's postoperative course was uneventful. This case strongly suggested the ability of CT enterography to accurately diagnose pathologies involving the small intestine, such as the perforation of Meckel's diverticulum, which open premises for its use in the diagnosis of acute abdomen preoperatively.

  14. Ruptured hepatic abscess mimicking perforated viscus.

    PubMed

    Lai, Yen-Chun; Su, Yu-Jang; Chang, Wen-Han

    2008-11-01

    In the majority of pneumoperitoneum cases we diagnose perforated viscus. We present herein a case of ruptured hepatic abscess mimicking perforated viscus. A 40-year-old man presented to the emergency room with fever and right upper quadrant abdominal pain. The fever had been on/off for a period of 1 month. On physical examination, diffuse abdominal pain with rebounding tenderness was noted. Blood tests showed leukocytosis with left shift, hyperglycemia, and elevated liver function tests. A chest X-ray showed a subdiaphragmatic region air-fluid level, indicating a hepatic abscess. Pneumoperitoneum was also seen. Owing to the status of peritonitis, computed tomography (CT) of the abdomen was performed and revealed an air-containing liver abscess in the right lobe of the liver. Perforation of a hollow organ was also suspected because of the pneumoperitoneum. An emergent laparotomy was immediately performed for the suspicion of a hollow organ perforation. No perforation of the hollow viscus was found. The ruptured hepatic abscess was attributed to the pneumoperitoneum. A blood culture grew Klebsiella pneumoniae four days later, and the same organism was also found in a surgical specimen culture of the abscess. For a ruptured hepatic abscess, surgical intervention with draining of the abscess and cleaning of the abdominal cavity are essential to save patient lives.

  15. Proliposomal Intravesical Paclitaxel for Treatment of Low-Grade, Stage Ta, Non Muscle Invasive Bladder Cancer

    ClinicalTrials.gov

    2017-03-16

    Bladder Cancer Cell Transitional; Non-Muscle Invasive Bladder Cancer; Bladder Cancer; Urinary Bladder; Transitional Cell Carcinoma of the Bladder; Urinary Bladder Neoplasms; Urologic Neoplasms; Urogenital Neoplasms; Urinary Bladder Diseases; Urologic Diseases

  16. Chemoprevention of bladder cancer.

    PubMed

    Kamat, Ashish M; Lamm, Donald L

    2002-02-01

    The data presented herein, although highly supportive for a protective role of various nutrients against bladder cancer, are far from definitive. Many authorities question the validity of current recommendations for nutritional chemoprevention against bladder cancer. The reason for the wide variations reported in epidemiologic studies lies in the nature of observational studies. Dietary studies are limited in their conclusions because the protection afforded by the consumption of a particular nutrient may be multifactorial, with different components of the food exerting potential chemopreventive effects. Furthermore, measuring levels of nutrients in the food intake of populations is confounded by factors that might affect these levels and also the incidence of cancer. For example, vitamin A can come from animal or vegetarian sources. Because animal fat has been identified as a potential carcinogen in man, depending on the source of the vitamin, varying levels of protection might be deduced. In addition, chemoprevention studies using dietary supplements are expected to have mild effects, and large studies would be required to confirm statistical significance. Even with agents such as intravesical chemotherapy, only half the studies achieve statistical significance [29]. Prospective randomized trials with a large sample size, longer follow-up, and an extended duration of treatment are needed to clarify the association between micronutrients and cancer protection. With these caveats in mind, several recommendations can be made. Simple measures, such as drinking more fluids (especially water), can have a profound impact on the incidence of bladder cancer. Vitamins are being extensively studied in chemopreventive trials for different cancers. There is strong evidence for a chemoprotective effect of vitamin A in bladder cancer. The authors recommend 32,000 IU/day of vitamin A initially, with lower doses (24,000 IU) for persons less than 50 kg. Because liver toxicity is a

  17. Obturator Nerve Block in Transurethral Resection of Bladder Tumor: A Comparative Study by two Techniques

    PubMed Central

    Sharma, Deepak; Singh, V. P.; Agarwal, Nidhi; Malhotra, M. K.

    2017-01-01

    Context: Sparing of obturator nerve is a common problem encountered during transurethral resection of bladder tumor (TURBT) under spinal anesthesia. Aims: To evaluate and compare obturator nerve block (ONB) by two different techniques during TURBT. Settings and Design: This is prospective observational study. Subjects and Methods: Forty adult male patients from the American Society of Anesthesiologists Class I–IV planned to undergo TURBT under spinal anesthesia were divided into two groups of twenty each. In one group, ONB was performed with nerve locator. In other group, transvesical nerve block was performed with a cystoscope. The primary endpoints of this study were the occurrence of adductor reflex, ability to resect the tumor, and number of surgical interruptions. A number of transfusions required and bladder perforation were the secondary endpoints. Results: There was statistically significant difference between the groups for resection without adductor jerk, resection with a minimal jerk, and unresectable with high-intensity adductor jerk. Bleeding was observed in both groups and one bladder perforation was encountered. Conclusions: We conclude that ONB, when administered along with spinal anesthesia for TURBT, is extremely safe and effective method of anesthesia to overcome adductor contraction. ONB with nerve locator appears to be more effective method compared to the transvesical nerve block. PMID:28298765

  18. Progress in management of typhoid perforation.

    PubMed

    Ukwenya, A Y; Ahmed, A; Garba, E S

    2011-01-01

    Case fatality rate (CFR) for typhoid perforation (TP) has been on gradual but variable decline world wide. This review highlights the progress in management of TP from 1960 including the controversies, current principles of management and the advances associated with the best results of treatment. This is a review of publications on TP from 1960 to 2010 principally from Medline and Ovid databases. Main search terms used are typhoid and perforation. The median CFR by decade was estimated from studies that reported CFR. With advances in surgery and supportive care, median CFR for TP declined from over 50% in 1960 to single digits in the last decade in some countries but with West Africa lagging behind at 16%. Variations in CFR are attributed to differences in perforation-operation interval and quality of care. Opportunities now exist for patients with TP to recover from the disease but priority remains with prevention of enteric fever in endemic areas.

  19. Perforated peptic ulcer in an adolescent girl.

    PubMed

    Schwartz, Shepard; Edden, Yair; Orkin, Boris; Erlichman, Matityahu

    2012-07-01

    A perforated peptic ulcer in a child is a rare entity. Severe abdominal pain in an ill-appearing child with a rigid abdomen and possibly with signs of shock is the typical presenting feature of this life-threatening complication of peptic ulcer disease. We present a case of a 14.5-year-old adolescent girl who developed abdominal and shoulder pain that resolved after 1 day. She was then completely well for 2 days until the abdominal and shoulder pain recurred. On examination, she appeared well, but in pain. A chest radiograph revealed a large pneumoperitoneum. She underwent emergent laparoscopic omental patch repair of a perforated ulcer on the anterior wall of her stomach. Result of a urea breath test to detect Helicobacter pylori was negative. The differential diagnosis of pneumoperitoneum in children is discussed, as are childhood perforated peptic ulcer in general, and the unique clinical features present in this case in particular.

  20. Traumatic Forefoot Reconstructions With Free Perforator Flaps.

    PubMed

    Zhu, Yue-Liang; He, Xiao-Qing; Wang, Yi; Lv, Qian; Fan, Xin-Yv; Xu, Yong-Qing

    2015-01-01

    The forefoot is critical to normal walking; thus, any reconstruction of forefoot defects, including the soft tissues, must be carefully done. The free perforator flap, with its physiologic circulation, lower donor site morbidity, and minimal thickness is the most popular technique in plastic and microsurgery, and is theoretically the most suitable for such forefoot reconstruction. However, these flaps are generally recognized as more difficult and time-consuming to create than other flaps. In 41 patients with traumatic forefoot defects, we reconstructed the forefoot integument using 5 types of free perforator flaps. The overall functional and cosmetic outcomes were excellent. Three flaps required repeat exploration; one survived. The most common complications were insufficient perfusion and the need for second debulking. The key to our success was thoroughly debriding devitalized bone and soft tissue before attaching the flap. Forefoot reconstruction with a free perforator flap provides better function, better cosmesis, better weightbearing, and better gait than the other flaps we have used.

  1. [Soft tissue defects treated with perforator flaps].

    PubMed

    Weum, Sven; de Weerd, Louis; Klein, Steven; Hage, J Joris

    2008-01-31

    Treatment of soft tissue defects caused by trauma, tumour surgery or pressure sores is a challenge to the reconstructive surgeon. Although contour and function may be restored by tissue transposition, traditional methods often cause significant donor site morbidity. This article describes how increased understanding of vascular anatomy has led to the development of new techniques. The article is based on textbooks of plastic surgery, selected articles and own clinical experience. Pedicled and free perforator flaps represent the latest development in surgical treatment of soft tissue defects. The use of perforator flaps can considerably reduce the disadvantages that are associated with other surgical methods. The use of perforator flaps demands microsurgical skills, but has many advantages. Reliable vascular supply and a good aesthetical result can be combined with minimal donor site morbidity. In many cases this technique may even give sensibility to the reconstructed area.

  2. Gastric Perforation by Ingested Rabbit Bone Fragment.

    PubMed

    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.

  3. 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

  4. Fast track pathway for perforated appendicitis.

    PubMed

    Frazee, Richard; Abernathy, Stephen; Davis, Matthew; Isbell, Travis; Regner, Justin; Smith, Randall

    2017-04-01

    Perforated appendicitis is associated with an increased morbidity and length of stay. "Fast track" protocols have demonstrated success in shortening hospitalization without increasing morbidity for a variety of surgical processes. This study evaluates a fast track pathway for perforated appendicitis. In 2013, a treatment pathway for perforated appendicitis was adopted by the Acute Care Surgery Service for patients having surgical management of perforated appendicitis. Interval appendectomy was excluded. Patients were treated initially with intravenous antibiotics and transitioned to oral antibiotics and dismissed when medically stable and tolerating oral intake. A retrospective review of patients managed on the fast track pathway was undertaken to analyze length of stay, morbidity, and readmissions. Thirty-four males and twenty-one females with an average age of 46.8 years underwent laparoscopic appendectomy for perforated appendicitis between January 2013 and December 2014. Pre-existing comorbidities included hypertension 42%, diabetes mellitus 11%, COPD 5% and heart disease 2%. No patient had conversion to open appendectomy. Average length of stay was 2.67 days and ranged from 1 to 12 days (median 2 days). Postoperative morbidity was 20% and included abscess (6 patients), prolonged ileus (3 patients), pneumonia (1 patient), and congestive heart failure (1 patient). Five patients were readmitted for abscess (3 patients), congestive heart failure (1 patient), and pneumonia (1 patient). A fast track pathway for perforated appendicitis produced shorter length of stay and acceptable postoperative morbidity and readmission. This offers the potential for significant cost savings over current national practice patterns. Copyright © 2016 Elsevier Inc. All rights reserved.

  5. The management of perforated gastric ulcers.

    PubMed

    Leeman, Matthew Fraser; Skouras, Christos; Paterson-Brown, Simon

    2013-01-01

    Perforated gastric ulcers are potentially complicated surgical emergencies and appropriate early management is essential in order to avoid subsequent problems including unnecessary gastrectomy. The aim of this study was to examine the management and outcome of patients with gastric ulcer perforation undergoing emergency laparotomy for peritonitis. Patients undergoing laparotomy at the Royal Infirmary of Edinburgh for perforated gastric ulcers were identified from the prospectively maintained Lothian Surgical Audit (LSA) database over the five-year period 2007-2011. Additional data were obtained by review of electronic records and review of case notes. Forty-four patients (25 male, 19 female) were identified. Procedures performed were: 41 omental patch repairs (91%), 2 simple closures (4.5%) and 2 distal gastrectomies (4.5%; both for large perforations). Four perforated gastric tumours were identified (8.8%), 2 of which were suspected intra-operatively and confirmed histologically, 1 had unexpected positive histology and 1 had negative intra-operative histology, but follow-up endoscopy confirmed the presence of carcinoma (1 positive biopsy in 21 follow-up endoscopies); all 4 were managed without initial resection. Median length of stay was 10 days (range 4-68). Overall 7 patients died in hospital (15.9%) and there were 21 morbidities (54.5%). Registrars performed the majority of the procedures (16 alone, 21 supervised) with no significant difference in post-operative morbidity (P = 0.098) or mortality (P = 0.855), compared to consultants. Almost all perforated gastric ulcers can be effectively managed by laparotomy and omental patch repair. Initial biopsy and follow-up endoscopy with repeat biopsy is essential to avoid missing an underlying malignancy. Copyright © 2013 Surgical Associates Ltd. Published by Elsevier Ltd. All rights reserved.

  6. Endoscopic endoluminal vacuum therapy in esophageal perforation.

    PubMed

    Heits, Nils; Stapel, Leonie; Reichert, Benedikt; Schafmayer, Clemens; Schniewind, Bodo; Becker, Thomas; Hampe, Jochen; Egberts, Jan-Hendrik

    2014-03-01

    Esophageal perforation is a serious disease with a high morbidity and mortality rate. Endoscopic vacuum therapy (EVT) is a new endoscopic treatment option, which is used to treat anastomotic leakages after rectal and esophageal resections. We report on 10 patients treated with EVT for esophageal perforation. Clinical and therapy-related data such as age, sex, duration of intensive care stay, length of hospital stay, reasons for perforation, EVT-associated complications, mortality, need for alternative treatment options, and course of infectious variables were analyzed. Ten patients were treated with 54 vacuum sponges that were placed in upper gastrointestinal defects. Causes for perforation were iatrogenic, spontaneous, or foreign body-associated. Mean number of sponge insertions was 5.4 (range, 2 to 12) with a mean period of 19 ± 14.26 days. Successful therapy was achieved in 9 of 10 patients. After successful primary treatment, 1 patient died during therapy as a result of general failure of the cardiovascular system. In 1 patient, surgical resection was necessary after repeated Mallory-Weiss lesions and minor perforations during the course of immunosuppressive therapy. In a third patient an endoscopic stent was inserted in the clean wound cavity after primary EVT. In this small trial EVT has been shown to be a safe and feasible therapy option for perforations of the upper gastrointestinal tract. If necessary, EVT can be combined with operative revision for better control of the local septic focus or used as a bridging procedure for wound conditioning before aggressive surgical treatment. Copyright © 2014 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  7. [Drug therapy of bladder dysfunction].

    PubMed

    Caremel, R; Cornu, J-N; Kerdraon, J; Castel-Lacanal, E; Bastide, C; Bruyere, F; Guy, L; Karsenty, G

    2013-11-01

    To describe drugs targeting urinary bladder to treat bladder dysfunctions such as OAB, NDO and bladder pain syndrome. Pubmed search for efficacy, mode of action and side effects for each molecule. Additional data were searched from the French regulatory agencies web sites (HAS and ANSM). Anticholinergics antimuscarinics remain the first-line treatment option for both OAB and NDO. Beta-3 adrenergics emerges as a new therapeutic class for OAB. Post approval safety as well as association with other micturition cycle's drugs need to be evaluated. Phosphodiesterase 5 inhibitors are effective to treat BPH-related LUTS including storage symptoms. Botulinum toxin type A injections within the detrusor are effective and approved to treat NDO in MS and spinal cord injured patients voiding with clean intermittent catheterization. Evaluation of such approach to treat OAB is ongoing. Drug therapy for bladder pain syndrome has limited efficacy including pentosan polyphosphate despite it has a temporary autorisation. There is no drug treatment to restore or improve bladder contraction. Armamenterium to treat bladder dysfunction has recently increased. Three new therapeutic classes emerged. Careful post approval evaluation is mandatory and study of these drugs' combination is expected. Results should drive changes in bladder dysfunction treatment algorithms. Copyright © 2013. Published by Elsevier Masson SAS.

  8. Teloscopy after bladder neck suspension.

    PubMed

    Shoemaker, E S; Wilkinson, P D

    1998-08-01

    Teloscopy, a method of suprapubic cystoscopy, involves placing a telescope into the dome of a full bladder to examine the bladder interior. A 5-mm Dexide cannula was pierced through the dome of the bladder and a telescope was inserted through it. This specialized cannula sleeve maintained bladder distention and allowed an excellent wide-angle view of the interior of the bladder and ureteral orifices. In a retrospective analysis, 103 consecutive women with stress urinary incontinence who underwent retropubic urethropexy were placed into one of three categories: Burch laparotomy (13), Burch laparoscopy (44), or laparoscopy with mesh and staples (46). Teloscopy was performed and indigo carmine was given intravenously at the end of the procedure in 90 patients. Of these, seven (8%) were positive. In all seven a suture was seen through the bladder mucosa, and in five an additional obstructed ureter was observed. In all seven women the suture was removed and replaced, and all obstructed ureters were patent before the end of the procedure. Average time required was 4 minutes. No complications, short- or long-term, occurred in the 90 women. Our results support the view that cystoscopy should be performed at the end of bladder neck suspension.

  9. Bladder Injury During Cesarean Delivery

    PubMed Central

    Tarney, Christopher M.

    2013-01-01

    Cesarean section is the most common surgery performed in the United States with over 30% of deliveries occurring via this route. This number is likely to increase given decreasing rates of vaginal birth after cesarean section (VBAC) and primary cesarean delivery on maternal request, which carries the inherent risk for intraoperative complications. Urologic injury is the most common injury at the time of either obstetric or gynecologic surgery, with the bladder being the most frequent organ damaged. Risk factors for bladder injury during cesarean section include previous cesarean delivery, adhesions, emergent cesarean delivery, and cesarean section performed at the time of the second stage of labor. Fortunately, most bladder injuries are recognized at the time of surgery, which is important, as quick recognition and repair are associated with a significant reduction in patient mortality. Although cesarean delivery is a cornerstone of obstetrics, there is a paucity of data in the literature either supporting or refuting specific techniques that are performed today. There is evidence to support double-layer closure of the hysterotomy, the routine use of adhesive barriers, and performing a Pfannenstiel skin incision versus a vertical midline subumbilical incision to decrease the risk for bladder injury during cesarean section. There is also no evidence that supports the creation of a bladder flap, although routinely performed during cesarean section, as a method to reduce the risk of bladder injury. Finally, more research is needed to determine if indwelling catheterization, exteriorization of the uterus, and methods to extend hysterotomy incision lead to bladder injury. PMID:24876830

  10. 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.

  11. Laser skin perforator with focal point detection

    NASA Astrophysics Data System (ADS)

    Ponce, L.; Arronte, M.; Cabrera, J. L.; Flores, T.

    2006-02-01

    The development of laser skin perforator device for obtaining blood samples is presented. The use of photoelectric proximity photoelectric sensor permits to determine the focal point eliminating any contact and them avoiding the risk of contamination. Perforation of about 0.2 mm - 0.5 mm in diameter can be obtained in order to take the sample of blood. The method permits to make the blood analysis not only avoiding the contamination risk but also diminishing the pain sensation in comparison with metal lancet.

  12. Pneumoperitoneum Secondary to Spontaneously Perforated Pyometra

    PubMed Central

    2017-01-01

    Pyometra, by definition, is a collection of purulent fluid within the uterine cavity. Incidence has been estimated to range from 0.1% to 0.5%. Typically, this is linked to postmenopausal women; however, it has been linked to premenopausal women with concordant use of intrauterine devices. Based on our knowledge, there have been less than 50 recorded cases reported in the English literature regarding perforation of pyometra resulting in acute abdomen and fewer than 25 resulting in pneumoperitoneum. We report a patient who was evaluated for diffuse peritonitis caused by perforated pyometra who was successfully treated with surgical intervention. PMID:28357145

  13. Tissue adhesives: new perspectives in corneal perforations.

    PubMed

    Hirst, L W; Stark, W J; Jensen, A D

    1979-03-01

    In corneal perforations associated with extensive progressive corneal disease, a technique using tissue adhesive closure of the perforation site and reformation of the anterior chamber before penetrating keratoplasty or conjunctival flap mobilization has been described. Over the past year, six eyes have been successfully treated in this manner. This method allows reformation of the eye under local anesthesia as an emergency procedure without incarceration or injury of the intraocular contents and without pain to the patient. The definitive surgical procedure can then be performed safely under retrobulbar anesthesia.

  14. 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.

  15. Clinical evaluation of cyanoacrylate glue in corneal perforations.

    PubMed

    Bansal, D C; Sandhu, P S; Khosla, A D

    1987-01-01

    Our experience of the use of Cyanoacrylate glue in 50 cases of perforation or impending perforation of cornea has been presented. The method of application has been described. Quite encouraging and useful results have been obtained.

  16. Intraperitoneal radiolabeled OC 125 in patients with advanced ovarian cancer

    SciTech Connect

    Finkler, N.J.; Muto, M.G.; Kassis, A.I.; Weadock, K.; Tumeh, S.S.; Zurawski, V.R. Jr.; Knapp, R.C. )

    1989-09-01

    Twenty patients with recurrent or persistent epithelial ovarian cancer failing conventional therapies were treated with a single intraperitoneal injection of iodine-131-labeled OC 125 monoclonal antibody. Rare acute side effects were nausea and mild diarrhea. At doses up to 120 mCi of iodine-131, median white blood cell and platelet count nadirs were 3.6k/microliters and 187k/microliters, respectively. Two patients acquired thyroid toxicities despite thyroid blockage with cold iodine. One patient had transient TSH elevation while remaining clinically euthyroid, and 1 patient developed activation of a thyroid nodule and clinical hyperthyroidism. Dose-limiting toxicity has not yet been observed. Twelve of 20 patients are alive 3 to 17 months following therapy. Tumor progression was noted in the majority of patients, although 3 patients had documented decreases in tumor burden of short duration. We conclude that, at the doses examined, iodine-131 OC 125 can be safely administered intraperitoneally.

  17. Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy for Malignant Peritoneal Mesothelioma

    PubMed Central

    Blackham, Aaron U.; Levine, Edward A.

    2013-01-01

    Malignant peritoneal mesothelioma (MPM) is a rare and aggressive neoplasm that is largely resistant to traditional anti-cancer therapies. For years it has been considered a terminal condition and once diagnosed, patients generally survived less than a year despite aggressive treatment. Although rare, the worldwide incidence of MPM continues to rise, in part due to its association with asbestos exposure. Patients usually present with non-specific symptoms of abdominal distension and pain making the diagnosis challenging. In recent years, aggressive cytoreductive surgery with the administration of hyperthermic intraperitoneal chemotherapy (HIPEC) has improved survival in patients with MPM treated at multiple centers worldwide. This review article briefly highlights the presentation, diagnosis, and natural history of MPM. We then explore the available treatment options with primary focus on cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. PMID:24039630

  18. [Activity of digestive enzymes during intraperitoneal intake of metal compounds].

    PubMed

    Zdol'nik, T D

    2001-01-01

    Digestive function was studied when three compounds from Group VIB of the Mendeleev periodic system of elements were intraperitoneally administered during 100 days. Potassium bichromate, ammonium molybdate in a dose of 0.2 mg/kg and sodium tungstate in a dose of 5.0 mg/kg (in terms of metal) were found to have a resorptive effect on pancreatic function and a local effect on the small intestinal mucosa.

  19. Intraperitoneal Local Anesthetic in Pediatric Surgery: A Systematic Review.

    PubMed

    Hamill, James K; Rahiri, Jamie-Lee; Liley, Andrew; Hill, Andrew G

    2016-12-01

    Introduction Systematic reviews report intraperitoneal local anesthetic (IPLA) effective in adults but until now no review has addressed IPLA in children. The objective of this review was to answer the question, does IPLA compared with control reduce pain after pediatric abdominal surgery. Materials and Methods Data sources: MEDLINE, EMBASE, Cochrane databases, trials registries, ProQuest, Web of Science, Google Scholar, and Open Gray.

  20. Learning curve in cytoreductive surgery and hyperthermic intraperitoneal chemotherapy.

    PubMed

    Moradi, Bijan N; Esquivel, Jesus

    2009-09-15

    Cytoreductive surgery and Hyperthermic Intraperitoneal Chemotherapy have achieved good long-term results in patients with complete surgical eradication of their peritoneal dissemination but at the expense of significant perioperative morbidity and mortality. The high complication rate has been attributed to the steep learning curve associated with this procedure. We report on the current literature regarding the learning curve for this procedure and the key components that determine the success in learning this new skill.

  1. Postoperative Gastric Perforation in a Newborn with Duodenal Atresia

    PubMed Central

    Antabak, Anko; Bogović, Marko; Vuković, Jurica; Grizelj, Ruža; Babić, Vinka Barbarić; Papeš, Dino; Luetić, Tomislav

    2016-01-01

    Gastric perforation (GP) in neonates is a rare entity with high mortality. Although the etiology is not completely understood, it mostly occurs in premature neonates on assisted ventilation. Combination of duodenal atresia and gastric perforation is very rare. We present a case duodenal atresia who developed gastric perforation after operetion for duodenal atresia. Analysis of the patient medical record and histology report did not reveal the etiology of the perforation. PMID:27896170

  2. Bladder Capacity is a Biomarker for a Bladder Centric versus Systemic Manifestation in Interstitial Cystitis/Bladder Pain Syndrome.

    PubMed

    Walker, Stephen J; Zambon, João; Andersson, Karl-Erik; Langefeld, Carl D; Matthews, Catherine A; Badlani, Gopal; Bowman, Heather; Evans, Robert J

    2017-02-12

    Interstitial cystitis/bladder pain syndrome presents a significant clinical challenge due to symptom heterogeneity and the myriad associated comorbid medical conditions. We recently reported that diminished bladder capacity may represent a specific interstitial cystitis/bladder pain syndrome subphenotype. The objective of this study was to investigate the relationship between anesthetic bladder capacity, and urological and nonurological clinical findings in a cohort of patients with interstitial cystitis/bladder pain syndrome who had undergone therapeutic urinary bladder hydrodistention. This is a retrospective chart review of prospectively collected data on women diagnosed with interstitial cystitis/bladder pain syndrome between 2011 and 2015 who underwent bladder hydrodistention. Assessments in each patient included a detailed history and physical examination, ICPI (Interstitial Cystitis Problem Index), ICSI (Interstitial Cystitis Symptom Index) and PUF (Pelvic Pain and Urgency/Frequency Patient Symptom Scale). Bladder capacity was determined during bladder hydrodistention with the patient under general anesthesia. Mean age was 45.8 years and mean bladder capacity was 857 ml in the 110 enrolled patients. We found a significant inverse correlation between bladder capacity and scores on 3 gold standard interstitial cystitis/bladder pain syndrome metrics, including ICPI (p = 0.0014), ICSI (p = 0.0022) and PUF (p = 0.0009) as well as urination frequency (p = 0.0025). Women with higher bladder capacity were significantly more likely to report depression (p = 0.0059) and irritable bowel syndrome (p = 0.022). Low bladder capacity while under anesthesia was significantly associated with high symptom scores on 3 validated interstitial cystitis/bladder pain syndrome questionnaires as well as with urinary frequency. However, it was not associated with depression or other common systemic pain problems. These results suggest that low bladder capacity is a marker for a bladder

  3. Bladder Diverticulitis: A Case Report

    PubMed Central

    Silberman, Michael; Jeanmonod, Rebecca

    2011-01-01

    Bladder diverticulum, an outpouching of the mucosa through the muscular wall of the bladder, is a multifactorial disease process that can be either acquired or congenital. Although small diverticuli are usually asymptomatic, a large diverticulum may result in hematuria, urinary tract infection, acute abdomen due to its rupture, acute urinary retention, or neoplasm formation. We describe the case of an elderly gentleman who presented to the emergency department with abdominal pain and was ultimately diagnosed with bladder diverticulitis, a disease not previously described in the literature. PMID:23326691

  4. Underactive Bladder in Older Adults.

    PubMed

    Chuang, Yao-Chi; Plata, Mauricio; Lamb, Laura E; Chancellor, Michael B

    2015-11-01

    Overactive bladder is one of the most common bladder problems, but an estimated 20 million Americans have underactive bladder (UAB), which makes going to the bathroom difficult, increases the risk of urinary tract infections, and even leads to institutionalization. This article provides an overview of UAB in older adults, and discusses the prevalence, predisposing factors, cause, clinical investigations, and treatments. At present, there is no effective therapy for UAB. A great deal of work still needs to be done on understanding the pathogenesis and the development of effective therapies.

  5. Bladder diverticulitis: a case report.

    PubMed

    Silberman, Michael; Jeanmonod, Rebecca

    2011-01-01

    Bladder diverticulum, an outpouching of the mucosa through the muscular wall of the bladder, is a multifactorial disease process that can be either acquired or congenital. Although small diverticuli are usually asymptomatic, a large diverticulum may result in hematuria, urinary tract infection, acute abdomen due to its rupture, acute urinary retention, or neoplasm formation. We describe the case of an elderly gentleman who presented to the emergency department with abdominal pain and was ultimately diagnosed with bladder diverticulitis, a disease not previously described in the literature.

  6. Increased bladder permeability in interstitial cystitis/painful bladder syndrome

    PubMed Central

    Greenwood-Van Meerveld, Beverley; Wisniewski, Amy B.; VanGordon, Samuel; Lin, HsuehKung; Kropp, Bradley P.; Towner, Rheal A.

    2015-01-01

    The definition of interstitial cystitis (IC) has evolved over the years from being a well-defined entity characterized by diagnostic lesion (Hunner’s ulcer) in the urothelium to a clinical diagnosis by exclusion [painful bladder syndrome (PBS)]. Although the etiology is unknown, a central theme has been an association with increased permeability of the bladder. This article reviews the evidence for increased permeability being important to the symptoms of interstitial cystitis/painful bladder syndrome (IC/PBS) and in treating the disorder. Recent work showing cross-communication among visceral organs is also reviewed to provide a basis for understanding IC/PBS as a systemic disorder of a complex, interconnected system consisting of the bladder, bowel and other organs, nerves, cytokine-responding cells and the nervous system. PMID:26751576

  7. Ketamine Analog Methoxetamine Induced Inflammation and Dysfunction of Bladder in Rats

    PubMed Central

    Wang, Qiang; Wu, Qinghui; Wang, Junpeng; Chen, Yang; Zhang, Guihao; Chen, Jiawei; Zhao, Jie; Wu, Peng

    2017-01-01

    The novel synthetic psychoactive ketamine analog methoxetamine is reportedly being used for recreational purposes. As ketamine use can result in urinary dysfunction, we conducted the present study to investigate how methoxetamine affects the bladder. A cystometry investigation showed that female Sprague-Dawley rats experienced increased micturition frequency bladder dysfunction after receiving a daily intraperitoneal injection of 30 mg/kg methoxetamine or ketamine for periods of 4 or 12 weeks. Histologic examinations of rat bladder tissue revealed damaged urothelium barriers, as well as evidence of inflammatory cell infiltration and matrix deposition. The drug-treated rats showed significantly upregulated levels of pro-inflammatory cytokines such as IL-1β, IL-6, CCL-2, CXCL-1, CXCL-10, NGF, and COX-2. In addition, interstitial fibrosis was confirmed by increased levels of collagen I, collagen III, fibronectin and TGF-β. Besides direct toxic effect on human urothelial cells, methoxetaminealso induced the upregulation related cytokines. Our results indicate that long term methoxetamine treatment can induce bladder dysfunction and inflammation in rats. Methoxetamine was confirmed to produce direct toxic and pro-inflammatory effects on human urothelial cells. Methoxetamine-associated bladder impairment may be similar to ketamine-induced cystitis. PMID:28106785

  8. Ketamine Analog Methoxetamine Induced Inflammation and Dysfunction of Bladder in Rats.

    PubMed

    Wang, Qiang; Wu, Qinghui; Wang, Junpeng; Chen, Yang; Zhang, Guihao; Chen, Jiawei; Zhao, Jie; Wu, Peng

    2017-01-18

    The novel synthetic psychoactive ketamine analog methoxetamine is reportedly being used for recreational purposes. As ketamine use can result in urinary dysfunction, we conducted the present study to investigate how methoxetamine affects the bladder. A cystometry investigation showed that female Sprague-Dawley rats experienced increased micturition frequency bladder dysfunction after receiving a daily intraperitoneal injection of 30 mg/kg methoxetamine or ketamine for periods of 4 or 12 weeks. Histologic examinations of rat bladder tissue revealed damaged urothelium barriers, as well as evidence of inflammatory cell infiltration and matrix deposition. The drug-treated rats showed significantly upregulated levels of pro-inflammatory cytokines such as IL-1β, IL-6, CCL-2, CXCL-1, CXCL-10, NGF, and COX-2. In addition, interstitial fibrosis was confirmed by increased levels of collagen I, collagen III, fibronectin and TGF-β. Besides direct toxic effect on human urothelial cells, methoxetaminealso induced the upregulation related cytokines. Our results indicate that long term methoxetamine treatment can induce bladder dysfunction and inflammation in rats. Methoxetamine was confirmed to produce direct toxic and pro-inflammatory effects on human urothelial cells. Methoxetamine-associated bladder impairment may be similar to ketamine-induced cystitis.

  9. Protective effects of leptin on ischemia/reperfusion injury in rat bladder.

    PubMed

    Hamarat, Mehmet; Yenilmez, Aydin; Erkasap, Nilufer; Isikli, Burhanettin; Aral, Erinc; Koken, Tulay; Can, Cavit; Demirustu, Canan Baydemir

    2010-06-30

    The aim of the study was to evaluate protective effects of exogenous leptin on ischemia/reperfusion (I/R)-induced injuries to the urinary bladder tissue and to investigate the effect on tumor necrosis factor alpha (TNF-alpha) levels and apoptotic cells during I/R injury. Bladder I/R injury was induced by abdominal aorta occlusion by ischemia for 45 min, followed by 60 min of reperfusion in rats. The rats were divided into three groups: control (n = 8 + 8), I/R (n = 8 + 8) and I/R+leptin group (n = 8 + 8). The rats in the I/R+leptin group were treated intraperitoneally with leptin (10 microg/kg) 60 min prior to ischemia induction. At the end of the reperfusion period, urinary bladders of the first eight rats from each group were removed for TUNEL staining processing while the others were removed for biochemical analyses for MDA and TNF-alpha levels. In the I/R group, the ratios of TUNEL-positive nuclei were higher than the control and the I/R+leptin groups. The MDA and TNF-alpha levels of the bladder tissue in the I/R group were higher than the control and leptin-treated groups. TUNEL-staining and biochemical studies revealed that leptin has a protective effect on urinary bladder I/R injury.

  10. Spontaneous perforation of a pyometra presenting as generalized peritonitis.

    PubMed Central

    Hosking, S. W.

    1985-01-01

    Eleven cases of spontaneous perforation of a pyometra have previously been reported. All were associated with, and probably secondary to, cervical occlusion. A further case is described, but differs in that the cervical canal was patent. In the absence of other possible causes of uterine perforation, the aetiology of the perforation in this case remains uncertain. Images Figure 1 PMID:4040634

  11. Experimental Data for Characterizing Perforating Impacts: Fragmentation Processes

    DTIC Science & Technology

    1985-05-01

    Damage Mechanisms, Penetration, Hypervelocity, Missile Warheads, Impact , Fragment Clouds, Perforation 20. ABSTRACT (Continue on ravaraa tide II...Perforating Impacts : Fragmentation Processes S. TYPE OF REPORT & PERIOD COVERED Technical Publication FY 81 and FY 82 8. PERFORMING ORG. REPORT NUMBER...Characterizing Perforating Impacts : Fragmentation Processes, by Marvin E. Backman and Stephen A. Finnegan. China Lake, Calif., Naval Weapons Center

  12. Reduction of carcinomatosis risk using icodextrin as a carrier solution of intraperitoneal oxaliplatin chemotherapy.

    PubMed

    Jouvin, I; Najah, H; Pimpie, C; Canet Jourdan, C; Kaci, R; Mirshahi, M; Eveno, C; Pocard, M

    2017-06-01

    There is no standard treatment in patients with high risk metachronous peritoneal carcinomatosis (PC) in colonic cancer, as perforated tumour or synchronous ovarian metastasis. Icodextrin 4% (ICDX), presently used to prevent postoperative abdominal adhesions, could inhibit the coactivation of the tumour cells and the microenvironment cells, associated with the development of PC. The aim of this study was to inhibit the formation of the PC in a murine model mimicking surgical situation using ICDX and intraperitoneal (IP) prophylactic chemotherapy. We created a model of growing PC in mice using cells of murine colonic cancer CT26. Cells and treatments were injected simultaneously. Five groups were created: CT26 (control group), CT26 + ICDX (ICDX group), CT26 + chemotherapy (oxaliplatin and 5FU) (chemo group), CT26 + chemotherapy + ICDX (ICDX chemo group), ICDX (toxicity group). At day 15, PC was evaluated with rodents PCI. In the chemo group, PCI was significantly lower than in the control group (3.2 versus 8.4, p = 0.02). ICDX had a synergetic effect on PC with chemotherapy; indeed PCI in ICDX chemo group was lower than in chemo group (1.4 versus 3.2, p = 0.04). There was no morbidity linked to ICDX in toxicity group. Safety of ICDX needs to be verified, particularly on colonic anastomosis before ICDX associated to IP chemotherapy could be used as a preventive treatment of PC in high risk patients. This prophylactic treatment is easy to use and would be administrated at the end of a curative surgery for a colonic cancer. Copyright © 2017 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.

  13. Teardrop bladder: additional considerations

    SciTech Connect

    Wechsler, R.J.; Brennan, R.E.

    1982-07-01

    Nine cases of teardrop bladder (TDB) seen at excretory urography are presented. In some of these patients, the iliopsoas muscles were at the upper limit of normal in size, and additional evaluation of the perivesical structures with computed tomography (CT) was necessary. CT demonstrated only hypertrophied muscles with or without perivesical fat. The psoas muscles and pelvic width were measured in 8 patients and compared with the measurements of a control group of males without TDB. Patients with TDB had large iliopsoas muscles and narrow pelves compared with the control group. The psoas muscle width/pelvic width ratio was significantly greater (p < 0.0005) in patients with TDB than in the control group, with values of 1.04 + 0.05 and 0.82 + 0.09, respectively. It is concluded that TDB is not an uncommon normal variant in black males. Both iliopsoas muscle hypertrophy and a narrow pelvis are factors that predispose a patient to TDB.

  14. Management of cervical esophageal and hypopharyngeal perforations.

    PubMed

    Zenga, Joseph; Kreisel, Daniel; Kushnir, Vladimir M; Rich, Jason T

    2015-01-01

    Evidence is limited for outcomes of surgical versus conservative management for patients with cervical esophageal or hypopharyngeal perforations. Patients with cervical esophageal or hypopharyngeal perforations treated between 1994 and 2014 were identified using an institutional database. Outcomes were compared between patients who underwent operative drainage and those who had conservative management with broad-spectrum antibiotics and withholding oral intake. Twenty-eight patients were identified with hypopharyngeal or cervical esophageal perforations, mostly due to iatrogenic (nasogastric tube placement, endoscopy, endotracheal intubation) injuries (68%). Fourteen were treated initially with conservative management and 14 with initial surgery. Six patients failed conservative treatment and two patients failed surgical treatment. Patients managed conservatively who had eaten between injury and diagnosis (p=0.003), those who had 24 hours or more between the time of injury and diagnosis (p=0.026), and those who showed signs of systemic toxicity (p=0.001) were significantly more likely to fail conservative treatment and require surgery. No variables were significant for treatment failure in the surgical group. Of the 20 patients who ultimately underwent a surgical procedure, two required a second procedure. Patients who have eaten between the time of perforation and diagnosis, have 24 hours or more between injury and diagnosis, and those that show signs of systemic toxicity are at higher risk of failing conservative management and surgical drainage should be considered. For patients without these risk factors, a trial of conservative management can be attempted. Copyright © 2015 Elsevier Inc. All rights reserved.

  15. Perforated stomach following the Heimlich maneuver.

    PubMed

    Cowan, M; Bardole, J; Dlesk, A

    1987-03-01

    The use of infradiaphragmatic abdominal pressure for relief of airway obstruction caused by food was first described by Henry Heimlich in 1974. Since that time, several complications have been reported. We report a case of gastric perforation occurring in a choking victim following the application of the Heimlich maneuver.

  16. 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.

  17. Perforating pilomatricoma: transepithelial elimination or not.

    PubMed

    Honda, Yoshihide; Oh-i, Tsunao; Koga, Michiyuki; Tokuda, Yasumoto

    2002-02-01

    We present a 56-year-old woman with a perforating pilomatricoma in the left eyebrow region. Histologically, the tumor consisted mainly of basophilic cells and shadow cells, and the tumor components were being eliminated through an ulcer with damage to the epithelial structures. In past reports of perforating pilomatricoma, this elimination pattern has often been described as transepithelial elimination. In many patients with perforating pilomatricoma, elimination is accompanied by ulceration and epithelial damage. Mehregan recently stated that elimination accompanied by epidermal necrosis and superficial ulceration constituted one form of transepithelial elimination. Epidermal necrosis and ulceration generally constitute severe damage. However, when Mehregan first proposed the concept of transepithelial elimination, it was defined as a phenomenon with relatively little or no damage to the epithelial structures, differentiating it from other types of elimination. This original definition makes transepithelial elimination a unique and interesting phenomenon, and its most important feature is that there is relatively little or no damage to the epithelial structures. Therefore, the terms "epidermal necrosis" and "ulceration" should not be used in association with transepithelial elimination. Hence, in patients with perforating pilomatricoma, the elimination of tumor components from ulcers with damage to the epithelial structures, as seen in the present case, should not be described as transepithelial elimination.

  18. A laparoscopic intraperitoneal onlay mesh technique for the repair of an indirect inguinal hernia.

    PubMed Central

    Fitzgibbons, R J; Salerno, G M; Filipi, C J; Hunter, W J; Watson, P

    1994-01-01

    OBJECTIVE: This study was done (1) to determine whether congenital indirect inguinal hernias in male pigs could be repaired by placing a polypropylene mesh prosthesis over the defect intra-abdominally, (2) to measure the incidence of adhesions between intra-abdominal viscera and the prosthesis with and without the adhesion barrier oxidized regenerated cellulose, (3) to determine the incidence of other complications, and (4) to assess the effect on fertility. SUMMARY BACKGROUND DATA: Several techniques for laparoscopic inguinal herniorrhaphy are currently being evaluated to determine whether there are advantages over conventional inguinal herniorrhaphy. Perhaps the most controversial is the intraperitoneal onlay mesh procedure (IPOM). Its advantage is its simplicity (in that the repair is accomplished by placing a prosthesis over the hernia defect intra-abdominally, avoiding a groin dissection). Its disadvantage is the potential for complications because the prosthesis is in contact with the intra-abdominal viscera. METHODS: In male pigs, polypropylene mesh alone or polypropylene mesh plus the adhesion barrier oxidized regenerated cellulose (composite prosthesis) was fixed to the peritoneum surrounding the hernia defect. In phase 1 (6-week follow-up), two groups of 13 pigs each underwent herniorrhaphy at laparotomy or laparoscopy. In phase 2 (7.1-month follow-up), 21 pigs underwent laparoscopic herniorrhaphy. RESULTS: All IPOM herniorrhaphies were successful. The prostheses adhered most frequently to the bladder, followed by small bowel, peritoneum, and cord structures. Prosthetic erosion into these organs was not observed. Laparoscopically placed prostheses in phases 1 and 2 had significantly less surface covered by adhesions (13% +/- 13% and 19% +/- 27%, respectively) and a lower adhesion tenacity grade (1.5 +/- 0.9 and 1.3 +/- 1.1, respectively) than those placed at laparotomy (44% +/- 27% and 2.5 +/- 0.7, respectively; p < 0.01). In phase 1, a histologic

  19. Drugs Approved for Bladder Cancer

    Cancer.gov

    This page lists cancer drugs approved by the Food and Drug Administration (FDA) for bladder cancer. The list includes generic names, brand names, and common drug combinations, which are shown in capital letters.

  20. Treatment of superficial bladder cancer.

    PubMed Central

    Morales, A.

    1980-01-01

    Most patients with bladder cancer initially present with localized, potentially curable tumours. Endoscopic surgery offers the best opportunity to eliminate these early lesions, but the rate of tumour recurrence after adequate resection is high (around 70%). Conventional methods of treatment have a place in the management of early bladder neoplasms, but their success rate is still unsatisfactory and they frequently fail to decrease the risk of recurrence. New drugs and more effective forms of administration have enhanced the use of chemotherapeutic agents. Fundamentally different approaches, such as specific immunotherapy, the use of laser energy and photodynamic therapy, are emerging as valuable approaches in the treatment of superficial bladder cancer and the prevention of recurrence. Randomized trials to assess their value and a concerted multidisciplinary effort with combined treatment give hope for effective control of early bladder cancer. PMID:6770987

  1. Treatment of superficial bladder cancer.

    PubMed

    Morales, A

    1980-05-24

    Most patients with bladder cancer initially present with localized, potentially curable tumours. Endoscopic surgery offers the best opportunity to eliminate these early lesions, but the rate of tumour recurrence after adequate resection is high (around 70%). Conventional methods of treatment have a place in the management of early bladder neoplasms, but their success rate is still unsatisfactory and they frequently fail to decrease the risk of recurrence. New drugs and more effective forms of administration have enhanced the use of chemotherapeutic agents. Fundamentally different approaches, such as specific immunotherapy, the use of laser energy and photodynamic therapy, are emerging as valuable approaches in the treatment of superficial bladder cancer and the prevention of recurrence. Randomized trials to assess their value and a concerted multidisciplinary effort with combined treatment give hope for effective control of early bladder cancer.

  2. Radiation-induced bladder carcinoma

    SciTech Connect

    Uyama, T.; Nakamura, S.; Moriwaki, S.

    1981-01-01

    Two cases are presented of radiation-induced bladder carcinoma which followed prior irradiation for cervical carcinoma of the uterus. One was a sixty-eight-year-old woman with bladder carcinoma fourteen years after irradiation (total dose of 4,500 rad) for cervical carcinoma of the uterus. The other was a sixty-four-year-old woman with bladder carcinoma twenty-five years after irradiation with 150-K volt apparatus for cervical carcinoma of the uterus. From the late radiation change of the skin, it was estimated that the total dose of prior radiation might be 4,000 rad or more. Both had high-grade, high-stage transitional cell bladder carcinoma, and the former was with marked mucus-forming adenomatous metaplasia.

  3. Endemic bladder calculi in children.

    PubMed

    Soliman, Neveen A; Rizvi, S Adibul Hasan

    2016-11-15

    Urinary calculi are being recognized more frequently in children and the urinary bladder is the most common site for stone formation in the lower urinary tract. Bladder calculi are grouped into three basic categories: primary idiopathic/endemic, secondary, and migrant. The incidence of vesical calculi has declined significantly in the last 70 years in developed nations owing to improvements in nutrition and socioeconomic conditions, but it is still high in developing nations. Primary idiopathic/endemic bladder calculi typically occur in children, in the absence of urinary tract infection (UTI), urinary stasis, or foreign body, and diet lacking in animal proteins is the major contributor factor. Comprehensive preventive and treatment strategies are critical for improving the quality of life of diseased children, in addition to helping to eradicate, or at least decrease, the incidence of endemic bladder calculi in developing nations.

  4. Assessing continence with bladder ultrasound.

    PubMed

    Addison, Ray

    Ray Addison outlines the principal uses of portable bladder ultrasound and reminds readers of the importance of reviewing the results of this investigation with other clinical investigations and the patient's health status.

  5. [Evolution of urinary bladder substitution].

    PubMed

    Kock, N G

    1992-11-01

    The historical background to the currently used methods for continent bladder substitution is shortly outlined. The significance for the patient's quality of life of various methods for bladder reconstruction or urinary diversion is briefly discussed. The importance of reservoir configuration for achieving a high compliant urinary receptacle is pointed out. Factors affecting reabsorption of urinary constituents are stressed and the significance of an antireflux mechanism is discussed. Currently the majority of patients undergoing cystectomy for cancer or for other reasons can be offered bladder substitutes providing continence and easy emptying; that is, complete control over voiding. This can be achieved by orthotopic bladder reconstruction or by diverting the urine to the augmented and valved rectum or to the skin via a continent intestinal reservoir.

  6. Bladder and urethral repair - slideshow

    MedlinePlus

    ... 100002.htm Bladder and urethral repair - series—Normal anatomy To use the sharing features on this page, ... Bethesda, MD 20894 U.S. Department of Health and Human Services National Institutes of Health Page last updated: ...

  7. Augmentation cystoplasty in neurogenic bladder

    PubMed Central

    Kocjancic, Ervin; Demirdağ, Çetin

    2016-01-01

    The aim of this review is to update the indications, contraindications, technique, complications, and the tissue engineering approaches of augmentation cystoplasty (AC) in patients with neurogenic bladder. PubMed/MEDLINE was searched for the keywords "augmentation cystoplasty," "neurogenic bladder," and "bladder augmentation." Additional relevant literature was determined by examining the reference lists of articles identified through the search. The update review of of the indications, contraindications, technique, outcome, complications, and tissue engineering approaches of AC in patients with neurogenic bladder is presented. Although some important progress has been made in tissue engineering AC, conventional AC still has an important role in the surgical treatment of refractory neurogenic lower urinary tract dysfunction. PMID:27617312

  8. The CNS and bladder dysfunction

    PubMed Central

    Holstege, Gert; Griffiths, Derek J.

    2012-01-01

    The brain's role in the development and maintenance of bladder control is critical, although its precise role in patient-reported complaints such as urgency and urine leakage is unknown. Functional brain imaging studies have advanced our knowledge of brain activity during the micturition cycle, showing multiple neuronal circuits involved as parts of a ‘brain-bladder control network.’ Yet, new advances need to be made in order to incorporate this knowledge into existing models of neuroanatomy and of clinical syndromes of bladder dysfunction and related clinical practice. This short article explains why and how brain imaging methods are poised to achieve that goal and decode the role of the brain in widely prevalent clinical conditions related to bladder dysfunction. PMID:23091564

  9. Genetics Home Reference: bladder cancer

    MedlinePlus

    ... Kozlowski JM. The p53 tumor suppressor gene and nuclear protein: basic science review and relevance in the ... Zwarthoff EC, Radvanyi F. Novel fibroblast growth factor receptor 3 (FGFR3) mutations in bladder cancer previously identified ...

  10. Optimal design of perforating completion for gas well

    SciTech Connect

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

    1995-10-01

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

  11. Neurogenic bladder in Hunter's syndrome.

    PubMed Central

    Koyama, K; Moda, Y; Sone, A; Tanaka, H; Hino, Y

    1994-01-01

    We encountered a rare patient with Hunter's syndrome who exhibited urinary retention as a result of a neurogenic bladder, uninhibited detrusor contractions, and detrusor-sphincter dyssynergia. Neurological findings were consistent with cervical myelopathy and cervical MR imaging showed very narrow segments at the cord level C2-4. We speculate that this Hunter's syndrome patient has cervical myelopathy and that this neurological dysfunction causes the neurogenic bladder. PMID:8014981

  12. Paraganglioma of the urinary bladder.

    PubMed

    Adraktas, Dionesia; Caserta, Melanie; Tchelepi, Hisham

    2014-09-01

    Extra-adrenal paragangliomas of the urinary bladder are rare. Typically, patients present with symptoms related to catecholamine hypersecretion or mass effect, but these tumors can also be encountered incidentally on imaging studies obtained for a different purpose. It is important to recognize the key imaging features of this entity so that it may be suggested as a possible differential diagnosis in the setting of a newly identified bladder mass.

  13. The histone deacetylase inhibitor belinostat (PXD101) suppresses bladder cancer cell growth in vitro and in vivo

    PubMed Central

    Buckley, Michael T; Yoon, Joanne; Yee, Herman; Chiriboga, Luis; Liebes, Leonard; Ara, Gulshan; Qian, Xiaozhong; Bajorin, Dean F; Sun, Tung-Tien; Wu, Xue-Ru; Osman, Iman

    2007-01-01

    Background Treatment options for patients with recurrent superficial bladder cancer are limited, necessitating aggressive exploration of new treatment strategies that effectively prevent recurrence and progression to invasive disease. We assessed the effects of belinostat (previously PXD101), a novel histone deacetylase inhibitor, on a panel of human bladder cancer cell lines representing superficial and invasive disease, and on a transgenic mouse model of superficial bladder cancer. Methods Growth inhibition and cell cycle distribution effect of belinostat on 5637, T24, J82, and RT4 urothelial lines were assessed. Ha-ras transgenic mice with established superficial bladder cancer were randomized to receive either belinostat or vehicle alone, and assessed for bladder weight, hematuria, gene expression profiling, and immunohistochemistry (IHC). Results Belinostat had a significant linear dose-dependent growth inhibition on all cell lines (IC50 range of 1.0–10.0 μM). The 5637 cell line, which was derived from a superficial papillary tumor, was the most sensitive to treatment. Belinostat (100 mg/kg, intraperitoneal, 5 days each week for 3 weeks) treated mice had less bladder weight (p < 0.05), and no hematuria compared with 6/10 control mice that developed at least one episode. IHC of bladder tumors showed less cell proliferation and a higher expression of p21WAF1 in the belinostat-treated mice. Gene expression profile analysis revealed 56 genes significantly different in the treated group; these included the upregulation of p21WAF1, induction of core histone deacetylase (HDAC), and cell communication genes. Conclusion Our data demonstrate that belinostat inhibits bladder cancer and supports the clinical evaluation of belinostat for the treatment of patients with superficial bladder cancer. PMID:17935615

  14. Use of Perforator-Based Fasciocutaneous Flaps for Pressure Sore Reconstruction: Single-Perforator-Based Versus Multiple-Perforator-Based Flaps.

    PubMed

    Chih-Hsun, Lin; Ma, Hsu

    2016-08-01

    A perforator-based fasciocutaneous flap is an alternative type of flap for pressure sore reconstruction. The aim of the present study was to determine whether a single-perforator-based flap or a multiple-perforator-based flap is better for pressure sore reconstruction. We reviewed the general data and postoperative complications in patients who received single-perforator-based or multiple-perforator-based fasciocutaneous flaps for pressure sore reconstruction between July 2009 and July 2012. No differences in general data, comorbidities, wound locations, flap sizes (73.9 vs. 67.0 cm(2), P = 0.455), and operative times were noted between the single-perforator-based and multiple-perforator-based flap groups. The flap rotation arc was larger in the single-perforator-based flap group than in the multiple-perforator-based flap group; however, the difference in the rotation arc was not significant (99.2° vs. 55.5°, respectively; P = 0.199). Two patients had total flap necrosis and one had partial flap necrosis in the single-perforator-based flap group. None of flap necrosis was noted in the multiple-perforator-based flap group; however, no significant differences in major complications were noted between the two groups. All donor sites underwent primary closure. This is the first clinical patient-matched research that considered the number of perforators and the rotation arc in applying perforator-based fasciocutaneous flaps in wound reconstruction. The results showed that the number of perforators is not the determinant factor of surgical outcome of the use of perforator-based fasciocutaneous flaps in pressure sore reconstruction. Thus, whether a single- or a multiple-perforator-based fasciocutaneous flap is used for flap perfusion does not jeopardize the operation. These results emphasize the reliability and convenience of using freestyle design of perforator-based flaps for pressure sore reconstruction. The design and clinical utility of the flaps have the

  15. Bladder cancer epidemiology and genetic susceptibility

    PubMed Central

    Chu, Haiyan; Wang, Meilin; Zhang, Zhengdong

    2013-01-01

    Bladder cancer is the most common malignancy of the urinary system. The incidence of bladder cancer of men is higher than that of women (approximately 4:1). Here, we summarize the bladder cancer-related risk factors, including environmental and genetic factors. In recent years, although the mortality rate induced by bladder cancer has been stable or decreased gradually, the public health effect may be pronounced. The well-established risk factors for bladder cancer are cigarette smoking and occupational exposure. Genetic factors also play important roles in the susceptibility to bladder cancer. A recent study demonstrated that hereditary non-polyposis colorectal cancer is associated with increased risk of bladder cancer. Since 2008, genome-wide association study (GWAS) has been used to identify the susceptibility loci for bladder cancer. Further gene-gene or gene-environment interaction studies need to be conducted to provide more information for the etiology of bladder cancer. PMID:23720672

  16. The neurogenic bladder: medical treatment

    PubMed Central

    Buyse, Gunnar M.

    2007-01-01

    Neurogenic bladder sphincter dysfunction (NBSD) can cause severe and irreversible renal damage and bladder-wall destruction years before incontinence becomes an issue. Therefore, the first step in adequate management is to recognize early the bladder at risk for upper- and lower-tract deterioration and to start adequate medical treatment proactively. Clean intermittent catheterization combined with anticholinergics (oral or intravesical) is the standard therapy for NBSD. Early institution of such treatment can prevent both renal damage and secondary bladder-wall changes, thereby potentially improving long-term outcomes. In children with severe side effects or with insufficient suppression of detrusor overactivity despite maximal dosage of oral oxybutynin, intravesical instillation is an effective alternative. Intravesical instillation eliminates systemic side effects by reducing the first-pass metabolism and, compared with oral oxybutynin, intravesical oxybutynin is a more potent and long-acting detrusor suppressor. There is growing evidence that with early adequate treatment, kidneys are saved and normal bladder growth can be achieved in children so they will no longer need surgical bladder augmentation to achieve safe urinary continence in adolescence and adulthood. PMID:18095004

  17. What Are the Risk Factors for Bladder Cancer?

    MedlinePlus

    ... of bladder cancer in the United States. Personal history of bladder or other urothelial cancer Urothelial carcinomas ... urinary infections and bladder cancer. Genetics and family history People who have family members with bladder cancer ...

  18. [Intraluminal Aspect of Femoro-femoral Cross-over Bypass Graft Mimics Bladder Stone].

    PubMed

    Sonak, I; Wiedemann, A; Heppner, H J

    2016-04-01

    Iatrogenic bladder perforation with delayed diagnosis and treatment in the context of the placement of a vascular prosthesis, e.g. a femoro-femoral cross-over bypass graft, is extremely rare. This is emphasised by the present publication, which is the second published case study worldwide. To identify such a situation is very important because there is a risk of inappropriate treatment if such a bypass complication remains undetected, and the potential complications of an improperly intended "treatment of a bladder stone" may be deleterious or even lethal. Therefore, the involved disciplines should be aware of this possibility in order to initiate relevant diagnostic measures, especially diagnostic cystoscopy, without any delay if symptoms such as voiding disorders or alguria coincide with vascular bypass grafting.

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

    PubMed

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

    2013-04-01

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

  20. The one-stage rhinoplasty septal perforation repair.

    PubMed

    Foda, H M

    1999-08-01

    A combined septal perforation repair and rhinoplasty was performed in 20 patients (12 males, eight females; age range 16-36, mean age 29.6) presenting with septal perforations (size 1-4 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. The perforation was totally closed in 18 cases (90 per cent) with complete resolution of the pre-operative symptoms occurring in 16 (80 per cent). Cosmetically, 19 cases (95 per cent) were very satisfied with their aesthetic result. The exposure provided by the external approach proved to be very helpful in the process of septal perforation repair. Our results show that septal perforation repair could safely be combined with rhinoplasty and that some of the rhinoplasty manoeuvres used could even facilitate the process of septal perforation repair.

  1. Paclitaxel-loaded Polymersomes for Enhanced Intraperitoneal Chemotherapy

    PubMed Central

    Simón-Gracia, Lorena; Hunt, Hedi; Scodeller, Pablo D; Gaitzsch, Jens; Braun, Gary B; Willmore, Anne-Mari A; Ruoslahti, Erkki; Battaglia, Giuseppe; Teesalu, Tambet

    2016-01-01

    Peritoneal carcinomatosis is present in more than 60% of gastric cancer, 40% of ovarian cancer, and 35% of colon cancer patients. It is the second most common cause of cancer mortality, with a median survival of 1–3 months. Cytoreductive surgery combined with intraperitoneal chemotherapy is the current clinical treatment, but achieving curative drug accumulation and penetration in peritoneal carcinomatosis lesions remains an unresolved challenge. Here we employed flexible and pH-sensitive polymersomes for payload delivery to peritoneal gastric (MKN-45P) and colon (CT26) carcinoma in mice. Polymersomes were loaded with Paclitaxel® and in vitro drug release was studied as a function of pH and time. Paclitaxel-loaded polymersomes remained stable in aqueous solution at neutral pH for up to four months. In cell viability assay on cultured cancer cell lines (MKN-45P, SKOV3, CT26), Paclitaxel-loaded polymersomes were more toxic than free drug or albumin-bound Paclitaxel (Abraxane®). Intraperitoneally administered fluorescent polymersomes accumulated in malignant lesions, and immunofluorescence revealed intense signal inside tumors with no detectable signal in control organs. A dual targeting of tumors was observed: direct (circulation independent) penetration, and systemic, blood vessel-associated accumulation. Finally, we evaluated preclinical antitumor efficacy of polymersomes-paclitaxel in treatment of MKN-45P disseminated gastric carcinoma using a total dose of 7 mg/kg. Experimental therapy with polymersome-Paclitaxel improved the therapeutic index of drug over Paclitaxel-Cremophor and Abraxane®, as evaluated by intraperitoneal tumor burden and number of metastatic nodules. Our findings underline the potential utility of the polymersome platform for delivery of drugs and imaging agents to peritoneal carcinomatosis lesions. PMID:26880267

  2. Malignant intraperitoneal mesothelioma-Başkent University experience

    PubMed Central

    Macuks, Ronalds; Özdemir, Halis; Dursun, Polat; Özen, Özlem Işıksaçan; Haberal, Nihan; Ayhan, Ali

    2011-01-01

    Objective To evaluate diagnostic and treatment results of malignant intraperitoneal mesothelioma in one setting. Materials and Method: 12 patients treated for malignant peritoneal mesothelioma from January 2007 to June 2009 in Başkent University Ankara Hospital, Department of Gynaecology and Obstetrics were evaluated. In a retrospective observational study design tumour stage, grade, differentiation, time from first symptoms, pleural involvement, peritoneal cancer index, surgical cytoreduction, chemotherapeutic regimen, number of cycles, disease free survival and overall survival were evaluated. Disease free survival, overall survival, time until first symptoms were researched. Results The main presenting symptom was abdominal distension. Primary cytoreductive surgery followed by chemotherapy was performed in 9 patients. In 6 patients completeness of cytoreductive score below 2 was achieved. As a first line chemotherapy the most often used was cisplatin in combination with pemetrexed. Themean time from first symptoms until the diagnosis was 1.9 months. Disease free survival of 4.4±1.0 months after completing particular treatment and overall 1-year survival of 85.7 % was observed. No correlations between first symptoms (0.27, p=0.52), time until the diagnosis (−0.29, p=0.44) and overall survival were observed. Similarly, correlations between peritoneal cancer index (0.25, p=0.67), prior surgical score (−.45, p=0.37), completeness of cytoreduction score (0.61, p=0.27) and overall survival were not observed. Conclusions Because of the low number of patients and different treatment approaches data from a particular patient setting are inconclusive, but from the literature there is evidence that patients with malignant intraperitoneal mesothelioma should undergo optimal cytoreduction and receive a combination of cisplatin and pemetrexed as a first line chemotherapy for intravenous or cisplatin in different chemotherapy regimens using the intraperitoneal

  3. Sperm migration in pigs after deep intrauterine and intraperitoneal insemination.

    PubMed

    Brüssow, Klaus-Peter; Torner, Helmut; Rátky, Jozsef

    2011-06-01

    Deep intrauterine insemination in pigs allows sperm deposition only into one uterine horn, but bilateral fertilization of oocytes occurs. How the sperm reach the contralateral oviduct remains disputable. The aim of this experiment was to study possible transperitoneal and/or transuterine sperm migration ways. Follicle growth and ovulation were induced in 24 peripubertal gilts with eCG and hCG 72 h after eCG. Endoscopic intrauterine insemination (IUI) was performed 32 h after hCG with 20 ml of extended semen (60 × 10(6) spermatozoa) as follows: Group CONTROL (n=8) received IUI into the right horn, and the left horn served as non-treated control; Group LIGATURE (n=8) received IUI into the right horn, and the left horn was closed by endoscopic double ligature close to the bifurcation; Group INTRAPERITONEAL (IPI; n=8) received IUI into the right uterine horn, the left horn was closed by double ligature and semen was deposited intraperitoneally at the surface of the left ovary. Genital tracts were removed 65-66 h after hCG, the oviducts were flushed and ova (n=299) were analyzed for fertilization and cleavage. Furthermore, the accessory spermatozoa count/oocyte was graded as 0, without spermatozoa, 1, <5 spermatozoa, 2, 5-50 spermatozoa, 3, 50-100 spermatozoa and 4, >100 spermatozoa. The results indicate that low dose IUI into one horn provides a lower grade of accessory spermatozoa in the contra-lateral side (1.6 vs. 2.8). No spermatozoa were found in ova flushed from oviducts of the ligated uterine horn, even after intraperitoneal insemination (P<0.05), and no fertilization occurred, respectively. Our results clearly indicate that after low dose IUI into one uterine horn, spermatozoa reach the contralateral oviduct via transuterine migration.

  4. Fate of tritiated didemnin B in mice: excretion and tissue concentrations after an intraperitoneal dose.

    PubMed

    Beasley, Val R; Bruno, Sally J; Burner, John S; Choi, Byoung W; Rinehart, Kenneth L; Koritz, Gary D; Levengood, Jeffrey M

    2005-11-01

    Didemnin B has undergone trials in cancer patients, and has antiviral and immunosuppressive properties. [(3)H]didemnin B was administered intraperitoneally (i.p.) to mice at 320 or 1280 microg/kg. Urine and feces were collected until 168 h, at which time the mice were killed and tissues collected. Additionally, [(3)H]didemnin B was given i.p. at 320 microg/kg, and mice were killed at 1-120 h post-dosing. Radiolabel increased rapidly in blood then rapidly declined. Most radiolabel in urine, feces and tissues represented parent compound. Concentrations of [(3)H]didemnin B were greatest in the liver > gallbladder > lower digestive tract congruent with pancreas > spleen > kidney congruent with adipose tissue congruent with urinary bladder with urine. The pancreas had the longest terminal half-life of the tissues and the highest radioactivity at 7 days. Intermediate concentrations were in the duodenum congruent with jejunum > lung > iliopsoas > stomach congruent with testes congruent with skin > heart. Low concentrations were in the humerus congruent with femur congruent with quadriceps congruent with triceps > brain. Fecal excretion accounted for 45.9%-58.3% of the dose and declined after 24 h, followed by an increase, suggesting possible enterohepatic recycling or an impact of circadian rhythms. Urinary excretion accounted for 18.4%-25.2% of the dose, but was minimal after 24 h. The concentrations were highest in organs previously found to be sensitive in animals and humans. Didemnin B should be evaluated in animal models for treatment of pancreatic cancer.

  5. Elective bladder-sparing treatment for muscle invasive bladder cancer.

    PubMed

    Lendínez-Cano, G; Rico-López, J; Moreno, S; Fernández Parra, E; González-Almeida, C; Camacho Martínez, E

    2014-01-01

    Radical cystectomy is the standard treatment for localised muscle invasive bladder cancer (MIBC). We offer a bladder-sparing treatment with TURB +/- Chemotherapy+Radiotherapy to selected patients as an alternative. We analyze, retrospectively, 30 patients diagnosed with MIBC from March 1991 to October 2010. The mean age was 62.7 years (51-74). All patients were candidates for a curative treatment, and underwent strict selection criteria: T2 stage, primary tumor, solitary lesion smaller than 5cm with a macroscopic disease-free status after TURB, negative random biopsy without hydronephrosis. Staging CT evaluation was normal. Restaging TURB or tumor bed biopsy showed a disease-free status or microscopic muscle invasion. 14 patients underwent TURB alone, 13 TURB+Chemotherapy and 3 TURB+Chemotherapy+Radiotherapy. The mean follow up was 88.7 months (19-220). 14 patients remained disease free (46.6%), 10 had recurrent non-muscle invasive bladder cancer (33%). 81.3% complete clinical response. 71% bladder preserved at 5-years. Overall, 5-years survival rate was 79% and 85% cancer-specific survival rate. Although radical cystectomy is the standard treatment for localised MIBC, in strictly selected cases, bladder-sparing treatment offers an alternative with good long term results. Copyright © 2013 AEU. Published by Elsevier Espana. All rights reserved.

  6. 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.

  7. A novel transurethral resection technique for superficial flat bladder tumor: Grasp and bite technique

    PubMed Central

    Oh, Kyung Jin; Choi, Yoo-Duk; Chung, Ho Suck; Hwang, Eu Chang; Jung, Seung Il; Kwon, Dong Deuk

    2015-01-01

    Purpose Transurethral resection of bladder tumor (TURBT) can be a challenging procedure for an inexperienced surgeon. We suggest an easy technique for TURBT, which we have named the "grasp and bite" technique. We describe this technique and compare its effectiveness and safety with that of conventional TURBT. Materials and Methods Monopolar TURBT (24-Fr Karl Storz) was performed in 35 patients who had superficial bladder tumors. After defining the tumor margin, the tumor and surrounding mucosa were grasped by use of a loop electrode and resectoscope sheath. With tight grasping, linear moving resection was performed. The patients' demographic, intraoperative, and postoperative data were analyzed between the conventional and grasp and bite TURBT groups. Results Of 35 patients, 16 patients underwent conventional TURBT (group 1), and the other 19 patients underwent grasp and bite TURBT (group 2). Both groups were similar in age, tumor multiplicity, size, anesthesia method, and location. Grasp and bite TURBT could be performed as safely and effectively as conventional TURBT. There were no significant differences in irrigation duration, urethral catheterization, postoperative hemoglobin drop, or length of hospital stay. No significant side effects such as bladder perforation, severe obturator reflex, or persistent bleeding occurred. There were no significant pathological differences between specimens according to the type of resection technique. Conclusions The grasp and bite TURBT technique was feasible for superficial bladder tumors. It may be a good tool for inexperienced surgeons owing to its convenient and easy manner. PMID:25763127

  8. Gall bladder rupture associated with cholecystitis in a domestic ferret (Mustela putorius).

    PubMed

    Huynh, M; Guillaumot, P; Hernandez, J; Ragetly, G

    2014-09-01

    A six-year-old neutered female albino ferret was presented with an acute episode of lethargy and anorexia. Clinical examination revealed marked cranial abdominal pain. A severe neutrophilic leukocytosis was present. Abdominal ultrasound was consistent with a diffuse peritonitis and severe bile duct inflammation. Cytology of the abdominal effusion revealed bile peritonitis. An exploratory laparotomy was performed and the gall bladder appeared inflamed with multiple perforations. A cholecystectomy was performed. The ferret recovered without complication. Bacteriological culture of the bile and gall bladder yielded a pure growth of Pseudomonas aeruginosa. Histopathological analysis of the gall bladder and liver was consistent with a marked cholecystitis and cholangiohepatitis. On the basis of sensitivity testing, the ferret was treated with marbofloxacin for one month. No complications or reoccurrence were seen up to 1 year after the diagnosis. To the author's knowledge, this is the first report of bile peritonitis secondary to gall bladder rupture in a ferret. © 2014 British Small Animal Veterinary Association.

  9. A healthy bladder: a consensus statement.

    PubMed

    Lukacz, E S; Sampselle, C; Gray, M; Macdiarmid, S; Rosenberg, M; Ellsworth, P; Palmer, M H

    2011-10-01

    A panel of experts in urology, urogynecology, nursing, and behavioral therapy convened in 2010 to discuss the importance of a healthy bladder on overall health. They determined that a consensus statement was necessary to raise awareness among the general public, healthcare providers, payors, and policymakers, with the goals of minimizing the impact of poor bladder health and stimulating primary prevention of bladder conditions. In this statement, 'healthy' bladder function is described, as well as internal and external factors that influence bladder health. It is suggested that primary prevention strategies should be aimed at providing education regarding normal lower urinary tract structures and functioning to the public, including patients and healthcare providers. This education may promote the achievement of optimal bladder health by increasing healthy bladder habits and behaviors, awareness of risk factors, healthcare seeking, and clinician engagement and reducing stigma and other barriers to treatment. Promoting optimal bladder health may reduce the personal, societal and economic impact of bladder conditions, including anxiety and depression and costs associated with conditions or diseases and their treatment. While adopting healthy bladder habits and behaviors and behaviors may improve or maintain bladder health, it is important to recognize that certain symptoms may indicate the presence of conditions that require medical attention; many bladder conditions are treatable with a range of options for most bladder conditions. Lastly, the authors propose clinical directives based on persuasive and convergent research to improve and maintain bladder health. The authors hope that this statement will lead to promotion and achievement of optimal bladder health, which may improve overall health and help minimize the effects of bladder conditions on the public, healthcare professionals, educators, employers, and payors. The advisors are in consensus regarding the

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

    PubMed

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

    2014-06-27

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

  11. Overactive bladder in children

    PubMed Central

    Ramsay, Sophie; Bolduc, Stéphane

    2017-01-01

    Overactive bladder (OAB) is a highly prevalent disorder in the pediatric population. This condition is especially troublesome for pediatric patients and their families when associated with incontinence, since it negatively affects self-esteem and impairs children’s development. From the patient’s perspective, urgency and urge incontinence can have a significant impact, negatively affecting their quality of life. For a therapy to have true benefit, changes must not only be statistically significant, but must also be perceived as meaningful by the patient. A stepwise approach is favoured to treat this pathology, starting with behavioural therapy, followed by medical management, and eventually more invasive procedures. Antimuscarinic agents are the mainstay of medical treatment for OAB. Oxybutynin is the most commonly used antimuscarinic in the pediatric population. However, some patients have a suboptimal response to antimuscarinics and many experience bothersome side effects, which have been documented with all antimuscarinics to a significantly higher degree than placebo. Although there have been reports about the use of tolterodine, fesoterodine, trospium, propiverine, and solifenacin in children, to date, only oxybutynin has been officially approved for pediatric use by medical authorities in North America. This review will address alternative treatment options for pediatric patients presenting with OAB, from conservative measures to more invasive therapies. PMID:28265325

  12. Overactive bladder in children.

    PubMed

    Franco, Israel

    2016-09-01

    Overactive bladder (OAB) is a ubiquitous syndrome that is defined by urinary urgency with, or without urinary incontinence. OAB is observed in all parts of the world, with a prevalence of 5-12% in children (5-10 years of age) and a prevalence of 0.5% in older adolescents (16-18 years of age). Published data indicate that around a third of children with OAB are likely to become adults with similar complaints. Studies in children and in adults with OAB indicate that these individuals are more likely to also have anxiety, depression and attention deficit problems, and that appropriate treatment of these comorbidities can often improve the patient's OAB symptoms. Furthermore, data from twin studies and familial surveys seem to indicate a genetic component of OAB. Pharmacological treatments of OAB in children have improved in the past 5 years, moving beyond anticholinergic agents and including the off-label use of α-blockers, β3-agonists and intravesical botulinum toxin. Use of several different electrical stimulation techniques is also effective, both as first-line treatments, and for patients with treatment-refractory symptoms. Overall the outlook of children with OAB seems to be improving, with a greater understanding of the pathophysiology of this syndrome. Treatment modalities that target the source of the underlying problem, especially in children, are likely to provide the best patient outcomes.

  13. Adenovirus serotype 11 causes less long-term intraperitoneal inflammation than serotype 5: Implications for ovarian cancer therapy

    SciTech Connect

    Thoma, Clemens; Bachy, Veronique; Seaton, Patricia; Green, Nicola K.; Greaves, David R.; Klavinskis, Linda; Seymour, Leonard W.; Morrison, Joanne

    2013-12-15

    In a phase II/III clinical trial intraperitoneal (i.p.) administration of a group C adenovirus vector (Ad5) caused bowel adhesion formation, perforation and obstruction. However, we had found that i.p. group B, in contrast to group C adenoviruses, did not cause adhesions in nude BALB/c ovarian cancer models, prompting further investigation. Ex vivo, group B Ad11 caused lower inflammatory responses than Ad5 on BALB/c peritoneal macrophages. In vivo, i.p. Ad11 triggered short-term cytokine and cellular responses equal to Ad5 in both human CD46-positive and -negative mice. In contrast, in a long-term study of repeated i.p. administration, Ad11 caused no/mild, whereas Ad5 induced moderate/severe adhesions and substantial liver toxicity accompanied by elevated levels of IFNγ and VEGF and loss of i.p. macrophages, regardless of CD46 expression. It appears that, although i.p. Ad11 evokes immediate inflammation similar to Ad5, repeated administration of Ad11 is better tolerated and long-term fibrotic tissue remodelling is reduced. - Highlights: • i.p. Ad11 causes less long-term intraperitoneal inflammation than Ad5 in CD46-transgenic mice. • Ex vivo BALB/c peritoneal macrophages express less RANTES after Ad11 than Ad3 or Ad5 treatment. • In vivo, cytokine and cellular responses 6 h after i.p. Ad11 are equal to Ad5. • In contrast, after repeated i.p. application, Ad5, but not Ad11, causes severe i.p. toxicity. • The use of Ad11 instead of Ad5 might increase patient safety in future virotherapy of ovarian cancer.

  14. What's new in intraperitoneal test on Kevlar (asbestos substitute)?

    PubMed

    Brinkmann, O A; Müller, K M

    1989-09-01

    The intraperitoneal test is a suitable experimental method for studying the different patterns of morphological reaction to foreign body substances of various kinds and concentrations as well as their transport within and elimination from the organism, Kevlar fibres are synthetic aromatic polyamid (aramid) fibres which, investigated by means of the intraperitoneal test in Wistar rats, show distinct pathogenetic reaction patterns: 1. In the early stage after application, the formation of multinucleated giant cells with phagocytosis of the amber-coloured Kevlar fibres, and an inflammatory reaction are foremost features. 2. The typical feature of the second stage is the development of granulomas with central necrosis indicating the cytotoxic nature of Kevlar fibres. 3. The third stage is dominated by the mesenchymal activation with capsular structures of collagenous fibres. Besides granulomatous foci, a slight submesothelial fibrosis is observed. 4. Fragments of Kevlar fibres are drained through lymphatic pathways and stored in lymph nodes where they lead to inflammatory reactions. 5. The reactive granulomatous changes in the greater omentum of rats are accompanied by proliferative mesothelial changes which, in one cases, even led to the development of a multilocular mesothelioma.

  15. Effect of Hypericum perforatum on intraperitoneal adhesion formation in rats

    PubMed Central

    Hızlı, Fatih; Köşüş, Aydın; Yılmaz, Saynur; Köşüş, Nermin; Haltaş, Hacer; Dede, Hülya; Kafalı, Hasan

    2013-01-01

    Introduction The aim of this study was to evaluate the efficacy of Hypericum perforatum for prevention of adhesion formation in rats. Material and methods Twenty-four female wistar rats underwent left uterine horn adhesion model. Rats were randomised into 4 groups. Group 1 (Control): Closure of abdominal incision without any agent administration. Group 2: Closure of incision after administration of intraperitoneal (i.p.) Ringer's lactate solution. Group 3: Closure of incision after administration of i.p. olive oil (diluent of H. perforatum). Group 4: Hypericum perforatum extract (Ecodab®) was administered i.p. before the closure of incision. Fourteen days later, relaparatomy was performed and surgical adhesion scores, inflammation and fibrosis scores were noted. Groups were compared according to these scores. Results There was statistical significant difference between ringer's lactate group and olive oil group according to surgical adhesion score (p = 0.009). However, groups were not different according to inflammation and fibrosis scores (p > 0.05). Conclusions Despite antiinflammatory, antioxidants and antimicrobial properties of H. perforatum, our results revealed no positive effect of H. perforatum on the prevention of intraperitoneal adhesion formation. PMID:24904678

  16. Enteric bacterial translocation after intraperitoneal implantation of rubber drain pieces.

    PubMed

    Guo, W; Andersson, R; Ljungh, A; Wang, X D; Bengmark, S

    1993-05-01

    To study the kinetics and mechanisms of bacterial translocation from the gut after intraperitoneal (IP) implantation of prosthetic materials, different sizes of rubber drain pieces were intraperitoneally implanted in the rat, followed by evaluation of ileal mucosal permeability after 2 days and of the occurrence of bacterial translocation and gut oxygen extraction at various time points. Enteric bacteria translocated to mesenteric lymph nodes and disseminated to systemic organs (liver, spleen, lungs, and kidneys), the portal vein, and inferior vena cava 2, 4, and 6 h after IP implantation of rubber drain pieces with 10-, 7-, and 3-cm2 areas, respectively, and subsequently to the IP rubber drain piece and the peritoneal cavity on the 2nd postoperative day. The incidence of translocation correlated with the size of the implanted material and time after implantation. The gut oxygen extraction increased significantly after IP implantation of 7- and 10-cm2 rubber drain pieces. The ileal mucosal permeability was enhanced in the groups implanted with 7- and 10-cm2 drain pieces. Thus, bacterial translocation occurs already in the early period after IP implantation of rubber drain and increased with time. The increased gut oxygen extraction implies that the gut is susceptible to IP inflammatory stimulation, and the enhanced ileal permeability suggests that the integrity of the gastrointestinal tract is compromised, which might facilitate bacterial translocation.

  17. Comparison of the efficacy and feasibility of en bloc transurethral resection of bladder tumor versus conventional transurethral resection of bladder tumor

    PubMed Central

    Wu, Yu-Peng; Lin, Ting-Ting; Chen, Shao-Hao; Xu, Ning; Wei, Yong; Huang, Jin-Bei; Sun, Xiong-Lin; Zheng, Qing-Shui; Xue, Xue-Yi; Li, Xiao-Dong

    2016-01-01

    Abstract Background: The aim of this meta-analysis was to compare the feasibility of en bloc transurethral resection of bladder tumor (ETURBT) versus conventional transurethral resection of bladder tumor (CTURBT). Methods: Relevant trials were identified in a literature search of MEDLINE, EMBASE, Cochrane Library, Web of Science, and Google Scholar using appropriate search terms. All comparative studies reporting participant demographics, tumor characteristics, study characteristics, and outcome data were included. Results: Seven trials with 886 participants were included, 438 underwent ETURBT and 448 underwent CTURBT. There was no significant difference in operation time between 2 groups (P = 0.38). The hospitalization time (HT) and catheterization time (CT) were shorter in ETURBT group (mean difference[MD] −1.22, 95% confidence interval [CI] −1.63 to −0.80, P < 0.01; MD −0.61, 95% CI −1.11 to −0.11, P < 0.01). There was significant difference in 24-month recurrence rate (24-month RR) (odds ratio [OR] 0.66, 95% CI 0.47–0.92, P = 0.02). The rate of complication with respect to bladder perforation (P = 0.004), bladder irritation (P < 0.01), and obturator nerve reflex (P < 0.01) was lower in ETURBT. The postoperative adjuvant intravesical chemotherapy was evaluated by subgroup analysis, and 24-month RR in CTURBT is higher than that in ETURBT in mitomycin intravesical irrigation group (P = 0.02). Conclusion: The first meta-analysis indicates that ETURBT might prove to be preferable alternative to CTURBT management of nonmuscle invasive bladder carcinoma. ETURBT is associated with shorter HT and CT, less complication rate, and lower recurrence-free rate. Moreover, it can provide high-qualified specimen for the pathologic diagnosis. Well designed randomized controlled trials are needed to make results comparable. PMID:27828864

  18. Ileal perforation by an odd foreign object

    PubMed Central

    Abdullayev, Ruslan; Aslan, Mahmut

    2015-01-01

    Perforation of the gastrointestinal system by a foreign body is seldom observed in clinical practice; however, it has great importance because it is preventable and can usually be easily treated. In this case report, we present a young male patient, who mistakenly swallowed a foreign body and presented to the emergency service one day later with acute abdomen. The 23-year-old patient was diagnosed with acute appendicitis and underwent emergency laparotomy. During the operation, a plastic object that perforated the terminal ileum lumen and protruded into the abdominal cavity was identified. Along with appendectomy, the foreign body was removed and the ileum was repaired. The detailed history of the patient revealed that he had mistakenly swallowed something one day before the onset of abdominal pain. The patient was discharged on the postoperative seventh day following an uneventful course. PMID:26170746

  19. 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.

  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. Cephalocentesis with the modified Smellie's perforator.

    PubMed

    Chanrachakul, B; Chittachareon, A; Herabutya, Y

    2002-02-01

    A 37-year-old pregnant woman, gravida 2, para 0, was referred to Ramathibodi Hospital at 31 weeks of gestation with the diagnosis of hydrocephalus and polyhydramnios. Repeated ultrasound scans revealed hydrocephalus with macrocephaly (BPD=10.3 cm), polyhydramnios (AFI=31.5), and a suspected esophageal atresia. After counseling, both parents decided not to pursue the pregnancy and requested vaginal delivery. They decided against transabdominal, ultrasonic-guided cephalocentesis because of its invasiveness, patient's awareness, and pain. Skull decompression with the modified Smellie's perforator was performed after five 400-microg doses of misoprostol were applied to dilate the cervix. The post-partum condition was uneventful. Fetal skull decompression with the modified Smellie's perforator and misoprostol for cervix dilation is a useful, simple, and safe procedure that can be performed with no previous experience.

  2. Pneumomediastinum caused by colonic diverticulitis perforation

    PubMed Central

    2011-01-01

    A 59-year-old man presented with abdominal and left flank pain. The symptom had started 30 days before as an acute nephrolithiasis, which had worsened despite conservative management. The abdomen was slightly distended and tender over the lower abdomen, without signs of generalized peritoneal irritation. A computed tomography (CT) scan showed an abscess in left para-renal space up to the subphrenic space and an unexpected pneumomediastinum. An emergency operation was performed, which showed retroperitoneal diverticulitis perforation of the sigmoid descending junction with abscess formation. A segmental resection of the diseased colon and end-colostomy was performed (Hartmann's procedure). However, the patient's condition progressively deteriorated, and he died of sepsis and multi-organ failure on the 5th postoperative day. Although pneumomediastinum caused by colonic diverticulitis perforation is extremely rare, it could be a life-threatening condition in patients without signs of peritonitis because of delayed diagnosis. PMID:22066076

  3. Bowel perforations induced by multiple magnet ingestion.

    PubMed

    Lee, Byung Kook; Ryu, Hyun Ho; Moon, Jeong Mi; Jeung, Kyung Woon

    2010-04-01

    We report two cases of bowel perforation that presented to the ED after ingesting multiple magnets as diagnosed with exploratory laparotomy. Foreign body ingestion is a common occurrence in the paediatric population. Diagnosis is often delayed because it is difficult to obtain a precise history of foreign body ingestion. Fortunately, in many cases, ingested foreign bodies pass spontaneously without complications. However, surgical intervention is required for about one percent of foreign body ingestions. Multiple magnet ingestion produces bowel injuries, including bowel obstruction, ischaemia, necrosis, perforation and fistula formation, finally requiring surgical intervention. The incidence, which is rare, of magnet ingestion with complications has increased as a result of the popularity of magnetic toys. This case report highlights the complications that might occur with multiple magnet ingestion. We aim to alert physicians that multiple magnet ingestion can be a serious matter.

  4. 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.

  5. Ileal J-Pouch Perforation: Case Report.

    PubMed

    Dogan, U; Dogan, B; Habibi, M; Erol, M K; Mayir, B; Aslaner, A; Bulbuller, N

    2015-01-01

    A 34-year-old male patient who had undergone total colectomy and J-pouch ileanal anastomosis subsequent to diagnosis of familial adenomatous polyposis five years previously was admitted to the emergency room with complaints of severe abdominal pain of a four-day duration. Physical examination revealed widespread tenderness throughout the abdomen, especially in the lower quadrant. Abdominal ultrasonography revealed fluid between intestinal loops and computed tomography revealed free air and fluid in the abdomen. During laparotomy to expand the ileal J-pouch to approximately 12 cm in diameter, a 2-mm perforation was detected in the blind end of the ileal J-pouch. The perforation was repaired primarily and protective ileostomy was performed. During postoperative endoscopy, neither obstruction nor stasis was observed, but pouchitis was observed in the ileal J-pouch. The patient was postoperatively discharged on the 20th day and followed endoscopically. The endoscopic findings were normal in the sixth month postsurgery.

  6. 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.

  7. Gastroduodenal perforation after open heart surgery.

    PubMed

    Shocket, E; Boruchow, I B; Rotbart, A; Ciment, L; Jude, J R

    1977-11-01

    During a thirty month period, 319 patients underwent open heart operations, and of these, three experienced a life-threatening explosive abdominal catastrophe. Aggressive radiographic maneuvers established the diagnosis of gastroduodenal perforation. Appropriate abdominal surgery with plication of the perforation and, whenever possible, the establishment of tube gastrostomy for decompression and a tube jejunostomy for feeding is desirable. All three patients required mechanical ventilatory support and tracheostomy prior to the abdominal catastrophe. Prophylactic antacids and sedation seem appropriate, particularly for selected patients (those with a prior peptic history and those with pulmonary dysfunction). Pulmonary toilet for those identified by preoperative pulmonary screening may circumvent the need for postoperative ventilatory support, which increases the risk of stress ulceration. Of the three patients described, all survived the gastrointestinal surgery but only one left the hospital. One died twenty days and another forty-eight days after the intestinal surgery, both of pneumonitis and septicemia.

  8. Treatment of bladder cancer. Oncology overview

    SciTech Connect

    Not Available

    1982-10-01

    Oncology Overviews are a service of the International Cancer Research Data Bank (ICRDB) Program of the National Cancer Institute, intended to facilitate and promote the exchange of information between cancer scientists by keeping them aware of literature related to their research being published by other laboratories throughout the world. Each Oncology Overview represents a survey of the literature associated with a selected area of cancer research. It contains abstracts of articles which have been selected and organized by researchers associated with the field. Contents: Surgical treatment of common bladder cancers; Radiation therapy of common bladder cancers; Chemotherapy of common bladder cancers; Immunotherapy of common bladder cancers; Multimodal treatment of common bladder cancers; Other treatment modalities of common bladder cancers; Treatment of less common bladder cancers; Reviews of treatment of bladder cancers.

  9. Genetic and Epigenetic Alterations in Bladder Cancer

    PubMed Central

    2016-01-01

    Bladder cancer is one of the most common cancers worldwide, with a high rate of recurrence and poor outcomes as a result of relapse. Bladder cancer patients require lifelong invasive monitoring and treatment, making bladder cancer one of the most expensive malignancies. Lines of evidence increasingly point to distinct genetic and epigenetic alteration patterns in bladder cancer, even between the different stages and grades of disease. In addition, genetic and epigenetic alterations have been demonstrated to play important roles during bladder tumorigenesis. This review will focus on bladder cancer-associated genomic and epigenomic alterations, which are common in bladder cancer and provide potential diagnostic markers and therapeutic targets for bladder cancer treatment. PMID:27915480

  10. Bladder Morphology Using 2 Different Catheter Designs

    ClinicalTrials.gov

    2017-04-10

    Urologic Injuries; Urologic Diseases; Bladder Infection; Urinary Tract Infections; Mucosal Inflammation; Mucosal Infection; Bladder Injury; Catheter-Related Infections; Catheter Complications; Catheter; Infection (Indwelling Catheter); Pelvic Floor Disorders; Urinary Incontinence

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

    SciTech Connect

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

    1991-05-01

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

  12. Significance of random bladder biopsies in superficial bladder cancer.

    PubMed

    May, F; Treiber, U; Hartung, R; Schwaibold, H

    2003-07-01

    We investigated to what extent biopsies of normal-appearing urothelium taken from patients with superficial bladder cancer (Ta, T1, Tis) showed malignant disease and whether those findings had impact on therapeutical decisions. 1033 consecutive patients presenting with Ta, T1 or Tis (carcinoma in situ) superficial bladder tumors at increased risk for recurrence underwent multiple random biopsies from normal-appearing urothelium during transurethral resection (TUR). Patients with small, primary, singular tumors (smaller or equal to 1cm) were excluded from random biopsies. No tumor was found in the random biopsies of 905 patients (87.6%). 128 patients (12.4%) showed urothelial bladder cancer in their random biopsies (Tis: 74, Ta: 41, T1: 12, T2: 1). In 14 patients, where transurethral resection of the primary tumor revealed no signs of malignancy, urothelial bladder cancer was detected in the random biopsy material: Ta 8 patients, Tis 5 patients and T1 one patient. 21 patients with Ta tumors and 29 patients with T1 disease showed concomitant Tis. Upstaging of the primary, resected tumor by histological examination of the random biopsy material occurred in 75 patients (7%). Altogether, due to the random biopsy results therapy was altered in 70 patients (6.8%) of our series: It changed intravesical chemotherapy to BCG in 45, provoked a second TUR in 48 and cystectomy in 15 patients. While the clinical significance of random biopsies is still controversial, random biopsy results had strong impact on therapeutical decisions in our series. Regarding random bladder biopsies a simple tool for the urologist to identify high risk groups of patients, we recommend them as part of the routine management of superficial bladder cancer.

  13. 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.

  14. Predictable Pattern Digital Artery Perforator Flap

    PubMed Central

    Epameinondas, Kostopoulos; Christos, Agiannidis; Petros, Konofaos; Avraam, Dounavis; Othon, Papadopoulos; Vincent, Casoli

    2016-01-01

    Background: The proper digital arteries as any other axial vessel give rise to multiple cutaneous perforators either volar or dorsal along their course. Their identification is performed with Doppler flowmetry. The vasculo-cutano-tendino-osseous complex (VCTOC), which was described by the senior authors, was responsible for the vascularization of all digital anatomic structures (extensor apparatus, skin, periosteum). Their consistent appearance to well measured distances from the digital joints led the way to the present clinical study for highlighting this described anatomy in-vivo and demonstrating the predictability in digital artery perforator (DAP) flap harvest. Methods: From November 2012 to March 2014, fifteen patients underwent reconstruction with a predictable pattern digital artery perforator flap (PPDAP), based on the previously described VCTOC mapping, for digital lesions secondary to tumor extirpation. Flaps were designed as V-Y advancement or propeller type. Postoperative control concerned flap viability and digital function. Results: Seven males and 8 females underwent elective surgery using PPDAP flaps for digital defects following tumor extirpation. The diameter of the defect ranged from 0.5 to 1.5 cm. The vast majority of the lesions were identified on the right hand, the index, the ring finger and the distal phalanx. All flaps survived without signs of venous congestion. No functional digital problems were observed during follow up (mean of 77 months). A minor wound dehiscence presented in one patient. Conclusions: Authors introduced the concept of a “predictable pattern” in the surgery of perforator flaps in the digits. These flaps are reliable and could be a valuable reconstructive option. PMID:27418896

  15. Chronic Gastric Ischemia Leading to Gastric Perforation

    PubMed Central

    Lundsmith, Emma; Zheng, Matthew; McCue, Peter

    2016-01-01

    A 69-year-old man with diabetes, peripheral vascular disease, and hypertension presented with 3 months of diffuse abdominal pain that worsened with meals, weight loss, and dysphagia. Esophagogastroduodenoscopy and computed tomography revealed findings consistent with chronic gastric ischemia secondary to atherosclerosis. Gastric ischemia eventually led to perforation. We discuss causes, symptoms, diagnosis, and management of gastric ischemia, an underdiagnosed and potentially fatal condition that requires urgent diagnosis and treatment. PMID:28119945

  16. Perforated peptic ulcer in southeastern Taiwan.

    PubMed

    Li, Chin-Hsien; Chang, Wen-Hsiung; Shih, Shou-Chuan; Lin, Shee-Chan; Bair, Ming-Jong

    2010-09-01

    No studies focus on the population with perforated peptic ulcer in southeastern Taiwan. The present study aimed to assess the differences between the different races and the risk factors related to mortality and morbidity in postoperative patients in southeastern Taiwan. The medical records of 237 patients were reviewed retrospectively. The following factors were analyzed: patient profiles, coexisting illnesses, diagnostic method, fever, preoperative shock, clinical data at emergency room, delay operation, site of perforation, operative method, positive ascites culture, species of microbes in ascites culture, postoperative complications, death and the length of hospital stay. Aborigines were significantly different from non-aborigines in the ratio of female cases and in the habits of alcohol drinking and betel nut chewing. There were also four significantly different variables between them: fever, hemoglobin value, site of perforation and operative method. Total postoperative complication rate was 41.3% and 39 patients (16.6%) died. In multivariate analysis, age > or = 65 years, lipase > upper normal limit and preoperative shock were independent predictors of mortality. Significant risk factors associated with morbidity were NSAIDs use, creatinine > 1.5 mg/dL and preoperative shock. Aborigines were different from non-aborigines in several categories. In southeastern Taiwan, NSAIDs use, creatinine > 1.5 mg/dL and preoperative shock were independent risk factors of morbidity, and age > or = 65 years, lipase > upper normal limit and preoperative shock were independent risk factors of mortality in postoperative perforated peptic ulcer. Lipase > upper normal limit is needed for further research on the influence on mortality.

  17. Contained colonic perforation due to cecal retroflexion.

    PubMed

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

    2016-03-21

    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.

  18. Lateral perforation in parallel post space preparations.

    PubMed

    Tinaz, A Cemal; Alaçam, Tayfun; Topuz, Ozgur; Er, Ozgur; Maden, Murat

    2004-08-15

    This study evaluates the amount of remaining tooth structure and possibility of producing lateral perforation following the use of different diameters of parallel-sided Parapost drills in groups of different canal curvatures (0 degrees-15 degrees, 16 degrees-25 degrees, 26 degrees <) in distal canals of first and second mandibular molar teeth. After enlargement of root canals using the crown-down pressureless technique, Parapost drills #1, #2, and #3 were used in the different canal groups for the preparation of a post space. Standardized digital radiographs were taken before the post space preparation and after each Parapost drill application. Four horizontal lines (a, b, c, and d) were drawn at equal distances on these images, starting from the pulp chamber floor moving apically at 2 mm increments. There were no significant differences between the different curvature groups at the a, b, c, and d levels for the critical level of the remaining tooth structure (multiple comparison test; p>0.05). However, in considering root perforation, both at the inner and outer side of the roots, there were statistically significant differences at "c" and "d" levels in group 3 (#3 drill) without taking into account the root curvature (ANOVA; p< 0.5). None of the specimens showed strip perforation.

  19. Tectonic grafts for corneal thinning and perforations.

    PubMed

    Vanathi, M; Sharma, Namrata; Titiyal, Jeewan S; Tandon, Radhika; Vajpayee, Rasik B

    2002-11-01

    To evaluate the success of tectonic grafts in cases of corneal thinning and perforations. We performed 42 tectonic grafts in 41 eyes of 40 patients. Three types of tectonic grafts were used in our treatment protocol. These were (a) full-thickness grafts, (b) mushroom grafts, and (c) lamellar grafts. The parameters evaluated were indications, visual acuity, location, size and type of graft, postoperative outcome, and complications, if any. The most common indication for tectonic grafts was corneal thinning and perforation subsequent to infection (12 eyes) followed by those due to immunologic causes (six eyes) and trauma (six eyes). Twenty-four full-thickness tectonic grafts, nine mushroom grafts, and nine lamellar patch grafts were performed. Anatomical success was achieved in 35 of 41 (85.4%) eyes. Visual acuity of 6/24 or better was obtained in 29 of 41 (70.73%) eyes. The mean of best-corrected visual acuity (expressed in decimal) improved from 0.2 +/- 0.26 to 0.34 +/- 0.26 at an average follow-up of 10.83 +/- 6.27 months. The major complications were peripheral anterior synechiae in four eyes (9.76%) and graft melting in five eyes (12.2%). Tectonic graft is a useful therapeutic option in selected cases of corneal thinning and perforations because it effectively restores the integrity of the eye and allows acceptable visual rehabilitation.

  20. Occult glove perforation during ophthalmic surgery.

    PubMed Central

    Apt, L; Miller, K M

    1992-01-01

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

  1. Molecular pathology and biomarkers of bladder cancer.

    PubMed

    Czerniak, Bogdan

    2010-01-01

    Bladder cancer originates in the epithelial lining of the bladder's mucosa and develops in association with several habitual, industrial, and environmental risk factors via papillary and non-papillary pathways. In this chapter we review novel concepts concerning the molecular mechanisms of early field change in bladder neoplasia stemming from whole-organ genomic mapping studies. These mechanisms are discussed in the context of molecular pathogenesis of bladder cancer and in relation to treatment and biomarker-based detection strategies.

  2. Gall bladder malignancy: an unusual association.

    PubMed

    Appukutty, Sona J; Worthington, Tim; Bagwan, Izhar N

    2013-06-01

    Gall bladder malignancy predominantly comprises adenocarcinoma and is found mostly in a late stage whereas primary lymphoma of mucosa associated lymphoid tissue (MALT) within the gall bladder is exceedingly rare and has an incidental presentation. We report a case of well differentiated adenocarcinoma with MALT lymphoma of the gall bladder in an 83 year old woman. To our knowledge, this is the first case of a carcinoma and lymphoma occurring simultaneously in the gall bladder.

  3. Bladder Outlet Obstruction: Causes in Men?

    MedlinePlus

    ... is the most common cause of bladder outlet obstruction in men Scarring of the urinary channel (urethra) or bladder neck, as a result of injury or surgery Use of certain medications, including antihistamines, decongestants ... of bladder outlet obstruction is important to prevent serious problems caused by ...

  4. Implantable Bladder Sensors: A Methodological Review.

    PubMed

    Dakurah, Mathias Naangmenkpeong; Koo, Chiwan; Choi, Wonseok; Joung, Yeun-Ho

    2015-09-01

    The loss of urinary bladder control/sensation, also known as urinary incontinence (UI), is a common clinical problem in autistic children, diabetics, and the elderly. UI not only causes discomfort for patients but may also lead to kidney failure, infections, and even death. The increase of bladder urine volume/pressure above normal ranges without sensation of UI patients necessitates the need for bladder sensors. Currently, a catheter-based sensor is introduced directly through the urethra into the bladder to measure pressure variations. Unfortunately, this method is inaccurate because measurement is affected by disturbances in catheter lines as well as delays in response time owing to the inertia of urine inside the bladder. Moreover, this technique can cause infection during prolonged use; hence, it is only suitable for short-term measurement. Development of discrete wireless implantable sensors to measure bladder volume/pressure would allow for long-term monitoring within the bladder, while maintaining the patient's quality of life. With the recent advances in microfabrication, the size of implantable bladder sensors has been significantly reduced. However, microfabricated sensors face hostility from the bladder environment and require surgical intervention for implantation inside the bladder. Here, we explore the various types of implantable bladder sensors and current efforts to solve issues like hermeticity, biocompatibility, drift, telemetry, power, and compatibility issues with popular imaging tools such as computed tomography and magnetic resonance imaging. We also discuss some possible improvements/emerging trends in the design of an implantable bladder sensor.

  5. Bladder trauma: multidetector computed tomography cystography.

    PubMed

    Ishak, Charbel; Kanth, Nalini

    2011-08-01

    Multidetector computed tomography (MDCT) cystography is rapidly becoming the most recommended study for evaluation of the bladder for suspected trauma. This article reviews the bladder trauma with emphasis on the application of MDCT cystography to traumatic bladder injuries using a pictorial essay based on images collected in our level I trauma center.

  6. Implantable Bladder Sensors: A Methodological Review

    PubMed Central

    Dakurah, Mathias Naangmenkpeong; Koo, Chiwan; Choi, Wonseok; Joung, Yeun-Ho

    2015-01-01

    The loss of urinary bladder control/sensation, also known as urinary incontinence (UI), is a common clinical problem in autistic children, diabetics, and the elderly. UI not only causes discomfort for patients but may also lead to kidney failure, infections, and even death. The increase of bladder urine volume/pressure above normal ranges without sensation of UI patients necessitates the need for bladder sensors. Currently, a catheter-based sensor is introduced directly through the urethra into the bladder to measure pressure variations. Unfortunately, this method is inaccurate because measurement is affected by disturbances in catheter lines as well as delays in response time owing to the inertia of urine inside the bladder. Moreover, this technique can cause infection during prolonged use; hence, it is only suitable for short-term measurement. Development of discrete wireless implantable sensors to measure bladder volume/pressure would allow for long-term monitoring within the bladder, while maintaining the patient’s quality of life. With the recent advances in microfabrication, the size of implantable bladder sensors has been significantly reduced. However, microfabricated sensors face hostility from the bladder environment and require surgical intervention for implantation inside the bladder. Here, we explore the various types of implantable bladder sensors and current efforts to solve issues like hermeticity, biocompatibility, drift, telemetry, power, and compatibility issues with popular imaging tools such as computed tomography and magnetic resonance imaging. We also discuss some possible improvements/emerging trends in the design of an implantable bladder sensor. PMID:26620894

  7. Circulating Biomarkers in Bladder Cancer

    PubMed Central

    Nandagopal, Lakshminarayanan; Sonpavde, Guru

    2016-01-01

    Bladder cancer is a molecularly heterogeneous disease characterized by multiple unmet needs in the realm of diagnosis, clinical staging, monitoring and therapy. There is an urgent need to develop precision medicine for advanced urothelial carcinoma. Given the difficulty of serial analyses of metastatic tumor tissue to identify resistance and new therapeutic targets, development of non-invasive monitoring using circulating molecular biomarkers is critically important. Although the development of circulating biomarkers for the management of bladder cancer is in its infancy and may currently suffer from lower sensitivity of detection, they have inherent advantages owing to non-invasiveness. Additionally, circulating molecular alterations may capture tumor heterogeneity without the sampling bias of tissue biopsy. This review describes the accumulating data to support further development of circulating biomarkers including circulating tumor cells, cell-free circulating tumor (ct)-DNA, RNA, micro-RNA and proteomics to improve the management of bladder cancer. PMID:28035318

  8. [Occupational hazards and bladder cancer].

    PubMed

    Nizamova, R S

    1991-01-01

    Occupational exposure to health hazards was studied in 258 industrial workers who had developed cancer of the bladder against 454 matched controls. All the test subjects and controls were residents of the Tambov Province centers of chemical industry. Statistical significance (relative risk-4.7) was established for exposure to aromatic amines. For those contacting with aniline dyes the relative risk (RR) made up 2.4. The risk to develop bladder cancer in powder shops (RR-3.2) was attributed to the hazards of dyes and diphenylamine. In leather-shoe and textile industry the exposure to dyes was not safe (RR-6.1), neither was it to chemicals, oil products, pesticides, overheating (RR-3.2, 1.6, 3.2 and 2.9, respectively). It is stated that in line with a significant risk to develop bladder cancer at exposure to aromatic amines there exist a number of occupational factors contributing to this risk.

  9. Bladder cavernous hemangioma. Case report.

    PubMed

    Rodriguez Collar, Tomás Lázaro; Casa de Valle Castro, Midalys; Báez Sarría, Felix; Trujillo Fernández, Reinerio

    2014-07-01

    To report a case of a bladder cavernous hemangioma, as well as the main features of its diagnosis and treatment. A 74 year old patient, regular smoker, presented with total macroscopic hematuria of moderate intensity with large rounded clots. On physical examination the patient's mucous membranes color was normal, and digital rectal examination showed a normal size prostate with fibroelastic consistency. An abdominal ultrasound was performed showing a slight bladder bottom thickening in addition to free clots and a homogeneous and normal prostate. Cystoscopy confirmed the presence of a sessile violet-colored rounded retrotrigonal tumor, 2 cm in diameter and 0.5 in height; it was immediately resected. The pathological study reported cavernous hemangioma. Patient's evolution has been satisfactory. Bladder cavernous hemangioma is a rare cause of hematuria, and transurethral resection of the small size lesions constitutes an effective option as a definitive surgical treatment.

  10. Intestinal obstruction due to migration of a thermometer from bladder to abdominal cavity: a case report.

    PubMed

    Nie, Jing; Zhang, Bo; Duan, Yan-Chao; Hu, Yue-Hua; Gao, Xin-Ying; Gong, Jian; Cheng, Ming; Li, Yan-Qing

    2014-03-07

    Intraperitoneal foreign bodies such as retained surgical instruments can cause intestinal obstruction. However, intestinal obstruction due to transmural migration of foreign bodies has rarely been reported. Here, we report a case of intestinal obstruction due to a clinical thermometer which migrated from the bladder into the abdominal cavity. A 45-year-old man was admitted to our hospital with a one-year history of recurrent lower abdominal cramps. Two days before admission, the abdominal cramps aggravated. Intestinal obstruction was confirmed with upright abdominal radiography and computerized tomography scan which showed dilation of the small intestines and a thermometer in the abdominal cavity. Then laparotomy was performed. A scar was observed at the fundus of the bladder and a thermometer was adhering to the small bowels and mesentery which resulted in intestinal obstruction. Abdominal cramps were eliminated and defecation and flatus recovered soon after removal of the thermometer.

  11. Intestinal obstruction due to migration of a thermometer from bladder to abdominal cavity: A case report

    PubMed Central

    Nie, Jing; Zhang, Bo; Duan, Yan-Chao; Hu, Yue-Hua; Gao, Xin-Ying; Gong, Jian; Cheng, Ming; Li, Yan-Qing

    2014-01-01

    Intraperitoneal foreign bodies such as retained surgical instruments can cause intestinal obstruction. However, intestinal obstruction due to transmural migration of foreign bodies has rarely been reported. Here, we report a case of intestinal obstruction due to a clinical thermometer which migrated from the bladder into the abdominal cavity. A 45-year-old man was admitted to our hospital with a one-year history of recurrent lower abdominal cramps. Two days before admission, the abdominal cramps aggravated. Intestinal obstruction was confirmed with upright abdominal radiography and computerized tomography scan which showed dilation of the small intestines and a thermometer in the abdominal cavity. Then laparotomy was performed. A scar was observed at the fundus of the bladder and a thermometer was adhering to the small bowels and mesentery which resulted in intestinal obstruction. Abdominal cramps were eliminated and defecation and flatus recovered soon after removal of the thermometer. PMID:24605042

  12. Whyever bladder tissue engineering clinical applications still remain unusual even though many intriguing technological advances have been reached?

    PubMed

    Alberti, C

    2016-01-01

    To prevent problematic outcomes of bowel-based bladder reconstructive surgery, such as prosthetic tumors and systemic metabolic complications, research works, to either regenerate and strengthen failing organ or build organ replacement biosubstitute, have been turned, from 90s of the last century, to both regenerative medicine and tissue engineering.Various types of acellular matrices, naturally-derived materials, synthetic polymers have been used for either "unseeded" (cell free) or autologous "cell seeded" tissue engineering scaffolds. Different categories of cell sources - from autologous differentiated urothelial and smooth muscle cells to natural or laboratory procedure-derived stem cells - have been taken into consideration to reach the construction of suitable "cell seeded" templates. Current clinically validated bladder tissue engineering approaches essentially consist of augmentation cystoplasty in patients suffering from poorly compliant neuropathic bladder. No clinical applications of wholly tissue engineered neobladder have been carried out to radical-reconstructive surgical treatment of bladder malignancies or chronic inflammation-due vesical coarctation. Reliable reasons why bladder tissue engineering clinical applications so far remain unusual, particularly imply the risk of graft ischemia, hence its both fibrous contraction and even worse perforation. Therefore, the achievement of graft vascular network (vasculogenesis) could allow, together with the promotion of host surrounding vessel sprouting (angiogenesis), an effective graft blood supply, so avoiding the ischemia-related serious complications.

  13. Whyever bladder tissue engineering clinical applications still remain unusual even though many intriguing technological advances have been reached?

    PubMed Central

    ALBERTI, C.

    2016-01-01

    To prevent problematic outcomes of bowel-based bladder reconstructive surgery, such as prosthetic tumors and systemic metabolic complications, research works, to either regenerate and strengthen failing organ or build organ replacement biosubstitute, have been turned, from 90s of the last century, to both regenerative medicine and tissue engineering. Various types of acellular matrices, naturally-derived materials, synthetic polymers have been used for either “unseeded” (cell free) or autologous “cell seeded” tissue engineering scaffolds. Different categories of cell sources – from autologous differentiated urothelial and smooth muscle cells to natural or laboratory procedure-derived stem cells – have been taken into consideration to reach the construction of suitable “cell seeded” templates. Current clinically validated bladder tissue engineering approaches essentially consist of augmentation cystoplasty in patients suffering from poorly compliant neuropathic bladder. No clinical applications of wholly tissue engineered neobladder have been carried out to radical-reconstructive surgical treatment of bladder malignancies or chronic inflammation-due vesical coarctation. Reliable reasons why bladder tissue engineering clinical applications so far remain unusual, particularly imply the risk of graft ischemia, hence its both fibrous contraction and even worse perforation. Therefore, the achievement of graft vascular network (vasculogenesis) could allow, together with the promotion of host surrounding vessel sprouting (angiogenesis), an effective graft blood supply, so avoiding the ischemia-related serious complications. PMID:27142819

  14. EFFICACY OF DIFFERENT RESECTIONS ON NON-MUSCLE-INVASIVE BLADDER CANCER AND ANALYSIS OF THE OPTIMAL SURGICAL METHOD.

    PubMed

    Chen, G F; Shi, T P; Wang, B J; Wang, X Y; Zang, Q

    2015-01-01

    This study aimed to analyze the clinical efficacy of different resections in treating non-muscle-invasive bladder cancer (NMIBC), including partial cystectomy, transurethral resection of bladder tumor (TURBT) and holmium laser resection of bladder tumor. Two hundred and sixteen patients were recruited with NMIBC who were available for follow-up visits in hospital, including 62 cases treated with partial cystectomy, 90 cases treated with TURBT and 64 cases with holmium laser resection. Analysis was made on the cases with tumor relapse in the two years, on operation time, blood loss, time for indwelling urinary catheter, hospital stay and complications after operation. Results were compared to the clinical efficacy of these operation patterns. It was found that the two-year relapse rate for TURBT group, partial cystectomy group and Holmium laser resection group was 41%, 31%, and 33% respectively, and the difference had no statistical significance (p>0.05). Both the TURBT group and holmium laser resection group had shorter operation time, hospital stay and time for indwelling urinary catheter as well as much less blood loss when compared with the partial cystectomy group; the difference had statistical significance (p<0.001). In terms of complications, the TURBT group was likely to induce obturator nerve reflex and bladder perforation while the partial cystectomy group was likely to induce bladder spasm. Therefore, this study presumes that holmium laser resection and TURBT are much safer and quicker for recovery and obviously superior to the partial cystectomy.

  15. [Rare cases of bladder stones].

    PubMed

    Sampalmieri, Gregorio; Moretti, Antonello; Sampalmieri, Matteo

    2014-01-01

    We present here two special cases of urolithiasis. The first one shows a giant bladder lithiasis resulting in severe renal insufficiency in a 63-year-old patient, who had previously had nicturia (2-3 times), occasional episodes of urinary frequency and burning micturition, in the absence of renal colic, hematuria or interrupted urination. The second case referes to an 85-year-old man suffering from prostatic enlargement and bladder stones, hospitalized to undergo intervention of trans-vesical prostatic adenomectomy, during which two star-shaped stones were found without obvious symptoms.

  16. Urinary markers for bladder cancer

    PubMed Central

    Smith, Zachary L.

    2013-01-01

    Bladder cancer has the fifth highest incidence of all malignancies in the United States, with a propensity to recur, requiring lifelong surveillance after diagnosis. Urinary markers of disease have been of extreme interest in this field in an effort to simplify surveillance schedules and improve early detection of tumors. Many markers have been described, but most remain investigational. However, some markers have undergone clinical trials and are approved for clinical use. In this review, urinary markers and their application for screening and surveillance of bladder cancer are discussed. PMID:23864929

  17. Immunobiology of human bladder cancer.

    PubMed

    Herr, H W

    1976-02-01

    The immune destruction of bladder cancer most likely results from an interaction of specific and non-specific cellular and humoral responses evoked by tumor-associated antigens. We are just beginning to comprehend the complex immune mechanisms operating to retard or facilitate tumor growth in patients with this disease. This understanding has led to renewed hope that the immune system may be manipulated for the benefit of the tumor-bearing patient. However, only a thorough understanding of the basic functions of the immune system in man will permit a rational approach to immunotherapy in patients with bladder cancer.

  18. Gallbladder perforation complicating typhoid fever: report of two cases.

    PubMed

    Gali, B M; Ali, N; Agbese, G O; Duna, V D; Dawha, S D; Ismai, G I; Mohammed, M

    2011-01-01

    Gallbladder perforation (GBP) is rare and as a complication of typhoid fever is extremely rare. We present two consecutive patients with GBP diagnosed incidentally at laparotomy. Information on the management of two patients with gallbladder perforation seen at Federal Medical Centre Azare in June and October 2008 was extracted from their case records. The two patients were both males aged 13 years and 16 years. They both presented with high fever of more than 2 weeks duration; and abdominal pain and distension. Both patients had features of generalised peritonitis. Pre-operative diagnoses of typhoid enteric perforation were made based on a positive Widal test. Intra-operative findings however, were that of bile peritonitis and gallbladder perforation. Both had cholecystectomy. Culture of the bile aspirate yielded Salmonella typhi. Gallbladder perforation secondary to typhoid fever should be considered as a differential diagnosis in patients with suspected typhoid enteric perforation in typhoid fever endemic region.

  19. Acquired perforating dermatosis in a patient with chronic renal failure*

    PubMed Central

    Fernandes, Karen de Almeida Pinto; Lima, Lourenço de Azevedo; Guedes, Juliana Chaves Ruiz; Lima, Ricardo Barbosa; D'Acri, Antônio Macedo; Martins, Carlos José

    2016-01-01

    Perforating dermatoses are a group of skin diseases characterized by transepidermal elimination of dermal material. The disease is divided into two groups: the primary group and the secondary group. The classical or primary perforating dermatoses are subdivided into four types according to the eliminated dermal materials: Kyrle disease, perforating reactive collagenosis, elastosis perforans serpiginosa, and perforating folliculitis. The secondary form is known as acquired perforating dermatosis. The term was proposed in 1989 by Rapini to designate the perforating dermatoses affecting adult patients with systemic disease, regardless of the dermal materials eliminated. This report describes a case of the disease with elimination of collagen and elastic fibers in a patient with chronic renal failure. PMID:28300880

  20. [Effect of Passiflora edulis (passion fruit) extract on rats' bladder wound healing: morphological study].

    PubMed

    Gonçalves Filho, Antonio; Torres, Orlando Jorge Martins; Campos, Antonio Carlos Ligocki; Tâmbara Filho, Renato; Rocha, Luiz Carlos de Almeida; Thiede, Arnulf; Lunedo, Sandra Maria Corrêa; Barbosa, Raimundo Eri de Araújo; Bernhardt, Joel Antonio; Vasconcelos, Paulo Roberto Leitão de

    2006-01-01

    To evaluate the effects of hydroalcoholic extract of Passiflora edulis leaves in the healing of urinary bladder in rats from histological aspects. Forty Wistar male rats were submitted to a longitudinal incision of the bladder followed by a stetching in only one level. After this common procedure, animals were divided at random two groups: Passiflora and Control. In the Passiflora group the only dosage used was administered by intraperitoneal injection of hydroalcoholic extract of Passiflora edulis leaves while in the Control group distilled water was injected. Each subgroup was then divided in two subgroups according to the death of these animals: Control, three and seven days, Passiflora, three and seven days. After the death of these animals, an inventory of the abdominal cavity was performed and the bladder was removed. A comparative analysis was done between the two groups with microscopic evaluation of the healing. There was less acute inflammation (p=0.008), greater collagenous formation (p=0.001) and greater capillary neo-formation (p=0.000) in the third day Passiflora subgroup when compared to the Control subgroup of the third day. There was less acute inflammation (p=0.001), greater fibroblastic proliferation (p=0.011) and greater collagenous formation (p=0.001) in the Passiflora subgroup of seventh day when compared with the Control seventh day subgroup. The use of Passiflora edulis leaves extract resulted in less acute inflammation, greater fibroblastic proliferation, collagenous formation and capillary neo-formation on rats' bladder wound healing.

  1. Neutron-Activatable Nanoparticles for Intraperitoneal Radiation Therapy.

    PubMed

    Hargrove, Derek; Lu, Xiuling

    2017-01-01

    Intraperitoneal internal radiation therapy is a cancer treatment option that is employed in situations where surgical resection, systemic chemotherapy, and external beam radiotherapy are not amenable for patients. However, exposure of noncancerous tissues to radiation continues to be a hindrance to safe and effective treatment of patients. In addition, reducing prolonged radiation exposure of personnel during preparation of internal radiation therapy agents makes their manufacture complicated and hazardous. Developments in nanotechnology have provided a platform for targeted treatments that combine dual imaging and treatment capabilities all in one package, while also being robust enough to withstand the intense stresses faced during neutron activation. Here, we describe a method for synthesizing neutron activatable mesoporous silica nanoparticles for use in radiotherapy of metastatic peritoneal cancers while limiting personal exposure to radioactive materials, limiting the leakage of radioactive isotopes caused by nanoparticle degradation during neutron activation, and increasing cancer tissue specificity of radiation.

  2. Intraperitoneal secretion of interleukin-6 during continuous ambulatory peritoneal dialysis.

    PubMed

    Goldman, M; Vandenabeele, P; Moulart, J; Amraoui, Z; Abramowicz, D; Nortier, J; Vanherweghem, J L; Fiers, W

    1990-01-01

    Interleukin-6 (IL-6) was determined in serum and peritoneal dialysis effluent (PDE) of patients on chronic ambulatory peritoneal dialysis (CAPD) by a biological assay measuring the proliferation of the IL-6-dependent 7TD1 cell line. Six patients free of peritonitis displayed low but significant levels of IL-6 (mean +/- 42 pg/ml) in PDE, while IL-6 was undetectable in serum. In 6 patients with staphylococcal peritonitis, a tremendous increase in PDE levels of IL-6 was noted (range: 5,832-37,491 pg/ml), while serum IL-6 remained either undetectable or on a low level except in one case. After 5 days of antibiotic treatment, IL-6 levels in PDE returned to basal values. We conclude that CAPD results in an intraperitoneal secretion of IL-6 which is markedly but transiently increased during peritonitis episodes.

  3. Intraperitoneal blood missed on a FAST examination using portable ultrasound.

    PubMed

    Blaivas, Michael; Theodoro, Daniel

    2002-03-01

    Bedside ultrasonography is rapidly gaining popularity in the evaluation of emergency patients. Several manufacturers have developed hand-held ultrasound machines that make the technology easy to transport and available in settings where such diagnostic tests were previously unobtainable. The miniaturization of equipment often means compromises and no studies exist comparing the high quality imaging capabilities of larger conventional ultrasound units to hand-held machines on actual patients. We present 3 cases in which intra-abdominal fluid stripes, important markers of intraperitoneal bleeding, were not visible with a popular hand-held unit, but were identified with a larger mobile ultrasound machine. These findings should caution emergency physicians to be aware of this limitation along with the many advantages of these new and popular hand-held ultrasound units.

  4. Mesothelial reaction of asbestos and other irritants after intraperitoneal injection.

    PubMed

    Engelbrecht, F M; Burger, B F

    1975-01-18

    Ten groups of rats were injected intraperitoneally with one of the following suspensions; (i) standard reference crocidolite; (ii) acid-treated crocidolite (iii) crocidolite plus iron oxide; (iv) crocidolite plus silica; (v) iron oxide; (vi) silica; (vii) long fibre crocidolite; (viii) short fibre crocidolite; (ix) long fibre glass and (x) short fibre glass. Two rats from each group were killed at 45, 90, 150, 240 and 330 days respectively, and the pathology induced by the different suspensions was studied histologically at each time interval. No evidence in support of the chemical induction theory or mechanical irritation theory in the pathogenesis of peritoneal mesotheliomas could be found, although all the suspensions except iron oxide caused a reactive mesothelium.

  5. Intraperitoneal mesotheliomas induced in mice by a polycyclic aromatic hydrocarbon

    SciTech Connect

    Rice, J.M.; Anderson, L.M. ); Kovatch, R.M. )

    1989-01-01

    Female mice of 6 strains (C3H/HeN, BALB/c, C57BL/6N, DBA/2, NIH Swiss, and AKR/N) were given the polycyclic aromatic hydrocarbon carcinogen 3-methylcholanthrene (MC) intragastrically in olive oil at a dose of 20 mg/kg, weekly for 12 wk. Half were pretreated 24 h before each MC administration with intraperitoneal {beta}-naphthoflavone ({beta}-NF, 150 mg/kg in olive oil), a noncarinogenic inducer of certain cytochrome P-450 isozymes. Remaining mice were given olive oil prior to MC in the same fashion, or {beta}-NF in olive oil or olive oil alone without subsequent exposure to MC. All mice were killed when moribund or 13 mo after the start of treatment. Most of the mice, irrespective of treatment, exhibited signs of peritoneal injury, including inflammation, necrosis, granuloma formation, and mineralization. Mice of some of the strains also presented peritoneal mesotheliomas, in addition to a variety of other tumors. {beta}-NF pretreatment reduced the frequency of mesotheliomas: there was only one definite mesothelioma in any of the {beta}-NF-MC groups, in a C3H/He mouse. Most of the measotheliomas were mixed fibro-mesothelial type, sometimes with papillary epithelial excrescences. They typically grew in a botryoid pattern within the peritoneal cavity, coating the abdominal organs and sometimes actively invading these organs and the diaphragm. Some lesions exhibited pleomorphism, prominent giant cells, and frequent mitoses. In addition, several lesions consisting of severe mesothelial hyperplasia associated with tissue necrosis and inflammation were considered as possible early stages of mesothelioma development. It was postulated that peritoneal injury imposed by repeated intraperitoneal injection of oil acted as an enhancing factor for mesothelioma induction by MC.

  6. Intraperitoneal germ cell transplantation in the Nile tilapia Oreochromis niloticus.

    PubMed

    Farlora, Rodolfo; Hattori-Ihara, Shoko; Takeuchi, Yukata; Hayashi, Makoto; Octavera, Anna; Alimuddin; Yoshizaki, Goro

    2014-06-01

    Germ cell transplantation offers promising applications in finfish aquaculture and the preservation of endangered species. Here, we describe an intraperitoneal spermatogonia transplantation procedure in the Nile tilapia Oreochromis niloticus. Through histological analysis of early gonad development, we first determined the best suitable stage at which exogenous germ cells should be transplanted into the recipients. For the transplantation procedure, donor testes from a transgenic Nile tilapia strain carrying the medaka β-actin/enhanced green fluorescent protein (EGFP) gene were subjected to enzymatic dissociation. These testicular cells were then stained with PKH26 and microinjected into the peritoneal cavity of the recipient fish. To confirm colonization of the donor-derived germ cells, the recipient gonads were examined by fluorescent and confocal microscopy. PKH26-labeled cells exhibiting typical spermatogonial morphology were incorporated into the recipient gonads and were not rejected within 22 days posttransplantation. Long-term survival of transgenic donor-derived germ cells was then verified in the gonads of 5-month-old recipients and in the milt and vitelogenic oocytes of 1-year-old recipients, by means of PCR using EGFP-specific primers. EGFP-positive milt from adult male recipients was used to fertilize non-transgenic oocytes and produced transgenic offspring expressing the donor-derived phenotype. These results imply that long-term survival, proliferation, and differentiation of the donor-derived spermatogonia into vitelogenic oocytes and functional spermatozoa are all possible. Upon further improvements in the transplantation efficiency, this intraperitoneal transplantation system could become a valuable tool in the conservation of genetic resources for cichlid species.

  7. Social stress induces changes in urinary bladder function, bladder NGF content, and generalized bladder inflammation in mice.

    PubMed

    Mingin, Gerald C; Peterson, Abbey; Erickson, Cuixia Shi; Nelson, Mark T; Vizzard, Margaret A

    2014-10-01

    Social stress may play a role in urinary bladder dysfunction in humans, but the underlying mechanisms are unknown. In the present study, we explored changes in bladder function caused by social stress using mouse models of stress and increasing stress. In the stress paradigm, individual submissive FVB mice were exposed to C57BL/6 aggressor mice directly/indirectly for 1 h/day for 2 or 4 wk. Increased stress was induced by continuous, direct/indirect exposure of FVB mice to aggressor mice for 2 wk. Stressed FVB mice exhibited nonvoiding bladder contractions and a decrease in both micturition interval (increased voiding frequency) and bladder capacity compared with control animals. ELISAs demonstrated a significant increase in histamine protein expression with no change in nerve growth factor protein expression in the urinary bladder compared with controls. Unlike stressed mice, mice exposed to an increased stress paradigm exhibited increased bladder capacities and intermicturition intervals (decreased voiding frequency). Both histamine and nerve growth factor protein expression were significantly increased with increased stress compared with control bladders. The change in bladder function from increased voiding frequency to decreased voiding frequency with increased stress intensity suggests that changes in social stress-induced urinary bladder dysfunction are context and duration dependent. In addition, changes in the bladder inflammatory milieu with social stress may be important contributors to changes in urinary bladder function.

  8. Gallbladder perforation in a patient on steroid therapy.

    PubMed

    Andrabi, Syed Imran; Ahmad, Jawad; Rathore, Munir A; El-Hakeem, Ahmed A

    2007-08-24

    Gallbladder perforation is a serious clinical condition. A definitive diagnosis is contentious before surgery. We discuss a case where a young patient with Crohn's disease taking oral steroids presented with an acute abdomen. CT scan demonstrated a perforated gallbladder without evidence of gallstones. The patient underwent an emergency cholecystectomy and peritoneal lavage. The history and clinical findings of this patient are reviewed to highlight perforation of the gallbladder in relation to steroid therapy.

  9. 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

  10. Neonatal Sleeve Gastrectomy for Multiple Gastric Perforations: A Case Report

    PubMed Central

    Reyna-Sepulveda, Francisco

    2017-01-01

    Neonatal gastric perforation (NGP) may be spontaneous, secondary to necrotizing enterocolitis (NEC), or due to distal obstruction. A 27-week old premature male newborn presented with pneumoperitoneum. A single perforation of stomach was found at surgery. Primary repair and gastrostomy were performed. On fifth postoperative day, pneumoperitoneum was again detected. At reoperation, multiple gastric perforations of the greater curvature were found. Sleeve gastrectomy was performed. The patient responded well to the treatment. PMID:28083496

  11. Endoscopic clip closure of gastrointestinal perforations, fistulae, and leaks.

    PubMed

    Raju, Gottumukkala S

    2014-01-01

    Development of endoscopic devices to close perforations has certainly revolutionized endoscopy. Immediate closure of perforations eliminates the need for surgery, which allows us to push the limits of endoscopic surgery from the mucosal plane to deep submucosal layers and eventually transmurally. The present article focuses on endoscopic closure devices, closure techniques, followed by a review of animal and clinical studies on endoscopic closure of perforations. © 2013 The Author. Digestive Endoscopy © 2013 Japan Gastroenterological Endoscopy Society.

  12. Peptic ulcer perforation: sonographic imaging of active fluid leakage.

    PubMed

    Minardos, Ioannis; Ioannis, Minardos; Ziogana, Dimitra; Dimitra, Ziogana; Hristopoulos, Hristos; Hristos, Hristopoulos; Dermitzakis, Ioannis; Ioannis, Dermitzakis

    2006-01-01

    Sonography is not the method of choice for the evaluation of suspected peptic ulcer perforation (PUP). However, indirect sonographic signs and direct visualization of PUP have been reported by several authors in recent years. We report a case of an elderly woman who presented with severe abdominal pain and positive rebound sign, in whom abdominal sonography demonstrated indirect signs of PUP, the site of perforation, and active air fluid leakage through the perforated anterior prepyloric antral wall.

  13. Dorsolateral musculocutaneous perforators of posterior intercostal artery: an anatomical study.

    PubMed

    Prasad, Vani; Almutairi, Khalid; Kimble, Frank W; Stewart, Fiona; Morris, Steven F

    2012-11-01

    The posterior intercostal artery (PICA) is divided into four segments, vertebral, costal, intermuscular, and rectus, based on the neurovascular branching pattern. Dorsal branches arise from the vertebral segment. Several musculocutaneous perforators and a lateral branch originate from the costal segment. Musculocutaneous branches arise from the intermuscular and rectus segments. The purpose of this study is to describe in detail the musculocutaneous perforators of the costal segment of the posterior intercostal artery. Fresh cadavers were injected with a modified lead oxide-gelatin mixture. Intercostal spaces (8-11) were dissected in twelve cadavers (six preserved cadavers and six fresh cadavers). Angiograms were assembled with Adobe Photoshop. Two fresh cadavers underwent CT angiography and three dimensional reconstructions of the intercostal perforators were performed using Materialise's Interactive Medical Image Control System (MIMICS). In twelve cadavers, a total of 356 perforators (size > 0.5 mm) were found to arise from the posterior intercostal arteries in 96 intercostal (IC) spaces. 154 perforators (>0.5 mm) were found in the costal segment of the PICA. An average of 6.4 perforators was found in each hemithorax. All perforators were found within 2 cm of the midscapular line. At least one perforator was found in all intercostal spaces. Two or more perforators were found in 40% of the 8th and 9th IC spaces and 60% of the 10th and 11th IC spaces. Perforators were oriented perpendicular to the direction of the muscle fibres of the latissimus dorsi and were usually present one or two intercostal spaces below their origin from the PICA. Perforators of the costal segment of the PICA are described in detail. We propose to call these currently unnamed musculocutaneous perforators "dorsolateral" branches of the PICA, as they are located between dorsal and lateral branches of PICA. Copyright © 2012 British Association of Plastic, Reconstructive and Aesthetic Surgeons

  14. Cytomegalovirus infection of the graft duodenum and urinary bladder after simultaneous pancreas-kidney transplantation.

    PubMed

    Jang, H J; Kim, S C; Cho, Y P; Kim, Y H; Han, M S; Han, D J

    2004-09-01

    Cytomegalovirus (CMV) is an important cause of morbidity after solid organ transplantation. We report a case of CMV infection involving the transplanted duodenum that developed after simultaneous pancreas-kidney transplantation. The patient, a 30-year-old woman with insulin-dependent diabetes undergoing hemodialysis due to chronic renal failure, received a simultaneous cadaveric pancreas-kidney transplantation. The exocrine secretion was diverted using bladder drainage. Immunosuppression was maintained by a combination of tacrolimus, mycophenolate mofetil, and steroids together with OKT3 induction. Both the donor and the recipient were serologically positive for CMV IgG CMV prophylaxis consisted of a short course of parenteral gancyclovir. The patient was discharged on postoperative day 39 with normal pancreas and kidney function. She presented 2 months after transplantation with hematuria. Cystoscopic pancreas allograft biopsy specimens showed evidence of tissue invasive CMV infection in the graft duodenum and bladder. The CMV antigenemia test was positive. At 4 months after transplantation, the patient underwent surgery with the diagnosis of acute abdomen. The surgical findings consisted of a diffuse acute purulent peritonitis due to perforation of the duodenal graft. We sutured the perforation with nonreabsorbable material. The CMV antigenemia test was negative. Eight days later, the patient developed massive hematuria. At surgery, the graft was removed. The patient was discharged from the hospital with normal renal function. Pathological study of the removed graft showed the duodenal segment to have multiple wide ulcers with CMV inclusions in epithelial cells.

  15. Gall-bladder duplication - case report.

    PubMed

    Koszman, Bogusław

    2014-12-18

    Gall-bladder duplication is a rare anatomical variation, which can affect safe performance of cholecystectomy and be a cause of persistent symptoms and a need for reoperation in case of accessory gall-bladder omission. A case of successfully performed elective laparoscopic cholecystectomy in a patient with duplicated gall-bladder accidentally intraoperatively disclosed is presented. The identified anomaly was classified according to the Harlaftis Classification of Multiple Gall-bladders. Attention was drawn to the uneffectivenes of ultrasound scanning in multiple gall-bladders preoperative detecting, and presence of other non-biliary anatomical variation in the same individual as well.

  16. Perforated Solitary Diverticulitis of the Ascending Colon

    DTIC Science & Technology

    2005-06-01

    immobile gallstone at the neck of the gallbladder and peri-cholecystic fluid. We took the patient to the operating room for laparoscopic cholecystectomy...white blood cell count, and focal peritonitis in the right upper quadrant with an ultrasound examination show- ing a large gallstone and peri-cholecystic...ultrasound. Once the gall- bladder was determined not to be the cause of the illness and free purulent fluid found in the peritoneum, we were obli- gated to

  17. Effects of septal perforation on nasal airflow: computer simulation study.

    PubMed

    Lee, H P; Garlapati, R R; Chong, V F H; Wang, D Y

    2010-01-01

    Nasal septal perforation is a structural or anatomical defect in the septum. The present study focused on the effects of septal perforation on nasal airflow and nasal patency, investigated using a computer simulation model. The effect of nasal septal perforation size on nasal airflow pattern was analysed using computer-generated, three-dimensional nasal models reconstructed using data from magnetic resonance imaging scans of a healthy human subject. Computer-based simulations using computational fluid dynamics were then conducted to determine nasal airflow patterns. The maximum velocity and wall shear stress were found always to occur in the downstream region of the septal perforation, and could potentially cause bleeding in that region, as previously reported. During the breathing process, there was flow exchange and flow reversal through the septal perforation, from the higher flow rate to the lower flow rate nostril side, especially for moderate and larger sized perforations. In the breathing process of patients with septal perforations, there is airflow exchange from the higher flow rate to the lower flow rate nostril side, especially for moderate and large sized perforations. For relatively small septal perforations, the amount of cross-flow is negligible. This cross-flow may cause the whistling sound typically experienced by patients.

  18. An Unusual Etiology of Spontaneous Pyometra Perforation; A Case Report

    PubMed Central

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

    2011-01-01

    Introduction By presenting this case we aimed to describe an uncommon complication of generalized peritonitis following spontaneous pyometra perforation in untreated cervical carcinoma. Case Presentation This report describes a 60-year-old postmenopausal woman presenting with clinical features mimicking intestinal perforation who was later diagnosed as cervical carcinoma with pyometra perforation at exploratory laparotomy. The patient had good post-operative recovery following drainage and peritoneal lavage. Conclusion Spontaneous pyometra perforation in a case of untreated carcinoma of cervix is a rare condition, yet it should be suspected and kept in the differential diagnosis of acute abdomen in elderly women. PMID:23926508

  19. 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

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

    PubMed Central

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

    2015-01-01

    Iatrogenic colon perforation is one the most pernicious complications for patients undergoing endoscopic screening or therapy. It is a serious but rare complication of colonoscopy. However, with the expansion of the indications for endoscopic therapies for gastrointestinal diseases, the frequency of colorectal perforation has increased. The management of iatrogenic colorectal perforation is still a challenge for many endoscopists. The methods for treating this complication vary, including conservative treatment, surgical treatment, laparoscopy and endoscopy. In this review, we highlight the etiology, recognition and treatment of colorectal iatrogenic perforation. Specifically, we shed light on the endoscopic management of this rare complication. PMID:26191347

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

    PubMed Central

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

    2013-01-01

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

  2. Spontaneous free perforation of the small intestine in adults

    PubMed Central

    Freeman, Hugh James

    2014-01-01

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

  3. 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.

  4. 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. © Georg Thieme Verlag KG Stuttgart · New York.

  5. 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

  6. Duodenal ulcer perforation: the effect of H2 antagonists?

    PubMed Central

    Gillen, P.; Ryan, W.; Peel, A. L.; Devlin, H. B.

    1986-01-01

    One hundred and two patients with perforated duodenal ulcers over a 13 year period (1970 to 1982) have been prospectively followed-up at a special gastric clinic. Of the 37 patients with perforation of their acute ulcer, 34 were treated by oversew and three had an initial definitive operation (vagotomy and drainage). The remaining 65 patients presented with perforation of a chronic ulcer and 54 were treated by oversew and 11 underwent definitive surgery--nine had vagotomy and drainage and two had partial gastrectomies. Seven of the 34 patients (20.5%) with acute ulcer perforation treated by simple oversew subsequently required definitive ulcer surgery at a mean 17.5 months after perforation and 31 of the 54 patients (57.4%) with chronic ulcer perforations required definitive surgery at a mean 27.4 months after perforation. The introduction of H2 antagonists in 1977 did not alter the re-operation rate in patients with chronic ulcer perforation managed by oversew. Results of this study provide further evidence in favour of treating patients with perforation of their chronic duodenal ulcer by definitive surgery whenever possible. PMID:3789618

  7. Obesity, Physical Activity and Bladder Cancer.

    PubMed

    Noguchi, Jonathan L; Liss, Michael A; Parsons, J Kellogg

    2015-10-01

    While smoking and exposure to certain chemicals are well-defined risk factors for bladder cancer, there is no consensus as to the roles of modifiable lifestyle factors, notably physical activity, and obesity. We evaluated associations of obesity and physical activity with bladder cancer risk by performing a system-wide search of PubMed for cohort and case-control studies focused on obesity, exercise, and bladder cancer. A total of 31 studies were identified that evaluated the associations of obesity and physical activity with bladder cancer risk: 20 focused on obesity, eight on physical activity, and three on both. There was marked heterogeneity in population composition and outcomes assessment. Fifteen (65%) of the obesity studies used prevalence or incidence as the primary outcome and seven (30%) used bladder cancer mortality. Ten (44%) observed positive and 13 (56%) null associations of obesity with bladder cancer. Three (100%) of three studies also noted strong positive associations of obesity with bladder cancer progression or recurrence. Ten (91%) of the physical activity studies analyzed prevalence or incidence and one (9%) mortality. One (9%) study observed positive, seven (64%) null, and three (27%) negative associations of physical activity with bladder cancer. Study heterogeneity precluded quantitative assessment of outcomes. Obesity is potentially associated with an increased risk of bladder cancer, particularly for progression, recurrence, or death. Further studies of physical activity and bladder cancer are needed to validate these observations and elucidate the associations of exercise with bladder cancer progression and mortality.

  8. Overactive bladder - 18 years - Part II.

    PubMed

    Truzzi, Jose Carlos; Gomes, Cristiano Mendes; Bezerra, Carlos A; Plata, Ivan Mauricio; Campos, Jose; Garrido, Gustavo Luis; Almeida, Fernando G; Averbeck, Marcio Augusto; Fornari, Alexandre; Salazar, Anibal; Dell'Oro, Arturo; Cintra, Caio; Sacomani, Carlos Alberto Ricetto; Tapia, Juan Pablo; Brambila, Eduardo; Longo, Emilio Miguel; Rocha, Flavio Trigo; Coutinho, Francisco; Favre, Gabriel; Garcia, Jose Antonio; Castano, Juan; Reyes, Miguel; Leyton, Rodrigo Eugenio; Ferreira, Ruiter Silva; Duran, Sergio; Lopez, Vanda; Reges, Ricardo

    2016-01-01

    Traditionally, the treatment of overactive bladder syndrome has been based on the use of oral medications with the purpose of reestablishing the detrusor stability. The recent better understanding of the urothelial physiology fostered conceptual changes, and the oral anticholinergics - pillars of the overactive bladder pharmacotherapy - started to be not only recognized for their properties of inhibiting the detrusor contractile activity, but also their action on the bladder afference, and therefore, on the reduction of the symptoms that constitute the syndrome. Beta-adrenergic agonists, which were recently added to the list of drugs for the treatment of overactive bladder, still wait for a definitive positioning - as either a second-line therapy or an adjuvant to oral anticholinergics. Conservative treatment failure, whether due to unsatisfactory results or the presence of adverse side effects, define it as refractory overactive bladder. In this context, the intravesical injection of botulinum toxin type A emerged as an effective option for the existing gap between the primary measures and more complex procedures such as bladder augmentation. Sacral neuromodulation, described three decades ago, had its indication reinforced in this overactive bladder era. Likewise, the electric stimulation of the tibial nerve is now a minimally invasive alternative to treat those with refractory overactive bladder. The results of the systematic literature review on the oral pharmacological treatment and the treatment of refractory overactive bladder gave rise to this second part of the review article Overactive Bladder - 18 years, prepared during the 1st Latin-American Consultation on Overactive Bladder.

  9. Bladder health across the life course.

    PubMed

    Ellsworth, P; Marschall-Kehrel, D; King, S; Lukacz, E

    2013-05-01

    Influences on bladder health begin during infancy and continue throughout the lifespan. Bladder anatomy and physiology change as individuals age, and the risk and propensity for bladder conditions, including lower urinary tract symptoms, throughout life are related to factors specific to age, sex, and life events. Bladder habits and dysfunctions at one stage of life may affect bladder health in subsequent stages. However, bladder problems are neither a normal part of aging nor inevitable at any stage of life. Many of the factors that negatively impact bladder health at all ages may be modifiable, and healthy bladder habits may prevent or reverse bladder dysfunctions that can occur naturally or in response to life events. There are opportunities to further define and promote healthy bladder habits through focused research and heightened public awareness of the importance of bladder health, which may lead to improvements in overall health and quality of life. It is our hope that this paper will inform and encourage public health initiatives and research programs aimed at this goal.

  10. Stem Cells in Functional Bladder Engineering

    PubMed Central

    Smolar, Jakub; Salemi, Souzan; Horst, Maya; Sulser, Tullio; Eberli, Daniel

    2016-01-01

    Conditions impairing bladder function in children and adults, such as myelomeningocele, posterior urethral valves, bladder exstrophy or spinal cord injury, often need urinary diversion or augmentation cystoplasty as when untreated they may cause severe bladder dysfunction and kidney failure. Currently, the gold standard therapy of end-stage bladder disease refractory to conservative management is enterocystoplasty, a surgical enlargement of the bladder with intestinal tissue. Despite providing functional improvement, enterocystoplasty is associated with significant long-term complications, such as recurrent urinary tract infections, metabolic abnormalities, stone formation, and malignancies. Therefore, there is a strong clinical need for alternative therapies for these reconstructive procedures, of which stem cell-based tissue engineering (TE) is considered to be the most promising future strategy. This review is focused on the recent progress in bladder stem cell research and therapy and the challenges that remain for the development of a functional bladder wall. PMID:27781020

  11. Pathobiology and Chemoprevention of Bladder Cancer

    PubMed Central

    Tanaka, Takuji; Miyazawa, Katsuhito; Tsukamoto, Tetsuya; Kuno, Toshiya; Suzuki, Koji

    2011-01-01

    Our understanding of the pathogenesis of bladder cancer has improved considerably over the past decade. Translating these novel pathobiological discoveries into therapies, prevention, or strategies to manage patients who are suspected to have or who have been diagnosed with bladder cancer is the ultimate goal. In particular, the chemoprevention of bladder cancer development is important, since urothelial cancer frequently recurs, even if the primary cancer is completely removed. The numerous alterations of both oncogenes and tumor suppressor genes that have been implicated in bladder carcinogenesis represent novel targets for therapy and prevention. In addition, knowledge about these genetic alterations will help provide a better understanding of the biological significance of preneoplastic lesions of bladder cancer. Animal models for investigating bladder cancer development and prevention can also be developed based on these alterations. This paper summarizes the results of recent preclinical and clinical chemoprevention studies and discusses screening for bladder cancer. PMID:21941546

  12. Intravesical oxybutynin affects bladder permeability.

    PubMed

    Ersay, A; Demirtas, O C

    2001-01-01

    To investigate the effects of intravesical application of oxybutynin chloride on bladder permeability we designed an animal model. Female Guinea pigs were given 3 different test solutions: phosphate buffered saline (PBS), 50% acetone and 1.27 x 10(-2) M oxybutynin chloride solution. Then 99mTc-DTPA 45 microCi in 2 ml normal saline was instilled into the bladder lumen in each animals and allowed to dwell for 30 minutes. At the end of exposure time, the net count data in each 1 ml serum sample were corrected for radioactive decay and converted to the total percentage of administered dose. 99mTc-DTPA absorption percentages of both acetone and oxybutynin groups were significantly higher than that of PBS group (mean 3.2 +/- 2.9% p < 0.001). Intravesical oxybutynin application increases bladder permeability 5 times compared with PBS administration. This observation can also explain how rapid absorption of oxybutynin through the bladder into the systemic circulation occurs.

  13. Bladder Cancer Risk Prediction Models

    Cancer.gov

    Developing statistical models that estimate the probability of developing bladder cancer over a defined period of time will help clinicians identify individuals at higher risk of specific cancers, allowing for earlier or more frequent screening and counseling of behavioral changes to decrease risk.

  14. Ultrasonic lithotripsy of bladder stones.

    PubMed

    Cetin, S; Ozgür, S; Yazicioğlu, A; Unsal, K; Ilker, Y

    1988-01-01

    In the second half of 1985, 15 patients with 25 bladder stones were treated with Lutzeyer's Ultrasonic Lithotriptor. Of the patients 13 underwent additional operations, mostly transurethral resection of the prostate. The average duration of lithotripsy was 30.5 minutes. Some difficulties were experienced especially when drilling hard stones and as a complication late urethral bleeding occurred in one patient.

  15. Perforator-to-perforator musculocutaneous anterolateral thigh flap for reconstruction of a lumbosacral defect using the lumbar artery perforator as recipient vessel.

    PubMed

    Mureau, Marc A M; Hofer, Stefan O P

    2008-05-01

    Reconstruction of large-sized lumbosacral or sacral defects often is not possible using local or regional flaps, making the use of free flaps necessary. However, the difficulty of any microsurgical procedure in this region is complicated by the need to search for potential recipient vessels to revascularize the flap. In the present case, a free musculocutaneous anterolateral thigh flap to cover a large-sized and deep lumbosacral defect was used. Arterial anastomosis was performed, connecting the cutaneous anterolateral thigh (ALT) perforator to the perforator of the second lumbar artery. In this fashion, the arterial circulation through the flap was flowing reversely through the muscle. The concomitant vein of the descending branch of the lateral circumflex femoral artery was hooked up to the thoracodorsal vein using a long interposition vein graft because the perforator of the second lumbar vein was too small. Postoperative healing was uneventful. In conclusion, a successful reconstruction of a lumbar defect has shown that local perforators in the lumbar area may be accessible for easier perforator-to-perforator anastomoses and that the muscular part of the musculocutaneous ALT flap can survive on retrograde arterial perfusion from a perforator of the skin island.

  16. A case of hard palate perforation

    PubMed Central

    Saroch, Atul; Pannu, Ashok Kumar

    2016-01-01

    Tuberculosis (TB) is a major public health problem in developing countries. Lung is most common affected organ, however extra pulmonary tuberculosis (EPTB) is also not uncommon. The clinical manifestations of EPTB may be non-specific that mimics other diseases and is usually misdiagnosed. Therefore, high clinical suspicion of EPTB infection is important, especially in endemic areas. Here, we present a case of hard palate perforation that proved to be tuberculous in origin. The diagnosis was made by histo-pathological examination and positive TB Polymerase chain reaction (PCR). PMID:28349008

  17. 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.

  18. Proceedings of a GOG Workshop on Intraperitoneal Therapy for Ovarian Cancer

    PubMed Central

    Alberts, DS; Bookman, MA; Chen, T; Curtin, J; Eldermire, E; Hess, LM; Liebes, L; Markman, M; Muggia, F; Ozols, RF; Young, RC; Trimble, E

    2007-01-01

    Ovarian cancer is the leading cause of gynecologic cancer deaths in the U.S. The concept of intraperitoneal drug delivery for therapy of intraperitoneal cancers, such as ovarian cancer, arose in the 1960s. The field of intraperitoneal cisplatin therapy for ovarian cancer was initiated in the late 1970s and early 1980s. The markedly improved survival data resulting from a third phase III trial of intraperitoneal cisplatin for ovarian cancer in early 2006 led to an NCI Clinical Announcement and a Gynecologic Oncology Group-sponsored workshop on Intraperitoneal Therapy in January, 2006, in San Diego, California. The proceedings of this workshop summarize both research trial results and practical implementation issues associated with intraperitoneal therapy discussed at this workshop. PMID:17070570

  19. Choroidal detachment in perforated corneal ulcers: frequency and management

    PubMed Central

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

    2006-01-01

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

  20. Reporting the impact of inferior vena cava perforation by filters.

    PubMed

    Wood, Emily A; Malgor, Rafael D; Gasparis, Antonios P; Labropoulos, Nicos

    2014-08-01

    Perforation of the inferior vena cava by filters struts is a known complication. The goal of our review is to assess the impact of inferior vena cava perforation by filters based on an open, voluntary national database. We reviewed 3311 adverse events of inferior vena cava filters reported in Manufacturer and User Facility Device Experience database from January 2000 to June 2011. Outcomes of interest were incidence of inferior vena cava perforation, type of filter, clinical presentation, and management of the perforation, including retrievability rates. Three hundred ninety-one (12%) cases of inferior vena cava perforation were reported. The annual distribution of inferior vena cava perforation was 35 cases (9%), varying from seven (2%) to 70 (18%). A three-fold increment in the number of adverse events related to inferior vena cava filters has been noted since 2004. Wall perforation as an incidental finding was the most common presentation (N = 268, 69%). Surrounding organ involvement was found in 117 cases (30%), with the aorta being the most common in 43 cases (37%), followed by small bowel in 36 (31%). Filters were retrieved in 97 patients (83%) regardless of wall perforation. Twenty-five (26%) cases required an open procedure to remove the filter. Neither major bleeding requiring further intervention nor mortality was reported. Inferior vena cava perforation by filters remains stable over the studied years despite increasing numbers of adverse events reported. The majority of filters involved in a perforation were retrievable. Filter retrieval, regardless of inferior vena cava wall perforation, is feasible and must be attempted whenever possible in order to avoid complications. © The Author(s) 2013 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

  1. Long term protection in bladder cancer following intralesional immunotherapy.

    PubMed

    Reichert, D F; Lamm, D L

    1984-09-01

    Despite effective treatment of existing tumors, patients with bladder cancer remain at risk of developing new tumors. Effective immunotherapy may lower that risk. To test this hypothesis, mice that had survived transitional cell carcinoma (MBT2) transplantation with the aid of bacillus Calmette-Guerin immunotherapy were randomized and tested for long term protective immunity against bladder carcinoma. Fifty-one tumor-free mice that had survived tumor challenge 10 to 15 months previously were randomized into 3 groups to receive intradermal tumor .noculation and intraperitoneal levamisole, intralesional Tice strain bacillus Calmette-Guerin, or intralesional saline. Fifteen previously unchallenged animals also received tumor and intralesional saline. All 3 groups of survivors had less tumor growth (p less than 0.01) than nonsurviving controls. Even among survivors, additional bacillus Calmette-Guerin immunization, but not levamisole treatment, significantly inhibited tumor growth (p less than 0.01). A 2nd experiment compared 22 nonimmune mice, 21 mice preimmunized intravenously with 300 micrograms of bacillus Calmette-Guerin cell walls, and 18 mice that had survived MBT2 by 8 months after live bacillus Calmette-Guerin treatment. Nonimmune and survivor groups were randomly subdivided into saline or treatment groups. Cell wall-preimmunized mice were divided into matching groups according to footpad response to purified protein derivative. The cell-wall preimmunized and nonimmune mice received the immunostimulant P3+Re-glycolipid or the carrier solution alone. The group of survivors received either intralesional saline or live bacillus Calmette-Guerin. Both bacillus Calmette-Guerin and saline-treated groups had significantly less tumor growth (p less than 0.001) than nonsurviving controls. Animals treated with P3-Re-glycolipid (with or without preimmunization with cell wall) did not differ from nonsurviving control. Footpad response to purified protein derivative did not

  2. Patient reported outcome measures in neurogenic bladder

    PubMed Central

    Clark, Roderick

    2016-01-01

    Many interventions for neurogenic bladder patients are directed towards improving quality of life (QOL). Patient reported outcome measures (PROMs) are the primary method of evaluating QOL, and they provide an important quantification of symptoms which can’t be measured objectively. Our goal was to review general measurement principles, and identify and discuss PROMs relevant to neurogenic bladder patients. We identify two recent reviews of the state of the literature and updated the results with an additional Medline search up to September 1, 2015. Using the previous identified reviews, and our updated literature review, we identified 16 PROMs which are used for the assessment of QOL and symptoms in neurogenic bladder patients. Several are specifically designed for neurogenic bladder patients, such as the Qualiveen (for neurogenic bladder related QOL), and the Neurogenic Bladder Symptom Score (NBSS) (for neurogenic bladder symptoms). We also highlight general QOL measures for patients with multiple sclerosis (MS) and spinal cord injury (SCI) which include questions about bladder symptoms, and incontinence PROMs which are commonly used, but not specifically designed for neurogenic bladder patients. It is essential for clinicians and researchers with an interest in neurogenic bladder to be aware of the current PROMs, and to have a basic understanding of the principals of measurement in order to select the most appropriate one for their purpose. PMID:26904409

  3. HAMLET treatment delays bladder cancer development.

    PubMed

    Mossberg, Ann-Kristin; Hou, Yuchuan; Svensson, Majlis; Holmqvist, Bo; Svanborg, Catharina

    2010-04-01

    HAMLET is a protein-lipid complex that kills different types of cancer cells. Recently we observed a rapid reduction in human bladder cancer size after intravesical HAMLET treatment. In this study we evaluated the therapeutic effect of HAMLET in the mouse MB49 bladder carcinoma model. Bladder tumors were established by intravesical injection of MB49 cells into poly L-lysine treated bladders of C57BL/6 mice. Treatment groups received repeat intravesical HAMLET instillations and controls received alpha-lactalbumin or phosphate buffer. Effects of HAMLET on tumor size and putative apoptotic effects were analyzed in bladder tissue sections. Whole body imaging was used to study HAMLET distribution in tumor bearing mice compared to healthy bladder tissue. HAMLET caused a dose dependent decrease in MB49 cell viability in vitro. Five intravesical HAMLET instillations significantly decreased tumor size and delayed development in vivo compared to controls. TUNEL staining revealed selective apoptotic effects in tumor areas but not in adjacent healthy bladder tissue. On in vivo imaging Alexa-HAMLET was retained for more than 24 hours in the bladder of tumor bearing mice but not in tumor-free bladders or in tumor bearing mice that received Alexa-alpha-lactalbumin. Results show that HAMLET is active as a tumoricidal agent and suggest that topical HAMLET administration may delay bladder cancer development. Copyright (c) 2010 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

  4. Duodenal perforation in a cheetah (Acinonyx jubilatus).

    PubMed

    Johnson, J H; Wolf, A M; Jensen, J M; Fossum, T; Rohn, D; Green, R W; Willard, M

    1997-12-01

    An 11-yr-old female cheetah (Acinonyx jubilatus) from a privately owned breeding center for endangered species was referred for evaluation with a history of vomiting and depression of 10 days' duration. After anesthetic induction with tiletamine and zolazepam and anesthetic maintenance with isoflurane, a complete diagnostic workup was performed, including hematology, serum chemistry, and radiography. The clinical diagnosis was septic suppurative inflammation and hemorrhage in the abdomen, consistent with perforation or rupture of the gastrointestinal tract. An exploratory laparotomy showed a perforated duodenal ulcer, which was resected. Subsequent endoscopy revealed no further evidence of ulceration in the upper gastrointestinal tract. Biopsy of the ulcerated tissue collected from the duodenum revealed Gastrospirillum-like organisms. Histologic examination revealed widespread infiltration of lymphocytes and plasma cells into the lamina propria and submucosa. Intraepithelial leukocytes were present along with attenuation, erosion, and ulceration of the superficial epithelium. Fourteen days after surgery, this cheetah was returned to its breeding compound, and no subsequent vomiting has been observed for 4 yr.

  5. Small bowel perforation caused by advanced melanoma.

    PubMed

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

    2014-01-01

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

  6. [Gastric perforation by MALT lymphoma. Case report].

    PubMed

    López-Zamudio, José; Ramírez-González, Luis Ricardo; Núñez-Márquez, Julia; Fuentes Orozco, Clotilde; González Ojeda, Alejandro; Leonher-Ruezga, Karla Lisseth

    2015-01-01

    Gastric non-Hodgkin lymphoma is a rare tumour that represents approximately 7% of all stomach cancers and 2% of all lymphomas. The most frequent location of gastric MALT (mucosa associated lymphoid tissue) lymphomas is in the antrum in 41% of the cases, and 33% can be multifocal. The risk of spontaneous perforation of a gastric MALT lymphoma is 4-10%. 24 year old male patient carrying the Human Immunodeficiency Virus, who began with signs and symptoms of acute abdomen and fever 72 hours before arriving in the emergency room. A computed tomography was performed that showed free fluid in the cavity, and gastric wall thickening. The patient underwent a laparotomy, finding absence of the anterior wall of the stomach, sealed with the left lobe of the liver, colon and omentum. Total gastrectomy, with oesophagosty and jejunostomy tube, was performed. Gastric perforation secondary to a MALT lymphoma is rare, with high mortality. There is limited information reported of this complication and should be highly suspected in order to provide appropriate treatment for a complication of this type. Copyright © 2015 Academia Mexicana de Cirugía A.C. Published by Masson Doyma México S.A. All rights reserved.

  7. Freon: accidental ingestion and gastric perforation.

    PubMed

    Gotelli, Mariano Javier; Monserrat, Alberto Juan; Lo Balbo, Alfredo; Valdes Quintana, Eduardo Fernando; Gotelli, Carlos

    2008-04-01

    Freons generally have a low order of toxicity, but exposure to relatively high concentrations (>100 ppm) may produce adverse effects on health. Currently, intoxication reports are unintentional inhalation of CFCs. We report an unintentional ingestion of a mixture of CFCs and the results of a rat study. A 43-year-old man was admitted to the Emergency Department with a chief complaint of acute abdominal pain that developed minutes after he ingested a clear liquid in a water glass, which contained a mixture of Freon and water. Subsequent surgical evaluation revealed perforation of the stomach and necrosis of the stomach wall. He developed a transient rise in his hepatic transaminases, which resolved spontaneously, and fully recovered from his surgery. A murine model of the injury was created to evaluate threshold concentration and effect of time on injury grade. Injury grade increased with delay to histologic analysis from 8 to 24 hours after exposure to Freon. Increasing amounts of Freon also increased the lesion grade score. Patients ingesting Freon need to be closely evaluated for risk of gastric damage and perforation.

  8. Duodenal perforation caused by a bird feather.

    PubMed

    Sahoo, Manash Ranjan; Kumar, Anil

    2013-02-15

    Ingestion of gastrointestinal (GI) foreign bodies represents a challenging clinical scenario. The greater risk is at extremes of age, in those wearing dentures, alcoholics and mentally handicapped. We present a case of duodenal perforation caused by a bird feather. A 64-year-old man was presented with abdominal pain for 4 days. Abdominal examination showed signs of peritonitis. The erect abdominal x-ray showed free gas under diaphragm. Exploratory laparotomy showed purulent fluid, but no definite site of perforation could be found. So the abdomen was closed with a drain in Morison's pouch. The postoperative recovery was uneventful. He came for a repeat check-up at 4 weeks with dull aching pain in the upper abdomen and was advised for a routine upper GI endoscopy which revealed a feather penetrating the first part of the duodenum, which was removed with a foreign body removing forceps. GI foreign bodies represent a significant problem and an increased level of suspicion is important for timely diagnosis and treatment.

  9. Intraperitoneal implantation of life-long telemetry transmitters in otariids.

    PubMed

    Horning, Markus; Haulena, Martin; Tuomi, Pamela A; Mellish, Jo-Ann E

    2008-12-10

    Pinnipeds, including many endangered and declining species, are inaccessible and difficult to monitor for extended periods using externally attached telemetry devices that are shed during the annual molt. Archival satellite transmitters were implanted intraperitoneally into four rehabilitated California sea lions (Zalophus californianus) and 15 wild juvenile Steller sea lions (Eumetopias jubatus) to determine the viability of this surgical technique for the deployment of long-term telemetry devices in otariids. The life history transmitters record information throughout the life of the host and transmit data to orbiting satellites after extrusion following death of the host. Surgeries were performed under isoflurane anesthesia and single (n = 4) or dual (n = 15) transmitters were inserted into the ventrocaudal abdominal cavity via an 8.5 to 12 cm incision along the ventral midline between the umbilicus and pubic symphysis or preputial opening. Surgeries lasted 90 minutes (SD = 8) for the 19 sea lions. All animals recovered well and were released into the wild after extended monitoring periods from 27 to 69 days at two captive animal facilities. Minimum post-implant survival was determined via post-release tracking using externally attached satellite transmitters or via opportunistic re-sighting for mean durations of 73.7 days (SE = 9.0, Z. californianus) and 223.6 days (SE = 71.5, E. jubatus). The low morbidity and zero mortality encountered during captive observation and post-release tracking periods confirm the viability of this surgical technique for the implantation of long-term telemetry devices in otariids.

  10. Intraperitoneal photodynamic therapy for peritoneal carcinomatosis and sarcomatosis

    NASA Astrophysics Data System (ADS)

    Hahn, Stephen M.; Fraker, Douglas L.; Zhu, Timothy C.; Yodh, Arjun G.; Rodriguez, Carmen E.; Smith, Debbie; Currens, Ann; Glatstein, Eli

    2000-03-01

    The preliminary results of an ongoing Phase II trial of Photofrin-mediated intraperitoneal PDT (IP PDT) are presented. The clinical endpoints of this trial are to determine the response rates of patients with carcinomatosis and sarcomatosis to IP PDT and to document the toxicities of IP PDT in a defined patient population. Photofrin, 2.5 mg/kg, was administered intravenously 48 hours prior to debulking surgery and light delivery, 57 patients with ovarian cancer, gastrointestinal cancers, and sarcomas were enrolled. 44 patients received Photofrin and received light treatment. 39 patients are valuable for response. 8 of 39 patients had a complete radiographic response to IP PDT 3 months after treatment. 3 patients are alive without evidence of disease 6, 6 and 9 months after treatment. 1 patient is alive and has no evidence of intra-abdominal disease but has developed lung metastases. Toxicities include post-operative fluid shifts, hypotension, hydronephrosis, pleural effusions, enteric fistula, transient liver function test elevation, thrombocytopenia, and wound dehiscence. Toxicity is related to pre-operative tumor bulk and to the extensiveness of surgery required. IP PDT is feasible and leads to an initial clinical response rate of 25 percent in patients with incurable peritoneal carcinomatosis and sarcomatosis.

  11. TUMOR PENETRATING MICROPARTICLES FOR INTRAPERITONEAL THERAPY OF OVARIAN CANCER

    PubMed Central

    Lu, Ze; Tsai, Max; Lu, Dan; Wang, Jie; Wientjes, M. Guillaume; Au, Jessie L.-S.

    2009-01-01

    Intraperitoneal (IP) chemotherapy prolongs survival of ovarian cancer patients, but its utility is limited by treatment-related complications and inadequate drug penetration in larger tumors. Previous IP therapy used the paclitaxel/Cremophor formulation designed for intravenous use. The present report describes the development of paclitaxel-loaded microparticles designed for IP treatment (referred to as tumor penetrating microparticles or TPM). Evaluation of TPM was performed using IP metastatic, human ovarian SKOV3 xenograft tumor models in mice. TPM were retained in the peritoneal cavity and adhered to tumor surface. TPM consisted of two biocompatible and biodegradable polymeric components with different drug release rates; one component released the drug load rapidly to induce tumor priming while the second component provided sustained drug release. Tumor priming, by expanding interstitial space, promoted transport and penetration of particulates in tumors. These combined features resulted in the following advantages over paclitaxel/Cremophor: greater tumor targeting (16-times higher and more sustained concentration in omental tumors), lower toxicity to intestinal crypts and less body weight loss, greater therapeutic efficacy (longer survival and higher cure rate), and greater convenience (less frequent dosing). TPM may overcome the toxicities and compliance-related problems that have limited the utility of IP therapy. PMID:18780831

  12. Intraperitoneal photodynamic therapy for peritoneal carcinomatosis and sarcomatosis

    NASA Astrophysics Data System (ADS)

    Hahn, Stephen M.; Fraker, Douglas L.; Zhu, Timothy C.; Yodh, Arjun G.; Rodriguez, Carmen E.; Smith, Debbie; Currens, Ann; Glatstein, Eli

    2000-03-01

    The preliminary results of an ongoing Phase II trial of Photofrin-mediated intraperitoneal PDT (IP PDT) are presented. The clinical endpoints of this trial are to determine the response rates of patients with carcinomatosis and sarcomatosis to IP PDT and to document the toxicities of IP PDT in a defined patient population. Photofrin, 2.5 mg/kg, was administered intravenously 48 hours prior to debulking surgery and light delivery, 57 patients with ovarian cancer, gastrointestinal cancers, and sarcomas were enrolled. 44 patients received Photofrin and received light treatment. 39 patients are valuable for response. 8 of 39 patients had a complete radiographic response to IP PDT 3 months after treatment. 3 patients are alive without evidence of disease 6, 6 and 9 months after treatment. 1 patient is alive and has no evidence of intra-abdominal disease but has developed lung metastases. Toxicities include post-operative fluid shifts, hypotension, hydronephrosis, pleural effusions, enteric fistula, transient liver function test elevation, thrombocytopenia, and wound dehiscence. Toxicity is related to pre-operative tumor bulk and to the extensiveness of surgery required. IP PDT is feasible and leads to an initial clinical response rate of 25 percent in patients with incurable peritoneal carcinomatosis and sarcomatosis.

  13. Serum Antibodies Protect against Intraperitoneal Challenge with Enterotoxigenic Escherichia coli

    PubMed Central

    Yang, Xinghong; Thornburg, Theresa; Holderness, Kathryn; Suo, Zhiyong; Cao, Ling; Lim, Timothy; Avci, Recep; Pascual, David W.

    2011-01-01

    To assess whether anticolonization factor antigen I (CFA/I) fimbriae antibodies (Abs) from enterotoxigenic Escherichia coli (ETEC) can protect against various routes of challenge, BALB/c mice were immunized with a live attenuated Salmonella vaccine vector expressing CFA/I fimbriae. Vaccinated mice elicited elevated systemic IgG and mucosal IgA Abs, unlike mice immunized with the empty Salmonella vector. Mice were challenged with wild-type ETEC by the oral, intranasal (i.n.), and intraperitoneal (i.p.) routes. Naïve mice did not succumb to oral challenge, but did to i.n. challenge, as did immunized mice; however, vaccinated mice were protected against i.p. ETEC challenge. Two intramuscular (i.m.) immunizations with CFA/I fimbriae without adjuvant conferred 100% protection against i.p. ETEC challenge, while a single 30 μg dose conferred 88% protection. Bactericidal assays showed that ETEC is highly sensitive to anti-CFA/I sera. These results suggest that parenteral immunization with purified CFA/I fimbriae can induce protective Abs and may represent an alternative method to elicit protective Abs for passive immunity to ETEC. PMID:22007145

  14. [Hyaluronidase as a therapeutic alternative in perforated tympanum].

    PubMed

    Sánchez-Alcón, M D; Alamar, A; Pérez, H; Sancho-Miñana, P; Sánchez, S; Morera, C

    1995-01-01

    There are many causes of tympanic perforation but usually only one treatment, surgical. However, many patients cannot or will not undergo surgery. In such cases, treatment with sodium hyaluronidate may be satisfactory. In our group of 20 patients with 21 tympanic perforations who underwent this treatment, 15 evolved favorably. The drawbacks and patient selection are discussed.

  15. 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.

  16. Laparoscopic removal of a perforating intrauterine device mimicking chronic appendicitis.

    PubMed

    Brunner, Stefan M; Comman, Andreas; Gaetzschmann, Peter; Kipf, Bianca; Behrend, Matthias

    2008-08-01

    The intrauterine contraceptive device (IUD) is a common form of reversible birth control. One of the rare, but serious, complications is uterine perforation. In this paper, we report a case of a patient who underwent laparoscopy for presumed chronic appendicitis. Intraoperatively, uterine perforation by the IUD was found. The IUD was removed laparoscopically. The postoperative course was uneventful.

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

    PubMed

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

    2000-05-01

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

  18. [Retroperitoneal perforations of the colon. Apropos of 2 cases].

    PubMed

    Jurczak, F; Likholatnikov, D; Courant, O; Hamy, A; Visset, J; Paineau, J

    1994-01-01

    The retroperitoneal perforation of the colon is rare and our observations illustrate its two modes of revelation: a retroperitoneal suppuration; it must be traited quickly in order to decrease the mortality. Note that the abscess of the thigh is exceptional. Retroperitoneal perforations during colonoscopy whose treatment (initially medical) become surgical if there is no clinical improvement.

  19. Pathogenesis of reduced or increased bladder sensation.

    PubMed

    Tsunoyama, Kuniko; Sakakibara, Ryuji; Yamaguchi, Chiharu; Uchiyama, Tomoyuki; Yamamoto, Tatsuya; Yamanishi, Tomonori; Takahashi, Osamu; Sugiyama, Megumi; Kishi, Masahiko; Ogawa, Emina

    2011-03-01

    Pathogenesis of reduced or increased bladder sensation is not well known. Hence, we systematically investigated the frequency of reduced or increased bladder sensation in neurologic/mental diseases. We analyzed 911 patients who were referred from within our hospital. Data registries included a diagnosis, a lower urinary tract symptom questionnaire, a urodynamic study, and neurological examinations. Reduced bladder sensation is defined as bladder volume at the first sensation >300 ml. Increased bladder sensation is defined as bladder volume at the first sensation <100 ml. These patients were stratified into those with and without DO. Neuropathies are the most common cause of reduced bladder sensation (33.3-43.8% in diabetic neuropathy, etc.). Myelopathies are the second most common cause (17.4-25.0% in multiple sclerosis, etc.). Less common is brain diseases (9.6% in multiple system atrophy, etc.). In contrast, myelopathies are the most common cause of increased bladder sensation without DO (25.0-40.0% in spinal forms of systemic lupus erythematosus, Sjogren's syndrome, etc.). Neuropathies are the second most common (17.3-22.2% in post-pelvic organ surgery, diabetic neuropathy, etc.). Less common is brain/mental diseases (20.0% in psychogenic bladder dysfunction, 8.1% in Parkinson's disease, etc.). The present study revealed that neuropathies are the most common cause of reduced bladder sensation in neurologic/mental diseases. Increased bladder sensation without DO occurs mainly in peripheral and central sensory pathway lesions, as well as in basal ganglia lesions and psychogenic bladder dysfunction. Reduced and increased bladder sensation should be a major treatment target for maximizing patients' quality of life. Copyright © 2011 Wiley-Liss, Inc.

  20. Necrotizing fasciitis secondary to carcinoma of the gallbladder with perforation.

    PubMed

    Okada, Ken-ichi; Shatari, Tomoo; Yamamoto, Tatsuma; Sasaki, Takahiro; Suwa, Tatsushi; Furuuchi, Takayuki; Takenaka, Yoshifumi; Hori, Masao; Sakuma, Masayoshi

    2007-01-01

    We present an unusual case of necrotizing fasciitis in the upper abdominal wall caused by penetrating perforation of the gallbladder. It was manifested as an elastic and reddish abdominal swelling with severe tenderness, but no peritoneal irritation. Computed tomography (CT) demonstrated water density with a slightly elevated CT value and air bubbles in the subcutaneous space. The preoperative diagnosis was subcutaneous abscess with fasciitis. At surgery, necrotizing fasciitis and subcutaneous abscess secondary to penetrating perforation of the gallbladder were revealed. Cholecystectomy and peritoneal irrigation were performed. Although no tumor was evident during surgery, a tumor located close to the perforation site was found just after the operation. Pathological examination revealed gallbladder carcinoma without stones. There have been very few previous reports of necrotizing fasciitis following gallbladder perforation. The presentation, diagnosis, and management of fasciitis, as well as carcinoma of the gallbladder with perforation, are discussed.

  1. Coronary artery dissection and perforation complicating percutaneous coronary intervention.

    PubMed

    Rogers, Jason H; Lasala, John M

    2004-09-01

    Percutaneous coronary intervention (PCI) is widely utilized in the treatment of symptomatic coronary artery disease. Despite its numerous benefits, serious and potentially life-threatening complications of PCI can occur, including iatrogenic coronary artery dissection and perforation. The incidence of these complications has been augmented by the development of coronary interventional devices intended to remove or ablate tissue. We herein review the classification, incidence, pathogenesis, clinical sequelae and management of coronary artery dissection and perforation in the current era. Specifically, the current angiographic classifications of coronary artery dissections and perforations are reviewed. The findings of several recent, large registries of PCI-related coronary artery perforations are summarized. The management of coronary artery dissection and perforation is discussed at length, including the application of newer modalities such as covered stents.

  2. Spontaneous Uterine Perforation due to Pyometra Presenting as Acute Abdomen

    PubMed Central

    Geranpayeh, Loabat; Fadaei-Araghi, Mohsen; Shakiba, Behnam

    2006-01-01

    Spontaneous perforation of the uterus is rare, its incidence being about 0.01% − 0.05%. We report a rare case of diffuse peritonitis caused by spontaneously perforated pyometra. A 63-year-old woman with severe abdominal pain was admitted to our hospital. Laparotomy was performed because of the suspicion of gastrointestinal perforation with generalized peritonitis. At laparotomy, about 900 mL of pus was found in the peritoneal cavity. There were no abnormal findings in the alimentary tract, liver, or gallbladder. A total abdominal hysterectomy with bilateral salpingo-oophorectomy was performed. Pathological investigation of the surgical specimen revealed endometritis and myometritis of the uterus; but there was no evidence of malignancy, and the cervical canal was patent. Although spontaneously perforated pyometra is rare, a perforated pyometra should therefore also be considered when elderly women present with acute abdominal pain. PMID:17485806

  3. Experimental study on reflection coefficient of curved perforated plate

    NASA Astrophysics Data System (ADS)

    Hodaei, Sayed Mohammad Reza; Chamani, Mohammad Reza; Moghim, Mohammad Navid; Mansoorzadeh, Shahriar; Kabiri-Samani, Abdoreza

    2016-12-01

    A set of experiments is carried out in a towing tank to study the effects of the curvature of perforated plates on the wave reflection coefficient ( C r ). The curvature of a perforated plate can be changed by rotating a reference perforated plate aboutits origin according to the parabolic equation y=- x 2. A plunger-type wave maker is used to generate regular waves. The reflection coefficients are calculated using Goda and Suzuki's (1976) method. The results are compared with those of vertical or sloped passive wave absorbers. The comparison shows that a perforated plate with a curved profile is highly efficient in terms of reducing the wave reflection coefficient. A correlation is established to estimate the reflection coefficient of curved perforated plates as a function of both flow and geometry characteristics.

  4. 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.

  5. The protective effect of Moringa oleifera leaves against cyclophosphamide-induced urinary bladder toxicity in rats.

    PubMed

    Taha, Nevine R; Amin, Hanan Ali; Sultan, Asrar A

    2015-02-01

    Cyclophosphamide (CP), an alkylating antineoplastic agent is widely used in the treatment of solid tumors and B-cell malignant disease. It is known to cause urinary bladder damage due to inducing oxidative stress. Moringa oleifera (Mof) is commonly known as drumstick tree. Moringa leaves have been reported to be a rich source of β-carotene, protein, vitamin C, calcium, and potassium. It acts as a good source of natural antioxidants; due to the presence of various types of antioxidant compounds such as ascorbic acid, flavonoids, phenolics and carotenoids. The aim of this work was to test the possible antioxidant protective effects of M. oleifera leaves against CP induced urinary bladder toxicity in rats. Female Wister albino rats were divided into 4 groups. Group I served as control, received orally normal saline, group II received a single dose CP 100mg/kg intraperitoneally, group III and VI both received orally hydroethanolic extract of Mof; 500 mg/kg and 1000 mg/kg respectively daily for a week, 1h before and 4h after CP administration. Rats were sacrificed 24h after CP injection. The bladder was removed, sectioned, and subjected to light, transition electron microscopic studies, and biochemical studies (measuring the parameter of lipid peroxidation; malondialdehyde along with the activities of the antioxidant enzyme reduced glutathione). The bladders of CP treated rats showed ulcered mucosa, edematous, hemorrhagic, and fibrotic submucosa by light microscopy. Ultrastructure observation showed; losing large areas of uroepithelium, extended intercellular gaps, junction complexes were affected as well as damage of mitochondria in the form of swelling and destruction of cristae. Biochemical analysis showed significant elevation of malondialdhyde, while reduced glutathione activity was significantly lowered. From the results obtained in this work, we can say that Moringa leaves play an important role in ameliorating and protecting the bladder from CP toxicity.

  6. A model to predict bladder shapes from changes in bladder and rectal filling.

    PubMed

    Lotz, Heidi T; Remeijer, Peter; van Herk, Marcel; Lebesque, Joos V; de Bois, Josien A; Zijp, Lambert J; Moonen, Luc M

    2004-06-01

    The purpose of this study is to develop a model that quantifies in three dimensions changes in bladder shape due to changes in bladder and/or rectal volume. The new technique enables us to predict changes in bladder shape over a short period of time, based on known urinary inflow. Shortly prior to the treatment, the patient will be scanned using a cone beam CT scanner (x-ray volume imager) that is integrated with the linear accelerator. After (automated) delineation of the bladder, the model will be used to predict the short-term shape changes of the bladder for the time interval between image acquisition and dose delivery. The model was developed using multiple daily CT scans of the pelvic area of 19 patients. For each patient, the rigid bony structure in follow-up scans was matched to that of the planning CT scan, and the outer bladder and rectal wall were delineated. Each bladder wall was subdivided in 2500 domains. A fixed reference point inside the bladder was used to calculate for each bladder structure a "Mercator-like" 2D scalar map (similar to a height map of the globe), containing the distances from this reference point to each domain on the bladder wall. Subsequently, for all bladder shapes of a patient and for all domains on the wall individually, the distance to the reference point was fitted by a linear function of both bladder and rectal volume. The model uses an existing bladder structure to create a new structure via expansion (or contraction), until the expressed volume is reached. To evaluate the predictive power of the model, the jack-knife method was used. The errors in the fitting procedure depended on the part of the bladder and range from 0 to 0.5 cm (0.2 cm on average). It was found that a volume increase of 150 cc can lead to a displacement up to about 2.5 cm of the cranial part of the bladder. With the model, the uncertainty in the position of the bladder wall can be reduced down to a maximum value of about 0.5 cm in case the bladder

  7. Ultrasound and Biomarker Tests in Predicting Cancer Aggressiveness in Tissue Samples of Patients With Bladder Cancer

    ClinicalTrials.gov

    2017-06-23

    Bladder Papillary Urothelial Carcinoma; Stage 0a Bladder Urothelial Carcinoma; Stage 0is Bladder Urothelial Carcinoma; Stage I Bladder Cancer With Carcinoma In Situ; Stage I Bladder Urothelial Carcinoma; Stage II Bladder Urothelial Carcinoma; Stage III Bladder Urothelial Carcinoma; Stage IV Bladder Urothelial Carcinoma

  8. Pharmacologic management of overactive bladder

    PubMed Central

    Lam, Sum; Hilas, Olga

    2007-01-01

    Overactive bladder (OAB) is a prevalent and costly condition that can affect any age group. Typical symptoms include urinary urgency, frequency, incontinence and nocturia. OAB occurs as a result of abnormal contractions of the bladder detrusor muscle caused by the stimulation of certain muscarinic receptors. Therefore, antimuscarinic agents have long been considered the mainstay of pharmacologic treatment for OAB. Currently, there are five such agents approved for the management of OAB in the United States: oxybutynin, tolterodine, trospium, solifenacin and darifenacin. This article summarizes the efficacy, contraindications, precautions, dosing and common side effects of these agents. All available clinical trials on trospium, solifenacin and darifenacin were reviewed to determine its place in therapy. PMID:18044184

  9. Research Findings on Overactive Bladder

    PubMed Central

    Patra, Phani B.; Patra, Sayani

    2015-01-01

    Several physiopathologic conditions lead to the manifestation of overactive bladder (OAB). These conditions include ageing, diabetes mellitus, bladder outlet obstruction, spinal cord injury, stroke and brain injury, Parkinson's disease, multiple sclerosis, interstitial cystitis, stress and depression. This review has discussed research findings in human and animal studies conducted on the above conditions. Several structural and functional changes under these conditions have not only been observed in the lower urinary tract, but also in the brain and spinal cord. Significant changes were observed in the following areas: neurotransmitters, prostaglandins, nerve growth factor, Rho-kinase, interstitial cells of Cajal, and ion and transient receptor potential channels. Interestingly, alterations in these areas showed great variation in each of the conditions of the OAB, suggesting that the pathophysiology of the OAB might be different in each condition of the disease. It is anticipated that this review will be helpful for further research on new and specific drug development against OAB. PMID:26195957

  10. [Oral anticholinergics in overactive bladder].

    PubMed

    Madersbacher, H

    2006-07-01

    Behavioural therapy and anticholinergics are the mainstays in the treatment of symptoms of overactive bladder in patients with idiopathic and neurogenic detrusor overactivity; they are the first-line treatment. Oxybutynin, propiverine, tolterodine and trospium chloride as well as the "newcomers" solifenacin and darifenacin are comparable in regards to their efficacy. However, based on different pharmacokinetics and pharmacodynamics with different resorption velocity, different metabolisation and different CNS penetration, the profile of adverse events is different, qualitatively and quantitatively. Substances that are resorbed slowly or available as slow-release formulations are tolerated better. Lipophilic anticholinergics which pass the blood-brain barrier may compromise cognitive functions, especially in geriatric patients, who are already on cholinesterase inhibitors due to memory disorders. The following article gives an overview of the anticholinergics currently prescribed in patients with symptoms of overactive bladder with special attention to the influence of pharmacokinetics/pharmacodynamics on the adverse events profile including possible CNS side effects.

  11. Emulating a Fish Swim Bladder

    NASA Astrophysics Data System (ADS)

    Vesenka, James; Meredith, Dawn; Bolker, Jessica; Schubert, Christopher; Kraut, Gertrud

    2009-10-01

    The University of New Hampshire and the University of New England are developing biologically relevant physics laboratories for their predominantly health science audiences. Buoyancy plays an important role in a variety of biological processes. We describe an inexpensive laboratory activity based on the Cartesian Diver that allows students to quantitatively emulate the swim bladder of a fish. Inflation of the ``bladder'' is externally controlled through an external gas syringe or squeezing on the plastic water containment vessel (a 2L soda bottle). The students can accurately determine the volume of a ``fish'' at the point of neutral buoyancy by visual measurement of the trapped air pocket. A simple electronic gas pressure sensor allows the hydrostatic pressure on the fish to be analyzed simultaneously.

  12. Role of angiogenesis in urothelial bladder carcinoma

    PubMed Central

    Górnicka, Barbara

    2016-01-01

    Introduction Bladder cancer is the most common urinary tract malignancy in western countries. In recent years, extensive research has suggested that angiogenesis plays an important role in bladder cancer biology, contributing to tumor growth and progression. Material and methods In this review, we discuss general mechanisms of angiogenesis and highlight the influence of pro- and anti-angiogenic factors, and cancer stem cells on bladder cancer biology, their relation to disease progression, and potential use in novel targeted therapies. Results Expression of a number of proangiogenic factors, including HIF-1, VEGF, bFGF, IL-8 and MMPs, as well as anti-angiogenic factor TSP-1, was found to be altered in bladder tumors. Involvement of cancer stem cells in bladder cancer development was also proposed. Conclusions High expression of most pro-angiogenic factors correlated with disease progression and shorter patient survival, but discrepancies between studies urge us to continue evaluating the significance of angiogenesis in bladder cancer. PMID:27729991

  13. Duplex gall bladder: bystander or culprit.

    PubMed

    Kumar, Jogender; Yadav, Arushi

    2017-08-30

    Gall bladder (GB) duplication is a rare anatomical malformation, which can be detected by preoperative imaging study. We present a case of duplex gall bladder in a 14-year-old boy who presented with abdominal pain. On ultrasound, he had right nephrolithiasis and duplex gall bladder. Duplex gall bladder was confirmed on MR cholangiopancreatography. There was a dilemma for surgical management of duplex gall bladder; however, he became asymptomatic after conservative treatment. Prophylactic surgery is not recommended for asymptomatic incidentally detected duplex gall bladder. Radiologists and paediatric surgeons should be sensitised about the exact anatomy of this entity. © BMJ Publishing Group Ltd (unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  14. A method of isolation of apical membranous sheets from frog urinary bladder epithelium by stripping with gelatin.

    PubMed

    Favard, P; Favard, N; Zhu, Q L; Bourguet, J; Lechaire, J P

    1989-01-01

    We have developed a technique for recovering apical membranous sheets from amphibian urinary bladders by gelatin stripping. The tissue is mounted on a lucite support and the apical surface is first stuck onto a gelatin-coated glass slide at 30 degrees C. This sandwich is then chilled on ice and the bladder is pulled away from the slide. Preliminary results indicate that this simple technique could be used to remove membranous apical sheets of various sizes, almost devoid of cytoplasmic contamination and without significant damage to the underlying cell structures. The method could also be adapted to prepare perforated cells and to study the cohesive forces between the different layers of the tissue.

  15. Bladder cancer: Present and future.

    PubMed

    Martinez Rodriguez, Roberto Hugo; Buisan Rueda, Oscar; Ibarz, Luis

    2017-07-20

    Bladder cancer has a high incidence and involves high associated morbidity and mortality. Since its initial clinical suspicion, early diagnostic confirmation and multimodal treatment involve different medical specialties. For this reason, we consider it important to spread the current consensus for its management. Recent advances in immunology and Chemotherapy make it necessary to expose and reflect on future perspectives. Copyright © 2017 Elsevier España, S.L.U. All rights reserved.

  16. Bioavailability of cyclophosphamide and vincristine after intraperitoneal administration in cats.

    PubMed

    Voorhorst, Marieke J; van Maarseveen, Erik M; van Lankveld, Adriaan J; Teske, Erik

    2014-11-01

    Cyclophosphamide and vincristine are widely used intravenous chemotherapeutic agents in both human and veterinary oncology. Although intravenous administration of these chemotherapeutics is the gold standard in most treatment protocols, this route of administration has several disadvantages (e.g. long infusion times and risk of extravasation). Therefore, alternative routes have been explored in the past. Recently, good clinical results were achieved with intraperitoneal (i.p.) administration of cyclophosphamide and vincristine in cats. However, the bioavailability following i.p. administration of cyclophosphamide and vincristine providing proof of principle has not been investigated and is the focus of the present study. The pharmacokinetics of cyclophosphamide and vincristine after i.p. and intravenous administration was investigated in six cats in a cross-over study by analysis of plasma levels of cyclophosphamide and vincristine after simultaneously administration of 0.6 mg/m vincristine and 200 mg/m cyclophosphamide. The median bioavailability on i.p. administration was 76% for cyclophosphamide and 100% for vincristine. Median areas under the curve for i.p. and intravenous administration were 11.4 and 16.0 ng h/ml for cyclophosphamide and 16.7 and 16.5 ng h/ml for vincristine, respectively. No specific i.p. administration-related adverse events were observed after i.p. administration. The high bioavailability of both cyclophosphamide and vincristine after i.p. administration and the absence of specific i.p. administration-related side effects suggest that i.p. administration is a suitable route of systemic chemotherapy for both chemotherapeutics. These results are promising and may serve as a stepping stone for the investigation of the pharmacology, safety, and efficacy of i.p. administration of cyclophosphamide and vincristine in humans.

  17. Intraperitoneal administration of thioredoxin decreases brain damage from ischemic stroke.

    PubMed

    Wang, Bin; Tian, Shilai; Wang, Jiayi; Han, Feng; Zhao, Lei; Wang, Rencong; Ning, Weidong; Chen, Wei; Qu, Yan

    2015-07-30

    Recent studies demonstrate that Thioredixin (Trx) possesses a neuronal protective effect and closely relates to oxidative stress and apoptosis of cerebral ischemia injury. The present study was conducted to validate the neuroprotective effect of recombinant human Trx-1 (rhTrx-1) and its potential mechanisms against ischemia injury at middle cerebral artery occlusion (MCAO) in mice. rhTrx-1 was administrated intraperitoneally at a dose of 5, 10 and 20mg/kg 30 min before MCAO in mice, and its neuronal protective effect was evaluated by neurological deficit score, brain dry-wet weight, 2,3,5-triphenyltetrazolium chloride (TTC) staining. The protein carbonyl content and HO-1 were detected to investigate its potential anti-oxidative and anti-inflammatory property, and the anti-apoptotic ability of rhTrx-1 was assessed by casepase-3 and TUNEL staining. The results demonstrated that rhTrx-1 significantly improved neurological functions and reduced cerebral infarction and apoptotic cell death at 24h after MCAO. Moreover, rhTrx-1 resulted in a significant decrease in carbonyl contents and HO-1 against oxidative stress, which turned to be fast reduction during the first 24h and tended to be stable from 24h to 72h after MCAO. The study shows that rhTrx-1 exerts an neuroprotective effect in cerebral ischemia injury. The anti-oxidative, anti-apoptotic and anti-inflammatory properties of rhTrx-1 are more likely to succeed as a therapeutic approach to diminish oxidative stress-induced neuronal apoptotic cell death in acute ischemic stroke.

  18. Intraperitoneal implantation of life-long telemetry transmitters in otariids

    PubMed Central

    Horning, Markus; Haulena, Martin; Tuomi, Pamela A; Mellish, Jo-Ann E

    2008-01-01

    Background Pinnipeds, including many endangered and declining species, are inaccessible and difficult to monitor for extended periods using externally attached telemetry devices that are shed during the annual molt. Archival satellite transmitters were implanted intraperitoneally into four rehabilitated California sea lions (Zalophus californianus) and 15 wild juvenile Steller sea lions (Eumetopias jubatus) to determine the viability of this surgical technique for the deployment of long-term telemetry devices in otariids. The life history transmitters record information throughout the life of the host and transmit data to orbiting satellites after extrusion following death of the host. Results Surgeries were performed under isoflurane anesthesia and single (n = 4) or dual (n = 15) transmitters were inserted into the ventrocaudal abdominal cavity via an 8.5 to 12 cm incision along the ventral midline between the umbilicus and pubic symphysis or preputial opening. Surgeries lasted 90 minutes (SD = 8) for the 19 sea lions. All animals recovered well and were released into the wild after extended monitoring periods from 27 to 69 days at two captive animal facilities. Minimum post-implant survival was determined via post-release tracking using externally attached satellite transmitters or via opportunistic re-sighting for mean durations of 73.7 days (SE = 9.0, Z. californianus) and 223.6 days (SE = 71.5, E. jubatus). Conclusion The low morbidity and zero mortality encountered during captive observation and post-release tracking periods confirm the viability of this surgical technique for the implantation of long-term telemetry devices in otariids. PMID:19077193

  19. Prevention of postoperative adhesions by single intraperitoneal medication.

    PubMed

    Treutner, K H; Bertram, P; Lerch, M M; Klimaszewski, M; Petrovic-Källholm, S; Sobesky, J; Winkeltau, G; Schumpelick, V

    1995-12-01

    Postoperative adhesions account for a significant morbidity after abdominal, gynecological, or cardiac surgery. A large number of compounds have been suggested to prevent such adhesions, but none is generally accepted. We have compared eight different substances that could be beneficial for the prevention of postoperative adhesions in a new standardized rabbit model with measurement of the areas of adhesion. In 10 groups of 20 rabbits an area of abrasion of the serosa of the ileum, the appendix, and the abdominal wall measuring 10,000 mm2 was created by an emery piston during celiotomy. The controls received no medication. The treatment groups received a single intraperitoneal administration of 1 ml per 100 g body wt of normal saline (NaCl), 5 mg taurolidine (T), 0.5 U plasmin/300 U DNase (PD), 2000 IU streptokinase/500 IU streptodornase (SS), 7 mg phosphatidylcholine (PC), 4 mg hyaluronic acid (HA), 7 mg sphingolipid (SL), 7 mg galactolipid (GL), or 0.5 ml tetrachlorodecaoxide (TCDO), respectively. Ten days later the extent of adhesions was quantified by morphometry. The total area of adhesions (+/- SEM) was found to be 1998 +/- 124 mm2 in controls. The application of NaCl reduced the adhesions to 1368 +/- 58 mm2, of T to 1012 +/- 48 mm2, of PD to 673 +/- 33 mm2, of SS to 360 +/- 44 mm2, of PC to 335 +/- 84 mm2, of HA to 328 +/- 76 mm2, of SL to 278 +/- 80 mm2, of GL to 261 +/- 67 mm2, and of TCDO to 240 +/- 45 mm2. The effects of PD, SS, PC, HA, SL, GL, and TCDO were significant in comparison to controls and NaCl. Our experimental data suggest that the two new lipid substances, SL and GL, are the most likely candidates for routine clinical use in the prevention of postsurgical adhesions.

  20. Analgesic efficacy of intraperitoneal administration of bupivacaine in cats.

    PubMed

    Benito, Javier; Monteiro, Beatriz; Lavoie, Anne-Marie; Beauchamp, Guy; Lascelles, B Duncan X; Steagall, Paulo V

    2016-11-01

    Objectives The aim of this study was to evaluate the analgesic efficacy of intraperitoneal (IP) bupivacaine in cats undergoing ovariohysterectomy (OVH). Methods Forty-five cats were included in a randomized, prospective, blinded study after owners' written consent was obtained. The anesthetic protocol included acepromazine-buprenorphine-propofol-isoflurane. A ventral midline incision was made and cats (n = 15/group) were administered either IP saline 0.9% (negative and positive control groups; NG and PG, respectively) or IP bupivacaine (2 mg/kg; bupivacaine group; BG). Cats in the PG received meloxicam (0.2 mg/kg SC). An OVH was performed and postoperative pain was evaluated using a dynamic interactive visual analog scale (DIVAS), the UNESP-Botucatu multidimensional composite pain scale (MCPS) and mechanical nociceptive thresholds (MNT) for up to 8 h after the end of surgery. Postoperative sedation was evaluated using DIVAS. Rescue analgesia was provided with buprenorphine and/or meloxicam. Repeated measures linear models and a Cochran-Mantel-Haenszel test were used for statistical analysis ( P <0.05). Results There was a significant effect of treatment on the number of times rescue analgesia was administered ( P = 0.002) (PG, n = 2, 13%; NG, n = 12, 80%; BG, n = 4, 27%) with the number of rescues being higher in the NG group than in the PG ( P = 0.0004) and BG ( P = 0.02) groups. The DIVAS, MCPS and MNT were significantly different when compared with baseline values at different time points; however, data were not significantly different among groups. Conclusions and relevance Treatments PG and BG produced similar analgesia in terms of pain scores, number of times rescue analgesia was administered and MNT. Based on rescue analgesia, IP administration of bupivacaine provides analgesia in cats after OVH.

  1. [Cost of an intraperitoneal chemohyperthermia (IPCH) related to cytoreductive surgery].

    PubMed

    Bonastre, J; Jan, P; de Pouvourville, G; Pocard, M; Estphan, G; Elias, D

    2005-10-01

    A complete cytoreductive surgery followed with an intraperitoneal chemohyperthermia (IPCH) is a new treatment allowing curing some patients with a peritoneal carcinomatosis. The cost of this treatment, evaluated in different countries, is high. In France, we do not have any cost evaluation of this therapy, and this state slows its diffusion in our country. The aim of this study is to evaluate the real cost of maximal cytoreductive surgery with IPCH, and to compare it with the financial support given by the Ministery of Health. The real cost of this therapy was established on the standard analytic accountancy of our Institute. The analysis of the financial support received was done after the classification of the patients in the current official diagnosis-related groups, and according to the current rates of reimbursing of these acts. Seventy-three patients were treated with IPCH in our Institute during 2002 and 2003. The real mean cost for our hospital was 39,358 euros per patient, with a mean hospital staying of 27.7 days. In counterpart, our hospital received a mean financial support of 20,485 euros, resulting in a deficit of 18,873 euros per patient (and close to 1.4 million of euros for the two years). Our current classification of diagnosis-related groups does not allow to describe the real importance of this therapy which combines a maximal cytoreductive surgery with IPCH. In our system of reimbursing, the hospital which offers this type of new therapy to its patients receives only half of the real rate. Two correctives measures are suitable: to describe this combining treatment in the official list of medical acts, and to determine its specific cost for reimbursing.

  2. Pharmacokinetics of bupivacaine after intraperitoneal administration to cats undergoing ovariohysterectomy.

    PubMed

    Benito, Javier; Monteiro, Beatriz P; Beaudry, Francis; Lavoie, Anne-Marie; Lascelles, B Duncan X; Steagall, Paulo V

    2016-06-01

    OBJECTIVE To evaluate pharmacokinetics of bupivacaine after IP administration to cats undergoing ovariohysterectomy. ANIMALS 8 healthy cats. PROCEDURES Anesthesia was induced with propofol and maintained with isoflurane. Buprenorphine (0.02 mg/kg, IV) and meloxicam (0.2 mg/kg, SC) were administered. A 20-gauge catheter was inserted into a jugular vein for blood sample collection. A ventral midline incision was made, and a solution of 0.5% bupivacaine (2 mg/kg) diluted with an equal volume of saline (0.9% NaCl) solution (final concentration, 0.25% bupivacaine) was injected into the peritoneal space over the right and left ovarian pedicles and caudal aspect of the uterus before ovariohysterectomy. Cats were monitored for signs of bupivacaine toxicosis. Venous blood samples (2 mL) were collected before (time 0) and 2, 5, 10, 15, 20, 30, 60, 120, and 240 minutes after bupivacaine administration. Plasma bupivacaine concentrations were determined with a liquid chromatography-tandem mass spectrometry method. Pharmacokinetic parameters were determined by data plotting followed by analysis with a noncompartmental model. RESULTS No signs of bupivacaine toxicosis were observed. Maximum bupivacaine plasma concentration was 1,030 ± 497.5 ng/mL at a mean ± SD value of 30 ± 24 minutes after administration. Mean elimination half-life was 4.79 ± 2.7 hours. Mean clearance indexed by bioavailability and volume of distribution indexed by bioavailability were 0.35 ± 0.18 L•h/kg and 2.10 ± 0.84 L/kg, respectively. CONCLUSIONS AND CLINICAL RELEVANCE Intraperitoneal administration of bupivacaine resulted in concentrations that did not cause observable toxicosis. Studies to investigate analgesic effects for this technique in cats are warranted.

  3. Thulium Laser Endoscopic En Bloc Enucleation of Nonmuscle-Invasive Bladder Cancer.

    PubMed

    Migliari, Roberto; Buffardi, Andrea; Ghabin, Hassan

    2015-11-01

    To evaluate if thulium laser enucleation of bladder tumor (ThuLEBT) offers any advantage over monopolar resection of nonmuscle-invasive bladder cancer (NMIBC) without increasing complications. From February 2012 to September 2013, 58 patients (41 males and 17 females) newly diagnosed with having a single papillary bladder tumor more than 1 cm in diameter were selected for this prospective study on ThuLEBT. A similar historical cohort of 61 patients who underwent traditional monopolar resection (TURB-T) of NMIBC (Group B) was used to compare the two procedures. Mean tumor diameter in the ThuLEBT group was 2.5 cm (range 0.5-4.5). Mean operative time was 25 minutes (range 12-30). Re-resection and cold cup biopsy of the tumor base (in 90 days) were negative for bladder cancer (BC) persistence or recurrence in all patients with NMIBC treated with ThuLEBT. In Group B, seven patients were found with disease persistence. In eight cases of TURB-T patients, no detrusor muscle was identified, while it was always easily identified in the ThuLEBT group. No patient in Group A experienced obturator nerve reflection intraoperatively and no bladder perforation was evidenced in dome-located neoplasm; when involved, ureteral meatus was sharply excised without subsequent postoperative evidence of distortion. No significant intraoperative or postoperative bleeding occurred in all but one patient in the two groups. ThuLEBT may represent a potential alternative to TURB-T, which nowadays is considered the standard for diagnosis and treatment of NMBIC. In our study, ThuLEBT allowed accurate reporting of neoplastic depth invasion, suggesting the possibility to avoid a second-look resection at 90 days. All the different intravesical sites of the BC may be enucleated with the thulium laser, which offers advantages over the monopolar energy, especially when the tumor is located in the lateral bladder wall, at the bladder dome, or in the perimeatal zone.

  4. Primary malignant lymphoma of urinary bladder.

    PubMed

    Aigen, A B; Phillips, M

    1986-09-01

    A case of primary malignant lymphoma of the urinary bladder is described. The classic presentation of gross hematuria and dysuria with a benign clinical course is illustrated. From a review of the literature and our experience, we conclude that localized primary lymphoma of the bladder, especially those with favorable histologic findings, often does not require medical or surgical intervention. Persistent irritative bladder symptoms can be palliated adequately with external beam radiotherapy, while surgical intervention is rarely indicated.

  5. [The latest news on bladder cancer].

    PubMed

    Retz, M; Lehmann, J; Nawroth, R; Gschwend, J E

    2007-07-01

    A review of the current literature provides new scientific insights into the diagnosis, prognosis and novel molecular targets for bladder cancer. The new WHO classification refines our staging system and influences treatment options. International clinical databases provide new tools for calculating the individual risk for bladder cancer recurrence and progression. Systematic gene cluster analysis defines multimarker panels that can serve as robust predictors of outcome. Discoveries of new signaling pathways in bladder cancer are leading to novel molecular targets for innovative therapies.

  6. [Diagnosis of tuberculosis of bladder].

    PubMed

    Kul'chavenia, E V; Kholtobin, D P

    2014-01-01

    A comparative analysis of cystoscopic and pathologic patterns in 190 patients hospitalized for differential diagnosis or treatment of genitourinary tuberculosis in 2008-2011 was performed. All patients underwent polyfocal biopsy followed by pathologic examination of biopsy specimens. Furthermore, a comparison of results ofpathomorphological studies of tissue obtained by biopsy and after cystectomy was conducted. Cystoscopy in all patients with tuberculosis of the bladder (TB) revealed the reduced bladder capacity in contrast to patients with other urological diseases. Deformation of orifices, trabecularity and contact bleeding were observed in 66.7 to 94.4% of cases in patients with TB, which were significantly more common than in other diseases. Polymorphism of pathological pattern and the lack of specific changes in the majority of patients with TB were noted; multinucleated Pirogov-Langhans cells were found only in 11.8% of cases, and only in biopsies, whereas in the tissues obtained after cystectomy in same patients, lymphocytic infiltration and fibrosis were observed. The algorithm of diagnosis of tuberculosis of the bladder is suggested.

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

    PubMed

    Yu, Peirong

    2014-09-01

    When anterolateral thigh (ALT) perforators are inadequate, exploration of the contralateral thigh or a new flap may be required. If the anteromedial thigh (AMT) perforators were useable in these instances, harvest could proceed from a single donor site. The purposes of this study were to define the AMT perforator anatomy and examine the relationships between the AMT and ALT perforators. A total of 100 consecutive thighs were explored. The ALT and AMT perforator size and number were documented. The relationship between ALT and AMT size and number was examined using Fisher exact test, logistic regression, and linear regression. The main blood supply to the AMT flap was the rectus femoris branch (RFB) off the descending branch of the lateral circumflex femoris artery. AMT perforators were only present in 51% of the thighs and most likely a single perforator near the midpoint and 3.2 cm medial to the line connecting the anterior superior iliac spine and the patella (perforator B location). Patients with one or fewer ALT perforators had fourfold increased chance of an AMT perforator. Patients with small or no ALT perforators usually had a large AMT perforator. After assigning numeric values to perforators based on size, lower ALT perforator scores were significantly related to higher AMT scores. The RFB is the main vascular pedicle of the AMT flap. There is an inverse relationship between size and number of ALT and AMT perforators: when ALT perforators are inadequate, AMT perforators are typically useable. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

  8. Occult mucin secreting adenocarcinoma of gall bladder with metastasis to urinary bladder.

    PubMed

    Jindal, Tarun; Mandal, Soumendra Nath; Kamal, Mir Reza; Das, Anjan Kumar; Karmakar, Dilip

    2012-09-01

    Mucin secreting adenocarcinoma of the gall bladder is rare. Although it has propensity to metastasise, urinary metastasis is extremely unusual. We report a case with mucin secreting adenocarcinoma of the gall bladder with metastasis to the urinary bladder. To the best of our knowledge, this is the first case of its kind in the literature.

  9. Clinical applications of the superior epigastric artery perforator (SEAP) flap: anatomical studies and preoperative perforator mapping with multidetector CT.

    PubMed

    Hamdi, Moustapha; Van Landuyt, Koenraad; Ulens, Sara; Van Hedent, Eddy; Roche, Nathalie; Monstrey, Stan

    2009-09-01

    Pedicled superior epigastric artery perforator (SEAP) flaps can be raised to cover challenging thoracic defects. We present an anatomical study based on multidetector computerized tomography (MDCT) scan findings of the SEA perforators in addition to the first reported clinical series of SEAP flaps in anterior chest wall reconstruction. (a) In the CT scan study, images of a group of 20 patients who underwent MDCT scan analysis were used to visualise bilaterally the location of musculocutaneous SEAP. X- and Y-axes were used as landmarks to localise the perforators. The X-axis is a horizontal line at the junction of sternum and xyphoid (JCX) and the Y-axis is at the midline. (b) In the clinical study, seven pedicled SEAP flaps were performed in another group of patients. MDCT images revealed totally 157 perforators with a mean of 7.85 perforators per patient. The dominant perforators (137 perforators) were mainly localised in an area between 1.5 and 6.5 cm from the X-axis on both sides and between 3 and 16 cm below the Y-axis. The calibre of these dominant perforators was judged as 'good' to 'very good' in 82.5% of the cases. The average dimension of the flap was 21.7x6.7 cm. All flaps were based on one perforator. Mean harvesting time was 110 min. There were no flap losses. Minor tip necrosis occurred in two flaps. One of them was treated with excision and primary closure. Our clinical experience indicates that the SEAP flap provides a novel and useful approach for reconstruction of anterior chest wall defects. CT-based imaging allows for anatomical assessment of the perforators of the superior epigastric artery (SEA).

  10. Intraperitoneal chemotherapy for gastric cancer with peritoneal disease: experience from Singapore and Japan.

    PubMed

    Kono, Koji; Yong, Wei-Peng; Okayama, Hirokazu; Shabbir, Asim; Momma, Tomoyuki; Ohki, Shinji; Takenoshita, Seiichi; So, Jimmy

    2017-03-01

    Among advanced gastric cancer cases, peritoneal dissemination is a life-threatening mode of metastasis, and any strategy to control peritoneal metastasis will significantly improve treatment outcomes. Since intraperitoneal administration of anticancer drugs can induce an extremely high concentration of drugs in the peritoneal cavity, intraperitoneal chemotherapy would appear to be a reasonable and promising strategy to control the peritoneal dissemination. However, it has been reported in the past that intraperitoneal administration of mitomycin C or cisplatin resulted in no significant clinical effects against peritoneal metastasis of gastric cancer. In contrast, intraperitoneal paclitaxel is expected to remain inside the peritoneal cavity due to its large molecular weight and fat solubility, leading to a high concentration of the drug in the peritoneal cavity. In fact, promising results in several phase II clinical trials using intraperitoneal paclitaxel have been reported, including a median survival time of 16.2-24.6 months and a 1-year overall survival rate of 69-78 %. Thereafter, a phase III randomized control study (PHOENIX-GC trial) with intraperitoneal paclitaxel plus systemic S-1 and intravenous paclitaxel in comparison to systemic S-1 plus cisplatin was conducted in Japan. Moreover, a phase II clinical trial of combination chemotherapy of intraperitoneal paclitaxel with systemic capecitabine plus oxaliplatin is currently ongoing in Singapore. In this review, based on clinical experience from Singapore and Japan, the clinical significance of intraperitoneal chemotherapy for gastric cancer with peritoneal disease is discussed.

  11. Uneventful intraperitoneal rupture of a hepatic hydatid cyst: a case report.

    PubMed

    Abdel Hameed, A A; Abu Aisha, H

    1987-01-01

    Acute intraperitoneal rupture is a rather rare complication of hepatic hydatid cysts; anaphylaxis and sudden death have frequently been reported in such cases. In the present report we are presenting a case of acute traumatic intraperitoneal rupture of a huge hydatid cyst to which the patient showed no hypersensitivity reactions.

  12. Combined usage with intraperitoneal and incisional ropivacaine reduces pain severity after laparoscopic cholecystectomy.

    PubMed

    Liu, Dan-Shu; Guan, Feng; Wang, Bin; Zhang, Tian

    2015-01-01

    Postoperative pain is the main obstacle for safely rapid recovery of patients undergoing laparoscopic cholecystectomy (LC). In this study, we systemically evaluated the analgesic efficacy of intraperitoneal and incisional ropivacaine injected at the end of the LC. A total of 160 patients, scheduled for elective LC, were allocated into four groups. Group Sham received intraperitoneal and incisional normal saline (NS). Group IC received incisional ropivacaine and intraperitoneal NS. Group IP received incisional NS and intraperitoneal ropivacaine. Group ICP received intraperitoneal and incisional ropivacaine. At the end of the surgery, ropivacaine was injected into the surgical bed through the right subcostal port and infiltrated at the four ports. Dynamic pain by a visual analogue scale (VAS) and cumulative morphine consumption at 2 h, 6 h, 24 h, and 48 h postoperatively, as well as incidence of side-effects over 48 h after LC was recorded. Compared with those in group Sham, the time of post-anesthesia care unit (PACU) stay, dynamic VAS score (VAS-D) 2 h and 6 h postoperatively, cumulative morphine consumption 6 h and 24 h postoperatively, and incidence of nausea and vomiting 48 h after LC in group IC and ICP were less (P<0.05). Furthermore, intraperitoneal and incisional ropivacaine exerts more powerful analgesic effect than single usage with intraperitoneal or incisional ropivacaine (P<0.05). No patients exhibited signs of local anesthetic toxicity. In conclusion, intraperitoneal and incisional ropivacaine might facilitate PACU transfer and effectively and safely reduce pain intensity after LC.

  13. Videofetoscopically assisted fetal tissue engineering: bladder augmentation.

    PubMed

    Fauza, D O; Fishman, S J; Mehegan, K; Atala, A

    1998-01-01

    Treatment of several congenital anomalies is frequently hindered by lack of enough tissue for surgical reconstruction in the neonatal period. Minimally invasive harvest of fetal tissue, which is then processed through tissue engineering techniques in vitro while pregnancy is allowed to continue so that at delivery a newborn with a prenatally diagnosed congenital anomaly can benefit from having autologous, expanded tissue promptly available for surgical reconstruction at birth. This concept was applied to a bladder defect. Bladder exstrophy was surgically created in ten 90- to 95-day gestation fetal lambs, which were divided in two groups. In group I, a small fetal bladder specimen was harvested through a minimally invasive technique (videofetoscopy). Urothelial and smooth muscle cells were then separately cultivated and expanded in vitro for 55 to 60 days, resulting in a total of approximately 200 million cells. Seven to 10 days before delivery, the cells were seeded in two layers in a 16- to 20-cm2, 3-mm thick biodegradable polyglycolic acid polymer matrix. One to 4 days after delivery, autologous engineered tissue was used for surgical augmentation of the exstrophic bladder. In group II, no harvest was performed, and the bladder exstrophy was primarily closed after delivery. In both groups, a catheter was left inside the bladder for 3 weeks, at which time a cystogram was performed and the catheter then removed. In all animals, at 60 days, another cystogram was performed and urodynamic studies of the bladder were performed. The bladder was then removed for histological analysis. Fetal survival rate was 100%. One newborn died immediately after the implantation of the engineered bladder from an anesthetic accident. The other nine (four in group I and five in group II) survived. One of the animals from group I lost its bladder catheter prematurely and had a urinary leak detected only at the time of death. There were no other complications. The engineered bladders

  14. Ruptured urinary bladder in a heifer.

    PubMed

    Roussel, A J; Ward, D S

    1985-06-15

    A yearling Holstein heifer was admitted with abdominal pain and bilateral, ventral abdominal distention. Bladder rupture was diagnosed by abdominocentesis and endoscopy. Correction of metabolic derangements was accomplished by volume diuresis, with maintenance of a urethral catheter before surgical repair of the bladder. The cause of the bladder rupture was believed to be related to adhesions resulting from previous surgery for urachal abscessation. Bladder rupture, which usually occurs in bulls or steers secondary to urolithiasis or in cows after dystocia, also should be considered in prepartum heifers with dehydration, abdominal pain, and abdominal distention.

  15. Atezolizumab in Treating Patients With Recurrent BCG-Unresponsive Non-muscle Invasive Bladder Cancer

    ClinicalTrials.gov

    2017-03-30

    Recurrent Bladder Urothelial Carcinoma; Stage 0a Bladder Urothelial Carcinoma; Stage 0is Bladder Urothelial Carcinoma; Stage I Bladder Cancer With Carcinoma In Situ; Stage I Bladder Urothelial Carcinoma

  16. 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.

  17. 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

  18. Intrathoracic caecal perforation presenting as dyspnea.

    PubMed

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

    2010-01-01

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

  19. Intrathoracic Caecal Perforation Presenting as Dyspnea

    PubMed Central

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

    2010-01-01

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

  20. 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.

  1. Tension pneumothorax due to perforated colon.

    PubMed

    Abdullah, Muhammad; Stonelake, Paul

    2016-05-31

    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.

  2. Management of Perforating Idiopathic Internal Root Resorption.

    PubMed

    Abdullah, Dalia; Eziana Hussein, Farah; Abd Ghani, Huwaina

    2017-01-01

    This case report describes the endodontic treatment of an idiopathic perforated internal root resorption. A 24-year-old male Malay patient presented with internal root resorption of two of his anterior teeth. The medical history was non-contributory and he had no history of traumatic injury or orthodontic treatment. Cone-beam computed tomography (CBCT) determined the nature, location and severity of the resorptive lesion. Non-surgical root canal treatment of tooth #22 and combined non-surgical and surgical approach for tooth #11 were carried out using mineral trioxide aggregate (MTA) as the filling material. The clinical and radiographic examination three years after completion of treatment revealed evidences of periapical healing. The appropriate diagnosis and the treatment of internal root resorption allowed good healing of these lesions and maintained the tooth in function for as long as possible.

  3. Palatopharyngeal wall perforation during Glidescope intubation.

    PubMed

    Leong, W L; Lim, Y; Sia, A T H

    2008-11-01

    We report a case of palatopharyngeal wall perforation during intubation with a GlideScope laryngoscope. The likely mechanism was advancing and rotating the endotracheal tube against a taut palatopharyngeal fold. This was missed during the initial laryngoscopy, because there is a potential blind-spot in the oropharynx when attention is focused on the GlideScope" monitor Fortunately, there were no sequelae other than minor bleeding and a mild sore throat and no surgical intervention was necessary. The use of unnecessary force during the endotracheal tube insertion, the use of too large a laryngoscope blade and the use of a rigid stylet could possibly also have been contributory factors to this complication.

  4. The Bloch Approximation in Periodically Perforated Media

    SciTech Connect

    Conca, C. Gomez, D. Lobo, M. Perez, E.

    2005-06-15

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

  5. 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

  6. Intraperitoneal cytology after laparoscopic hysterectomy in patients with endometrial cancer: A retrospective observational study.

    PubMed

    Tanaka, Tomohito; Terai, Yoshito; Maeda, Kazuya; Ashihara, Keisuke; Kogata, Yuhei; Maruoka, Hiroshi; Terada, Shinichi; Yamada, Takashi; Ohmichi, Masahide

    2017-07-01

    The aim of this study was to evaluate the dissemination of cancer cells at laparoscopic hysterectomy according to the intraperitoneal cytology.Patients with endometrial cancer underwent total laparoscopic modified radical hysterectomy. Peritoneal wash cytology was performed on entering the peritoneal cavity before surgical preparation and just after hysterectomy.Seventy-eight patients underwent laparoscopic hysterectomy for endometrial cancer. Among the 15 patients who had positive intraperitoneal cytology on entering the peritoneal cavity, 10 converted to negative intraperitoneal cytology after hysterectomy. In contrast, among the 63 patients who had negative intraperitoneal cytology on entering the peritoneal cavity, 2 converted to positive intraperitoneal cytology after hysterectomy.While surgery can reduce the number of cancer cells in the peritoneal cavity, leakage can occur, as seen in some cases of hysterectomy. Careful washing must be performed after hysterectomy.

  7. Risk of surgical glove perforation in oral and maxillofacial surgery.

    PubMed

    Kuroyanagi, N; Nagao, T; Sakuma, H; Miyachi, H; Ochiai, S; Kimura, Y; Fukano, H; Shimozato, K

    2012-08-01

    Oral and maxillofacial surgery, which involves several sharp instruments and fixation materials, is consistently at a high risk for cross-contamination due to perforated gloves, but it is unclear how often such perforations occur. This study aimed to address this issue. The frequency of the perforation of surgical gloves (n=1436) in 150 oral and maxillofacial surgeries including orthognathic surgery (n=45) was assessed by the hydroinsufflation technique. Orthognathic surgery had the highest perforation rate in at least 1 glove in 1 operation (91.1%), followed by cleft lip and palate surgery (55.0%), excision of oral soft tumour (54.5%) and dental implantation (50.0%). The perforation rate in scrub nurses was 63.4%, followed by 44.4% in surgeons and first assistants, and 16.3% in second assistants. The odds ratio for the perforation rate in orthognathic surgery versus other surgeries was 16.0 (95% confidence interval: 5.3-48.0). The protection rate offered by double gloving in orthognathic surgery was 95.2%. These results suggest that, regardless of the surgical duration and blood loss in all fields of surgery, orthognathic surgery must be categorized in the highest risk group for glove perforation, following gynaecological and open lung surgery, due to the involvement of sharp objects.

  8. 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.

  9. Modified lumbar artery perforator flaps for gluteal pressure sore reconstruction.

    PubMed

    Yoon, Chi Sun; Yim, Ji Hong; Kim, Min Ho; Ha, Won; Kim, Kyu Nam

    2016-03-21

    Gluteal perforator flaps (GPFs) are the most useful for gluteal region pressure sore reconstruction. However, application is difficult if the surrounding area has scar tissue from previous operations or trauma, especially with recurrent sores. We describe the use of modified lumbar artery perforator flaps when GPFs cannot be used. Between May 2009 and April 2014, 51 patients underwent gluteal pressure sore reconstructions with gluteal (n = 39) or modified lumbar artery (n = 12) perforator flaps. Patients in the modified lumbar artery perforator group had scar tissue from trauma or previous surgery. In this retrospective review, we analyzed patient age and sex, defect size and location, operative time, follow-up duration, immediate postoperative issues, flap necrosis, dehiscence, re-operation, donor-site morbidity and recurrence. Complications and clinical outcomes were compared between groups. We found no significant differences in patient demographics, surgical complications or clinical outcomes. There were eight cases of temporary congestion (20.51%) and four of partial flap necrosis (10.25%) in the gluteal perforator group. In the modified lumbar artery perforator group, there were three cases of temporary congestion (25%) and one of partial flap necrosis (8.33%). No pressure sores recurred during follow-up in either group. GPFs are the gold standards for gluteal pressure sores, but modified lumbar artery perforator flaps are relatively easy and useful when GPFs cannot be used due to scar tissue. © 2016 Royal Australasian College of Surgeons.

  10. 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

  11. [Non-surgical treatment of perforations of the thoracic esophagus].

    PubMed

    Slim, K; Elbaz, V; Pezet, D; Chipponi, J

    1996-02-03

    Thoracic oesophageal perforations are life-threatening conditions requiring immediate treatment. The type of treatment remains however controversial. The aim of this study was to evaluate the efficacy of the nonoperative management in this disease. Six patients were admitted in our surgical unit for thoracic oesophageal perforations during the study period. One perforation was spontaneous (Boerhaave's syndrome). One had complicated an oesophageal ulcer. Two were secondary to caustic lesions. Two were secondary to instrumental dilations. The diagnostic and therapeutic delay was < or = 1 day in 5 cases. In one case the delay was 4 days but the mediastinitis was well tolerated. The treatment was based on antibiotics, nasoesophageal tube suction, and total parenteral nutrition. There was no death in this group of patients. The mediastinitis healed in all cases. In the follow-up period two patients did not have nutritional restriction after healing. Three patients complained of oesophageal stenosis which required oesophageal replacement (n = 2) and dilation (n = 1). One neoplastic stenosis required an endoprosthesis. Nonoperative treatment is feasible and safe in selected cases of thoracic oesophageal perforations: perforations diagnosed early and confined to the mediastinum, instrumental perforations, and perforations diagnosed late but well tolerated.

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

    PubMed

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

    2016-01-01

    Accidental root canal perforations are among the main complications of endodontic treatment. 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. 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. The results showed lower volume and gap in the interface dentin/material in VOMG compared to the other groups (P < 0.05). The use of OM improved the quality of cervical perforations sealed with Vitremer, being indicated in clinical situations of iatrogenic cervical perforations.

  13. [Proximal urethra portion perforation during TVT-O in a patient with urethral deviation secondary to previous failed Burch surgery].

    PubMed

    Ricci Arriola, Paolo; Solà Dalenz, Vicente; Pardo Schanz, Jack

    2009-03-01

    A 59 years old woman with laparoscopic Burch made during 2003 in another hospital. During 2006, the patient is evaluating in our center for a persistent urinary incontinence, the urodynamic study demonstrated stress urinary incontinence type II and overactive bladder without obstruction evidences. A TVT-O (tension-free vaginal tape obturador in-out route) was made, nevertheless when the right branch was passed blood was observed in the Foley catheter. A cystoscopy showed an important deviation of urethra and the tape through urethra in the proximal portion. The right branch went again inserted taking the necessary precautions. Two days after surgery the Foley catheter was removed and the stress urinary incontinence symptoms disappeared. The urge incontinence symptoms disappeared with the pharmacalogical treatment (Tolterodine 2 mg/day). We believe that the urethral deviation caused by a technically deficient laparoscopic Burch was the reason for the urethral perforation during the TVT-O.

  14. Microvascular anatomy of the cerebellar parafloccular perforating space.

    PubMed

    Sosa, Pablo; Dujovny, Manuel; Onyekachi, Ibe; Sockwell, Noressia; Cremaschi, Fabián; Savastano, Luis E

    2016-02-01

    The cerebellopontine angle is a common site for tumor growth and vascular pathologies requiring surgical manipulations that jeopardize cranial nerve integrity and cerebellar and brainstem perfusion. To date, a detailed study of vessels perforating the cisternal surface of the middle cerebellar peduncle-namely, the paraflocculus or parafloccular perforating space-has yet to be published. In this report, the perforating vessels of the anterior inferior cerebellar artery (AICA) in the parafloccular space, or on the cisternal surface of the middle cerebellar peduncle, are described to elucidate their relevance pertaining to microsurgery and the different pathologies that occur at the cerebellopontine angle. Fourteen cadaveric cerebellopontine cisterns (CPCs) were studied. Anatomical dissections and analysis of the perforating arteries of the AICA and posterior inferior cerebellar artery at the parafloccular space were recorded using direct visualization by surgical microscope, optical histology, and scanning electron microscope. A comprehensive review of the English-language and Spanish-language literature was also performed, and findings related to anatomy, histology, physiology, neurology, neuroradiology, microsurgery, and endovascular surgery pertaining to the cerebellar flocculus or parafloccular spaces are summarized. A total of 298 perforating arteries were found in the dissected specimens, with a minimum of 15 to a maximum of 26 vessels per parafloccular perforating space. The average outer diameter of the cisternal portion of the perforating arteries was 0.11 ± 0.042 mm (mean ± SD) and the average length was 2.84 ± 1.2 mm. Detailed schematics and the surgical anatomy of the perforating vessels at the CPC and their clinical relevance are reported. The parafloccular space is a key entry point for many perforating vessels toward the middle cerebellar peduncle and lateral brainstem, and it must be respected and protected during surgical approaches to the

  15. Integration of Perforated Subretinal Prostheses With Retinal Tissue

    PubMed Central

    Adekunle, Adewumi N.; Adkins, Alice; Wang, Wei; Kaplan, Henry J.; de Castro, Juan Fernandez; Lee, Sang Joon; Huie, Philip; Palanker, Daniel; McCall, Maureen; Pardue, Machelle T.

    2015-01-01

    Purpose To investigate the integration of subretinal implants containing full-depth perforations of various widths with rat and pig retina across weeks of implantation. Methods In transgenic P23H rhodopsin line 1 (TgP23H-1) rats and wild-type (WT) pigs, we examined four subretinal implant designs: solid inactive polymer arrays (IPA), IPAs with 5- or 10-μm wide perforations, and active bipolar photovoltaic arrays (bPVA) with 5-μm perforations. We surgically placed the implants into the subretinal space using an external approach in rats or a vitreoretinal approach in pigs. Implant placement in the subretinal space was verified with optical coherence tomography and retinal perfusion was characterized with fluorescein angiography. Rats were sacrificed 8 or 16 weeks post-implantation (wpi) and pigs 2, 4, or 8 wpi, and retinas evaluated at the light microscopic level. Results Regardless of implant design, retinas of both species showed normal vasculature. In TgP23H-1 retinas implanted with 10-μm perforated IPAs, inner nuclear layer (INL) cells migrated through the perforations by 8 wpi, resulting in significant INL thinning by 16 wpi. Additionally, these retinas showed greater pseudo-rosette formation and fibrosis compared with retinas with solid or 5-μm perforated IPAs. TgP23H-1 retinas with bPVAs showed similar INL migration to retinas with 5-μm perforated IPAs, with less fibrosis and rosette formation. WT pig retina with perforated IPAs maintained photoreceptors, showed no migration, and less pseudo-rosette formation, but more fibrosis compared with implanted TgP23H-1 rat retinas. Conclusions In retinas with photoreceptor degeneration, solid implants, or those with 5-μm perforations lead to the best biocompatibility. PMID:26290776

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

    PubMed Central

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

    2014-01-01

    IMPORTANCE In the traditional model of acute appendicitis, time is the major driver of disease progression; luminal obstruction leads inexorably to perforation without timely intervention. This perceived association has long guided clinical behavior related to the timing of appendectomy. OBJECTIVE To evaluate whether there is an association between time and perforation after patients present to the hospital. DESIGN, SETTING, AND PARTICIPANTS Using data from the Washington State Surgical Care and Outcomes Assessment Program (SCOAP), we evaluated patterns of perforation among patients (≥18 years) who underwent appendectomy from January 1, 2010, to December 31, 2011. Patients were treated at 52 diverse hospitals including urban tertiary centers, a university hospital, small community and rural hospitals, and hospitals within multi-institutional organizations. MAIN OUTCOMES AND MEASURES The main outcome of interest was perforation as diagnosed on final pathology reports. The main predictor of interest was elapsed time as measured between presentation to the hospital and operating room (OR) start time. The relationship between in-hospital time and perforation was adjusted for potential confounding using multivariate logistic regression. Additional predictors of interest included sex, age, number of comorbid conditions, race and/or ethnicity, insurance status, and hospital characteristics such as community type and appendectomy volume. RESULTS A total of 9048 adults underwent appendectomy (15.8% perforated). Mean time from presentation to OR was the same (8.6 hours) for patients with perforated and nonperforated appendicitis. In multivariate analysis, increasing time to OR was not a predictor of perforation, either as a continuous variable (odds ratio = 1.0 [95% CI, 0.99-1.01]) or when considered as a categorical variable (patients ordered by elapsed time and divided into deciles). Factors associated with perforation were male sex, increasing age, 3 or more comorbid

  17. Spontaneous Uterine Perforation Caused by Pyometra: A Case Report

    PubMed Central

    Yousefi, Zohreh; Sharifi, Noorieh; Morshedy, Maryam

    2014-01-01

    Introduction: Pyometra is an accumulation of purulent material or pus in the uterine cavity. Spontaneous perforation of uterus by pyometra is rare. This is a clinical presentation and management of a spontaneous perforation of uterine caused by pyometra. Case Presentation: This is a case report on spontaneously perforated associated with pyometra secondary to cervical malignancy. The patient underwent exploratory laparotomy with total hysterectomy and bilateral salpingo-oophorectomy. Conclusions: Spontaneous rupture of pyometra duo to cervical cancer in cases of acute abdomen in elderly patients should be considered. PMID:25593714

  18. Perforated duodenal ulcer in a young child: an uncommon condition.

    PubMed

    Yadav, R P; Agrawal, C S; Gupta, R K; Rajbansi, S; Bajracharya, A; Adhikary, S

    2009-01-01

    Duodenal ulcer is an uncommonly diagnosed entity in children. H. pylori infection, blood group 'O' or secondary to medications like non steroidal anti-inflammatory drugs (NSAID) and corticosteroids or physiological stress in burns, head injury and mucosal ischemia are implicated as risk factors for their causation. The diagnosis is usually overlooked because of vague and variable symptoms and remote index of suspicion accounted for their low incidence in children. Undiagnosed or mistreated perforations may carry high morbidity and mortality. We report a successfully treated 41/2 year old male child who presented with features of perforation peritonitis and was incidentally found to have a perforated duodenal ulcer.

  19. Esophageal Perforation with Unilateral Fluidothorax Caused by Nasogastric Tube.

    PubMed

    Mileder, Lukas P; Müller, Martin; Reiterer, Friedrich; Pilhatsch, Alexander; Gürtl-Lackner, Barbara; Urlesberger, Berndt; Raith, Wolfgang

    2016-01-01

    Preterm infants are highly susceptible to injuries following necessary and often life-saving medical interventions. Esophageal perforation is a rare, yet serious complication that can be caused by aerodigestive tract suction, endotracheal intubation, or nasogastric tube placement. We present the case of a neonate born at 23 weeks plus three days of gestation with chest radiography showing malposition of the nasogastric feeding tube and massive right-sided effusion of Iopamidol in the pleural cavity due to esophageal perforation. In addition, the article summarizes common signs and symptoms associated with esophageal perforation in infants and discusses diagnostic approaches.

  20. Central perforation of atretic pulmonary valve using coronary microcatheter.

    PubMed

    Gupta, Saurabh Kumar; Juneja, Rajnish; Saxena, Anita

    2017-01-01

    Percutaneous perforation of pulmonary valve, using 0.014" guidewires meant for coronary artery chronic total occlusion (CTO), is increasingly being performed for select cases of pulmonary atresia with intact ventricular septum (PA-IVS). Despite growing experience, procedural failures and complications are not uncommon. Even in infants treated successfully, the orifice created in the atretic pulmonary valve is eccentric. In this report, we present usefulness of coronary microcatheter in alignment of perforating coronary guidewire to the center of atretic pulmonary valve resulting in central perforation.