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Sample records for perforant path terminal

  1. 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

  2. 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.

  3. The terminal area automated path generation problem

    NASA Technical Reports Server (NTRS)

    Hsin, C.-C.

    1977-01-01

    The automated terminal area path generation problem in the advanced Air Traffic Control System (ATC), has been studied. Definitions, input, output and the interrelationships with other ATC functions have been discussed. Alternatives in modeling the problem have been identified. Problem formulations and solution techniques are presented. In particular, the solution of a minimum effort path stretching problem (path generation on a given schedule) has been carried out using the Newton-Raphson trajectory optimization method. Discussions are presented on the effect of different delivery time, aircraft entry position, initial guess on the boundary conditions, etc. Recommendations are made on real-world implementations.

  4. Mnemonic Discrimination Relates to Perforant Path Integrity: An Ultra-High Resolution Diffusion Tensor Imaging Study

    PubMed Central

    Bennett, Ilana J.; Stark, Craig E.L.

    2015-01-01

    Pattern separation describes the orthogonalization of similar inputs into unique, non-overlapping representations. This computational process is thought to serve memory by reducing interference and to be mediated by the dentate gyrus of the hippocampus. Using ultra-high in-plane resolution diffusion tensor imaging (hrDTI) in older adults, we previously demonstrated that integrity of the perforant path, which provides input to the dentate gyrus from entorhinal cortex, was associated with mnemonic discrimination, a behavioral outcome designed to load on pattern separation. The current hrDTI study assessed the specificity of this perforant path integrity-mnemonic discrimination relationship relative to other cognitive constructs (identified using a factor analysis) and white matter tracts (hippocampal cingulum, fornix, corpus callosum) in 112 healthy adults (20–87 years). Results revealed age-related declines in integrity of the perforant path and other medial temporal lobe (MTL) tracts (hippocampal cingulum, fornix). Controlling for global effects of brain aging, perforant path integrity related only to the factor that captured mnemonic discrimination performance. Comparable integrity-mnemonic discrimination relationships were also observed for the hippocampal cingulum and fornix. Thus, whereas perforant path integrity specifically relates to mnemonic discrimination, mnemonic discrimination may be mediated by a broader MTL network. PMID:26149893

  5. Mnemonic discrimination relates to perforant path integrity: An ultra-high resolution diffusion tensor imaging study.

    PubMed

    Bennett, Ilana J; Stark, Craig E L

    2016-03-01

    Pattern separation describes the orthogonalization of similar inputs into unique, non-overlapping representations. This computational process is thought to serve memory by reducing interference and to be mediated by the dentate gyrus of the hippocampus. Using ultra-high in-plane resolution diffusion tensor imaging (hrDTI) in older adults, we previously demonstrated that integrity of the perforant path, which provides input to the dentate gyrus from entorhinal cortex, was associated with mnemonic discrimination, a behavioral outcome designed to load on pattern separation. The current hrDTI study assessed the specificity of this perforant path integrity-mnemonic discrimination relationship relative to other cognitive constructs (identified using a factor analysis) and white matter tracts (hippocampal cingulum, fornix, corpus callosum) in 112 healthy adults (20-87 years). Results revealed age-related declines in integrity of the perforant path and other medial temporal lobe (MTL) tracts (hippocampal cingulum, fornix). Controlling for global effects of brain aging, perforant path integrity related only to the factor that captured mnemonic discrimination performance. Comparable integrity-mnemonic discrimination relationships were also observed for the hippocampal cingulum and fornix. Thus, whereas perforant path integrity specifically relates to mnemonic discrimination, mnemonic discrimination may be mediated by a broader MTL network.

  6. Medial and lateral perforant path evoked potentials are selectively modulated by pairing with glutamatergic activation of locus coeruleus in the dentate gyrus of the anesthetized rat.

    PubMed

    Edison, Hilary T; Harley, Carolyn W

    2012-03-01

    Norepinephrine (NE) in vitro produces long-lasting potentiation of medial perforant path input and depression of lateral perforant path input to dentate gyrus in the rat. Similar, but highly transient, effects have been reported in vivo using paragigantocellular stimulation to release NE. The present study uses alternate stimulation of the medial perforant path and lateral olfactory tract (eliciting a lateral perforant path-evoked potential) to examine the effects of glutamatergic activation of locus coeruleus (LC) on the two pathways for up to 3 h post-LC activation. In the first experiment, the expected potentiation of the medial perforant path population spike in dentate gyrus was observed, but without accompanying depression of the lateral perforant path-mediated evoked potential (lateral olfactory tract stimulation, 60 s ISI). In a second experiment, with more frequent pairing of input with NE release (10 s ISI), significant potentiation of lateral perforant path-mediated input to dentate gyrus occurred, but potentiation of medial perforant path input was not seen. A third experiment with a 30 s ISI again produced potentiation of lateral perforant path-mediated input without potentiation of the medial perforant path population spike. The size of effects with the 30 s ISI was intermediate between that seen with 10 s and 60 s ISI. Potentiation of lateral perforant path over medial perforant path input has previously been reported with acute nicotinic activation of the LC. This outcome also resembles heterosynaptic modulation previously reported with tetanic potentiation. The data argue for a competitive relationship between medial and lateral perforant path inputs to dentate gyrus and suggest pairing with increased NE produces a bias favoring one or the other pathway depending on parameters such as strength and frequency. NE potentiating effects on lateral perforant path input here may also have occurred in entorhinal cortex (EC) given the system-wide NE release

  7. Effects of gear crack propagation paths on vibration responses of the perforated gear system

    NASA Astrophysics Data System (ADS)

    Ma, Hui; Pang, Xu; Zeng, Jin; Wang, Qibin; Wen, Bangchun

    2015-10-01

    This paper investigates the dynamic behaviors of a perforated gear system considering effects of the gear crack propagation paths and this study focuses on the effects of a crack propagating through the rim on the time-varying mesh stiffness (TVMS) and vibration responses. Considering the effects of the extended tooth contact, a finite element (FE) model of a gear pair is established based on ANSYS software. TVMS of the perforated gear with crack propagating through tooth and rim are calculated by using the FE model. Furthermore, a lumped mass model is adopted to investigate the vibration responses of the perforated gear system. The results show that there exist three periods related to slots of the gear body in a rotating period of the perforated gear. Gear cracks propagating through tooth and rim both reduce the gear body stiffness and lead to reduction of TVMS besides the crack tooth contact moment, and the TVMS weakening for the former is less than that for the latter. Moreover, the results also show that the gear crack propagating through the rim (CPR) has a greater effect on vibration responses than the gear crack propagating through the tooth (CPT) under the same crack level. Vibration level increases with the increasing crack depth, especially for the gear with CPR.

  8. Cultural diversity: family path through terminal illness.

    PubMed

    Baider, L

    2012-04-01

    In trying to comprehend a culture and its ways of structuring the world, much can be learned from addressing the manner in which intimate family relationships are ordered and family crises channeled toward care. A family's experience with illness cannot be considered in isolation from the cultural milieu in which it occurs. Family adaptation to cancer diagnosis is a continuous motion between many critical strata--a fragile oscillation between hope and desperation. Processes for optimal functioning and the well-being of members are seen to vary over time, as challenges unfold and families evolve across the life cycle and illness trajectory. The manner in which the healthcare system and family manage illness and terminal care is a particularly helpful window into the cultural, religious and traditional values of every family in a particular society.

  9. Parvalbumin disappears from GABAergic CA1 neurons of the gerbil hippocampus with seizure onset while its presence persists in the perforant path.

    PubMed

    Scotti, A L; Kalt, G; Bollag, O; Nitsch, C

    1997-06-20

    Mongolian gerbils are epilepsy prone animals, a trait observable at the behavioural level during the 2nd month of life. As a unique species difference, gerbils express the calcium-binding protein parvalbumin (PV) in the perforant path from the entorhinal cortex to the hippocampus. In this study, we determined the time of appearance of PV in the layer II neurons of the entorhinal cortex and the perforant path terminals in gerbils between post-natal days 30 and 50. Signs of low grade seizures were observed in few animals from P40 onward. PV stain in the entorhinal cortex and perforant path terminals was already detectable at P30, well before the onset of behavioural seizures and did not change with age. It is suggested that the presence of PV in this pathway may be related to the generation early in life of an epileptogenic focus in the limbic forebrain. Altered inhibitory hippocampal circuits have also been suggested as a cause of seizures in the gerbil. Therefore, we quantitated hippocampal GABA-immunoreactive neurons and the PV-immunoreactive subpopulation. A group of gerbils with a high density of stained pyramidal interneurons in CA1 and one lacking PV-stained perikarya could be distinguished at P40 and P50. The density of GABA-immunoreactive nerve cells however, remained the same in both groups and through the ages studied. Thus, perikaryal PV is lost from intact GABAergic nerve cells at the same time as behavioural seizures are observed. The loss of PV from GABAergic neurons may affect their functional properties and be instrumental for the maintainance of behavioural seizures.

  10. Modeling the Nonlinear Properties of the in vitro Hippocampal Perforant Path-Dentate System Using Multielectrode Array Technology

    PubMed Central

    Courellis, Spiros H.; Gholmieh, Ghassan I.; Marmarelis, Vasilis Z.; Berger, Theodore W.

    2009-01-01

    A modeling approach to characterize the nonlinear dynamic transformations of the dentate gyrus of the hippocampus is presented and experimentally validated. The dentate gyrus is the first region of the hippocampus which receives and integrates sensory information via the perforant path. The perforant path is composed of two distinct pathways: 1) the lateral path and 2) the medial perforant path. The proposed approach examines and captures the short-term dynamic characteristics of these two pathways using a nonparametric, third-order Poisson–Volterra model. The nonlinear characteristics of the two pathways are represented by Poisson–Volterra kernels, which are quantitative descriptors of the nonlinear dynamic transformations. The kernels were computed with experimental data from in vitro hippocampal slices. The electrophysiological activity was measured with custom-made multielectrode arrays, which allowed selective stimulation with random impulse trains and simultaneous recordings of extracellular field potential activity. The results demonstrate that this mathematically rigorous approach is suitable for the multipathway complexity of the hippocampus and yields interpretable models that have excellent predictive capabilities. The resulting models not only accurately predict previously reported electrophysiological descriptors, such as paired pulses, but more important, can be used to predict the electrophysiological activity of dentate granule cells to arbitrary stimulation patterns at the perforant path. PMID:18270006

  11. 5-HT1a Receptor Antagonists Block Perforant Path-Dentate LTP Induced in Novel, but Not Familiar, Environments

    ERIC Educational Resources Information Center

    Sanberg, Cyndy Davis; Jones, Floretta L.; Do, Viet H.; Dieguez, Dario, Jr.; Derrick, Brian E.

    2006-01-01

    Numerous studies suggest roles for monoamines in modulating long-term potentiation (LTP). Previously, we reported that both induction and maintenance of perforant path-dentate gyrus LTP is enhanced when induced while animals explore novel environments. Here we investigate the contribution of serotonin and 5-HT1a receptors to the novelty-mediated…

  12. A Form of Perforant Path LTP Can Occur without ERK1/2 Phosphorylation or Immediate Early Gene Induction

    ERIC Educational Resources Information Center

    Steward, Oswald; Huang, Fen; Guzowski, John F.

    2007-01-01

    Stimulation paradigms that induce perforant path long-term potentiation (LTP) initiate phosphorylation of ERK1/2 and induce expression of a variety of immediate early genes (IEGs). These events are thought to be critical components of the mechanism for establishing the changes in synaptic efficacy that endure for hours or longer. Here we show that…

  13. Chronic Fluoxetine Induces the Enlargement of Perforant Path-Granule Cell Synapses in the Mouse Dentate Gyrus.

    PubMed

    Kitahara, Yosuke; Ohta, Keisuke; Hasuo, Hiroshi; Shuto, Takahide; Kuroiwa, Mahomi; Sotogaku, Naoki; Togo, Akinobu; Nakamura, Kei-ichiro; Nishi, Akinori

    2016-01-01

    A selective serotonin reuptake inhibitor is the most commonly prescribed antidepressant for the treatment of major depression. However, the mechanisms underlying the actions of selective serotonin reuptake inhibitors are not fully understood. In the dentate gyrus, chronic fluoxetine treatment induces increased excitability of mature granule cells (GCs) as well as neurogenesis. The major input to the dentate gyrus is the perforant path axons (boutons) from the entorhinal cortex (layer II). Through voltage-sensitive dye imaging, we found that the excitatory neurotransmission of the perforant path synapse onto the GCs in the middle molecular layer of the mouse dentate gyrus (perforant path-GC synapse) is enhanced after chronic fluoxetine treatment (15 mg/kg/day, 14 days). Therefore, we further examined whether chronic fluoxetine treatment affects the morphology of the perforant path-GC synapse, using FIB/SEM (focused ion beam/scanning electron microscopy). A three-dimensional reconstruction of dendritic spines revealed the appearance of extremely large-sized spines after chronic fluoxetine treatment. The large-sized spines had a postsynaptic density with a large volume. However, chronic fluoxetine treatment did not affect spine density. The presynaptic boutons that were in contact with the large-sized spines were large in volume, and the volumes of the mitochondria and synaptic vesicles inside the boutons were correlated with the size of the boutons. Thus, the large-sized perforant path-GC synapse induced by chronic fluoxetine treatment contains synaptic components that correlate with the synapse size and that may be involved in enhanced glutamatergic neurotransmission.

  14. Chronic Fluoxetine Induces the Enlargement of Perforant Path-Granule Cell Synapses in the Mouse Dentate Gyrus

    PubMed Central

    Kitahara, Yosuke; Ohta, Keisuke; Hasuo, Hiroshi; Shuto, Takahide; Kuroiwa, Mahomi; Sotogaku, Naoki; Togo, Akinobu; Nakamura, Kei-ichiro; Nishi, Akinori

    2016-01-01

    A selective serotonin reuptake inhibitor is the most commonly prescribed antidepressant for the treatment of major depression. However, the mechanisms underlying the actions of selective serotonin reuptake inhibitors are not fully understood. In the dentate gyrus, chronic fluoxetine treatment induces increased excitability of mature granule cells (GCs) as well as neurogenesis. The major input to the dentate gyrus is the perforant path axons (boutons) from the entorhinal cortex (layer II). Through voltage-sensitive dye imaging, we found that the excitatory neurotransmission of the perforant path synapse onto the GCs in the middle molecular layer of the mouse dentate gyrus (perforant path-GC synapse) is enhanced after chronic fluoxetine treatment (15 mg/kg/day, 14 days). Therefore, we further examined whether chronic fluoxetine treatment affects the morphology of the perforant path-GC synapse, using FIB/SEM (focused ion beam/scanning electron microscopy). A three-dimensional reconstruction of dendritic spines revealed the appearance of extremely large-sized spines after chronic fluoxetine treatment. The large-sized spines had a postsynaptic density with a large volume. However, chronic fluoxetine treatment did not affect spine density. The presynaptic boutons that were in contact with the large-sized spines were large in volume, and the volumes of the mitochondria and synaptic vesicles inside the boutons were correlated with the size of the boutons. Thus, the large-sized perforant path-GC synapse induced by chronic fluoxetine treatment contains synaptic components that correlate with the synapse size and that may be involved in enhanced glutamatergic neurotransmission. PMID:26788851

  15. Short- and long-term plasticity of the perforant path synapse in hippocampal area CA3.

    PubMed

    McMahon, David B T; Barrionuevo, German

    2002-07-01

    The direct perforant path (PP) projection to CA3 is a major source of cortical input to the hippocampal region, yet relatively little is known about the basic properties of physiology and plasticity in this pathway. We tested whether PP long-term potentiation (LTP) in CA3 possesses the Hebbian property of associativity; i.e., whether the firing of fibers of different orders can induce PP LTP. We stimulated PP with weak trains of high-frequency stimulation (HFS), which by itself was below the threshold for LTP induction. The identical HFS was effective in inducing LTP when the mossy fiber pathway (MF) was activated simultaneously, thus demonstrating associative plasticity between the two pathways. We also demonstrated associative LTP between PP and recurrent collateral fibers (RC). PP LTP was blocked by the N-methyl-D-aspartate receptor (NMDAR) antagonist 2-amino-5-phosphonovaleric acid in both the associative and homosynaptic induction conditions. Neither MF nor RC fiber HFS alone resulted in permanent changes in PP field excitatory postsynaptic potential (fEPSP) amplitude. However, HFS delivered to either MF or RC alone led to transient heterosynaptic depression of the PP fEPSP. Our results support the conceptual framework that regards CA3 as an autoassociative memory network in which efficient retrieval of previously stored activity patterns is mediated by associative plasticity of the PP synapse.

  16. Coincidence detection of convergent perforant path and mossy fibre inputs by CA3 interneurons

    PubMed Central

    Calixto, Eduardo; Galván, Emilio J; Card, J Patrick; Barrionuevo, Germán

    2008-01-01

    We performed whole-cell recordings from CA3 s. radiatum (R) and s. lacunosum-moleculare (L-M) interneurons in hippocampal slices to examine the temporal aspects of summation of converging perforant path (PP) and mossy fibre (MF) inputs. PP EPSPs were evoked from the s. lacunosum-moleculare in area CA1. MF EPSPs were evoked from the medial extent of the suprapyramidal blade of the dentate gyrus. Summation was strongly supralinear when examining PP EPSP with MF EPSP in a heterosynaptic pair at the 10 ms ISI, and linear to sublinear at longer ISIs. This pattern of nonlinearities suggests that R and L-M interneurons act as coincidence detectors for input from PP and MF. Summation at all ISIs was linear in voltage clamp mode demonstrating that nonlinearities were generated by postsynaptic voltage-dependent conductances. Supralinearity was not detected when the first EPSP in the pair was replaced by a simulated EPSP injected into the soma, suggesting that the conductances underlying the EPSP boosting were located in distal dendrites. Supralinearity was selectively eliminated with either Ni2+ (30 μm), mibefradil (10 μm) or nimodipine (15 μm), but was unaffected by QX-314. This pharmacological profile indicates that supralinearity is due to recruitment of dendritic T-type Ca2+channels by the first subthreshold EPSP in the pair. Results with the hyperpolarization-activated (Ih) channel blocker ZD 7288 (50 μm) revealed that Ih restricted the time course of supralinearity for coincidently summed EPSPs, and promoted linear to sublinear summation for asynchronous EPSPs. We conclude that coincidence detection results from the counterbalanced activation of T-type Ca2+ channels and inactivation of Ih. PMID:18388134

  17. Coincidence detection of convergent perforant path and mossy fibre inputs by CA3 interneurons.

    PubMed

    Calixto, Eduardo; Galván, Emilio J; Card, J Patrick; Barrionuevo, Germán

    2008-06-01

    We performed whole-cell recordings from CA3 s. radiatum (R) and s. lacunosum-moleculare (L-M) interneurons in hippocampal slices to examine the temporal aspects of summation of converging perforant path (PP) and mossy fibre (MF) inputs. PP EPSPs were evoked from the s. lacunosum-moleculare in area CA1. MF EPSPs were evoked from the medial extent of the suprapyramidal blade of the dentate gyrus. Summation was strongly supralinear when examining PP EPSP with MF EPSP in a heterosynaptic pair at the 10 ms ISI, and linear to sublinear at longer ISIs. This pattern of nonlinearities suggests that R and L-M interneurons act as coincidence detectors for input from PP and MF. Summation at all ISIs was linear in voltage clamp mode demonstrating that nonlinearities were generated by postsynaptic voltage-dependent conductances. Supralinearity was not detected when the first EPSP in the pair was replaced by a simulated EPSP injected into the soma, suggesting that the conductances underlying the EPSP boosting were located in distal dendrites. Supralinearity was selectively eliminated with either Ni2+ (30 microm), mibefradil (10 microm) or nimodipine (15 microm), but was unaffected by QX-314. This pharmacological profile indicates that supralinearity is due to recruitment of dendritic T-type Ca2+channels by the first subthreshold EPSP in the pair. Results with the hyperpolarization-activated (Ih) channel blocker ZD 7288 (50 microm) revealed that Ih restricted the time course of supralinearity for coincidently summed EPSPs, and promoted linear to sublinear summation for asynchronous EPSPs. We conclude that coincidence detection results from the counterbalanced activation of T-type Ca2+ channels and inactivation of Ih.

  18. Plasticity of NMDA receptor-mediated excitatory postsynaptic currents at perforant path inputs to dendrite-targeting interneurons.

    PubMed

    Harney, Sarah C; Anwyl, Roger

    2012-08-15

    Synaptic plasticity of NMDA receptors (NMDARs) has been recently described in a number of brain regions and we have previously characterised LTP and LTD of glutamatergic NMDA receptor-mediated EPSCs (NMDAR-EPSCs) in granule cells of dentate gyrus. The functional significance of NMDAR plasticity at perforant path synapses on hippocampal network activity depends on whether this is a common feature of perforant path synapses on all postsynaptic target cells or if this plasticity occurs only at synapses on principal cells. We recorded NMDAR-EPSCs at medial perforant path synapses on interneurons in dentate gyrus which had significantly slower decay kinetics compared to those recorded in granule cells. NMDAR pharmacology in interneurons was consistent with expression of both GluN2B- and GluN2D-containing receptors. In contrast to previously described high frequency stimulation-induced bidirectional plasticity of NMDAR-EPSCs in granule cells, only LTD of NMDAR-EPSCs was induced in interneurons in our standard experimental conditions. In interneurons, LTD of NMDAR-EPSCs was associated with a loss of sensitivity to a GluN2D-selective antagonist and was inhibited by the actin stabilising agent, jasplakinolide. While LTP of NMDAR-EPSCs can be readily induced in granule cells, this form of plasticity was only observed in interneurons when extracellular calcium was increased above physiological concentrations during HFS or when PKC was directly activated by phorbol ester, suggesting that opposing forms of plasticity at inputs to interneurons and principal cells may act to regulate granule cell dendritic integration and processing.

  19. Comparison of the short- and long-lasting effects of perforant path kindling on radial maze learning.

    PubMed

    Robinson, G B; McNeill, H A; Reed, G D

    1993-12-01

    The present experiment compared the long-lasting with the short-lasting effects of kindling the perforant path input to the hippocampal formation on the acquisition of two radial maze tasks. Animals in the long-term group were fully kindled (i.e., Stage 5 motor seizures were evoked) prior to a stimulation-free training period. Animals in the short-term group were kindled 30-45 min prior to each learning trial. A third group of animals served as controls and were never kindled. On both 8-arm and 4/8-arm radical maze tasks, learning impairments were apparent only in the short-term group. Thus, the impaired learning is more likely related to the short-term aftereffects of an afterdischarge than to any long-term alterations in the neuronal status of the brain caused by kindling.

  20. Ectopic abdominal pregnancy due to uterine perforation after an attempt to terminate pregnancy: a case presentation.

    PubMed

    Hernández Núñez, Jónathan; Abreu Díaz, Alexander; Michael Ndwambi, Ndivhuwo; Martínez, Fermín Luis

    2017-07-17

    Secondary abdominal ectopic pregnancy is rare in clinical practice, but may lead to an increased maternal mortality. We present the case of a patient with an abdominal pregnancy secondary to a uterine perforation caused by a voluntary attempt to interrupt pregnancy that presented with nine weeks of abdominal pain and minimal vaginal bleeding which was mistakenly diagnosed as acute pelvic inflammatory disease, urinary tract infection, and post-abortion products of conception. Finally, the abdominal ultrasound test found an abdominal ectopic pregnancy. An exploratory laparotomy was performed and the fetus and placenta were removed without difficulties with a favorable postoperative course. It was concluded that uterine perforation during curettage of the cavity went unnoticed, leading to secondary abdominal implantation of pregnancy with a inconclusive clinical presentation, where ultrasound plays a fundamental diagnostic role. Laparotomy is indicated in most of these cases.

  1. A free terminal ileal perforation from active crohn disease in pregnancy: a diagnostic challenge.

    PubMed

    Philip, Sunu; Kamyab, Armin; Orfanou, Paraskevi

    2015-03-01

    The surgical management of the complications of Crohn disease is often challenging. These difficulties are compounded in pregnancy by competing interests of the mother and the baby. In this report, we describe the presentation and surgical management of a patient in her second trimester with active Crohn disease who required emergent surgical intervention. She had presented with the uncommon complication of a free perforation in the presence of active untreated disease.

  2. Effects of prenatal protein malnutrition on perforant path kindling in the rat.

    PubMed

    Bronzino, J D; Austin-LaFrance, R J; Morgane, P J

    1990-05-07

    Rats born to dams fed either a 6% (malnourished) or 25% (control) casein diet during gestation were all fostered to lactating dams on the 25% casein diet 24 h after birth and were maintained on this diet throughout life following weaning. At 90-120 days of age electrographic and behavioral responses to electrical kindling of the medial perforant pathway were investigated in animals from both the straight 25% diet (designated 25%/25% for the pre- and postnatal periods) and the dietary rehabilitated (designated 6%/25% casein diet for the pre- and postnatal periods) groups. Animals of the dietary rehabilitated group (6%/25%) were found to: (1) require a significantly lower stimulus intensity to evoke afterdischarge activity in the ipsilateral dentate gyrus; (2) progress through the various behavioral stages of kindling in a markedly different manner from the 25%/25% group, and; (3) require significantly more daily kindling stimulations to attain the full motor convulsive stage indicative of the kindled state. These results indicate that dietary protein rehabilitation at birth is incapable of reversing or significantly ameliorating the effects of gestational protein deficiency on susceptibility to seizure activity and acquisition of the kindled state. These findings indicate that gestational protein deficiency results in long-lasting, if not permanent, changes in neuronal systems in the hippocampal formation which are involved in both the electrographic and behavioral correlates of the kindling process.

  3. AN ANALYSIS OF TERMINAL FLIGHT PATH CONTROL IN CARRIER LANDING

    DTIC Science & Technology

    Fresnel lens optical landing system/(FLOLS)/pilot/aircraft system, considering deck motions and air turbulence inputs. Performance of this model in terms of terminal conditions in the vertical plane (ramp clearance, impact velocity, dispersion of the touchdown point) and aircraft longitudinal motions in the groove prior to touchdown is consistent with and validated by actual performance. The terminal dispersions are statistically combined to yield probabilities of potential ramp strikes, landing gear failures, and bolters, which, when put through a simplified pilot/LSO

  4. Martian Aerocapture Terminal Point Guidance: A Reference Path Optimization Study

    NASA Technical Reports Server (NTRS)

    Ro, Theodore U.; Queen, Eric M.; Striepe, Scott A.

    1999-01-01

    An effective method of terminal point guidance is to employ influence coefficients, which are solved from a set of differential equations adjoint to the linearized perturbations of the equations of motion about a reference trajectory. Hence, to optimize this type of guidance, one must first optimize the reference trajectory that the guidance is based upon. This study concentrates on various methods to optimize a reference trajectory for a Martian aerocapture maneuver, including a parametric analysis and first order gradient method. Resulting reference trajectories were tested in separate 2000 6-DOF Monte Carlo runs, using the Atmospheric Guidance Algorithm Testbed for the Mars Surveyor Program 2001 (MSP '01) Orbiter. These results were compared to an August 1998 study using the same terminal point control guidance algorithm and simulation testbed. Satisfactory improvements over the 1998 study are amply demonstrated.

  5. 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 ...

  6. Regulation of cerebral blood flow in the hippocampus by neuronal activation through the perforant path: relationship between hippocampal blood flow and neuronal plasticity.

    PubMed

    Hamadate, Naobumi; Yamaguchi, Taku; Sugawara, Aya; Tsujimatsu, Aki; Izumi, Takeshi; Yoshida, Takayuki; Ohmura, Yu; Yoshioka, Mitsuhiro

    2011-09-30

    Although changes in regional cerebral blood flow (rCBF) have been used as an index of neuronal activity, the effects of long-term potentiation (LTP) in the hippocampus, widely assumed to be an electrophysiological basis of learning and memory, on the changes in rCBF by neuronal activity remain unclear. Hence, to elucidate whether the effects of LTP in the hippocampus reflect in the correlation between neuronal activity and co-occurring changes in rCBF, we investigated the effects of LTP on the responses of hippocampal blood flow (HBF) to the electrical stimulation of the perforant path in vivo. We continuously measured HBF using Laser-Doppler flowmetry, and systemic blood pressure and heart rate were measured from the femoral artery during electrical stimulations in halothane-anesthetized rats. The results showed that the reactivity of HBF to neuronal activation was potentiated by a tetanic stimulation that induces LTP, although the tetanic stimulation did not affect baseline of HBF values. These results suggest that the presence of the plasticity between neuronal activity and the rCBF in the perforant path-dentate pathway, and the neuronal plasticity can be reflected in the transient changes in rCBF when the brain region is activated but not in the steady state.

  7. Phasic boosting of medial perforant path-evoked granule cell output time-locked to spontaneous dentate EEG spikes in awake rats.

    PubMed

    Bramham, C R

    1998-06-01

    Dentate spikes (DSs) are positive-going field potential transients that occur intermittently in the hilar region of the dentate gyrus during alert wakefulness and slow-wave sleep. The function of dentate spikes is unknown; they have been suggested to be triggered by perforant path input and are associated with firing of hilar interneurons and inhibition of CA3 pyramidal cells. Here we investigated the effect of DSs on medial perforant path (MPP)-granule cell-evoked transmission in freely moving rats. The MPP was stimulated selectively in the angular bundle while evoked field potentials and the EEG were recorded with a vertical multielectrode array in the dentate gyrus. DSs were identified readily on the basis of their characteristic voltage-versus-depth profile, amplitude, duration, and state dependency. Using on-line detection of the DS peak, the timing of MPP stimulation relative to single DSs was controlled. DS-triggered evoked responses were compared with conventional, manually evoked responses in still-alert wakefulness (awake immobility) and, in some cases, slow-wave sleep. Input-output curves were obtained with stimulation on the positive DS peak (0 delay) and at delays of 50, 100, and 500 ms. Stimulation on the peak DS was associated with a significant increase in the population spike amplitude, a reduction in population spike latency, and a decrease in the field excitatory postsynaptic potential (fEPSP) slope, relative to manual stimulation. Granule cell excitability was enhanced markedly during DSs, as indicated by a mean 93% increase in the population spike amplitude and a leftward shift in the fEPSP-spike relation. Maximum effects occurred at the DS peak, and lasted between 50 and 100 ms. Paired-pulse inhibition of the population spike was unaffected, indicating intact recurrent inhibition during DSs. The results demonstrate enhancement of perforant path-evoked granule cell output time-locked to DSs. DSs therefore may function to intermittently boost

  8. Effect of High-Frequency Stimulation of the Perforant Path on Previously Acquired Spatial Memory in Rats: Influence of Memory Strength and Reactivation

    PubMed Central

    Akers, Katherine G.; Hamilton, Derek A.

    2014-01-01

    If memory depends on changes in synaptic strength, then manipulation of synaptic strength after learning should alter memory for what was learned. Here, we examined whether high frequency stimulation of the perforant path in vivo disrupts memory for a previously-learned hidden platform location in the Morris water task as well as whether this effect is modulated by memory strength or memory reactivation. We found that high frequency stimulation affected probe test performance regardless of memory strength or state of memory activation, although the precise nature of this effect differed depending on whether rats received minimal or extensive training prior to high frequency stimulation. These findings suggest that artificial manipulation of synaptic strength between the entorhinal cortex and hippocampus may destabilize memory for a previously-learned spatial location. PMID:24971994

  9. 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.

  10. Dopamine D1 and D5 Receptors Modulate Spike Timing-Dependent Plasticity at Medial Perforant Path to Dentate Granule Cell Synapses

    PubMed Central

    Yang, Kechun

    2014-01-01

    Although evidence suggests that DA modulates hippocampal function, the mechanisms underlying that dopaminergic modulation are largely unknown. Using perforated-patch electrophysiological techniques to maintain the intracellular milieu, we investigated how the activation of D1-type DA receptors regulates spike timing-dependent plasticity (STDP) of the medial perforant path (mPP) synapse onto dentate granule cells. When D1-type receptors were inhibited, a relatively mild STDP protocol induced LTP only within a very narrow timing window between presynaptic stimulation and postsynaptic response. The stimulus protocol produced timing-dependent LTP (tLTP) only when the presynaptic stimulation was followed 30 ms later by depolarization-induced postsynaptic action potentials. That is, the time between presynaptic stimulation and postsynaptic response was 30 ms (Δt = +30 ms). When D1-type receptors were activated, however, the same mild STDP protocol induced tLTP over a much broader timing window: tLTP was induced when −30 ms ≤ Δt ≤ +30 ms. The result indicated that D1-type receptor activation enabled synaptic potentiation even when postsynaptic activity preceded presynaptic stimulation within this Δt range. Results with null mice lacking the Kv4.2 potassium channel and with the potassium channel inhibitor, 4-aminopyridine, suggested that D1-type receptors enhanced tLTP induction by suppressing the transient IA-type K+ current. Results obtained with antagonists and DA receptor knock-out mice indicated that endogenous activity of both D1 and D5 receptors modulated plasticity in the mPP. The DA D5 receptors appeared particularly important in regulating plasticity of the mPP onto the dentate granule cells. PMID:25429131

  11. Pharmacological antagonism of the actions of group II and III mGluR agonists in the lateral perforant path of rat hippocampal slices.

    PubMed Central

    Bushell, T. J.; Jane, D. E.; Tse, H. W.; Watkins, J. C.; Garthwaite, J.; Collingridge, G. L.

    1996-01-01

    1. An understanding of the physiological and pathological roles of metabotropic glutamate receptors (mGluRs) is currently hampered by the lack of selective antagonists. Standard extracellular recording techniques were used to investigate the activity of recently reported mGluR antagonists on agonist-induced depressions of synaptic transmission in the lateral perforant path of hippocampal slices obtained from 12-16 day-old rats. 2. The group III specific mGluR agonist, (S)-2-amino-4-phosphonobutanoate (L-AP4) depressed basal synaptic transmission in a reversible and dose-dependent manner. The mean (+/-s.e. mean) depression obtained with 100 microM L-AP4 (the maximum concentration tested) was 74 +/- 3% and the IC50 value was 3 +/- 1 microM (n = 5). 3. The selective group II mGluR agonists, (1S,3S)-1-aminocyclopentane-1, 3-dicarboxylate ((1S,3s)-ACPD) and (2S, 1'R, 2'R, 3'R)-2-(2',3'-dicarboxycyclopropyl)glycine (DCG-IV) also depressed basal synaptic transmission in a reversible and dose-dependent manner. The mean depression obtained with 200 microM (1S,3S)-ACPD was 83 +/- 8% and the IC50 value was 12 +/- 3 microM (n = 5). The mean depression obtained with 1 microM DCG-IV was 73 +/- 7% and the IC50 value was 88 +/- 15 nM (n = 4). 4. Synaptic depressions induced by the actions of 20 microM (1S,3S)-ACPD and 10 microM L-AP4 were antagonized by the mGluR antagonists (+)-alpha-methyl-4-carboxyphenylglycine ((+)-MCPG), (S)-2-methyl-2-amino-4-phosphonobutanoate (MAP4), (2S,1'S,2'S)-2-methyl-2(2'-carboxycyclopropyl)glycine (MCCG), (RS)-alpha-methyl-4-tetrazolylphenylglycine (MTPG), (RS)-alpha-methyl-4-sulphonophenylglycine (MSPG) and (RS)-alpha-methyl-4-phosphonophenylglycine (MPPG) (all tested at 500 microM). 5. (+)-MCPG was a weak antagonist of both L-AP4 and (1S,3S)-ACPD-induced depressions. MCCG was selective towards (1S,3S)-ACPD, but analysis of its effects were complicated by apparent partial agonist activity. MAP4 showed good selectivity for L-AP4-induced effects. 6

  12. Pharmacological antagonism of the actions of group II and III mGluR agonists in the lateral perforant path of rat hippocampal slices.

    PubMed

    Bushell, T J; Jane, D E; Tse, H W; Watkins, J C; Garthwaite, J; Collingridge, G L

    1996-04-01

    1. An understanding of the physiological and pathological roles of metabotropic glutamate receptors (mGluRs) is currently hampered by the lack of selective antagonists. Standard extracellular recording techniques were used to investigate the activity of recently reported mGluR antagonists on agonist-induced depressions of synaptic transmission in the lateral perforant path of hippocampal slices obtained from 12-16 day-old rats. 2. The group III specific mGluR agonist, (S)-2-amino-4-phosphonobutanoate (L-AP4) depressed basal synaptic transmission in a reversible and dose-dependent manner. The mean (+/-s.e. mean) depression obtained with 100 microM L-AP4 (the maximum concentration tested) was 74 +/- 3% and the IC50 value was 3 +/- 1 microM (n = 5). 3. The selective group II mGluR agonists, (1S,3S)-1-aminocyclopentane-1, 3-dicarboxylate ((1S,3s)-ACPD) and (2S, 1'R, 2'R, 3'R)-2-(2',3'-dicarboxycyclopropyl)glycine (DCG-IV) also depressed basal synaptic transmission in a reversible and dose-dependent manner. The mean depression obtained with 200 microM (1S,3S)-ACPD was 83 +/- 8% and the IC50 value was 12 +/- 3 microM (n = 5). The mean depression obtained with 1 microM DCG-IV was 73 +/- 7% and the IC50 value was 88 +/- 15 nM (n = 4). 4. Synaptic depressions induced by the actions of 20 microM (1S,3S)-ACPD and 10 microM L-AP4 were antagonized by the mGluR antagonists (+)-alpha-methyl-4-carboxyphenylglycine ((+)-MCPG), (S)-2-methyl-2-amino-4-phosphonobutanoate (MAP4), (2S,1'S,2'S)-2-methyl-2(2'-carboxycyclopropyl)glycine (MCCG), (RS)-alpha-methyl-4-tetrazolylphenylglycine (MTPG), (RS)-alpha-methyl-4-sulphonophenylglycine (MSPG) and (RS)-alpha-methyl-4-phosphonophenylglycine (MPPG) (all tested at 500 microM). 5. (+)-MCPG was a weak antagonist of both L-AP4 and (1S,3S)-ACPD-induced depressions. MCCG was selective towards (1S,3S)-ACPD, but analysis of its effects were complicated by apparent partial agonist activity. MAP4 showed good selectivity for L-AP4-induced effects. 6

  13. Disruption of the direct perforant path input to the CA1 subregion of the dorsal hippocampus interferes with spatial working memory and novelty detection.

    PubMed

    Vago, David R; Kesner, Raymond P

    2008-06-03

    Subregional analyses of the hippocampus suggest CA1-dependent memory processes rely heavily upon interactions between the CA1 subregion and entorhinal cortex. There is evidence that the direct perforant path (pp) projection to CA1 is selectively modulated by dopamine while having little to no effect on the Schaffer collateral (SC) projection to CA1. The current study takes advantage of this pharmacological dissociation to demonstrate that local infusion of the non-selective dopamine agonist, apomorphine (10, 15 microg), into the CA1 subregion of awake animals produces impairments in working memory at intermediate (5 min), but not short-term (10 s) delays within a delayed non-match-to-place task on a radial arm maze. Sustained impairments were also found in a novel context with similar object-space relationships. Infusion of apomorphine into CA1 is also shown here to produce deficits in spatial, but not non-spatial novelty detection within an object exploration paradigm. In contrast, apomorphine produces no behavioral deficits when infused into the CA3 subregion or overlying cortex. These behavioral studies are supported by previous electrophysiological data that demonstrate local infusion of the same doses of apomorphine significantly modifies evoked responses in the distal dendrites of CA1 following angular bundle stimulation, but produces no significant effects in the proximal dendritic layer following stimulation of the SC. These results support a modulatory role for dopamine in EC-CA1, but not CA3-CA1 circuitry, and suggest the possibility of a fundamental role for EC-CA1 synaptic transmission in terms of detection of spatial novelty, and intermediate-term, but not short-term spatial working memory or object-novelty detection.

  14. The role of the direct perforant path input to the CA1 subregion of the dorsal hippocampus in memory retention and retrieval.

    PubMed

    Vago, David R; Bevan, Adam; Kesner, Raymond P

    2007-01-01

    Subregional analyses of the hippocampus have suggested a selective role for the CA1 subregion in intermediate/long-term spatial memory and consolidation, but not short-term acquisition or encoding processes. It remains unclear how the direct cortical projection to CA1 via the perforant path (pp) contributes to these CA1-dependent processes. It has been suggested that dopamine selectively modulates the pp projection to CA1 while having little to no effect on the Schaffer collateral (SC) projection to CA1. This series of behavioral and electrophysiological experiments takes advantage of this pharmacological dissociation to demonstrate that the direct pp inputs to CA1 are critical in CA1-dependent intermediate-term retention and retrieval function. Here we demonstrate that local infusion of the nonselective dopamine agonist, apomorphine (10, 15 microg), into the CA1 subregion of awake animals produces impairments in between-day retention and retrieval, sparing within-day encoding of a modified Hebb-Williams maze and contextual conditioning of fear. In contrast, apomorphine produces no deficits when infused into the CA3 subregion. To complement the behavioral analyses, electrophysiological data was collected. In anesthetized animals, local infusion of the same doses of apomorphine significantly modifies evoked responses in the distal dendrites of CA1 following angular bundle stimulation, but produces no significant effects in the more proximal dendritic layer following stimulation of the SC. These results support a modulatory role for dopamine in the EC-CA1, but not CA3-CA1 circuitry, and suggest the possibility of a more fundamental role for EC-CA1 synaptic transmission in terms of intermediate-term, but not short-term spatial memory.

  15. 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 ...

  16. [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.

  17. Application of modern control theory to scheduling and path-stretching maneuvers of aircraft in the near terminal area

    NASA Technical Reports Server (NTRS)

    Athans, M.

    1974-01-01

    A design concept of the dynamic control of aircraft in the near terminal area is discussed. An arbitrary set of nominal air routes, with possible multiple merging points, all leading to a single runway, is considered. The system allows for the automated determination of acceleration/deceleration of aircraft along the nominal air routes, as well as for the automated determination of path-stretching delay maneuvers. In addition to normal operating conditions, the system accommodates: (1) variable commanded separations over the outer marker to allow for takeoffs and between successive landings and (2) emergency conditions under which aircraft in distress have priority. The system design is based on a combination of three distinct optimal control problems involving a standard linear-quadratic problem, a parameter optimization problem, and a minimum-time rendezvous problem.

  18. 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.

  19. 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.

  20. 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.

  1. Mifepristone (RU486) inhibits lateral perforant path long-term potentiation in hippocampal slices from prenatally morphine-exposed female rats.

    PubMed

    Velísek, Libor; Vathy, Ilona

    2005-11-01

    In brain slices from prenatally saline-exposed female rats during proestrus and diestrus, long-term potentiation (LTP) can be induced in the lateral perforant pathway (LPP). Prenatal morphine exposure suppresses LTP induction in the LPP during proestrus. Here we studied synaptic plasticity in the LPP in slices from female rats prenatally exposed to morphine. Two additional factors were investigated: the role of the estrous cycle and role of glucocorticoid receptors. Hippocampal slices were prepared from adult, prenatally saline- or morphine-exposed female rats. One hour prior to decapitation, vaginal smears were obtained and the rats either in proestrus or diestrus were treated with a non-specific glucocorticoid receptor antagonist mifepristone (RU486) or with a vehicle. LPP was stimulated with high-frequency stimulation. Short-tem plasticity (STP) and the induction and maintenance of long-term potentiation (LTP) were assessed. In all groups of prenatally saline-exposed rats, LTP was induced and maintained with the exception of RU486-treated rats during proestrus where the LTP was induced but not maintained. In prenatally morphine-exposed females in diestrus, both STP and LTP were induced after postnatal vehicle treatment. In morphine-exposed, proestrous females, neither STP nor LTP were induced irrespective of the postnatal treatment. Thus, prenatal morphine exposure suppresses the induction of LTP in the LPP, except during diestrus. Data indicate that the induction and maintenance of LTP in the LPP in hippocampal slices from female rats is multifactorial: ovarian steroids and functionality of glucocorticoid receptors cooperation are necessary for induction and maintenance of the LTP, prenatal morphine exposure interferes with this process possibly by its long-term effects on synaptic plasticity.

  2. Terminal area automatic navigation, guidance, and control research using the Microwave Landing System (MLS). Part 4: Transition path reconstruction along a straight line path containing a glideslope change waypoint

    NASA Technical Reports Server (NTRS)

    Pines, S.

    1982-01-01

    The necessary algorithms to reconstruct the glideslope change waypoint along a straight line in the event the aircraft encounters a valid MLS update and transition in the terminal approach area are presented. Results of a simulation of the Langley B737 aircraft utilizing these algorithms are presented. The method is shown to reconstruct the necessary flight path during MLS transition resulting in zero cross track error, zero track angle error, and zero altitude error, thus requiring minimal aircraft response.

  3. Increased long-term potentiation at medial-perforant path-dentate granule cell synapses induced by selective inhibition of histone deacetylase 3 requires Fragile X mental retardation protein.

    PubMed

    Franklin, Aimee V; Rusche, James R; McMahon, Lori L

    2014-10-01

    Non-selective inhibition of histone deacetylases (HDACs), enzymes that remove acetyl groups from histone core proteins, enhances cognition and NMDAR-dependent long-term potentiation at hippocampal CA3-CA1 synapses. It is not known whether this is a general mechanism by which HDACs modulate plasticity at other hippocampal synapses. Furthermore, it has yet to be tested whether HDAC inhibition can reverse deficits in synaptic plasticity in disease models. Here, we investigated whether inhibition of HDACs, and specifically HDAC3, a class I HDAC isoform known to negatively regulate hippocampus-dependent learning and memory, enhances LTP at medial perforant path-dentate granule cell (MPP-DGC) synapses in wild-type and Fragile X (Fmr1-/y) mice, a model with known LTP deficits at this synapse. The non-selective HDAC inhibitor trichostatin A (TSA) significantly increased the magnitude of LTP at MPP-DGC synapses in wild-type mice, similar to reports at CA3-CA1 synapses. The enhancement of LTP was mimicked by selective HDAC3 inhibition, implicating a role for this isoform in the negative regulation of synaptic plasticity. However, HDAC3 inhibition was completely ineffective in reversing the deficit in LTP at MPP-DGC synapses in slices from Fmr1-/y mice, and in fact, HDAC3 inhibition was unable to induce any improvement whatsoever. These findings indicate that the enhancing effect of HDAC3 inhibition on LTP in wild-type mice requires FMRP, revealing a novel role for FMRP in hippocampal plasticity.

  4. Hippocampal long-term potentiation that is elicited by perforant path stimulation or that occurs in conjunction with spatial learning is tightly controlled by beta-adrenoreceptors and the locus coeruleus.

    PubMed

    Hansen, Niels; Manahan-Vaughan, Denise

    2015-11-01

    The noradrenergic system, driven by locus coeruleus (LC) activation, plays a key role in the regulating and directing of changes in hippocampal synaptic efficacy. The LC releases noradrenaline in response to novel experience and LC activation leads to an enhancement of hippocampus-based learning, and facilitates synaptic plasticity in the form of long-term depression (LTD) and long-term potentiation (LTP) that occur in association with spatial learning. The predominant receptor for mediating these effects is the β-adrenoreceptor. Interestingly, the dependency of synaptic plasticity on this receptor is different in the hippocampal subfields whereby in the CA1 in vivo, LTP, but not LTD requires β-adrenoreceptor activation, whereas in the mossy fiber synapse LTP and LTD do not depend on this receptor. By contrast, synaptic plasticity that is facilitated by spatial learning is highly dependent on β-adrenoreceptor activation in both hippocampal subfields. Here, we explored whether LTP induced by perforant-path (pp) stimulation in vivo or that is facilitated by spatial learning depends on β-adrenoreceptors. We found that under both LTP conditions, antagonising the receptors disabled the persistence of LTP. β-adrenoreceptor-antagonism also prevented spatial learning. Strikingly, activation of the LC before high-frequency stimulation (HFS) of the pp prevented short-term potentiation but not LTP, and LC stimulation after pp-HFS-induced depotentiation of LTP. This depotentiation was prevented by β-adrenoreceptor-antagonism. These data suggest that β-adrenoreceptor-activation, resulting from noradrenaline release from the LC during enhanced arousal and learning, comprises a mechanism whereby the duration and degree of LTP is regulated and fine tuned. This may serve to optimize the creation of a spatial memory engram by means of LTP and LTD. This process can be expected to support the special role of the dentate gyrus as a crucial subregional locus for detecting and

  5. Speed and path control for conflict-free flight in high air traffic demand in terminal airspace

    NASA Astrophysics Data System (ADS)

    Rezaei, Ali

    To accommodate the growing air traffic demand, flights will need to be planned and navigated with a much higher level of precision than today's aircraft flight path. The Next Generation Air Transportation System (NextGen) stands to benefit significantly in safety and efficiency from such movement of aircraft along precisely defined paths. Air Traffic Operations (ATO) relying on such precision--the Precision Air Traffic Operations or PATO--are the foundation of high throughput capacity envisioned for the future airports. In PATO, the preferred method is to manage the air traffic by assigning a speed profile to each aircraft in a given fleet in a given airspace (in practice known as (speed control). In this research, an algorithm has been developed, set in the context of a Hybrid Control System (HCS) model, that determines whether a speed control solution exists for a given fleet of aircraft in a given airspace and if so, computes this solution as a collective speed profile that assures separation if executed without deviation. Uncertainties such as weather are not considered but the algorithm can be modified to include uncertainties. The algorithm first computes all feasible sequences (i.e., all sequences that allow the given fleet of aircraft to reach destinations without violating the FAA's separation requirement) by looking at all pairs of aircraft. Then, the most likely sequence is determined and the speed control solution is constructed by a backward trajectory generation, starting with the aircraft last out and proceeds to the first out. This computation can be done for different sequences in parallel which helps to reduce the computation time. If such a solution does not exist, then the algorithm calculates a minimal path modification (known as path control) that will allow separation-compliance speed control. We will also prove that the algorithm will modify the path without creating a new separation violation. The new path will be generated by adding new

  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. 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.

  8. 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

  9. 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.

  10. 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.

  11. 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.

  12. 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.

  13. 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.

  14. 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

  15. 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

  16. 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.

  17. 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.

  18. 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

  19. 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

  20. 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.

  1. Rat Endovascular Perforation Model

    PubMed Central

    Sehba, Fatima A.

    2014-01-01

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

  2. 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.

  3. 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

  4. 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.

  5. 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

  6. 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

  7. 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

  8. 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.

  9. [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.

  10. Bilateral superior epigastric pedicle perforator flaps for total chest wall coverage.

    PubMed

    Oni, Georgette; Sharma, Rohit; Rao, Roshni; Unger, Jacob; Saint-Cyr, Michel

    2011-08-01

    The superior epigastric artery (SEA), a terminal branch of the internal mammary artery, is analogous to the deep inferior epigastric artery (DIEA) in that it supplies a large number of perforators that are clustered together. This allows tissue from the superior abdomen to be used as a pedicled flap for reconstruction. A reliable and well-perfused pedicled flap can be based on this cluster of perforators, hence the term 'pedicle cluster perforator flap'. We present a case of a patient with recurrent angiosarcoma, who required total anterior chest wall reconstruction. This was achieved using bilateral pedicled SEA perforator flaps for complete coverage. To our knowledge, this is the first documented case of bilateral pedicled perforator flap reconstruction for complete chest wall reconstruction. Published by Elsevier Ltd.

  11. 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.

  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. Cause rare d'une perforation de la cloison nasale

    PubMed Central

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

    2014-01-01

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

  15. Path Finder

    SciTech Connect

    Rigdon, J. Brian; Smith, Marcus Daniel; Mulder, Samuel A

    2014-01-07

    PathFinder is a graph search program, traversing a directed cyclic graph to find pathways between labeled nodes. Searches for paths through ordered sequences of labels are termed signatures. Determining the presence of signatures within one or more graphs is the primary function of Path Finder. Path Finder can work in either batch mode or interactively with an analyst. Results are limited to Path Finder whether or not a given signature is present in the graph(s).

  16. 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.

  17. 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

  18. 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.

  19. [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.

  20. 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

  1. 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.

  2. 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.

  3. Microsurgical confirmation of perforating arteries arising from the fundus of a posterior communicating artery aneurysm.

    PubMed

    Reynolds, Matthew R; Roland, Jarod L; Kamath, Ashwin A; Cross, DeWitte T; Dacey, Ralph G

    2015-07-01

    Perforating arteries rarely project from the fundus of an aneurysm. We present the case of a 35-year-old woman who was found to have a right posterior communicating artery (PCOM) aneurysm via catheter angiography. Superselective microcatheter angiography revealed that perforating arteries arose from the aneurysm fundus that supplied the anterolateral thalamus. Microsurgical exploration confirmed several small perforating arteries arising from the aneurysm dome as well as an atretic distal PCOM artery. Given the complex anatomy, the lesion was unsuitable for clipping. We propose that this aneurysm represents a developmental variant whereby the proximal PCOM artery becomes atretic and terminates in PCOM perforators. The video can be found here: http://youtu.be/iDcp9fsDjq4.

  4. 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

  5. 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.

  6. 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.

  7. 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.

  8. 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.

  9. 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.

  10. 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.

  11. 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.

  12. 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

  13. [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.

  14. 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.

  15. 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.

  16. 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

  17. Path ANalysis

    SciTech Connect

    Snell, Mark K.

    2007-07-14

    The PANL software determines path through an Adversary Sequence Diagram (ASD) with minimum Probability of Interruption, P(I), given the ASD information and data about site detection, delay, and response force times. To accomplish this, the software generates each path through the ASD, then applies the Estimate of Adversary Sequence Interruption (EASI) methodology for calculating P(I) to each path, and keeps track of the path with the lowest P(I). Primary use is for training purposes during courses on physical security design. During such courses PANL will be used to demonstrate to students how more complex software codes are used by the US Department of Energy to determine the most-vulnerable paths and, where security needs improvement, how such codes can help determine physical security upgrades.

  18. 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.

  19. 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

  20. 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.

  1. 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.

  2. 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

  3. Path Pascal

    NASA Technical Reports Server (NTRS)

    Campbell, R. H.; Kolstad, R. B.; Holle, D. F.; Miller, T. J.; Krause, P.; Horton, K.; Macke, T.

    1983-01-01

    Path Pascal is high-level experimental programming language based on PASCAL, which incorporates extensions for systems and real-time programming. Pascal is extended to treat real-time concurrent systems.

  4. Path Pascal

    NASA Technical Reports Server (NTRS)

    Campbell, R. H.; Kolstad, R. B.; Holle, D. F.; Miller, T. J.; Krause, P.; Horton, K.; Macke, T.

    1983-01-01

    Path Pascal is high-level experimental programming language based on PASCAL, which incorporates extensions for systems and real-time programming. Pascal is extended to treat real-time concurrent systems.

  5. 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

  6. 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.

  7. 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.

  8. 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.

  9. 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.

  10. Terminal field and firing selectivity of cholecystokinin-expressing interneurons in the hippocampal CA3 area.

    PubMed

    Lasztóczi, Bálint; Tukker, John J; Somogyi, Peter; Klausberger, Thomas

    2011-12-07

    Hippocampal oscillations reflect coordinated neuronal activity on many timescales. Distinct types of GABAergic interneuron participate in the coordination of pyramidal cells over different oscillatory cycle phases. In the CA3 area, which generates sharp waves and gamma oscillations, the contribution of identified GABAergic neurons remains to be defined. We have examined the firing of a family of cholecystokinin-expressing interneurons during network oscillations in urethane-anesthetized rats and compared them with firing of CA3 pyramidal cells. The position of the terminals of individual visualized interneurons was highly diverse, selective, and often spatially coaligned with either the entorhinal or the associational inputs to area CA3. The spike timing in relation to theta and gamma oscillations and sharp waves was correlated with the innervated pyramidal cell domain. Basket and dendritic-layer-innervating interneurons receive entorhinal and associational inputs and preferentially fire on the ascending theta phase, when pyramidal cell assemblies emerge. Perforant-path-associated cells, driven by recurrent collaterals of pyramidal cells fire on theta troughs, when established pyramidal cell assemblies are most active. In the CA3 area, slow and fast gamma oscillations occurred on opposite theta oscillation phases. Perforant-path-associated and some COUP-TFII-positive interneurons are strongly coupled to both fast and slow gamma oscillations, but basket and dendritic-layer-innervating cells are weakly coupled to fast gamma oscillations only. During sharp waves, different interneuron types are activated, inhibited, or remain unaffected. We suggest that specialization in pyramidal cell domain and glutamatergic input-specific operations, reflected in the position of GABAergic terminals, is the evolutionary drive underlying the diversity of cholecystokinin-expressing interneurons.

  11. Terminal Field and Firing Selectivity of Cholecystokinin-Expressing Interneurons in the Hippocampal CA3 Area

    PubMed Central

    Lasztóczi, Bálint; Tukker, John J.; Somogyi, Peter; Klausberger, Thomas

    2015-01-01

    Hippocampal oscillations reflect coordinated neuronal activity on many timescales. Distinct types of GABAergic interneuron participate in the coordination of pyramidal cells over different oscillatory cycle phases. In the CA3 area, which generates sharp waves and gamma oscillations, the contribution of identified GABAergic neurons remains to be defined. We have examined the firing of a family of cholecystokinin-expressing interneurons during network oscillations in urethane-anesthetized rats and compared them with firing of CA3 pyramidal cells. The position of the terminals of individual visualized interneurons was highly diverse, selective, and often spatially coaligned with either the entorhinal or the associational inputs to area CA3. The spike timing in relation to theta and gamma oscillations and sharp waves was correlated with the innervated pyramidal cell domain. Basket and dendritic-layer-innervating interneurons receive entorhinal and associational inputs and preferentially fire on the ascending theta phase, when pyramidal cell assemblies emerge. Perforant-path-associated cells, driven by recurrent collaterals of pyramidal cells fire on theta troughs, when established pyramidal cell assemblies are most active. In the CA3 area, slow and fast gamma oscillations occurred on opposite theta oscillation phases. Perforant-path-associated and some COUP-TFII-positive interneurons are strongly coupled to both fast and slow gamma oscillations, but basket and dendritic-layer-innervating cells are weakly coupled to fast gamma oscillations only. During sharp waves, different interneuron types are activated, inhibited, or remain unaffected. We suggest that specialization in pyramidal cell domain and glutamatergic input-specific operations, reflected in the position of GABAergic terminals, is the evolutionary drive underlying the diversity of cholecystokinin-expressing interneurons. PMID:22159120

  12. [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.

  13. 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.

  14. 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.

  15. [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.

  16. [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.

  17. 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.

  18. 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

  19. 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

  20. 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

  1. 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.

  2. 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.

  3. 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.

  4. 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.

  5. Pseudo-random tool paths for CNC sub-aperture polishing and other applications.

    PubMed

    Dunn, Christina R; Walker, David D

    2008-11-10

    In this paper we first contrast classical and CNC polishing techniques in regard to the repetitiveness of the machine motions. We then present a pseudo-random tool path for use with CNC sub-aperture polishing techniques and report polishing results from equivalent random and raster tool-paths. The random tool-path used - the unicursal random tool-path - employs a random seed to generate a pattern which never crosses itself. Because of this property, this tool-path is directly compatible with dwell time maps for corrective polishing. The tool-path can be used to polish any continuous area of any boundary shape, including surfaces with interior perforations.

  6. 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

  7. 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.

  8. 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.

  9. 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.

  10. 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.

  11. 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.

  12. 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

  13. Termination Documentation

    ERIC Educational Resources Information Center

    Duncan, Mike; Hill, Jillian

    2014-01-01

    In this study, we examined 11 workplaces to determine how they handle termination documentation, an empirically unexplored area in technical communication and rhetoric. We found that the use of termination documentation is context dependent while following a basic pattern of infraction, investigation, intervention, and termination. Furthermore,…

  14. Termination Documentation

    ERIC Educational Resources Information Center

    Duncan, Mike; Hill, Jillian

    2014-01-01

    In this study, we examined 11 workplaces to determine how they handle termination documentation, an empirically unexplored area in technical communication and rhetoric. We found that the use of termination documentation is context dependent while following a basic pattern of infraction, investigation, intervention, and termination. Furthermore,…

  15. Radar modeling of space diversity associated with slant path rain attenuation at variable path angles, frequencies, and drop size distributions

    NASA Technical Reports Server (NTRS)

    Goldhirsh, J.

    1983-01-01

    Single and joint terminal slant path attenuation statistics at frequencies of 28.56 and 19.04 GHz were derived from radar data. Statistics were independently obtained for path angles of 20, 45, and 90 deg, in order to examine how path angle influences both single terminal and joint probability distributions. A prediction technique is demonstrated to work well for calculating both single and joint terminal distributions at other path angles. Diversity gains and autocorrelation function dependence on site spacing were determined employing the radar modeling results.

  16. 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.

  17. 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.

  18. 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

  19. Perforator pedicled propeller flaps for soft tissue coverage of lower leg and foot defects.

    PubMed

    Dong, Kai-xuan; Xu, Yong-qing; Fan, Xin-yu; Xu, Long-jiang; Su, Xi-xiong; Long, Hai; Xu, Li-qi; He, Xiao-qing

    2014-02-01

    To investigate the efficiency of perforator pedicled propeller flaps for soft tissue coverage of lower leg and foot defects. Twenty patients (12 male, 8 females; mean age 28 years, range, 5-75) with soft tissue defects of the lower leg and foot were retrospectively reviewed. Their defects had been repaired with perforator pedicled propeller flaps from September 2011 to October 2013 and included five cases of injuries caused by spokes, four of infection with postoperative skin necrosis, two of dorsal skin defects caused by heavy objects and nine caused by car accidents. The areas of soft tissue defect were from 2 cm × 8 cm to 10 cm × 20 cm. Fifteen cases had terminal branch of the peroneal artery perforator flaps and five posterior tibia artery perforator flaps, flap size ranging from 5 cm × 11 cm to 12 cm × 28 cm. Color Doppler ultrasound was used to locate all perforator vessels, the calibers of which ranged from 0.8 mm to 1.0 mm. The intraoperative coincidence rate of the color Doppler ultrasound was 96.7%. The donor sites were sutured directly in 12 cases and skin grafted in 8. One case had a venous crisis within 24 h that was treated by removal some sutures and drainage. All cases were followed up for 1-18 months; all flaps survived well and pedicles had a satisfactory appearance. The patients were extremely satisfied with the results for repair. Perforator pedicled propeller flaps have the advantages over other pedicle flap of being simple, safe, and effective and not involving vascular anastomosis. © 2014 Chinese Orthopaedic Association and Wiley Publishing Asia Pty Ltd.

  20. Shock wave strength reduction by passive control using perforated plates

    NASA Astrophysics Data System (ADS)

    Doerffer, Piotr; Szulc, Oskar

    2007-05-01

    Strong, normal shock wave, terminating a local supersonic area on an airfoil, not only limits aerodynamic performance but also becomes a source of a high-speed impulsive helicopter noise. The application of a passive control system (a cavity covered by a perforated plate) on a rotor blade should reduce the noise created by a moving shock. This article covers the numerical implementation of the Bohning/Doerffer transpiration law into the SPARC code and includes an extended validation against the experimental data for relatively simple geometries of transonic nozzles. It is a first step towards a full simulation of a helicopter rotor equipped with a noise reducing passive control device in hover and in forward flight conditions.

  1. 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

  2. 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

  3. 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.

  4. 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.

  5. 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.

  6. Completion and production results from alternate-path gravel-packed wells

    SciTech Connect

    Bryant, D.W.; Jones, L.G.

    1995-09-01

    A successful gravel pack requires two things: perforations packed with gravel-pack sand and a completely packed annulus. Failure to obtain either one can result in low productivity and/or a sand-producing gravel pack. Alternate-path gravel packing ensures that the annulus will be completely packed and that all perforations taking fluid will be packed with gravel-pack sand. Altercate-path gravel packing has provided long and highly productive completions without any sand production. This paper presents completion data and production results from 39 wells completed with the alternate-path gravel-pack technique. The completion data include completion length, net perforations, carrier fluid, sand placement outside casing, workover fluid, and return rate during packaging. Production results include qualitative discussion of all completions with quantitative results, including permeability-thickness product and skin on select completions.

  7. All-Optical Monitoring Path Computation Using Lower Bounds of Required Number of Paths

    NASA Astrophysics Data System (ADS)

    Ogino, Nagao; Nakamura, Hajime

    To reduce the cost of fault management in all-optical networks, it is a promising approach to detect the degradation of optical signal quality solely at the terminal points of all-optical monitoring paths. The all-optical monitoring paths must be routed so that all single-link failures can be localized using route information of monitoring paths where signal quality degradation is detected. However, route computation for the all-optical monitoring paths that satisfy the above condition is time consuming. This paper proposes a procedure for deriving the lower bounds of the required number of monitoring paths to localize all single-link failures, and proposes an efficient monitoring path computation method based on the derived lower bounds. The proposed method repeats the route computation for the monitoring paths until feasible routes can be found, while the assumed number of monitoring paths increases, starting from the lower bounds. With the proposed method, the minimum number of monitoring paths with the overall shortest routes can be obtained quickly by solving several small-scale integer linear programming problems when the possible terminal nodes of monitoring paths are arbitrarily given. Thus, the proposed method can minimize the required number of monitors for detecting the degradation of signal quality and the total overhead traffic volume transferred through the monitoring paths.

  8. 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.

  9. 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.

  10. 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.

  11. [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.

  12. 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.

  13. 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

  14. 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.

  15. 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.

  16. 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.

  17. "Death by a thread"--peritonitis due to visceral perforation by a guide wire, during proximal femur osteosynthesis with DHS: a fatal case and legal implications.

    PubMed

    Durão, Carlos; Barros, André; Guerreiro, Rui; Pedrosa, Frederico

    2015-04-01

    Iatrogenic intestinal perforations in orthopaedic surgery are very rare. Reports of iatrogenic lesions caused by a guide wire during femur fracture osteosynthesis are even scarcer. There are no similar reports in recent literature. As opposed to what is normally described the lesion documented in this case report was not identified on time resulting in death by peritonitis. The forensic autopsy allowed the identification of an intestinal perforation with faecal leakage to peritoneal space in association with a vesical perforation enabling the reproduction of the guide wire path. In view of the increasing number of osteosynthesis it is essential for the surgeon to be aware of possible complications due to guide wire perforations. Cases like this go unnoticed if the forensic pathologist is not familiarized with the surgical technique which may explain the rarity of such descriptions in literature.

  18. 757 Path Loss Measurements

    NASA Technical Reports Server (NTRS)

    Horton, Kent; Huffman, Mitch; Eppic, Brian; White, Harrison

    2005-01-01

    Path Loss Measurements were obtained on three (3) GPS equipped 757 aircraft. Systems measured were Marker Beacon, LOC, VOR, VHF (3), Glide Slope, ATC (2), DME (2), TCAS, and GPS. This data will provide the basis for assessing the EMI (Electromagnetic Interference) safety margins of comm/nav (communication and navigation) systems to portable electronic device emissions. These Portable Electronic Devices (PEDs) include all devices operated in or around the aircraft by crews, passengers, servicing personnel, as well as the general public in the airport terminals. EMI assessment capability is an important step in determining if one system-wide PED EMI policy is appropriate. This data may also be used comparatively with theoretical analysis and computer modeling data sponsored by NASA Langley Research Center and others.

  19. 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.

  20. 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.

  1. 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

  2. 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.

  3. 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.

  4. 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.

  5. 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

  6. 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

  7. 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

  8. 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.

  9. 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.

  10. 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.

  11. Perforation of woven fabric by spherical projectiles

    SciTech Connect

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

    1995-12-31

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

  12. 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.

  13. 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.

  14. [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.

  15. 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.

  16. Acute Physiological and Chronic Health Evaluation II Score and its Correlation with Three Surgical Strategies for Management of Ileal Perforations

    PubMed Central

    Munghate, Anand; Kumar, Ashwani; Mittal, Sushil; Singh, Harnam; Sharma, Jyoti; Yadav, Manish

    2015-01-01

    Introduction: Ileal perforation peritonitis is a common surgical emergency in the Indian subcontinent and in tropical countries. It is reported to constitute the fifth common cause of abdominal emergencies due to high incidence of enteric fever and tuberculosis in these management based on Acute Physiological and Chronic Health Evaluation II (APACHE II) score. Methods: The following study was conducted in the Department of General Surgery, Government Medical College, Patiala. A total of 57 patients were studied and divided in to Group I, II, and III. APACHE II score accessed and score between 10 and 19 were blindly randomized into three procedures primary closure, resection-anastomosis, and ileostomy. The outcome was compared. Results: Ileal perforations were most commonly observed in the third and fourth decade of life with male dominance. APACHE II score was accessed and out of total 57 patients, 6 patients had APACHE II score of 0–9, 48 patients had APACHE II score of 10–19, and 3 patients had APACHE II score of ≥20. In APACHE II score 10–19, 15 patients underwent primary closure, 16 patients underwent resection-anastomosis, and 17 patients underwent ileostomy. Discussion and Conclusion: Primary closure of perforation is advocated in patients with single, small perforation (<1 cm) with APACHE II score 10–19 irrespective of duration of perforation. Ileostomy is advocated in APACHE II score 10–19, where the terminal ileum is grossly inflamed with multiple perforations, large perforations (>1 cm), fecal peritonitis, matted bowel loops, intraoperative evidence of caseating lymph nodes, strictures, and an unhealthy gut due to edema. PMID:27512550

  17. 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

  18. [Complex vacuum therapy of an abdominal abscess from gastric perforation : case report of innovative operative endoscopic management].

    PubMed

    Loske, G; Lang, U; Schorsch, T; Müller, C T

    2015-05-01

    The simultaneous use of abdominal and endoscopic vacuum therapy in a case of an abdominal abscess caused by gastric perforation is demonstrated and innovative operative endoscopic management is described. A computed tomography scan performed on a 67-year-old female patient showed a large abscess of the upper abdominal cavity where laparoscopic fundoplication had been performed 6 months previously. Endoscopy showed a transmural perforation of the dorsal wall of the stomach. The gastric perforation was closed and drained using intracavitary endoscopic vacuum therapy. Open pore polyurethane foam drainage was inserted through the defect into the extraluminal cavity for 3 days. A second period of therapy followed using intraluminal therapy with total drainage of the stomach, simultaneous enteral nutrition via a jejunal tube and a vacuum pressure of - 125 mmHg was applied with an electronic vacuum device. The abdominal abscess was drained via laparotomy and intra-abdominal vacuum therapy was performed with an open pore double-layered film using a vacuum pressure of - 75 mmHg. The perforation defect was not treated by operative means. Abdominal vacuum therapy ended 3 days postoperatively and the abdominal wall was closed by suture. Endoscopic vacuum therapy of the gastric perforation was terminated after 7 days and primary wound healing could then be achieved. Use of endoscopic and abdominal vacuum therapy as well as new open pore material is an innovative option for operative management.

  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. Bank Terminals

    NASA Technical Reports Server (NTRS)

    1978-01-01

    In the photo, employees of the UAB Bank, Knoxville, Tennessee, are using Teller Transaction Terminals manufactured by SCI Systems, Inc., Huntsville, Alabama, an electronics firm which has worked on a number of space projects under contract with NASA. The terminals are part of an advanced, computerized financial transaction system that offers high efficiency in bank operations. The key to the system's efficiency is a "multiplexing" technique developed for NASA's Space Shuttle. Multiplexing is simultaneous transmission of large amounts of data over a single transmission link at very high rates of speed. In the banking application, a small multiplex "data bus" interconnects all the terminals and a central computer which stores information on clients' accounts. The data bus replaces the maze-of wiring that would be needed to connect each terminal separately and it affords greater speed in recording transactions. The SCI system offers banks real-time data management through constant updating of the central computer. For example, a check is immediately cancelled at the teller's terminal and the computer is simultaneously advised of the transaction; under other methods, the check would be cancelled and the transaction recorded at the close of business. Teller checkout at the end of the day, conventionally a time-consuming matter of processing paper, can be accomplished in minutes by calling up a summary of the day's transactions. SCI manufactures other types of terminals for use in the system, such as an administrative terminal that provides an immediate printout of a client's account, and another for printing and recording savings account deposits and withdrawals. SCI systems have been installed in several banks in Tennessee, Arizona, and Oregon and additional installations are scheduled this year.

  2. 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.

  3. Amebic perforation of small bowel: an unexpected localization of a fatal complication.

    PubMed

    Ozer, Mehmet; Ergul, Emre; Donmez, Cem; Sisman, Ibrahim Cagatay; Ulger, Burak Veli; Kusdemir, Ahmet

    2009-01-01

    The intestinal protozoan parasite E. histolytica is the causative organism responsible for human amebiasis and amebic dysentery. Although it is primarily an infection of the colon, it may also be spread by hematogenous path to other organs, especially the liver. In general, the clinical spectrum of colorectal amebiasis ranges from the state of asymptomatic carrier to severe fulminant necrotizing colitis with bleeding and perforation. Here we present an extremely rare case of necrotizing amebiasis of small bowel with a fatal outcome (Fig. 1, Ref. 4). Full Text (Free, PDF) www.bmj.sk.

  4. 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.

  5. 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.

  6. 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.

  7. 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

  8. 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.

  9. 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.

  10. 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.

  11. 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.

  12. 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.

  13. 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.

  14. 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.

  15. 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

  16. 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.

  17. 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

  18. 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.

  19. 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.

  20. 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.

  1. 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.

  2. 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

  3. 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.

  4. 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

  5. Numerical simulation of airflow patterns in nose models with differently localized septal perforations.

    PubMed

    Lindemann, Joerg; Rettinger, Gerhard; Kröger, Ralf; Sommer, Fabian

    2013-09-01

    The most typical complaints of patients with nasal septal perforation (SP) are nasal obstruction, crusting, and recurrent epistaxis depending on the size and site of the SP mainly due to disturbed airflow patterns. The objective of the study was to determine the influence of differently localized SPs on intranasal airflow patterns during inspiration by means of numerical simulation. An experimental setup using three dimensional computer models of a human nose was created. Four different models with three differently localized septal perforation allowed an examination of intranasal airflow changes. Four high-resolution, realistic, bilateral computer models of the human nose with three differently localized SPs were reconstructed based on computed tomography. A numerical simulation was performed. The intranasal airflow patterns (path lines, velocity, turbulent kinetic energy) during inspiration were displayed, analyzed, and compared. SPs cause a highly disturbed airflow in the area of the SP and behind. A spacious vortex within the perforation, including various localized vortices, was detected. The airflow in the nose was disturbed to varying degrees depending on the location of the perforation. SPs within the anterior caudal septum in area II led to increased negative turbulences and crossflow. The numerical simulations demonstrate significantly disturbed intranasal airflow patterns due to SPs. This fact may contribute to crusting and nosebleed due to dehydration of the nasal mucosa. The location and size of the SP are crucial for the impact on disturbed airflow pattern and therefore the patients' complaints. Anterior caudal SPs seem to be the worst. Surgical closure of SPs or simply changes in the site and size of the SP if a complete closure is surgically impossible makes sense. Copyright © 2012 The American Laryngological, Rhinological and Otological Society, Inc.

  6. The Perforation of the Superior Vena Cava Secondary to the Left Subclavian Dialysis Catheter.

    PubMed

    Turkyilmaz, Atila; Karapolat, Sami; Kilic, Mehmet; Tekinbas, Celal

    2017-02-01

    The perforation of the superior vena cava during the placement of dialysis catheter and consequent hemothorax is a rare serious complication. Dialysis catheter was placed in the left subclavian vein in a 69-year-old male patient with chronic renal insufficiency who was hospitalized for intracerebral hematoma. During hemodialysis a day after the procedure, the patient was noted having right-sided hemothorax, causing lethargy, dyspnea, hypotension, and bradycardia. Right tube thoracostomy was performed and 1500 cc of hemorrhagic fluid was drained. Under general anesthesia, the right posterolateral thoracotomy was performed and the tip of the dialysis catheter was found in the pleural space, penetrating the anteromedial side of the superior vena cava. The perforation area was repaired by suturing with 3-0 prolene, and the dialysis catheter was removed externally. Postoperative period was uneventful, and tube thoracostomy was terminated on day 4. Establishing the diagnosis early and accurately and performing appropriate surgery would be lifesaving in superior vena cava perforation due to dialysis catheter.

  7. 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.

  8. 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

  9. 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

  10. 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.

  11. 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.

  12. 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

  13. Terminal structure

    DOEpatents

    Schmidt, Frank [Langenhagen, DE; Allais, Arnaud [Hannover, DE; Mirebeau, Pierre [Villebon sur Yvette, FR; Ganhungu, Francois [Vieux-Reng, FR; Lallouet, Nicolas [Saint Martin Boulogne, FR

    2009-10-20

    A terminal structure (2) for a superconducting cable (1) is described. It consists of a conductor (2a) and an insulator (2b) that surrounds the conductor (2a), wherein the superconducting cable (1) has a core with a superconducting conductor (5) and a layer of insulation that surrounds the conductor (5), and wherein the core is arranged in such a way that it can move longitudinally in a cryostat. The conductor (2a) of the terminal structure (2) is electrically connected with the superconducting conductor (5) or with a normal conductor (6) that is connected with the superconducting conductor (5) by means of a tubular part (7) made of an electrically conductive material, wherein the superconducting conductor (5) or the normal conductor (6) can slide in the part (7) in the direction of the superconductor.

  14. Terminal Ballistics

    DTIC Science & Technology

    1976-02-01

    ballistics doe, little to c~plaini the workings of explosike pro jectiles. The termni,iaf phase (of di esplodling tbalfftic weapon is comiposed of esents...citterior, and terminal baillistic phases, and the study of this n’!w systemn hius useful parallel% it) the proiecoile ballistic sysStem. The...charge liner collapse Vi Jet velocity V, Slug velocity W Work Wp Weight of projecti!e Z A length variable a, bi Empirical constants. (In Chap. 5, Eq

  15. Termination unit

    DOEpatents

    Traeholt, Chresten; Willen, Dag; Roden, Mark; Tolbert, Jerry C.; Lindsay, David; Fisher, Paul W.; Nielsen, Carsten Thidemann

    2016-05-03

    Cable end section comprises end-parts of N electrical phases/neutral, and a thermally-insulation envelope comprising cooling fluid. The end-parts each comprises a conductor and are arranged with phase 1 innermost, N outermost surrounded by the neutral, electrical insulation being between phases and N and neutral. The end-parts comprise contacting surfaces located sequentially along the longitudinal extension of the end-section. A termination unit has an insulating envelope connected to a cryostat, special parts at both ends comprising an adapter piece at the cable interface and a closing end-piece terminating the envelope in the end-section. The special parts houses an inlet and/or outlet for cooling fluid. The space between an inner wall of the envelope and a central opening of the cable is filled with cooling fluid. The special part at the end connecting to the cryostat houses an inlet or outlet, splitting cooling flow into cable annular flow and termination annular flow.

  16. 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.

  17. 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

  18. 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

  19. 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

  20. 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

  1. 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

  2. Bowel perforation in the newborn: diagnosis with metrizamide

    SciTech Connect

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

    1984-01-01

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

  3. 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.

  4. 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

  5. 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

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

    PubMed

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

    2016-06-01

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

  7. The absolute path command

    SciTech Connect

    Moody, A.

    2012-05-11

    The ap command traveres all symlinks in a given file, directory, or executable name to identify the final absolute path. It can print just the final path, each intermediate link along with the symlink chan, and the permissions and ownership of each directory component in the final path. It has functionality similar to "which", except that it shows the final path instead of the first path. It is also similar to "pwd", but it can provide the absolute path to a relative directory from the current working directory.

  8. 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.

  9. 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

  10. 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.

  11. 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

  12. 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.

  13. 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.

  14. 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.

  15. 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.

  16. [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.

  17. 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.

  18. [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.

  19. 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.

  20. [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.

  1. 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.

  2. 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.

  3. 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.

  4. [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.

  5. An analytic study of near terminal area optimal sequencing and flow control techniques

    NASA Technical Reports Server (NTRS)

    Park, S. K.; Straeter, T. A.; Hogge, J. E.

    1973-01-01

    Optimal flow control and sequencing of air traffic operations in the near terminal area are discussed. The near terminal area model is based on the assumptions that the aircraft enter the terminal area along precisely controlled approach paths and that the aircraft are segregated according to their near terminal area performance. Mathematical models are developed to support the optimal path generation, sequencing, and conflict resolution problems.

  6. 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.

  7. 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.

  8. 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

  9. 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.

  10. 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.

  11. 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.

  12. The Thinnest Path Problem

    DTIC Science & Technology

    2016-07-22

    single source to all other nodes in the network do not form a tree . In other words, the thinnest path to a node does not necessarily go through the...thinnest path to any of its neighbors. The loss of the tree structure is one of the main reasons that the thinnest path problem is much more complex than...path (referred to as the secluded path in [6]) and the thinnest Steiner tree in graphs. They showed that the problem in a general graph is NP-complete

  13. 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.

  14. 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).

  15. 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.

  16. 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

  17. 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.

  18. 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

  19. 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.

  20. 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.

  1. 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.

  2. 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.

  3. 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}.

  4. 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

  5. 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.

  6. 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.

  7. 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.

  8. 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

  9. [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.

  10. 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.

  11. Termination unit

    DOEpatents

    Traeholt, Chresten [Frederiksberg, DK; Willen, Dag [Klagshamn, SE; Roden, Mark [Newnan, GA; Tolbert, Jerry C [Carrollton, GA; Lindsay, David [Carrollton, GA; Fisher, Paul W [Heiskell, TN; Nielsen, Carsten Thidemann [Jaegerspris, DK

    2014-01-07

    This invention relates to a termination unit comprising an end-section of a cable. The end section of the cable defines a central longitudinal axis and comprising end-parts of N electrical phases, an end-part of a neutral conductor and a surrounding thermally insulation envelope adapted to comprising a cooling fluid. The end-parts of the N electrical phases and the end-part of the neutral conductor each comprising at least one electrical conductor and being arranged in the cable concentrically around a core former with a phase 1 located relatively innermost, and phase N relatively outermost in the cable, phase N being surrounded by the neutral conductor, electrical insulation being arrange between neighboring electrical phases and between phase N and the neutral conductor, and wherein the end-parts of the neutral conductor and the electrical phases each comprise a contacting surface electrically connected to at least one branch current lead to provide an electrical connection: The contacting surfaces each having a longitudinal extension, and being located sequentially along the longitudinal extension of the end-section of the cable. The branch current leads being individually insulated from said thermally insulation envelope by individual electrical insulators.

  12. Bowel perforation secondary to illegally induced abortion: a tertiary hospital experience in Tanzania

    PubMed Central

    2012-01-01

    Background Bowel perforation though rarely reported is a serious complication of induced abortion, which is often performed illegally by persons without any medical training in developing countries. A sudden increase in the number of patients in our centre in recent years prompted the authors to analyze this problem. The study was conducted to describe our own experiences in the surgical management of these patients. Methods This was a retrospective study involving patients who were jointly managed by the surgical and gynecological teams at Bugando Medical Centre (BMC) for bowel perforation secondary to illegally induced abortion from January 2002 to December 2011. The statistical analysis was performed using SPSS version 17.0. Results A total of 68 patients (representing 4.2% of cases) were enrolled in the study. Their ages ranged from 14 to 45 years with a median age of 21 years. Majority of patients were, secondary school students/leavers (70.6%), unmarried (88.2%), nulliparous (80.9%), unemployed (82.4%) and most of them were dependent member of the family. Previous history of contraceptive use was reported in only 14.7% of cases. The majority of patients (79.4%) had procured the abortion in the 2nd trimester. Dilatation and curettage (82.4%) was the most common reported method used in procuring abortion. The interval from termination of pregnancy to presentation in hospital ranged from 1 to 14 days (median 6 days ). The ileum (51.5%) and sigmoid colon (22.1%) was the most common portions of the bowel affected. Resection and anastomosis with uterine repair was the most common (86.8%) surgical procedure performed. Complication and mortality rates were 47.1% and 10.3% respectively. According to multivariate logistic regression analysis, gestational age at termination of pregnancy, delayed presentation, delayed surgical treatment and presence of complications were significantly associated with mortality (P<0.001). The overall median length of hospital stay (LOS

  13. 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

  14. 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

  15. The universal path integral

    NASA Astrophysics Data System (ADS)

    Lloyd, Seth; Dreyer, Olaf

    2016-02-01

    Path integrals calculate probabilities by summing over classical configurations of variables such as fields, assigning each configuration a phase equal to the action of that configuration. This paper defines a universal path integral, which sums over all computable structures. This path integral contains as sub-integrals all possible computable path integrals, including those of field theory, the standard model of elementary particles, discrete models of quantum gravity, string theory, etc. The universal path integral possesses a well-defined measure that guarantees its finiteness. The probabilities for events corresponding to sub-integrals can be calculated using the method of decoherent histories. The universal path integral supports a quantum theory of the universe in which the world that we see around us arises out of the interference between all computable structures.

  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.

  1. Esophageal laceration with intramural dissection mimics esophageal perforation.

    PubMed

    Wu, Hui-Chung; Hsia, Jiun-Yi; Hsu, Chung-Ping

    2008-10-01

    Esophageal laceration with intramural dissection is a rare type of injury but without perforation. It is difficult to differentiate from esophageal perforation at presentation time. We report the case of a 46-year-old man who was admitted to our hospital complaining of progressive chest pain, dysphagia, and odynophagia after swallowing a fish bone three days prior to admission. Esophagoscopy revealed a deep longitudinal laceration with pus discharge in the esophagus. Computed tomography of the chest revealed low posterior mediastinal abscess formation. Surgery was performed under the impression of esophageal perforation. The definite diagnosis was esophageal laceration with intramural dissection.

  2. Recurrent Pelvic Infections and Salpingitis after Perforated Appendicitis.

    PubMed

    Limberg, Jessica; Ginsburg, Howard; Lala, Shailee; Tomita, Sandra

    2015-12-01

    The effect of perforated appendicitis on the adnexa is an issue of concern and controversy. Long-term fertility studies have been conflicting. We present the case of a patient with chronic pelvic infections, salpingitis, and hydrosalpinx after perforated appendicitis. Magnetic resonance imaging was helpful in diagnosing a chronically obstructed fallopian tube, likely secondary to the dense adhesions from her previously treated perforated appendicitis. Salpingectomy relieved her symptoms of chronic pain and recurrent infections. Copyright © 2015 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. All rights reserved.

  3. [Spontaneous or idiopathic colonic perforation in the newborn (author's transl)].

    PubMed

    Chirurgischen Klinik des Kreiskrankenhauses Herford

    1977-01-01

    The present research informes about aetiology, pathology, clinic and therapy of spontaneous or idiopathic perforations of the colon in the newborn. According to our experiences it is a matter of a multifactorial proceeding like perforations in other parts of the gastrointestinal tract. The hitherto existing clinical and experimental experiences indicate that the ischemic component plays an important part in the aetiology of this disease. Only the knowledge of the polyaetiology of idiopathic perforations--which are more properly subsumed under the term necrotizing gastroenterocolitis--and an early diagnosis by a gynaecologist or a pediatrician as well as an early surgical intervention can save the lives of those newborns.

  4. Pre-expanded Intercostal Perforator Super-Thin Skin Flap.

    PubMed

    Liao, Yunjun; Luo, Yong; Lu, Feng; Hyakusoku, Hiko; Gao, Jianhua; Jiang, Ping

    2017-01-01

    This article introduces pre-expanded super-thin intercostal perforator flaps, particularly the flap that has a perforator from the first to second intercostal spaces. The key techniques, advantages and disadvantages, and complications and management of this flap are described. At present, the thinnest possible flap is achieved by thinning the pre-expanded flap that has a perforator from the first to second intercostal spaces. It is used to reconstruct large defects on the face and neck, thus restoring function and cosmetic appearance. Copyright © 2016 Elsevier Inc. All rights reserved.

  5. An unusual case of root perforation caused by surgical trephination.

    PubMed

    Kosti, E; Molyvdas, I; Lambrianidis, T

    2008-06-01

    To present the diagnosis and management of an unusual case of root perforation caused by surgical trephination. A root perforation caused by surgical trephination on a maxillary lateral incisor with diagnosis of symptomatic chronic periradicular periodontitis was managed with standard root canal preparation and filling with thermoplasticized gutta-percha. Recall radiographs up to 1 year revealed healing of the periapical lesion. *During surgical trephination, there is risk of damaging anatomical structures surrounding the tooth as well as the tooth itself. *Root perforation caused by trephination was successfully managed by standard canal preparation and filling with thermoplasticized gutta-percha.

  6. Vertical flight path steering system for aircraft

    NASA Technical Reports Server (NTRS)

    Lambregts, Antonius A. (Inventor)

    1983-01-01

    Disclosed is a vertical flight path angle steering system for aircraft, utilizing a digital flight control computer which processes pilot control inputs and aircraft response parameters into suitable elevator commands and control information for display to the pilot on a cathode ray tube. The system yields desirable airplane control handling qualities and responses as well as improvements in pilot workload and safety during airplane operation in the terminal area and under windshear conditions.

  7. Path Integrals and Hamiltonians

    NASA Astrophysics Data System (ADS)

    Baaquie, Belal E.

    2014-03-01

    1. Synopsis; Part I. Fundamental Principles: 2. The mathematical structure of quantum mechanics; 3. Operators; 4. The Feynman path integral; 5. Hamiltonian mechanics; 6. Path integral quantization; Part II. Stochastic Processes: 7. Stochastic systems; Part III. Discrete Degrees of Freedom: 8. Ising model; 9. Ising model: magnetic field; 10. Fermions; Part IV. Quadratic Path Integrals: 11. Simple harmonic oscillators; 12. Gaussian path integrals; Part V. Action with Acceleration: 13. Acceleration Lagrangian; 14. Pseudo-Hermitian Euclidean Hamiltonian; 15. Non-Hermitian Hamiltonian: Jordan blocks; 16. The quartic potential: instantons; 17. Compact degrees of freedom; Index.

  8. Pulled Motzkin paths

    NASA Astrophysics Data System (ADS)

    Janse van Rensburg, E. J.

    2010-08-01

    In this paper the models of pulled Dyck paths in Janse van Rensburg (2010 J. Phys. A: Math. Theor. 43 215001) are generalized to pulled Motzkin path models. The generating functions of pulled Motzkin paths are determined in terms of series over trinomial coefficients and the elastic response of a Motzkin path pulled at its endpoint (see Orlandini and Whittington (2004 J. Phys. A: Math. Gen. 37 5305-14)) is shown to be R(f) = 0 for forces pushing the endpoint toward the adsorbing line and R(f) = f(1 + 2cosh f))/(2sinh f) → f as f → ∞, for forces pulling the path away from the X-axis. In addition, the elastic response of a Motzkin path pulled at its midpoint is shown to be R(f) = 0 for forces pushing the midpoint toward the adsorbing line and R(f) = f(1 + 2cosh (f/2))/sinh (f/2) → 2f as f → ∞, for forces pulling the path away from the X-axis. Formal combinatorial identities arising from pulled Motzkin path models are also presented. These identities are the generalization of combinatorial identities obtained in directed paths models to their natural trinomial counterparts.

  9. Transition-path sampling of -hairpin folding

    NASA Astrophysics Data System (ADS)

    Bolhuis, Peter G.

    2003-10-01

    We examine the dynamical folding pathways of the C-terminal -hairpin of protein G-B1 in explicit solvent at room temperature by means of a transition-path sampling algorithm. In agreement with previous free-energy calculations, the resulting path ensembles reveal a folding mechanism in which the hydrophobic residues collapse first followed by backbone hydrogen-bond formation, starting with the hydrogen bonds inside the hydrophobic core. In addition, the path ensembles contain information on the folding kinetics, including solvent motion. Using the recently developed transition interface sampling technique, we calculate the rate constant for unfolding of the protein fragment and find it to be in reasonable agreement with experiments. The results support the validation of using all-atom force fields to study protein folding.

  10. Anatomical study on the "perforator-free zone": reconsidering the proximal superior cerebellar artery and basilar artery perforators.

    PubMed

    Garcia-Gonzalez, Ulises; Cavalcanti, Daniel D; Agrawal, Abhishek; Spetzler, Robert F; Preul, Mark C

    2012-03-01

    The proximal superior cerebellar artery (pSCA) is often considered a perforator-free area. Precise anatomical knowledge of this region clarifies the pathophysiology underlying posterior fossa ischemic syndromes and helps avoid treatment-related complications. To anatomically evaluate perforating branches arising from the pSCA and the upper basilar artery (BA). Forty-four SCAs from 20 cadaveric heads were examined to determine patterns of the pSCA; its morphometry for medial and lateral branches; and frequency, number, diameter, distribution, and vascular territory of perforators arising from the pSCA and rostral BA. SCA arose as a single trunk in 36 sides (90%): mean diameter at origin was 1.38 mm; mean length was 14.4 ± 7.9 mm. Ninety-nine pSCA perforator branches were present in 82% of specimens (mean, 2.3 ± 1.6; range, 0-7 perforators/side). Of these, 59% were direct, belonging to the interpeduncular group in 85% of cases; 28% were short circumflex, belonging to lateral and medial pontine group; and 13% were long circumflex, reaching the medullary perforation zone (basal cerebellar group). Median distance to the first perforator was 2.0 mm (range, 0.1-15 mm). There were 132 perforator branches in the last centimeter of the BA. The pSCA should not be regarded as a perforator-free area. Although the pSCA territories likely overlap with the posterior cerebral artery, BA, and anterior inferior cerebellar artery, the pSCA segment cannot be surgically manipulated with impunity.

  11. First laboratory perforating tests in coal show lower-than-expected penetration

    SciTech Connect

    Snider, P.M.; Walton, I.C.; Skinner, T.K.; Atwood, D.C.; Grove, B.M.; Graham, C.

    2008-06-15

    Worldwide Coal Bed Methane (CBM) resources are huge, estimated at 3,000 to 9,000 Tcf. The production rate from CBM reservoirs is low, perhaps 50-100 mcf/day. Various completion methods are being evaluated and new technologies are being developed with the aim of increasing production rates. Considering this interest and activity level, little attention has been paid to the CBM completion fundamentals. Perforating is a critical part of this process, especially considering the PRB development migration from single-coal, open-hole completions into multi-zone, cased-hole completions. This paper describes the first known laboratory-testing program to investigate shaped charge penetration in coal targets. We describe mechanical properties of the coals tested, and penetration results for different shaped charges (of different designs), shot at various stress conditions. CT scan and cutaway imaging of the perforation tunnels are also discussed. Tests were conducted under dry and saturated conditions. The preliminary experiments reported here indicate that shaped charge penetration in coal is significantly less than expected, considering the target's density and strength. The authors provide insight into what may be the reasons for these unexpected results and recommend a path forward for shaped charge testing, designs, predictive tools, and how to optimize CBM completions.

  12. Gastric perforation due to foreign body ingestion mimicking acute cholecystitis.

    PubMed

    Henneman, Daniel; Bosman, Willem-Maarten; Ritchie, Ewan D; van den Bremer, Jephta

    2015-03-04

    An 82-year-old man presented with signs and symptoms that were suggestive of acute cholecystitis. He underwent a laparoscopic cholecystectomy. During the intervention, a wooden foreign body was removed from the infiltrated omentum, probably after it had perforated the gastric antrum. The gastric perforation had led to a secondary infection of the gallbladder. The presumed gastric perforation was treated conservatively, and the patient recovered well and was discharged after 7 days. Secondary inflamed gallbladders are rare; the current case is, to the best of our knowledge, the first case reporting a secondary infection of the gallbladder due to a gastric perforation. Clinicians should be aware of possible ingestion of foreign bodies in elderly patients wearing dental prosthetic devices.

  13. Gastric perforation due to foreign body ingestion mimicking acute cholecystitis

    PubMed Central

    Henneman, Daniel; Bosman, Willem-Maarten; Ritchie, Ewan D; van den Bremer, Jephta

    2015-01-01

    An 82-year-old man presented with signs and symptoms that were suggestive of acute cholecystitis. He underwent a laparoscopic cholecystectomy. During the intervention, a wooden foreign body was removed from the infiltrated omentum, probably after it had perforated the gastric antrum. The gastric perforation had led to a secondary infection of the gallbladder. The presumed gastric perforation was treated conservatively, and the patient recovered well and was discharged after 7 days. Secondary inflamed gallbladders are rare; the current case is, to the best of our knowledge, the first case reporting a secondary infection of the gallbladder due to a gastric perforation. Clinicians should be aware of possible ingestion of foreign bodies in elderly patients wearing dental prosthetic devices. PMID:25739796

  14. Pressure radiation from a perforated duct exit region

    NASA Astrophysics Data System (ADS)

    Wang, Honglin; Vardy, Alan E.; Pokrajac, Dubravka

    2015-09-01

    The influence of a perforated extension region on pressures radiated from the end of a duct is studied numerically using CFD. Planar 2-D geometry is considered and particular attention is paid to the case of pressure disturbances radiated from railway tunnels in cut-and-cover regions. The mechanism that causes this behaviour is described and it is shown to have an important influence of the effectiveness of a perforated extension region. It is found that such regions can strongly reduce the pressures radiated from a duct outlet, but that this benefit is offset by pressures radiated directly from the holes along the perforated region itself. In the particular case of tunnel design, practical studies of wave transmission are usually based on 1-D, plane-wave, analyses. Accordingly, attention is paid to assessing the limitations of such approaches in the case of wave propagation along a perforated region.

  15. Perforation repair and one-step apexification procedures.

    PubMed

    Kratchman, Samuel I

    2004-01-01

    As with any dental treatment, procedural mishaps can occur during root canal therapy. One such occurrence is the perforation of a root or pulpal floor. After a perforation occurs, the goals are to "sterilize" (decontaminate) the site and then seal the perforation. The material most widely used in endodontics to seal perforations is mineral trioxide aggregate (MTA). MTA us extremely biocompatible, and it has been shown historically that osteoidlike material grows right into MTA. The technique of one-step apexification offers an alternative to draw-out cases with several medicament-changing appointments that often result in a failed attempt at root-end closure. With the favorable histologic response of MTA, this material is the best current choice for this procedure. Completion of these cases in an effective and efficient way allows for permanent restorations to be done in a more timely manner, prolonging the longevity of these teeth.

  16. Simple closure of a perforated duodenal diverticulum: "a case report".

    PubMed

    Yokomuro, Shigeki; Uchida, Eiji; Arima, Yasuo; Mizuguchi, Yoshiaki; Shimizu, Tetsuya; Kawahigashi, Yutaka; Kawamoto, Masao; Takahashi, Ken; Arai, Masao; Arima, Yasuo; Tajiri, Takashi

    2004-10-01

    Spontaneous perforation of a duodenal diverticulum is a rare but serious complication with significant mortality rates. Just over 100 cases have been reported in the world literature. One case of perforated duodenal diverticulum treated by simple closure is reported. An elderly female was admitted to our hospital with an acute abdomen. Computed tomography of the abdomen showed retroperitoneal air around the duodenum and right kidney. Laparotomy with a Kocher maneuver disclosed a perforated diverticulum in the second portion of the duodenum. Although diverticulectomy is the most common treatment, simple closure of the perforated duodenal diverticulum with drainage was performed to avoid injury to the distal common bile duct and ampulla of Vater, which were close to the diverticulum. The patient has fully recovered and has been asymptomatic with no signs of recurrence for 25 months.

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

    PubMed

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

    2016-09-01

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

  18. Endoscopic Management of Esophageal Perforations: Who, When, and How?

    PubMed

    Saxena, Payal; Khashab, Mouen A

    2017-03-01

    Esophageal perforations can be spontaneous or iatrogenic. Although they are a rare occurrence, they are associated with a significant morbidity and mortality. Traditionally, management of esophageal perforation consisted of surgery. However, endoscopic management is now emerging as the primary treatment modality and is less invasive and morbid than surgery. Endoscopic modalities include through-the-scope clips (TTS), over-the-scope clips (OTSC), placement of covered stents, and suturing. Suturing can be used for primary closure of the perforation as well as anchoring of stents to prevent migration. Smaller defects (<2 cm) can be closed with clips (TTS or OTSC), whereas larger defects require a stent placement or suturing to achieve closure. If the perforation is associated with a mediastinal collection, drainage is mandatory and can be done via CT-guided percutaneous drainage, surgery, or endoscopic vacuum therapy.

  19. Pulmonary Artery Perforation Repair During Thrombectomy Using Microcoil Embolization

    SciTech Connect

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

    2006-02-15

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

  20. 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.

  1. New devices and techniques for endoscopic closure of gastrointestinal perforations

    PubMed Central

    Li, Yue; Wu, Jian-Hua; Meng, Yan; Zhang, Qiang; Gong, Wei; Liu, Si-De

    2016-01-01

    Gastrointestinal perforations, which need to be managed quickly, are associated with high morbidity and mortality. Treatments used to close these perforations range from surgery to endoscopic therapy. Nowadays, with the development of new devices and techniques, endoscopic therapy is becoming more popular. However, there are different indications and clinical efficacies between different methods, because of the diverse properties of endoscopic devices and techniques. Successful management also depends on other factors, such as the precise location of the perforation, its size and the length of time between the occurrence and diagnosis. In this study, we performed a comprehensive review of various devices and introduced the different techniques that are considered effective to treat gastrointestinal perforations. In addition, we focused on the different methods used to achieve successful closure, based on the literature and our clinical experiences. PMID:27672268

  2. Leg perforator vein incompetence: functional anatomy.

    PubMed

    Delis, Konstantinos T

    2005-04-01

    To retrospectively determine the anatomic patterns of reflux of incompetent perforator veins (IPVs) at the sites of their highest prevalence in relation to the anatomic distribution of valvular incompetence in the veins of the calf and thigh, with emphasis on the deep system, across the clinical spectrum of chronic venous disease (CVD). This study was granted institutional ethics committee approval; the need for patient consent was waived. Five hundred five limbs in 359 consecutive subjects who were suspected of having CVD but did not have arterial disease, prior venous thrombosis (<1 year), venous or orthopedic surgery, or vascular malformations were clinically stratified for CVD according to the clinical, etiologic, anatomic, and pathophysiologic (CEAP) system and underwent venous hemodynamic investigation with duplex ultrasonography. One hundred thirty limbs were CEAP clinical classes C(0-1), 262 limbs were classes C(2-3), and 113 limbs were classes C(4-6). IPV reflux patterns and anatomic distribution of deep venous reflux in the lower limb were determined across the clinical classes of CVD. Statistical analysis was performed with Spearman rank correlation, chi(2), and Mann-Whitney testing. Valvular incompetence in limbs with IPVs increased with CEAP clinical class (P < .01) in femoral, popliteal, posterior tibial, peroneal, gastrocnemial, and soleal veins; reflux was distributed evenly across these veins. Of 554 IPVs found, 377 (68.0%) occurred at four sites: middle third of medial calf (n = 165 [29.8%]), lower third of medial calf (n = 85 [15.3%]), middle third of medial thigh (n = 73 [13.2%]), and middle third of posterior calf (n = 54 [9.7%]). IPVs with superficial and deep reflux in adjoining veins, as compared with IPVs with superficial reflux alone, increased as clinical class increased from C(2) to C(6) (P < .02) at all four sites of highest IPV prevalence; determined in detail, reflux patterns of IPVs were linked to CEAP clinical class (P < .05) but

  3. An unusual presentation of colon perforation following percutaneous nephrolithotomy

    PubMed Central

    Chubak, Barbara; Stern, Joshua M.

    2014-01-01

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

  4. Clinicopathological Analysis of Factors Related to Colorectal Tumor Perforation

    PubMed Central

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

    2015-01-01

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

  5. On the homogenization of semilinear elliptic operators in perforated domains

    SciTech Connect

    Matevossian, O A; Pikulin, S V

    2002-04-30

    A second-order semilinear elliptic equation whose lower term has power-like growth at infinity with respect to the unknown function is considered. It is proved that a sequence of its solutions in perforated domains converges to a solution in the non-perforated domain as the diameters of the holes converge to zero with a rate depending on the power exponent of the lower term.

  6. Jejunoileal perforation and volvulus caused by multiple magnet ingestion.

    PubMed

    Arslan, Serkan; Basuguy, Erol; Zeytun, Hikmet; Okur, Mehmet Hanifi; Aydogdu, Bahattin; Arslan, Mehmet Serif

    2015-03-01

    Foreign body ingestion is a common problem in children, but magnet ingestion is relatively rare. However, when it occurs, it tends to have a high rate of complications. This is a case report of a 3-year-old child who swallowed multiple magnetic toys, subsequently developing jejunoileal perforation and volvulus. This case report indicates that it is best to surgically remove multiple ingested magnets without delay to avoid intestinal perforation, fistula, and other complications such as volvulus.

  7. Plastic Deformation and Perforation of Metal using Metallic Jet

    NASA Astrophysics Data System (ADS)

    Sarkar, Partha; Chaturvedi, Shashank; Shyam, Anurag; Kumar, Rajesh; Lathi, Deepak; Chaudhari, Vilas; Verma, Rishi; Sonara, Jaswant; Shah, Kunal; Adhikary, Biswajit

    2002-12-01

    Pulsed underwater electrical discharges have been used in the past to generate pressures of the order of several tens of kilobars, for applications such as rock fragmentation and metallic jet production. Preliminary results for a metallic jet system have been reported earlier. A modified design for a metallic jet production system is reported here. With this arrangement, we are able to perforate 11 mm thick aluminium sheet. Such a system, at higher energy levels, could be used for oil and gas well perforation.

  8. Perforated-Layer Implementation Of Radio-Frequency Lenses

    NASA Technical Reports Server (NTRS)

    Dolgin, Benjamin P.

    1996-01-01

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

  9. 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

  10. Aging, Terminal Decline, and Terminal Drop

    ERIC Educational Resources Information Center

    Palmore, Erdman; Cleveland, William

    1976-01-01

    Data from a 20-year longitudinal study of persons over 60 were analyzed by step-wise multiple regression to test for declines in function with age, for terminal decline (linear relationship to time before death), and for terminal drop (curvilinear relationship to time before death). There were no substantial terminal drop effects. (Author)

  11. Perforator Flaps for Reconstruction of Lower Limb Defects

    PubMed Central

    Yasir, Mir; Wani, Adil Hafeez; Zargar, Haroon Rashid

    2017-01-01

    BACKGROUND Reconstruction of soft tissue defects in the lower third of the leg remains challenging. Anatomical constraints limit the local options available for complex defects especially lower third of leg. Local flaps based on perforator vessels are raising interest in reconstructive surgery of the limbs. We present our experience with perforator flaps for reconstruction of soft tissue defects in the lower limb. METHODS The study was carried prospectively and 23 patients with lower limb defects treated with various perforator flaps (both elective as well as emergency) were included in the study. A hand-held ultrasound Doppler was used preoperatively and intraoperatively to detect the perforator vessels. RESULTS Out of 23 patients, we witnessed partial flap loss in 1 and distal flap necrosis in 3 patients. Four patients had minor complications which included infection, wound dehiscence and congestion of flap. CONCLUSION Perforator flaps may represent a good alternative to the free flaps in the areas were other local reconstructive procedures are not possible. This is a versatile technique and with decreased donor site morbidity limited to a single body area. There is a specific like to like soft tissue replacement leading to a better cosmetic and reconstructive outcome. The main drawback of the perforator flaps however is the higher risk of venous congestion. PMID:28289617

  12. Percutaneous catheter drainage of abdominal abscesses associated with perforated viscus.

    PubMed

    Flancbaum, L; Nosher, J L; Brolin, R E

    1990-01-01

    Improvements in radiologic localization have made percutaneous catheter drainage (PCD) the initial procedure of choice for many intra-abdominal abscesses (IAA). During the past seven years 154 patients underwent PCD for treatment of abdominal abscesses. Fourteen of these patients had PCD as the initial treatment for IAA secondary to a perforated viscus and subsequently underwent an elective one-stage operation to treat the underlying disease. Etiologies of the abscesses included perforated appendicitis in six patients, sigmoid diverticulitis in three patients, Crohn's ileitis in two patients, and one case each of perforated gastric ulcer, perforated sigmoid carcinoma, and perforated gallbladder. Initial localization of the abscess was achieved by either CT or ultrasound. Seven abscesses were localized in the right lower quadrant, four were localized in the liver, and one was localized each in the left flank, right flank, subhepatic space, and pelvis. All patients subsequently underwent a definitive elective operation for their primary disease including six interval appendectomies, four sigmoid colectomies, two small-bowel resections, one subtotal gastrectomy and one cholecystectomy. There were no complications due to PCD and no deaths occurred. We conclude that PCD can be successfully performed as the initial treatment for IAA associated with a perforated viscus, obviating the first stage of the traditional two-stage surgical approach.

  13. Clinical experience of esophageal perforation occurring with endoscopic submucosal dissection.

    PubMed

    Sato, H; Inoue, H; Ikeda, H; Grace R Santi, E; Yoshida, A; Onimaru, M; Kudo, S

    2014-01-01

    Esophageal perforation occurring during or after endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD) is a rare, but serious complication. However, reports of its characteristics, including endoscopic imaging and management, have not been fully detailed. To analyze and report the clinical presentation and management of esophageal perforations occurred during or after EMR/ESD. Four hundred seventy-two esophageal neoplasms in 368 patients were treated (171 EMR; ESD 306) at Northern Yokohama Hospital from 2003 to 2012. Esophageal perforation occurred in a total of seven (1.9%) patients, all of whom were male and had undergone ESD. The etiology of perforation was: three (42.9%) intraoperative; three (42.9%) balloon dilatation for stricture prevention; one (14.2%) due to food bolus impaction. All cases were managed non-operatively based on the comprehensive assessment of clinical severity, extent of the injury, and the time interval from perforation to treatment onset. Conservative management included (i) bed rest and continuous monitoring to determine the need for operative intervention; (ii) fasting and intravenous fluid infusion/ tube feeding; and (iii) intravenous antibiotics. All defects closed spontaneously, save one case where closure was achieved by endoscopic clipping. Surgery was not required. Conservative management for esophageal perforation during advanced endoscopic resection is may be possible when there is no delay in diagnosis or treatment. Decision-making should be governed purely by multidisciplinary discussion.

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

    PubMed Central

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

    2014-01-01

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

  15. A hypervelocity projectile launcher for well perforation

    SciTech Connect

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

    1989-01-01

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

  16. Therapeutic attitude in perforated stress ulcer.

    PubMed

    Balalau, C; Popa, F; Negrei, Carolina; Andreianu, P

    2011-01-01

    There are medical conditions where the etiology is not at the level of digestive system, but as a result of a distant lesion, determined by head trauma. The latter is a severe impact on the whole body, not only locally; it produces damages in the gastro-duodenal area mainly as acute stress ulcer. Our study includes 4 cases of patients with multiple trauma, admitted in the "St. Pantelimon" Emergency Hospital, where, despite medication, they subsequently developed stress ulcer (Cushing ulcer). Laboratory tests were followed in the development the level of leukocytes, ESR(erythrocyte sedimentation rate) and abdominal ultrasound. Around the fifth day it was observed that the level of the leukocytes were high (between 15000-20000/microl). ESR between 40-70mm/hour and ultrasound showed fluid in peritoneal cavity, mainly in subhepatic space (Morison's pouch). A positive radiological result highlight the crescent transparency (mesogastric pneumoperitoneum) in dorsal decubitus position, lateral incidence (pacients that could not be mobilised and the radiologic exam was made in intensive care bed). On the group of four patients studied with multiple trauma and Cushing ulcer perforation, it was laparoscopically intervined in order to reduce the negativ effects of combined anesthesic and surgical trauma on an already fragile status. The study showed that emergency laparoscopy in patients with multiple trauma is a successful approach in it's minimally invasivity, being a diagnosis and therapeutic first option in acute abdominal conditions in these patients.

  17. Perforation of jejunal diverticulum with ectopic pancreas.

    PubMed

    Shiratori, Hiroshi; Nishikawa, Takeshi; Shintani, Yukako; Murono, Koji; Sasaki, Kazuhito; Yasuda, Koji; Otani, Kensuke; Tanaka, Toshiaki; Kiyomatsu, Tomomichi; Hata, Keisuke; Kawai, Kazushige; Nozawa, Hiroaki; Ishihara, Soichiro; Fukayama, Masashi; Watanabe, Toshiaki

    2017-04-01

    Perforation of jejunal diverticulum is a rare complication. Here, we report a case of jejunal diverticulum penetration with surrounding ectopic pancreas. An 83-year-old female patient was admitted to our department with acute onset of severe abdominal pain lasting for half a day. Abdominal computed tomography showed outpouching of the small intestine that contained air/fluid, with multiple surrounding air bubbles in the mesentery of the small intestine. She was diagnosed with penetration of the small intestine, and an emergency laparotomy was indicated. The penetrated jejunal diverticulum was identified ~20-cm distal to the ligament of Treitz. Partial resection of the jejunum was performed, and her postoperative course was uneventful. The pathological findings confirmed diverticulum penetration into the mesentery and severe inflammation at the site, with surrounding ectopic pancreas. Furthermore, the pancreatic ducts were opened through the penetrated diverticulum. This rare case shows that the ectopic pancreas might have caused penetration of jejunal diverticulum owing to the pancreatic duct opening through the diverticulum.

  18. 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

  19. Simulating perforation permeability damage and cleanup

    SciTech Connect

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

    2000-12-15

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

  20. Endoluminal perforation of a magnetic antireflux device.

    PubMed

    Bauer, Margit; Meining, Alexander; Kranzfelder, Michael; Jell, Alissa; Schirren, Rebekka; Wilhelm, Dirk; Friess, Helmut; Feussner, Hubertus

    2015-12-01

    The history of surgical antireflux treatment is coined by the search for better alternatives to Nissen fundoplication. Implantable devices are one option, beginning with the "Angelchik" prosthesis 30 years ago. However, this procedure was left soon because of the high rate of foreign body connected problems (migration, perforation). A modern approach is a magnetic sphincter augmentation device (LINX Reflux Management System, Torax Medical, Shoreview, MN, USA), a magnetic chain which is implanted laparoscopically. Advantages reported are simplicity to apply and good results in reflux control, with up to now only rare complication rates as reported in the literature (Lipham et al. in Dis Esophagus, 2014). We report one case of erosion of the esophagus by a LINX system resulting in severe dysphagia. A complete endoluminal removal could be achieved by a prototype OTSC-clip remover. Complete remission could be achieved. The technique is presented in detail (video). In principle, total endoscopic removal of the LINX device is feasible in case of major erosion.

  1. Zero-Slack, Noncritical Paths

    ERIC Educational Resources Information Center

    Simons, Jacob V., Jr.

    2017-01-01

    The critical path method/program evaluation and review technique method of project scheduling is based on the importance of managing a project's critical path(s). Although a critical path is the longest path through a network, its location in large projects is facilitated by the computation of activity slack. However, logical fallacies in…

  2. High Risk of Surgical Glove Perforation From Surgical Rotatory Instruments.

    PubMed

    Goldman, Ashton H; Haug, Emanuel; Owen, John R; Wayne, Jennifer S; Golladay, Gregory J

    2016-11-01

    Surgical gloves can be damaged during the course of a procedure, which can place the surgeon and patient at risk. Glove perforation may not always be readily apparent, and determining the risk factors for glove perforation can aid the surgeon in deciding when a glove change is advisable. Time of wear and needle sticks have been well studied; however, other mechanisms including mechanical stress from surgical equipment have had limited evaluation to date. We evaluated the risk of glove perforation in gloves that were caught in a surgical rotatory device (such as drills and reamers). The aims of our study were (1) to determine the percentage of undetected microperforations after entanglement on a rotatory tool during orthopaedic procedures, (2) to determine which kinds of rotatory devices most commonly cause such microperforations, and (3) to assess whether time of wear had an effect on the risk of perforation. From July 2014 to September 2015, 33 gloves were obtained from all orthopaedic subspecialties at our Level I trauma center if they were caught in a rotatory device greater than one revolution. Time of glove wear and location of the glove that was caught in a rotatory device were recorded. After an evaluation for macroperforations (≥ 5 mm), the gloves were evaluated for microperforations (< 5 mm) via the American Society for Testing and Materials (ASTM) one-liter load test. Time of wear was compared among gloves with macroperforations, microperforations, and no perforations. The 33 gloves obtained came from 33 procedures. Seventeen of 33 (52 %) gloves had perforations. Seven of the 17 perforated gloves had macroperforations while 10 had microperforations. Eleven of 33 entanglements were caught by drills, nine by reamers, eight by K-wires, and the remaining five gloves were caught by various other instruments. Eight of 17 perforations were caused by drills, three by reamers, three by K-wires, and three by various other instruments. The average time of wear was

  3. [Identification of perforating vessels by augmented reality: Application for the deep inferior epigastric perforator flap].

    PubMed

    Bosc, R; Fitoussi, A; Pigneur, F; Tacher, V; Hersant, B; Meningaud, J-P

    2017-08-01

    The augmented reality on smart glasses allows the surgeon to visualize three-dimensional virtual objects during surgery, superimposed in real time to the anatomy of the patient. This makes it possible to preserve the vision of the surgical field and to dispose of added computerized information without the need to use a physical surgical guide or a deported screen. The three-dimensional objects that we used and visualized in augmented reality came from the reconstructions made from the CT-scans of the patients. These objects have been transferred through a dedicated application on stereoscopic smart glasses. The positioning and the stabilization of the virtual layers on the anatomy of the patients were obtained thanks to the recognition, by the glasses, of a tracker placed on the skin. We used this technology, in addition to the usual locating methods for preoperative planning and the selection of perforating vessels for 12 patients operated on a breast reconstruction, by perforating flap of deep lower epigastric artery. The "hands-free" smart glasses with two stereoscopic screens make it possible to provide the reconstructive surgeon with binocular visualization in the operative field of the vessels identified with the CT-scan. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

  4. Analyses and applications of pressure, flowrate, and temperature measurements during a perforating run

    SciTech Connect

    Tariq, S.M.; Ayestaran, L.

    1986-01-01

    Perforating technology has undergone significant advances during the last decade. Tubing conveyed perforating (TCP), underbalanced perforating, high shot density guns, better shaped charges, and improved gun systems are some of the developments that 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 during a perforating run and has the capability of selectively firing a number of guns at different depths or times. These measurements include pressure, flow rate, temperature, GR, CCL, and cable tension. The simultaneous downhole measurements, in addition to providing better control of the perforating process, can in a single trip provide a production log, conventional well tests before and after perforating, and a fill-up or slug test soon after perforating for underbalanced conditions.

  5. Two are disjoint paths in Eulerian digraphs

    SciTech Connect

    Ibaraki, Toshihide

    1994-12-31

    Let G be an Eulerian digraph, and x{sub 1}, x{sub 2}, y{sub 1}, y{sub 2} be four vertices (called terminals) in G. A polynomial time algorithm is presented to decide whether G contains two arc-disjoint x{sub i}x{sub j}- and y{sub k}y{sub l}- paths, where i, j = k, l = 1, 2 (i.e., directions of these directed paths can be chosen arbitrarily). The algorithm is based on the following characterization of minimal infeasible instances of the problem. An instance is minimal infeasible (i.e., any instance obtained by contracting an arc becomes feasible) if and only if it satisfies the following conditions. (i) G is planar, and has at most one cut vertex. (ii) All the terminals have degree 2, and all other vertices have degree 4. (iii) G has a planar representation in which every face is a directed cycle (or equivalently, the arcs indident to a vertex are alternatively oriented out and in), and all the terminals lie on the boundary of one common face in the order of x{sub 1}, y{prime}, x{sub 2}, y{double_prime}, where (y{prime}, y{double_prime}) = (y{sub 1}, y{sub 2}). This is an extension of the previously known characterization of weak 3-linkings (i.e., the case of three terminals, in which the directions of three arc disjoint paths are prespecified). if G is a general digraph, it is easily shown that the problem is NP-complete.

  6. Factors related to persisting perforations after ventilation tube insertion.

    PubMed

    O'Connell Ferster, Ashley P; Tanner, April Michelle; Karikari, Kodjo; Roberts, Christopher; Wiltz, Derek; Carr, Michele M

    2016-02-01

    Over a million ventilation tubes are placed annually in the United States, making this one of the most commonly performed procedures in the field of medicine. Certain factors increase the risk of persistent tympanic membrane perforation following the extrusion of short term ventilation tubes. Persistent perforations may fail to heal on their own, necessitating surgical closure to avoid conductive hearing loss. It is important to detect factors that may predict children who are at increased risk for persistent perforations. This study was a retrospective chart review that involved 757 patients between 2003 and 2008. The patients studied were within the age of 2 months-17 years, and all had short term tubes placed. The chart data also included demographic information, comorbidities, and information related to tube insertion and follow-up care. Chi-square, t-test, and multivariate logistic regression were conducted to compare variables between patients with perforations and those without. Data from 757 patients was analyzed, showing that perforation rate is associated with rhinorrhea, operative tube removal, aural polyps, and otorrhea (OR 1.72, 8.16, 4.69, and 1.72 respectively). The absence of otorrhea decreased the likelihood of TM perforations and no significant differences were found in gender, total number of sets of tubes, type of tube, use of nasal steroids, adenoidectomy, or nasal congestion. Our findings suggest that children with rhinorrhea, otorrhea, aural polyps, or prolonged intubation requiring operative tube removal should be identified clinically as children at risk of persisting perforation. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  7. Tympanoplasty for blast-induced perforations: the Walter Reed experience.

    PubMed

    Sridhara, Shankar K; Rivera, Arnaldo; Littlefield, Philip

    2013-01-01

    To review our tympanoplasty results for blast-induced tympanic membrane perforations and evaluate the association of various clinical factors with surgical success. Case series with chart review. Two tertiary military healthcare institutions. This is a retrospective review of all patients who had nonrevision tympanoplasty during a 1-year period for blast-induced perforations by the 2 neurotologists at Walter Reed Army Medical Center and National Naval Medical Center. Various perioperative clinical factors were analyzed for relations to successful perforation closure, the need for a second operation, and postoperative hearing. Thirty-four patients met inclusion criteria. All were male, and the average age was 24.0 years. Twenty-two (65%) were total or near-total perforations, of which 12 (35%) were repaired using lateral graft technique. The remainder had various medial graft procedures. Ossicular abnormalities were found in 6 (18%) patients. Cholesteatoma was discovered in 3 (9%) patients. Closure was complete in 82% of patients. The incomplete closures were with large perforations, those with foreign bodies (shrapnel), and in 1 with postoperative water exposure. There were no major complications, and the mean conductive hearing improvement was 11.3 dB. Blast-induced tympanic membrane perforations are common in our population of wounded warriors. These cases are challenging because most have total or near-total perforations, the ossicles can be out of place, the blast itself can implant epithelium in the middle ear, and foreign bodies can create a hostile middle ear environment. However, given attention to detail, we found that standard tympanoplasty techniques work well.

  8. Nonoperative management of esophageal perforations in the newborn.

    PubMed

    Onwuka, Ekene A; Saadai, Payam; Boomer, Laura A; Nwomeh, Benedict C

    2016-09-01

    Esophageal perforation in neonates occurs most often in cases of extreme prematurity and is commonly due to iatrogenic causes. Treatment over recent decades has become more conservative. The purpose of this study was to review cases of esophageal perforation in neonates and to describe the presentation, management, and outcomes. A retrospective chart review was performed for patients with International Classification of Diseases, Ninth Revision code for esophageal perforation treated at our institution between the years 2009 and 2015. Data collected included demographic information, etiology of perforation (specifically focusing on cases secondary to orogastric tube placement), treatment course, time to resumption of enteral feeds, length of antibiotic use, time to subsequent radiographic resolution, and mortality. Twenty-five patients met study criteria. The average post-conceptual age at time of diagnosis was 26.5 ± 2.3 wk. All 25 patients were managed nonoperatively with bowel rest, parenteral nutrition, and broad-spectrum antibiotics. Enteral feeds were resumed after a median of 8 d (interquartile range [IQR]: 7-11), the median antibiotic duration was 7 d (IQR: 7-10), and the median time to follow-up esophagram was 7 d (IQR: 7-10). Overall, 24 of 25 patients (96%) demonstrated radiological resolution of perforation on initial follow-up esophagram. Four patients died during the study period, but no deaths were related to the diagnosis of esophageal perforation. In this largest reported sample of neonates treated for esophageal perforation, nonoperative management with bowel rest, parenteral nutrition, and antibiotics was successful. Copyright © 2016 Elsevier Inc. All rights reserved.

  9. Tortuous path chemical preconcentrator

    DOEpatents

    Manginell, Ronald P.; Lewis, Patrick R.; Adkins, Douglas R.; Wheeler, David R.; Simonson, Robert J.

    2010-09-21

    A non-planar, tortuous path chemical preconcentrator has a high internal surface area having a heatable sorptive coating that can be used to selectively collect and concentrate one or more chemical species of interest from a fluid stream that can be rapidly released as a concentrated plug into an analytical or microanalytical chain for separation and detection. The non-planar chemical preconcentrator comprises a sorptive support structure having a tortuous flow path. The tortuosity provides repeated twists, turns, and bends to the flow, thereby increasing the interfacial contact between sample fluid stream and the sorptive material. The tortuous path also provides more opportunities for desorption and readsorption of volatile species. Further, the thermal efficiency of the tortuous path chemical preconcentrator is comparable or superior to the prior non-planar chemical preconcentrator. Finally, the tortuosity can be varied in different directions to optimize flow rates during the adsorption and desorption phases of operation of the preconcentrator.

  10. Paths to Remarriage.

    ERIC Educational Resources Information Center

    Spanier, Graham B.; Glick, Paul C.

    1980-01-01

    Presents a demographic analysis of the paths to remarriage--the extent and timing of remarriage, social factors associated with remarriage, and the impact of the event which preceded remarriage (divorce or widowhood). (Author)

  11. A Path to Discovery

    ERIC Educational Resources Information Center

    Stegemoller, William; Stegemoller, Rebecca

    2004-01-01

    The path taken and the turns made as a turtle traces a polygon are examined to discover an important theorem in geometry. A unique tool, the Angle Adder, is implemented in the investigation. (Contains 9 figures.)

  12. Perforator flap breast reconstruction using internal mammary perforator branches as a recipient site: an anatomical and clinical analysis.

    PubMed

    Munhoz, Alexandre Mendonça; Ishida, Luis Henrique; Montag, Eduardo; Sturtz, Gustavo P; Saito, Fábio Lopes; Rodrigues, Leandro; Gemperli, Rolf; Ferreira, Marcus Castro

    2004-07-01

    A variety of useful recipient sites exist for breast reconstruction with free flaps, and correct selection remains a significant decision for the surgeon. Among the main pedicles, the disadvantages of the internal mammary vessels are the necessity of costal cartilage resection and the impairment of future cardiac bypass. This study was designed to reduce morbidity and to seek alternative recipient vessels. In the anatomical part of the study, 32 parasternal regions from 16 fresh cadavers were used. The locations and components of internal mammary perforator branches were measured and a histomorphometric analysis was performed. In the clinical part of the study, 36 patients underwent 38 deep inferior epigastric perforator (DIEP) flap and two superior gluteal artery perforator flap breast reconstructions (31 immediate and four bilateral). The recipient vessels were evaluated. In the anatomical study, there were 22 perforating vessels, with 14 (63.6 percent) on the second intercostal space and 11 (50 percent) with one artery and vein. The average (+/-SD) internal and external perforator artery diameters were 598.48 +/- 176.68 microm and 848.97 +/- 276.68 microm, respectively. In the clinical study, 13 successful anastomoses (32.5 percent) were performed at the internal mammary perforator branches (second and third intercostal spaces) with 12 DIEP flaps and one superior gluteal artery perforator flap (all performed as immediate reconstructions). One case of intraoperative vein thrombosis and one case of pedicle avulsion during flap molding were observed. The anatomic and clinical studies demonstrated that the internal mammary perforator branch as a recipient site is a further refinement to free flap breast reconstruction. However, it is neither a reproducible technique nor potentially applicable in all patients. Preoperative planning between the general surgeon and the plastic surgeon is crucial to preserve the main perforator branches during mastectomy. The procedure

  13. The reweighted path ensemble

    NASA Astrophysics Data System (ADS)

    Rogal, Jutta; Lechner, Wolfgang; Juraszek, Jarek; Ensing, Bernd; Bolhuis, Peter G.

    2010-11-01

    We introduce a reweighting scheme for the path ensembles in the transition interface sampling framework. The reweighting allows for the analysis of free energy landscapes and committor projections in any collective variable space. We illustrate the reweighting scheme on a two dimensional potential with a nonlinear reaction coordinate and on a more realistic simulation of the Trp-cage folding process. We suggest that the reweighted path ensemble can be used to optimize possible nonlinear reaction coordinates.

  14. Jet screech reduction with perforated flat reflector

    NASA Astrophysics Data System (ADS)

    Khan, Md. Tawhidul Islam; Teramoto, Kenbu; Matsuo, Shigeru; Setoguchi, Toshiaki

    2008-09-01

    In the present experimental study, investigations have been carried out to evaluate the performance of the new control technique of jet screech with different perforated flat reflectors. Mainly two types of porous flat reflectors had been used in the experiment. One reflector (reflector-V) designed for placing the reflector surface vertical to the jet axis, when, another type of reflector (reflector-H) designed for placing the reflecting surface horizontal to the jet axis. In both cases the reflectors had been placed at the nozzle (base tube with uniform cross-sectional area) exit. The diameter of the reflector-V was 15D when the diameter of the reflector-H was 10D. The porous area of the reflector-V was 6D and 4.5D for reflector-H where D indicated the diameter of the nozzle exit. The placement of the reflector at the exit of the nozzle reduces the sound pressure at the nozzle exit. Thus the muted sound can not excite the unstable disturbance at the nozzle exit and the loop of the feedback mechanism disappeared, finally, the generation of jet screech be cancelled. The suction space located at the back side of the porous surface of the reflector-V improves the efficiency of the screech control technique. However, in the case of reflector-H, the receptivity process of feedback loop had been controlled by reducing the disturbances at the effective shock fronts as well as at the nozzle exit. The performance of the proposed method was verified with a flat reflector concept and good performance in jet screech suppression has been confirmed in the case of porous reflector.

  15. Paths to nursing leadership.

    PubMed

    Bondas, Terese

    2006-07-01

    The aim was to explore why nurses enter nursing leadership and apply for a management position in health care. The study is part of a research programme in nursing leadership and evidence-based care. Nursing has not invested enough in the development of nursing leadership for the development of patient care. There is scarce research on nurses' motives and reasons for committing themselves to a career in nursing leadership. A strategic sample of 68 Finnish nurse leaders completed a semistructured questionnaire. Analytic induction was applied in an attempt to generate a theory. A theory, Paths to Nursing Leadership, is proposed for further research. Four different paths were found according to variations between the nurse leaders' education, primary commitment and situational factors. They are called the Path of Ideals, the Path of Chance, the Career Path and the Temporary Path. Situational factors and role models of good but also bad nursing leadership besides motivational and educational factors have played a significant role when Finnish nurses have entered nursing leadership. The educational requirements for nurse leaders and recruitment to nursing management positions need serious attention in order to develop a competent nursing leadership.

  16. A Plasma Display Terminal.

    ERIC Educational Resources Information Center

    Stifle, Jack

    A graphics terminal designed for use as a remote computer input/output terminal is described. Although the terminal is intended for use in teaching applications, it has several features which make it useful in many other computer terminal applications. These features include: a 10-inch square plasma display panel, permanent storage of information…

  17. Terminals for Education.

    ERIC Educational Resources Information Center

    Bork, Alfred M.

    The effectiveness of different types of computer terminals in programing learning is discussed with special reference to the experience of the Physics Computer Development Project. Experience with ten types of terminals including hardcopy terminals of several speeds, alphanumeric and graphic terminals is reviewed. Special consideration is given to…

  18. Computational investigation of heat transfer analysis through perforated pin fins of different materials

    NASA Astrophysics Data System (ADS)

    Maji, Ambarish; Bhanja, Dipankar; Patowari, P. K.; Choubey, Gautam; Deshamukhya, Tuhin

    2017-07-01

    The present work investigates the enhancement of heat transfer rate through staggered perforated pin fins of different materials with increasing number and size of perforations. Three dimensional CFD simulations have been carried out to analyze the effects of fin number, size and materials of fin to enhance heat transfer rate against pressure loss. Results show that the heat transfer rates of perforated fins up to certain perforation number and size are always greater than the solid ones and with the change of fin material heat transfer rate also improves significantly. On the other hand pressure drop through heat sink decreases not only with increasing perforation number but also with size of perforations.

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

    SciTech Connect

    Ozkan, Ugur

    2009-09-15

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

  20. Evolution of surgical treatment of amebiasis-associated colon perforation.

    PubMed

    Athié-Gutiérrez, César; Rodea-Rosas, Heriberto; Guízar-Bermúdez, Clemente; Alcántara, Avisaí; Montalvo-Javé, Eduardo E

    2010-01-01

    Amebiasis is a worldwide health problem that mainly affects developing countries. Invasive amebiasis tends to develop complications, and among these, perforation of the colon, although infrequent (1.9-9.1%), is the most lethal. Surgical treatment in these cases should be carried out in a timely fashion prior to the presentation of systemic repercussions or death. In the present study, we analyzed a total of 122 cases of invasive amebiasis-associated colon perforation. We conducted a clinical, retrospective, and observational study and presented cases of colonic perforation observed over the past 30 years at the Medical-Surgical Emergency Service of the Mexico City-based Hospital General de México OD during the 1970-1999 period. During this time, a total of 19,916 emergency abdominal surgeries were performed. One hundred twenty-two of these procedures corresponded to cases of colon perforation by ameba, which represents 0.6%; 80 patients were men (65.6%) and 42 were women (34.4%), with an average age of 48 years. Multiple colon perforation was 74%, with right colon the most affected (90.5%). Depending on the perforation's extension and localization, right hemicolectomy with ileostomy were performed in 53 patients (43.45%), subtotal colectomy with ileostomy in 43 (35.25%), left hemicolectomy with transverse colostomy in 12 (9.83%), exteriorization of perforated left colon (stoma) in 13 (10.65%), and primary closure with exteriorization in one patient (0.8%). Post-operative complications were present in 48 patients (39.3%), and 20 cases were related with the creation of a stoma. Eighteen of these cases were due to persistent abdominal sepsis and ten due to toxic colon; the latter correspond solely to patients with initial nonresective treatment. General mortality was 40%, with 32% (17 of 53 cases) of mortality in those submitted to right hemicolestomy, 16.7% (two of 12) of left hemicolestomy, 44.2% (19 of 43) in those in whom a subtotal colectomy was performed, with

  1. Laparoscopic Peptic Ulcer Perforation Closure: the Preferred Choice.

    PubMed

    Shah, Franal H; Mehta, Sudhir G; Gandhi, Mona D; Saraj

    2015-12-01

    Peptic ulcer perforation is a common life-threatening emergency needing immediate intervention. Laparoscopic closure of perforation is now widely practiced over conventional open closure. This study aimed to compare laparoscopic peptic ulcer perforation closure with conventional open closure in terms of operative time, postoperative analgesia, complications, hospital stay, and return to routine activities. This unicentric, nonblinded, prospective, randomized study was carried out in 50 patients with peptic ulcer perforation who were randomly allocated to undergo either laparoscopic closure or open closure surgery with 25 patients in each group. The mean operative time (60 vs 90 min) was less in the laparoscopic group (p < 0.05). Postoperative analgesia requirements (1 vs 6 days) were also less in laparoscopic patients (p < 0.05). Complications (nil vs 6; p < 0.05) and hospital stay (3 vs 8 days) were less in laparoscopic patients (p < 0.05). Patients return to normal activities (5 vs 10 days; p < 0.05) earlier in laparoscopic perforation closure than in open closure. Our study has shown better outcomes and lesser morbidities with laparoscopic approach in terms of shorter operative time, shorter hospital stay, less analgesic requirements, and less wound infections. Patients also return to routine activities earlier with the laparoscopic approach. It is a safe alternative to open surgery and should be a preferred choice when there are no contraindications to laparoscopy.

  2. Successful application of atelocollagen for treatment of perforated teeth.

    PubMed

    Masuda, Katsuhiko; Nakano, Kazuhiko; Okawa, Rena; Naka, Shuhei; Matsumoto, Michiyo; Ooshima, Takashi

    2011-01-01

    Cervical or furcal root perforation is a serious clinical problem and one of its treatment modalities is perforation repair with composite resin. However, many cases still progress in inevitable extraction. When primary teeth are affected, early tooth loss can cause problems related to the eruption space for the permanent successors. The aim of the present study was to evaluate a novel clinical treatment method for perforated teeth. Atelocollagen was applied to perforated furcal and cervical areas of 13 primary teeth in 13 children aged 4-9 years and 8 permanent teeth in 8 adults aged 35-69 years after debridement with an electric knife. Thereafter the final restorations were performed after confirming good tooth conditions. Clinical evaluations were performed at follow-up examinations at approximately 3-month intervals. None of the treated primary teeth showed any clinical problems throughout the observation period, with eruption of the permanent successors noted in 7 cases. In the permanent teeth, no clinical problems were identified in any of the cases during follow-up periods of 10-60 months. This novel method may enable preservation of perforated primary teeth for a longer duration.

  3. Perforated duodenal ulcer: a rare complication of deferasirox in children.

    PubMed

    Yadav, Sunil Kumar; Gupta, Vipul; El Kohly, Ashraf; Al Fadhli, Wasmi

    2013-01-01

    Duodenal ulcer perforation in pediatric age group is an uncommon entity; hence, it is not usually considered in the differential diagnosis of acute abdomen in these patients. It is important for the emergency physician to consider perforated peptic ulcer in the differential diagnosis of children presenting with acute abdominal pain, gastrointestinal bleeding, or shock. We report a 6½-year-old male child with thalassemia major who presented to emergency room with an acute abdomen and shock, who was subsequently found to have a perforated duodenal ulcer, probably related to use of oral chelating agent, deferasirox. Although, gastrointestinal symptoms like nausea, vomiting, and abdominal pain has been mentioned as infrequent adverse event in the scientific product information of deferasirox, in our current knowledge this is the first case report of perforated duodenal ulcer after oral deferasirox. The severity of this event justifies the reporting of this case. This patient had an atypical presentation in that there were no signs or symptoms of peptic ulcer disease before perforation and shock he was successfully managed with open surgery after initial resuscitation and stabilization of his general condition.

  4. Cascaded Perforates as One-Dimensional, Bulk Absorbers

    NASA Technical Reports Server (NTRS)

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

    2006-01-01

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

  5. Diagnosing perforated appendicitis in pediatric patients: a new model.

    PubMed

    van den Bogaard, Veerle A B; Euser, Sjoerd M; van der Ploeg, Tjeerd; de Korte, Niels; Sanders, Dave G M; de Winter, Derek; Vergroesen, Diederik; van Groningen, Krijn; de Winter, Peter

    2016-03-01

    Studies have investigated sensitivity and specificity of symptoms and tests for diagnosing appendicitis in children. Less is known with regard to the predictive value of these symptoms and tests with respect to the severity of appendicitis. The aim of this study was to determine the predictive value of patient's characteristics and tests for discriminating between perforated and nonperforated appendicitis in children. Pediatric patients who underwent an appendectomy at Spaarne Hospital Hoofddorp, the Netherlands, between January 1, 2009 and December 31, 2013, were included. Baseline patient's characteristics, history, physical examination, laboratory data and results of ultrasounds were collected. Univariate and multivariate logistic regressions were used to determine predictors of perforation. In total, 375 patients were included in this study of which 97 children (25.9%) had significant signs of perforation. Univariate analysis showed that age, duration of complaints, temperature, vomiting, CRP, WBC, different findings on ultrasound and the diameter of the appendix were good predictors of a perforated appendicitis. The final multivariate prediction model included temperature, CRP, clearly visible appendix and free fluids on ultrasound and diameter of the appendix and resulted in an area under the curve (AUC) of 0.91 showing sensitivity and specificity of respectively 85.2% and 81.2%. This prediction model can be used for identification of 'high-risk' children for a perforated appendicitis and might be helpful to prevent complications and longer hospitalization by bringing these children to theater earlier. Copyright © 2016 Elsevier Inc. All rights reserved.

  6. Predictors of Morbidity and Mortality After Surgery for Intestinal Perforation

    PubMed Central

    Shin, Rumi; Lee, Sang Mok; Sohn, Beonghoon; Lee, Dong Woon; Song, Inho; Chai, Young Jun; Lee, Hae Won; Ahn, Hye Seong; Jung, In Mok; Chung, Jung Kee

    2016-01-01

    Purpose An intestinal perforation is a rare condition, but has a high mortality rate, even after immediate surgical intervention. The clinical predictors of postoperative morbidity and mortality are still not well established, so this study attempted to identify risk factors for postoperative morbidity and mortality after surgery for an intestinal perforation. Methods We retrospectively analyzed the cases of 117 patients who underwent surgery for an intestinal perforation at a single institution in Korea from November 2008 to June 2014. Factors related with postoperative mortality at 1 month and other postoperative complications were investigated. Results The mean age of enrolled patients was 66.0 ± 15.8 years and 66% of the patients were male. Fifteen patients (13%) died within 1 month after surgical treatment. Univariate analysis indicated that patient-related factors associated with mortality were low systolic and diastolic blood pressure, low serum albumin, low serum protein, low total cholesterol, and high blood urea nitrogen; the surgery-related factor associated with mortality was feculent ascites. Multivariate analysis using a logistic regression indicated that low systolic blood pressure and feculent ascites independently increased the risk for mortality; postoperative complications were more likely in both females and those with low estimated glomerular filtration rates and elevated serum C-reactive protein levels. Conclusion Various factors were associated with postoperative clinical outcomes of patients with an intestinal perforation. Morbidity and mortality following an intestinal perforation were greater in patients with unstable initial vital signs, poor nutritional status, and feculent ascites. PMID:28119865

  7. Characterizing flow through a perforation using ultrasonic Doppler

    SciTech Connect

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

    1995-12-31

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

  8. Displacements and stresses in bending of circular perforated plate

    NASA Astrophysics Data System (ADS)

    Atanasiu, C.; Sorohan, St.

    2016-08-01

    The flat plates, perforated by a large number of holes are widely used in the engineering, especially in the component of the process equipment. Strength calculations and experimental methods used in the actual literature for study perforated plates, do not present the problem in all its complexity for stress distribution and displacements. Research and doctoral theses in last decades, with methods characteristic of the respective periods were engaged either perforated plates considered infinite and requested the median plane or rarely, plate loaded normal to the median plane, with a small number of holes. In this work the stress distribution and displacement is presented for a circular plate perforated by 96 holes arranged in a grid of squares, simply supported on the outline and loaded through a central concentrated force or by uniformly distributed load. It conducted a numerical analysis by finite element method (FEM) with a proper meshing of the plate and an experimental study by holographic interferometry. Holographic interferometry method permits to measure, with high accuracy, extremely small displacements and comparing the results with those obtained by FEM becomes sustainable. Supplementary, an analysis of a non-perforated plate with the same dimensions and stiffness, similar loaded, was performed, determining the coefficient of stress concentration for a particular arrangement of holes.

  9. Incarcerated small bowel associated with elective abortion uterine perforation.

    PubMed

    Coughlin, Lisa M; Sparks, Dorothy A; Chase, Daniel M; Smith, James

    2013-03-01

    Uterine perforation is a rare but recognized complication of abortion. Perforations may not be recognized at the time of the procedure, and patients may present days or weeks later with sequelae of the complication. To raise awareness of this rare complication that can present days to weeks after the precipitating event. A 21-year-old woman presented 3 weeks after an elective abortion with symptoms of bowel obstruction. Exploratory laparotomy revealed small bowel herniation into a perforated uterus, causing the obstruction. In retrospect, a pre-operative ultrasound and computed tomography (CT) scan suggested this finding, but it went unrecognized at that time. A small bowel resection was performed and the patient made an uneventful recovery. Intrauterine bowel after abortion has been described only a handful of times in the literature. Uterine perforation during abortion is usually asymptomatic and generally can be managed conservatively, but herniation of bowel through the uterine defect can result in obstruction and strangulation. Intrauterine bowel requires prompt laparotomy and possible resection of non-viable bowel. Although ultrasound and CT scans may aid in diagnosis of this rare complication, a clinical suspicion for uterine perforation should be maintained by health care providers when treating patients who have had an abortion. Copyright © 2013 Elsevier Inc. All rights reserved.

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

    PubMed

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

    2012-10-01

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

  11. Extended locoregional use of intercostal artery perforator propeller flaps.

    PubMed

    Baghaki, Semih; Diyarbakirlioglu, Murat; Sahin, Ugur; Kucuksucu, Muge Anil; Turna, Akif; Baca, Bilgi; Aydın, Yağmur

    2017-05-01

    Besides conventional flaps, intercostal artery perforator flaps have been reported to cover trunk defects. In this report the use of anterior intercostal artery perforator (AICAP) flap, lateral intercostal artery perforator (LICAP) flap and dorsal intercostal artery perforator (DICAP) flap for thoracic, abdominal, cervical, lumbar and sacral defects with larger dimensions and extended indications beyond the reported literature were reevaluated. Thirty-nine patients underwent surgery between August 2012 and August 2014. The age of the patients ranged between 16 and 79 with a mean of 49 years. The distribution of defects were as follows; 12 thoracic, 8 parascapular, 3 cervical, 8 abdominal, 4 sacral and 4 lumbar. AICAP, LICAP and DICAP flaps were used for reconstruction. Fifty-two ICAP flaps were performed on 39 patients. Flap dimensions ranged between 6 × 9 cm and 14 × 35 cm. Twenty-six patients had single flap coverage and 13 patients had double flap coverage. Forty-six flaps have been transferred as propeller flaps and 6 flaps have been transferred as perforator plus flap. Forty flaps (75%) went through transient venous congestion. In one DICAP flap, 30% of flap was lost. No infection, hematoma or seroma were observed in any patient. Follow-up period ranged between 3 and 32 months with a mean of 9 months. The ICAP flaps provide reliable and versatile options in reconstructive surgery and can be used for challenging defects in trunk. © 2016 Wiley Periodicals, Inc.

  12. 49 CFR 1242.27 - Coal marine terminals, ore marine terminals, TOFC/COFC terminals, other marine terminals, motor...

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 49 Transportation 9 2014-10-01 2014-10-01 false Coal marine terminals, ore marine terminals, TOFC/COFC terminals, other marine terminals, motor vehicle loading and distribution facilities, and... Structures § 1242.27 Coal marine terminals, ore marine terminals, TOFC/COFC terminals, other marine terminals...

  13. 49 CFR 1242.27 - Coal marine terminals, ore marine terminals, TOFC/COFC terminals, other marine terminals, motor...

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 49 Transportation 9 2011-10-01 2011-10-01 false Coal marine terminals, ore marine terminals, TOFC/COFC terminals, other marine terminals, motor vehicle loading and distribution facilities, and... Structures § 1242.27 Coal marine terminals, ore marine terminals, TOFC/COFC terminals, other marine terminals...

  14. 49 CFR 1242.27 - Coal marine terminals, ore marine terminals, TOFC/COFC terminals, other marine terminals, motor...

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 49 Transportation 9 2013-10-01 2013-10-01 false Coal marine terminals, ore marine terminals, TOFC/COFC terminals, other marine terminals, motor vehicle loading and distribution facilities, and... Structures § 1242.27 Coal marine terminals, ore marine terminals, TOFC/COFC terminals, other marine terminals...

  15. 49 CFR 1242.27 - Coal marine terminals, ore marine terminals, TOFC/COFC terminals, other marine terminals, motor...

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 49 Transportation 9 2012-10-01 2012-10-01 false Coal marine terminals, ore marine terminals, TOFC/COFC terminals, other marine terminals, motor vehicle loading and distribution facilities, and... Structures § 1242.27 Coal marine terminals, ore marine terminals, TOFC/COFC terminals, other marine terminals...

  16. Position paper: management of perforated sigmoid diverticulitis

    PubMed Central

    2013-01-01

    Over the last three decades, emergency surgery for perforated sigmoid diverticulitis has evolved dramatically but remains controversial. Diverticulitis is categorized as uncomplicated (amenable to outpatient treatment) versus complicated (requiring hospitalization). Patients with complicated diverticulitis undergo computerized tomography (CT) scanning and the CT findings are used categorize the severity of disease. Treatment of stage I (phlegmon with or without small abscess) and stage II (phlegmon with large abscess) diverticulitis (which includes bowel rest, intravenous antibiotics and percutaneous drainage (PCD) of the larger abscesses) has not changed much over last two decades. On the other hand, treatment of stage III (purulent peritonitis) and stage IV (feculent peritonitis) diverticulitis has evolved dramatically and remains morbid. In the 1980s a two stage procedure (1st - segmental sigmoid resection with end colostomy and 2nd - colostomy closure after three to six months) was standard of care for most general surgeons. However, it was recognized that half of these patients never had their colostomy reversed and that colostomy closure was a morbid procedure. As a result starting in the 1990s colorectal surgical specialists increasing performed a one stage primary resection anastomosis (PRA) and demonstrated similar outcomes to the two stage procedure. In the mid 2000s, the colorectal surgeons promoted this as standard of care. But unfortunately despite advances in perioperative care and their excellent surgical skills, PRA for stage III/IV diverticulitis continued to have a high mortality (10-15%). The survivors require prolonged hospital stays and often do not fully recover. Recent case series indicate that a substantial portion of the patients who previously were subjected to emergency sigmoid colectomy can be successfully treated with less invasive nonoperative management with salvage PCD and/or laparoscopic lavage and drainage. These patients

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

    NASA Technical Reports Server (NTRS)

    Howerton, Brian M.; Jones, Michael G.

    2016-01-01

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

  18. [A case of jejunal perforation in gallstone ileus].

    PubMed

    Taira, Akiko; Yamada, Masami; Takehira, Yasunori; Kageyama, Fujito; Yoshii, Shigeto; Murohisa, Gou; Yoshida, Kenichi; Iwaoka, Yasushi; Terai, Tomohiro; Uotani, Takahiro; Watanabe, Shinya; Noritake, Hidenao; Ikematu, Yoshito; Kanai, Toshikazu

    2008-04-01

    Gallstone ileus is a rare but important cause of small bowel obstruction in the geriatric population. A 65-year-old man with a twenty year history of cholecystolithiasis was admitted to our hospital with abdominal pain and vomiting. Physical exams showed abdominal defence and rebound tenderness. A plain abdominal X-ray suggested a small bowel obstruction and pneumobilia. CT scan revealed a 2.5-cm gallstone at the jejunum and air in the biliary tree. The patient underwent a emergency laparotomy based on a diagnosis of panperitonitis with a perforation associated with gallstone ileus. Operative findings revealed a jejunal perforation and a impacted stone on the anal side of perforation. Enterolithotomy and jejunal resection were performed with cholecystectomy and repairment of the cholecystoduodenal fistula.

  19. [A case of perforated xanthogranulomatous cholecystitis presenting as biloma].

    PubMed

    Ahn, Yeon Jeong; Kim, Tae Hyo; Moon, Sung Won; Choi, Su Nyoung; Kim, Hyun Jin; Jung, Woon Tae; Lee, Ok Jae; Ko, Gyung Hyuck

    2011-09-25

    Xanthogranulomatous cholecystitis is an unusual inflammatory disease of the gallbladder characterized by severe proliferative fibrosis and the accumulation of lipid-laden macrophages in areas of destructive inflammation. Its macroscopic appearance may occasionally be confused with gallbladder carcinoma. We present a case of perforated xanthogranulomatous cholecystitis presenting as biloma. An 80-year-old woman was referred to our hospital with a 1-week history of abdominal pain and febrile sensation. Abdominal CT showed a biloma in the subhepatic area. The follow-up CT showed that the biloma increased in size. Therefore, ultrasonography-guided aspiration was performed. The aspirated fluid/serum bilirubin ratio was greater than 5, which was strongly suggestive of bile leakage complicated by perforated cholecystitis. She underwent a laparoscopic cholecystectomy with cyst aspiration and adhesiolysis. A histological diagnosis of perforated xanthogranulomatous cholecystitis was made.

  20. Microsporidium infection and perforation peritonitis: A rare association.

    PubMed

    Tanveer, Nadeem; Barman, Sandip

    2015-01-01

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

  1. Increased incidence of perforated appendicitis in children with obesity.

    PubMed

    Blanco, Felix C; Sandler, Anthony D; Nadler, Evan P

    2012-10-01

    Based on their clinical impression, the authors hypothesized that children with obesity may more commonly present with perforated appendicitis. Therefore, the authors reviewed their experience from 2008 to 2010 to determine whether obesity affected the clinical presentation of appendicitis. Variables studied were height, weight, use of diagnostic imaging, and clinical findings of appendicitis at presentation. Outcomes assessed were length of stay and complication rate. The study identified 319 patients with appendicitis. Children with obesity were more likely (P = .026) to present with perforation (28/62, 45%) than nonobese patients (78/257, 30%). Neither length of stay nor complication rate was affected by the presence of obesity. The data suggest that children with obesity are more likely to present with perforated appendicitis. This finding suggests that the diagnosis of appendicitis may be more difficult in obese patients or their presentation may be delayed. Practitioners should have heightened awareness in children with obesity and symptoms of abdominal pain.

  2. Inferior vena caval filter strut perforation causing intramural duodenal haematoma

    PubMed Central

    Williams, Zoheb Berry; Organ, Nicole M.; Deane, Stephen

    2016-01-01

    We present a case of intramural duodenal haematoma caused by inferior vena caval (IVC) filter strut perforation requiring innovative open and endovascular retrieval. A 32-year-old woman presents in shock with dull epigastric pain and non-bilious vomiting. She had previously had an IVC filter for deep venous thrombosis and pulmonary embolism. Computed tomography demonstrated strut perforation into the second part of the duodenum, causing intramural haematoma and duodenal obstruction. Laparotomy facilitated evacuation of the duodenal haematoma, while the IVC filter was retrieved by endovascular means. Causes of duodenal haematoma include blunt trauma, haematologic malignancy, coagulopathy, percutaneous or endoscopic procedures, pancreatic pathology, peptic ulcer disease and aortoenteric fistula. Duodenal haematoma is rare and is usually managed conservatively or by percutaneous drainage. While this patient had a typical presentation, IVC filter strut perforation has not been described in the literature as a cause for duodenal haematoma. PMID:27887016

  3. Systemic lupus erythematosus with intestinal perforation: A case report

    PubMed Central

    GU, YUQING; ZHU, TAO; WANG, YIQING; XU, HONGXING

    2015-01-01

    Systemic lupus erythematosus (SLE) is a systemic autoimmune inflammatory disease, which can affect almost all systems and organs. Gastrointestinal disorder is one of the most noteworthy complications of patients with SLE. However, gastrointestinal disorder with intestinal perforation is rare, but potentially life-threatening if not treated promptly. The present study reported a case of SLE with intestinal perforation, where surgical intervention was performed and a crevasse (~3 cm in diameter) was detected in the ileum, ~60 cm from the ileocecal valve. Following surgery, the patient suffered from difficult ventilator weaning, septic shock and intestinal obstruction. The patient was successfully treated and discharged from the hospital after ~4 months of treatment. Intestinal perforation in SLE patients is potentially life-threatening; early diagnosis and prompt treatment are crucial to the management of this rare complication of SLE. PMID:26622471

  4. 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.

  5. Perinatal risk factors in newborns with gastrointestinal perforation

    PubMed Central

    Prgomet, Sandra; Lukšić, Boris; Pogorelić, Zenon; Jurić, Ivo; Čapkun, Vesna; Arapović, Adela; Boban, Nataša

    2017-01-01

    AIM To investigate correlation of perinatal risk factors in newborns with gastrointestinal perforation (GIP). METHODS Single-center retrospective cohort study was conducted between January 1990 and December 2012. Medical records on all newborns with GIP were reviewed (n = 35). Surgical records and histopathologic examination of all perforated intestine samples were also reviewed. RESULTS The most common cause of GIP was necrotizing enterocolitis (51.4%). The most common site of perforation was large intestine. Mortality rate was 31%. Infants with GIP more frequently had very low birth weight (< 1500 g), especially birth weight below 10th percentile according to gestational age. Ponderal index was not differing between infants with GIP and control subjects. In infants with GIP anemia was more frequently found than in control group. CONCLUSION GIP in newborns is mostly disease of infants with birth weight below 10th percentile according to gestational age. GIP occurs more often in infants with anemia. PMID:28289509

  6. Selectively fired, tubing-conveyed perforating guns save rig time

    SciTech Connect

    Snider, P.M. ); Bond, P.L. )

    1993-07-19

    Selective firing of tubing-conveyed perforating (TCP) guns during drill stem tests (DSTs) added flexibility and saved costs for Marathon Oil Co. As an example, in the Garland field in Wyoming, the guns allowed perforating multiple zones in one trip. This saved 1 1/2--2 days/well in rig time and $25,000--30,000/well in electric wire line and DST tool charges. For international offshore operations, savings of $200,000/well appear possible. Savings result not only from perforating multiple zones, but also from arbitrarily setting firing patterns with or without zone isolation. The paper describes the testing of equipment, the design of the guns, firing heads, crossover assembly, pressure isolation sub, control line, and select-fire sub, and applications for the guns.

  7. Distally based perforator sural flaps for foot and ankle reconstruction

    PubMed Central

    Chang, Shi-Min; Li, Xiao-Hua; Gu, Yu-Dong

    2015-01-01

    Distally based perforator sural flaps from the posterolateral or posteromedial lower leg aspect are initially a neurofasciocutaneous flap that can be transferred reversely to the foot and ankle region with no need to harvest and sacrifice the deep major artery. These flaps are supplied by a perforating artery issued from the deep peroneal artery or the posterior tibial artery, and the chain-linked adipofascial neurovascular axis around the sural/saphenous nerve. It is a versatile and reliable technique for soft-tissue reconstruction of the heel and ankle region with 180-degrees rotation. In this paper, we present its developing history, vascular basis, surgical techniques including flap design and elevation, flap variations in pedicle and component, surgical indications, and illustrative case reports with different perforating vessels as pivot points for foot and ankle coverage. PMID:25893175

  8. Distal thoracic oesophageal perforation secondary to blunt trauma: Case report

    PubMed Central

    Strauss, Dirk C; Tandon, Ruchi; Mason, Robert C

    2007-01-01

    Background Traumatic perforation of the distal oesophagus due to blunt trauma is a very rare condition and is still associated with a significant morbidity and mortality. This is further exacerbated by delayed diagnosis and management as symptoms and signs are often masked by or ascribed to more common blunt thoracic injuries. Case report We present a case of a distal oesophageal perforation, secondary to a fall from a third storey window, which was masked by concomitant thoracic injuries and missed on both computed tomography imaging and laparotomy. The delay in his diagnosis significantly worsened the patient's recovery by allowing the development of an overwhelming chest sepsis that contributed to his death. Conclusion Early identification of an intrathoracic oesophageal perforation requires deliberate consideration and is essential to ensure a favorable outcome. Treatment should be individualised taking into account the nature of the oesophageal defect, time elapsed from injury and the patient's general condition. PMID:17374175

  9. Pedicled perforator flaps in the head and neck.

    PubMed

    Hofer, Stefan O P; Mureau, Marc A M

    2010-10-01

    Perforator flaps, since their first description in 1989, have in many ways revolutionized reconstructive surgery. Whereas little more than a decade ago many surgeons were still hesitant to fully trust perforator flaps to be a reliable option, nowadays these flaps are often first choice. Investigators have to remain critical, however, of their advances and realize that not every reconstruction will require or benefit from a perforator flap, as previously well-established, nonperforator flaps still have their indication and can give excellent results. The most important skill in reconstructive surgery of the head and neck is not cutting the flap but assessing the defect, planning the reconstruction, and choosing wisely from the ever-increasing options available.

  10. Perforated jejunal diverticulum: a rare case of acute abdomen

    PubMed Central

    Sehgal, Rishabh; Cheung, Cherry X.; Hills, Tristram; Waris, Aqueel; Healy, Donagh; Khan, Tahir

    2016-01-01

    Jejunal pseudo-diverticulosis is a rare acquired herniation of the mucosa and submucosa through weakened areas of the muscularis mucosa of the mesenteric aspect of the bowel. They are asymptomatic in the majority of cases; however, they can present with a wide spectrum of non-specific symptoms such as chronic abdominal discomfort, postprandial flatulence, diarrhoea, malabsorption and steattorhoea. In up to 15% of cases, more serious acute complications may arise such as the development of intestinal obstruction, haemorrhage or as in our case, localized peritonitis secondary to perforation. Perforation carries an overall mortality rate of up to 40% and exploratory laparotomy followed by copious lavage with segmental resection and primary anastomosis remains the mainstay of managing such sequalae of jejunal pseudo-diverticulosis. Our case report highlights the importance of maintaining a high clinical suspicion of a perforated jejunal diverticulum in an elderly patient presenting with an acute abdomen. PMID:27765806

  11. Pure Primary Ovarian Squamous Cell Carcinoma Perforating the Rectum

    PubMed Central

    Okada, Aiko; Haraguchi, Naotsugu; Tomimatsu, Takuji; Kimura, Tadashi

    2017-01-01

    Rectal perforation is uncommon in ovarian cancer, even in advanced stages. Pure primary ovarian squamous cell carcinoma is a very rare subtype of ovarian cancer and has not been reported to cause rectal perforation. A 50-year-old woman presented with rectal bleeding. Rectosigmoidoscopy suggested perforation of a pelvic tumor into the rectum. Abdominopelvic magnetic resonance imaging revealed a 9 cm heterogeneous mass in the pouch of Douglas. We performed complete cytoreduction, including an en-bloc resection of the tumor and rectosigmoid colon. Histopathology showed squamous cell carcinoma of the left ovary penetrating the rectal wall. A common symptom of rectal bleeding was caused by a very rare entity of ovarian cancer penetrating the rectal wall, but thorough evaluation led to its accurate diagnosis and appropriate treatment. PMID:28316851

  12. 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.

  13. Sampling diffusive transition paths

    SciTech Connect

    F. Miller III, Thomas; Predescu, Cristian

    2006-10-12

    We address the problem of sampling double-ended diffusive paths. The ensemble of paths is expressed using a symmetric version of the Onsager-Machlup formula, which only requires evaluation of the force field and which, upon direct time discretization, gives rise to a symmetric integrator that is accurate to second order. Efficiently sampling this ensemble requires avoiding the well-known stiffness problem associated with sampling infinitesimal Brownian increments of the path, as well as a different type of stiffness associated with sampling the coarse features of long paths. The fine-features sampling stiffness is eliminated with the use of the fast sampling algorithm (FSA), and the coarse-feature sampling stiffness is avoided by introducing the sliding and sampling (S&S) algorithm. A key feature of the S&S algorithm is that it enables massively parallel computers to sample diffusive trajectories that are long in time. We use the algorithm to sample the transition path ensemble for the structural interconversion of the 38-atom Lennard-Jones cluster at low temperature.

  14. Global audit on bowel perforations related to transanal irrigation.

    PubMed

    Christensen, P; Krogh, K; Perrouin-Verbe, B; Leder, D; Bazzocchi, G; Petersen Jakobsen, B; Emmanuel, A V

    2016-02-01

    Transanal irrigation is increasingly used against chronic constipation and fecal incontinence in selected patients. The aims were to estimate the incidence of irrigation-related bowel perforation in patients using the Peristeen Anal Irrigation(®) system, and to explore patient- and procedure-related factors associated with perforation. External independent expert audit on the complete set of global vigilance data related to Peristeen Anal Irrigation from 2005 to 2013. In total, 49 reports of bowel perforation had been recorded. Based on sales figures, this corresponds to an average risk of bowel perforation of 6 per million procedures. The latest two-year data indicate a risk of 2 per million procedures. In 29 out of 43 evaluable cases (67 %), perforation happened within the first 8 weeks since start of treatment. After 8 weeks, long-term use has an estimated risk of less than 2 per million procedures. Among patients with non-neurogenic bowel dysfunction, 11 out of 15 (73 %) had a history of pelvic organ surgery compared to 5 out of 26 (19 %) in neurogenic bowel dysfunction. In 11 of 46 (24 %) evaluable cases, burst of the rectal balloon was reported. Enema-induced perforation is a rare complication to transanal irrigation with Peristeen Anal Irrigation, which increases the benefit risk ratio in support of the further use of transanal irrigation. Increased risk is present during treatment initiation and in patients with prior pelvic organ surgery. Careful patient selection, patient evaluation and proper training of patients are critical to safe practice of this technique.

  15. Perforating the atretic pulmonary valve with CTO hardware: Technical aspects.

    PubMed

    Patil, Nilkanth C; Saxena, Anita; Gupta, Saurabh K; Juneja, Rajnish; Mishra, Sundeep; Ramakrishnan, Sivasubramanian; Kothari, Shyam S

    2016-11-01

    To review the success and technical aspects of pulmonary valve (PV) perforation using chronic total occlusion (CTO) hardware in patients with pulmonary atresia and intact ventricular septum (PA-IVS). Interventional therapy is possible in selected patients with PA-IVS. Among the various interventional options available, radiofrequency and laser assisted perforation may be more successful, but require expertise and may be substantially costly. We describe the technique of mechanical catheter PV perforation using currently available coronary hardware meant for coronary CTO in nine cases with PA-IVS. After complete echocardiographic evaluation and informed parental consent was obtained, patients were electively intubated, mechanically ventilated, adequately heparinized and were placed on intravenous prostaglandin infusion. Basic steps involved were-localizing the atretic segment and accomplishing coaxial alignment of catheters using biplane fluoroscopy, crossing the atretic segment with the soft end of perforating guidewire, stabilizing the assembly and performing graded balloon dilatation with the balloon size never exceeding 130% of pulmonary annulus diameter. For crossing the atretic PV, a retrograde approach was used in one patient where the antegrade approach was not possible. The procedure was successful in 8/9 cases (89%). Valve opening was achieved in all eight patients with immediate fall in right ventricular (RV) systolic pressures. One neonate died following surgery after catheter induced RV perforation. All surviving cases were discharged from the hospital in good general condition with no evidence of heart failure and a room air oxygen saturation of >85%. No patient required an additional pulmonary irrigation procedure. With appropriate patient and hardware selection, PV perforation using readily available coronary hardware is feasible in PA-IVS. © 2014 Wiley Periodicals, Inc. © 2014 Wiley Periodicals, Inc.

  16. Typhoid intestinal perforation under 5 years of age.

    PubMed

    Ekenze, Sebastian O; Ikefuna, Anthony N

    2008-03-01

    Typhoid intestinal perforation is an important cause of morbidity and mortality in many developing countries. The peculiar features in children <5 years old need to be recognised in order to improve outcome. To determine the characteristic pattern and outcome of typhoid intestinal perforation in children under 5 years of age in south-east Nigeria. Comparative analysis of 83 children with typhoid intestinal perforation between January 2001 and December 2006 at the University of Nigeria Teaching Hospital, Enugu. There were 22 (26.5%) children <5 years of age and 61 (73.5%) >5 years. In the younger children, the predominant presentation was fever, vomiting and abdominal tenderness, and in the older children it was fever, abdominal pain and distension. Features of peritonitis were present in only 54.5% aged <5 years compared with 90.2% of the older children (p<0.001). The average number of perforations in the under-5s was 2.1 (range 1-4) and >1.3 (range 1-3) in the older children (p<0.01). The types of operative procedure (simple closure and segmental bowel resection) were similar in both groups. Post-operative complications were not significantly different in the two groups and included surgical wound infection, prolonged ileus, pulmonary infection, wound dehiscence, re-perforation, intra-abdominal abscess and incisional hernia. There were nine (40.9%) deaths in the <5s and 12 (19.7%) in the >5s (p<0.05). Typhoid intestinal perforation in children <5 is associated with atypical presentation and high mortality. A high index of suspicion will ensure earlier presentation and might improve outcome.

  17. Comparison of laparoscopic, open, and converted appendectomy for perforated appendicitis.

    PubMed

    Piskun, G; Kozik, D; Rajpal, S; Shaftan, G; Fogler, R

    2001-07-01

    Perforated appendicitis is associated with a significant risk of postoperative abdominal and wound infection. Only a few controversial studies evaluate the role of laparoscopy in perforated appendicitis. The significance of conversion from laparoscopy to open appendectomy for perforated appendicitis is not well defined. Statistical analysis was performed using Student's t-test. Data on 52 patients with perforated appendicitis were prospectively collected and retrospectively reviewed. Among these patients, 18 had laparoscopic appendectomies (LA); 24 had open appendectomies (OA); and 10 had converted appendectomies (CA). The indications for either method were based on the attending surgeons's philosophy. Laparoscopic appendectomy was performed using a retrograde stapler technique. Operative time, hospital stay, ability to tolerate a liquid diet, and postoperative infectious complications were documented. No statistically significant difference in the operative time in minutes was found between the LA (114 +/- 29.3), CA (120.0 +/- 32.2), and OA (105.8 +/- 64.1) groups (p = NS). There was no statistically significance difference in length of stay (days) between the LA (9.2 +/- 4.1), OA (10.5 +/- 3.3), and CA (10.0 +/- 1.8) groups. The wound infection rate was less frequent in the LA group (0%) than in 0A (14%) and CA (10%) groups. The rate of intra-abdominal abscess infections (IAAs) and ileus were 22% and 28%, respectively, in LA group, 38% and 29%, respectively, in OA group, and 60% and 50%, respectively, in CA group. No difference in the rate of postoperative intra-abdominal abscesses exists between laparoscopic and open appendectomy for perforated appendicitis. Wound infections and ileus complicate the postoperative course of patients after laparoscopic appendectomy less frequently than after open appendectomy. The conversion of laparoscopic to open appendectomy for perforated appendicitis is associated with increased postoperative morbidity.

  18. Reverse flow facial artery as recipient vessel for perforator flaps.

    PubMed

    Hölzle, Frank; Hohlweg-Majert, Bettina; Kesting, Marco R; Mücke, Thomas; Loeffelbein, Denys J; Wolff, Klaus-Dietrich; Wysluch, Andreas

    2009-01-01

    In perforator flaps, anastomosis between flap and recipient vessels in the neck area is often difficult due to small vessel diameter and short pedicle. The aim of this study was to investigate whether the retrograde flow of the distal, paramandibular part of the facial artery would provide sufficient pressure and size to perfuse perforator flaps. Before and after occlusion of the contralateral facial artery, retrograde and anterograde arterial pressure was measured on both sides of the facial artery in 50 patients. The values were compared with the mean systemic arterial pressure. Diameters of facial arteries in the paramandibular region and perforator flap vessels were evaluated by morphometry. Arterial pressure in the distal facial artery with retrograde flow was 76% of the systemic arterial pressure. The latter equaled approximately the anterograde arterial pressure in the proximal end of the facial artery. Mean arterial pressure of the facial arteries decreased after proximal occlusion of the contralateral facial artery, which was not significant (P = 0.09). Mean diameter of the distal facial arteries in the mandibular region was 1.6 mm (range 1.3-2.2 mm; standard deviation 0.3 mm; n = 50), that of the perforator flap arteries 1.3 mm (0.9-2.6 mm; 0.4 mm; n = 20). Facial arteries, based on reverse flow, successfully supported all 20 perforator flaps. Retrograde pulsatile flow in the distal facial artery sustains perforator flaps even if the contralateral facial artery is occluded. Proximity of the distal facial arteries to the defect compensates for short pedicles. Matching diameters of the arteries are ideal for end-to-end anastomosis. Copyright 2009 Wiley-Liss, Inc. Microsurgery 2009.

  19. Perforation holes in ventricular catheters--is less more?

    PubMed

    Thomale, Ulrich W; Hosch, Henning; Koch, Arend; Schulz, Matthias; Stoltenburg, Giesela; Haberl, Ernst-Johannes; Sprung, Christian

    2010-06-01

    Obstruction is a common cause of cerebrospinal fluid (CSF) shunt failure. Risk factors for proximal obstructive malfunction are suboptimal ventricular catheter positioning and slit-like ventricles. A new ventricular catheter design to decrease risk of obstruction was evaluated. A review of histopathological tissue investigation from occluded ventricular catheters (n = 70) was performed. A new ventricular catheter design was realized with six perforation holes. These catheters were compared to regular catheters (16 holes, Miethke, Aesculap) for flow characteristics using ink studies and flow velocity at hydrostatic pressure levels from 14 to 2 cmH(2)O in an experimental setup. The six-hole catheters were implanted in hydrocephalic patients with slit-like ventricles (n = 55). A follow-up was performed to evaluate the need of catheter revisions. Histological evaluation showed that obstructive tissue involved 43-60% extraventricular tissue, including gliosis, connective and inflammatory cells. In flow characteristic studies, the 16-hole catheters showed that only proximal perforations are of functional relevance. For six-hole catheters, all perforations were shown to be relevant with remaining reserve capacity. Flow velocity however showed no significant differences between six and 16 perforations. The six-hole catheter was implanted in 55 patients with a mean follow-up period of 15 +/- 9 months. A total of 12 catheters were explanted, revealing an overall survival proportion of 77.4%. In narrow ventricles, we assume that catheter perforations that are located also in the tissue might be a risk for CSF shunt obstruction. Fewer amounts of perforations in the catheters with equal flow features might decrease this risk when catheters can be implanted with adequate precision.

  20. Parallel path planning in unknown terrains

    NASA Astrophysics Data System (ADS)

    Prassler, Erwin A.; Milios, Evangelos E.

    1991-03-01

    ensemble of known obstacles. An essential advantage of high-level path planning is the property of compleleness: path planning does not terminate until a satisfactory path is found provided there exists one. To base a navigation system which is supposed to guide a robot through an unknown terrain solely on mapbased high-level planning is not advisable for obvious reasons however. By refering to a precompiled map such a system would have severe problems to cope with situations where the real world has changed and deviates from the robot''s map. This goes back to a basic architectural principle which clearly separates the planning task from the execution of a plan and provides only a limited feed back from execution to planning. The interaction with the real world is the concern of the low-level conirol part of the system whose task is limited to the execution of elementary operations guiding the robot along the precisely specified path. The performance of the overall navigation system is bound by

  1. An Improved Model for Air Damping of Perforated Structures

    NASA Astrophysics Data System (ADS)

    Lu, Cunhao; Li, Pu

    2017-07-01

    the prediction of air damping of micromachined mechanical resonant structures is significant in the design of high quality factor devices. In rarefied air, based on Bao’s molecule model, Li gives an analytical model for air damping of perforated structures. By studying the action of molecules going through holes and reflected by the fixed plate, this paper gives a probability of molecules through holes going into the gap between the moving plate and the fixed one. Comparison with Li’s model, the new model can play a better performance of air damping for perforated structures, at a wide range of size of holes.

  2. Esophageal perforation associated with noninvasive ventilation: a case report.

    PubMed

    Van de Louw, Andry; Brocas, Elsa; Boiteau, Richard; Perrin-Gachadoat, Dominique; Tenaillon, Alain

    2002-11-01

    Noninvasive positive-pressure ventilation (NIPPV) is widely used to treat acute respiratory failure, the goal being to avoid exposing patients to the morbidity associated with tracheal intubation. NIPPV may reduce the rates of intubation, morbidity, and mortality in selected patient subgroups. Although time-consuming for physicians and nurses, NIPPV is fairly easy to use, and few severe complications have been reported. Esophageal perforation is a well-recognized complication of tracheal intubation but has not been described in association with NIPPV. We report a case of fatal esophageal perforation associated with NIPPV after a surgical procedure.

  3. Pre-expanded Anterolateral Thigh Perforator Flap for Phalloplasty.

    PubMed

    D'Arpa, Salvatore; Colebunders, Britt; Stillaert, Filip; Monstrey, Stan

    2017-01-01

    The anterolateral thigh (ALT) perforator flap for phalloplasty is gaining popularity because it avoids the well-known scars of the radial forearm flap. However, scars are not eliminated, just moved to a different location, the thigh, that can for some patients be of great sexual value. Preexpansion of the ALT flap allows primary donor site closure, thus avoiding not only the unsightly appearance of a skin grafted ALT donor site, but also the skin graft donor site scar. Preoperative perforator location by means of computed tomography angiography allows safe expander placement through 2 small remote incisions.

  4. Colonic Perforation in a Young Tetraplegic Male Caused by Zucchini.

    PubMed

    Pigac, Biserka; Masic, Silvija

    2016-10-01

    Colonic perforation is a clinical condition which occurs due to variety of reasons, such as intrinsic disorders of the intestine, extrinsic causes, but also due to presence of foreign bodies. Foreign objects enter gastrointestinal tract by oral or transanal introduction. we present an uncommon case of a 26- year-old tetraplegic male, whose death was a consequence of a widespread purulent peritonitis provoked by colonic perforation inflicted by an unusual foreign body, transanally introduced 28 centimeters long zucchini (Cucurbita pepo L.). we share our experience in order to emphasize the importance of consideration and early recognition of foreign body presence in the alimentary tract as possible diagnosis.

  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. Reconstruction of Thermographic Signals to Map Perforator Vessels in Humans.

    PubMed

    Liu, Wei-Min; Maivelett, Jordan; Kato, Gregory J; Taylor, James G; Yang, Wen-Chin; Liu, Yun-Chung; Yang, You-Gang; Gorbach, Alexander M

    2012-01-01

    Thermal representations on the surface of a human forearm of underlying perforator vessels have previously been mapped via recovery-enhanced infrared imaging, which is performed as skin blood flow recovers to baseline levels following cooling of the forearm. We noted that the same vessels could also be observed during reactive hyperaemia tests after complete 5-min occlusion of the forearm by an inflatable cuff. However, not all subjects showed vessels with acceptable contrast. Therefore, we applied a thermographic signal reconstruction algorithm to reactive hyperaemia testing, which substantially enhanced signal-to-noise ratios between perforator vessels and their surroundings, thereby enabling their mapping with higher accuracy and a shorter occlusion period.

  7. Gastric Perforation and Phlegmon Formation by Foreign BodyIngestion

    PubMed Central

    Avila Alvarez, Albert Alejandro; Parra, Jose Fernando; Buitrago, Diego Andres; Rodriguez, Fernando; Moreno, Atilio

    2014-01-01

    This is a case report of foreign body ingestion in a suicide attempt resulting in gastric perforation and phlegmon formation during a subsequent 6 month period that eventually required surgical intervention. The patient had a prolonged course because she did not report a history of foreign body ingestion and the initial evaluating physicians had no suspicion about possible foreign body ingestion and may have missed important findings on physical examination. Gastric perforation by a foreign object may have a slow course rather than presenting acute abdomen. The realization of a proper physical examination in the emergency department is key to an accurate diagnosis. PMID:26495367

  8. Bowel perforation after single-dose activated charcoal.

    PubMed

    Green, Jason P; McCauley, William

    2006-09-01

    Patients presenting to the emergency department (ED) after medication overdose are often given activated charcoal initially for gastrointestinal decontamination. Complications of charcoal are rare, but do occur. The following case describes a patient with pre-existing undiagnosed diverticular disease who developed sigmoid perforation after a single dose of activated charcoal, given without cathartic for a drug overdose. A literature search revealed no other cases of bowel perforation associated with single-dose activated charcoal. This case report discusses adverse effects associated with activated charcoal and the role of cathartics in gastrointestinal decontamination.

  9. Furcal perforation repair using calcium enriched mixture cement

    PubMed Central

    Asgary, Saeed

    2010-01-01

    This case describes a furcal perforation in a mandibular first molar accompanied by furcal lesion which has been managed after one month. Root canal treatment was performed; subsequently, the defect was repaired with calcium enriched mixture (CEM) cement. The endodontically treated tooth was restored with amalgam. A 24-month recall showed no evidence of periodontal breakdown, no symptoms, in addition to completes healing of furcal lesion. According to physical and biological properties of the newly introduced CEM cement, this novel material may be suitable for sealing and repairing the perforations. The present case report supports this hypothesis. PMID:21116393

  10. Homogenization in perforated domains and interior Lipschitz estimates

    NASA Astrophysics Data System (ADS)

    Russell, B. Chase

    2017-09-01

    We establish interior Lipschitz estimates at the macroscopic scale for solutions to systems of linear elasticity with rapidly oscillating periodic coefficients and mixed boundary conditions in domains periodically perforated at a microscopic scale ε by establishing H1-convergence rates for such solutions. The interior estimates are derived directly without the use of compactness via an argument presented in [3] that was adapted for elliptic equations in [2] and [11]. As a consequence, we derive a Liouville type estimate for solutions to the systems of linear elasticity in unbounded periodically perforated domains.

  11. An unusual presentation of implantable cardioverter-defibrillator lead perforation.

    PubMed

    Crusio, Robbert H J; Greenberg, Yisachar J

    2009-01-01

    Recently, there have been increased reports of implantable cardioverter-defibrillator (ICD) lead perforation. Controversy exists about the safety of certain leads. A 37-year-old man with an ischemic cardiomyopathy presented four days postimplantation of an ICD lead with localized nonpleuritic chest wall pain. Imaging demonstrated proximity of the lead to the rib, suggestive of irritation of the periosteum. The lead was repositioned to the right ventricular septum without adverse effect on defibrillation. Lead perforation presenting with focal chest pain due to rib irritation is unusual. Placement of ICD leads on the right ventricular septum should be considered to improve safety.

  12. Gastric perforation secondary to metastasis from breast cancer.

    PubMed

    Wong, Chee Siong; Gumber, Ashutosh; Kiruparan, Pasupathy; Blackmore, Alexander

    2016-07-18

    Gastric perforation secondary to metastasis from breast cancer occurs infrequently. We present the case of a 72-year-old postmenopausal female patient with a known history of lobular carcinoma of the breast who presented to a district general hospital with a clinical diagnosis of an acute abdomen. Further contrast-enhanced CT scan demonstrated free gas and fluid in the abdomen. She underwent emergency exploratory laparotomy and onlay Graham's omentopexy patch due to 1×1 cm prepyloric gastric perforation. Final histopathology proved the presence of metastatic malignant cells in the breast origin. We discuss the issues involved in postoperative investigation and management.

  13. [Intestinal perforation in a Tunisian woman: peritonitis due to a fishbone].

    PubMed

    Abid, M; Derbel, R; Annabi, S; Guirat, A; Mzali, R; Frikha, M F; Ben Amar, M; Beyrouti, M I

    2010-02-01

    Diagnosis of foreign body perforation of the gastrointestinal tract can be difficult. The purpose of this report is to describe a case of acute peritonitis after perforation of the ileum by a fish bone that was detected by computed tomography.

  14. Mobile transporter path planning

    NASA Technical Reports Server (NTRS)

    Baffes, Paul; Wang, Lui

    1990-01-01

    The use of a genetic algorithm (GA) for solving the mobile transporter path planning problem is investigated. The mobile transporter is a traveling robotic vehicle proposed for the space station which must be able to reach any point of the structure autonomously. Elements of the genetic algorithm are explored in both a theoretical and experimental sense. Specifically, double crossover, greedy crossover, and tournament selection techniques are examined. Additionally, the use of local optimization techniques working in concert with the GA are also explored. Recent developments in genetic algorithm theory are shown to be particularly effective in a path planning problem domain, though problem areas can be cited which require more research.

  15. Spontaneous Perforation of Pyometra Presented as an Acute Abdomen: A Case Report

    PubMed Central

    Saha, Pradip Kumar; Gupta, Pratiksha; Mehra, Reeti; Goel, Poonam; Huria, Anju

    2008-01-01

    Spontaneous perforation of pyometra is a rare pathologic condition that presents as diffuse peritonitis. This report describes an interesting case of spontaneous uterine perforation that mimicked gut perforation clinically and was finally diagnosed at exploratory laparotomy. Although rare, perforation of pyometra should be kept as one of the differential diagnosis in an elderly woman with an acute abdomen. A high index of suspicion is required to make a correct preoperative diagnosis, which allows early intervention, thus reducing morbidity and mortality. PMID:18324325

  16. 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.

  17. Treatment of Distal Left Anterior Descending Artery Perforation with Fat Embolization

    PubMed Central

    Abushahba, Galal Ahmed; Abujalala, Salem; Butt, Mehmood S.

    2016-01-01

    Coronary perforation is a potentially fatal complication during percutaneous coronary intervention. Reports have shown that it occurs in 0.2 to 0.6% of all patients undergoing the procedures. Although the frequency of coronary perforation is low, it is a serious and potentially life-threatening situation that warrants prompt recognition and management. Here we present a case of distal coronary perforation, and review the management of coronary perforation in the current practice.

  18. Management of radial artery perforation during transradial catheterization using a polytetrafluoroethylene-covered coronary stent.

    PubMed

    Chatterjee, Arka; White, Jeremy S; Leesar, Massoud A

    2017-03-01

    An 88-year-old woman underwent attempted percutaneous coronary intervention (PCI) through a right radial approach. Catheterization was complicated by radial artery perforation. Conservative therapeutic options including external compression, advancement of a diagnostic catheter distal to the perforation, and balloon tamponade failed to control the bleeding requiring deployment of a Polytetrafluoroethylene (PTFE)-covered stent to seal the perforation. We describe the stepwise approach advocated for managing a radial perforation and summarize relevant literature available for the same.

  19. An Unplanned Path

    ERIC Educational Resources Information Center

    McGarvey, Lynn M.; Sterenberg, Gladys Y.; Long, Julie S.

    2013-01-01

    The authors elucidate what they saw as three important challenges to overcome along the path to becoming elementary school mathematics teacher leaders: marginal interest in math, low self-confidence, and teaching in isolation. To illustrate how these challenges were mitigated, they focus on the stories of two elementary school teachers--Laura and…

  20. Gas path seal

    NASA Technical Reports Server (NTRS)

    Bill, R. C.; Johnson, R. D. (Inventor)

    1979-01-01

    A gas path seal suitable for use with a turbine engine or compressor is described. A shroud wearable or abradable by the abrasion of the rotor blades of the turbine or compressor shrouds the rotor bades. A compliant backing surrounds the shroud. The backing is a yieldingly deformable porous material covered with a thin ductile layer. A mounting fixture surrounds the backing.

  1. An Unplanned Path

    ERIC Educational Resources Information Center

    McGarvey, Lynn M.; Sterenberg, Gladys Y.; Long, Julie S.

    2013-01-01

    The authors elucidate what they saw as three important challenges to overcome along the path to becoming elementary school mathematics teacher leaders: marginal interest in math, low self-confidence, and teaching in isolation. To illustrate how these challenges were mitigated, they focus on the stories of two elementary school teachers--Laura and…

  2. Transition Path Sampling Methods

    NASA Astrophysics Data System (ADS)

    Dellago, C.; Bolhuis, P. G.; Geissler, P. L.

    Transition path sampling, based on a statistical mechanics in trajectory space, is a set of computational methods for the simulation of rare events in complex systems. In this chapter we give an overview of these techniques and describe their statistical mechanical basis as well as their application.

  3. An improved empirical model for diversity gain on Earth-space propagation paths

    NASA Technical Reports Server (NTRS)

    Hodge, D. B.

    1981-01-01

    An empirical model was generated to estimate diversity gain on Earth-space propagation paths as a function of Earth terminal separation distance, link frequency, elevation angle, and angle between the baseline and the path azimuth. The resulting model reproduces the entire experimental data set with an RMS error of 0.73 dB.

  4. ACTS Mobile Terminals

    NASA Technical Reports Server (NTRS)

    Abbe, Brian S.; Agan, Martin J.; Jedrey, Thomas C.

    1997-01-01

    The development of the Advanced Communications Technology Satellite (ACTS) Mobile Terminal (AMT) and its follow-on, the Broadband Aeronautical Terminal (BAT), have provided an excellent testbed for the evaluation of K- and Ka-band mobile satellite communications systems. An overview of both of these terminals is presented in this paper.

  5. ACTS Mobile Terminals

    NASA Technical Reports Server (NTRS)

    Abbe, Brian S.; Agan, Martin J.; Jedrey, Thomas C.

    1997-01-01

    The development of the Advanced Communications Technology Satellite (ACTS) Mobile Terminal (AMT) and its follow-on, the Broadband Aeronautical Terminal (BAT), have provided an excellent testbed for the evaluation of K- and Ka-band mobile satellite communications systems. An overview of both of these terminals is presented in this paper.

  6. The PLATO V Terminal.

    ERIC Educational Resources Information Center

    Stifle, J. E.

    This report provides a detailed description of the architecture and programming of the PLATO V terminal, which contains an 8080 microprocessor and is capable of being operated by programs located in a host computer. The terminal contains 8k of memory for storing local programs, a 4k ROM resident program which supervises terminal operation, a 2k…

  7. Auxetic Perforated Mechanical Metamaterials with Randomly Oriented Cuts.

    PubMed

    Grima, Joseph N; Mizzi, Luke; Azzopardi, Keith M; Gatt, Ruben

    2016-01-13

    Perforated systems with quasi-disordered arrays of slits are found to exhibit auxetic characteristics almost as much as their traditional ordered "rotating-squares" counterparts. This provides a highly robust methodology for constructing auxetics that may be used for various practical applications such as skin grafting, where a high degree of precision may not always be achievable.

  8. Parametric study of wave propagation in hierarchical auxetic perforated metamaterials

    NASA Astrophysics Data System (ADS)

    Billon, K.; Ouisse, M.; Sadoulet-Reboul, E.; Scarpa, F.; Collet, M.

    2016-04-01

    The understanding of wave propagation in a metamaterial with hierarchical, auxetic rectangular perforations is presented in this work. The metamaterial is a 2D structure with chaining horizontal and vertical perforations exhibiting auxetic in-plane behaviour. The unit cell of this lattice is identified as the reference level 0. Hierarchical structures are composed of structural elements which themselves have structure. At level 0, 4 rigid squares are present in the unit cell. In each square, the reference structure is used by applying a scale ratio to obtain the level 1. The same strategy is used to reach the upper level in each subunit. A geometric parametric investigation of these rectangular perforations using a numerical asymptotic homogenisation finite element approach is done. Some numerical eigenvalue tools are used for the dispersion analysis of this structure. It is first observed that the total width of Band gaps increases with the hierarchy. The porosity induced by the perforations is taken into account in the mechanical properties. The symmetry of the geometry in the x-y plane allow to define the entire geometry of the unit cell using only 2 parameters: the void aspect ratio, the intercell spacing and the hierarchy level. When decreasing the intercell spacing, the total width of Band gaps increases and the effective stiffness in x and y directions decrease, allowing for increased rotations of the rigid squares, so auxetic behaviour is greater. Hierarchical levels shift from isotropic to orthotropic, hierarchical levels are always auxetic.

  9. Automatic drop-off device for perforating guns

    SciTech Connect

    Barker, J.M.; Miller, T.M.

    1988-09-20

    This patent describes a perforating gun assembly adapted to be run into a tightly dimensioned well borehole for perforating into producing formations at a specified depth, the perforating gun assembly comprising: (a) an elongated body adapted to be lowered into a tightly dimensioned passageway along a well; (b) a carrier for supporting one or more shaped charges thereon, the carrier being supported below the elongate body; (c) connective means joining the body and carrier coaxially together for running into a well borehole for subsequent separation wherein the connective means connects to the body and carrier and includes: (1) a circular set of extending collet fingers having engaging surfaces thereon and adapted to flex, the fingers flexing radially inwardly and outwardly; (2) a surrounding sleeve about the collet fingers having a collet finger engaging surface cooperative with the finger engaging surfaces; (3) piston means abutting the collet fingers to lock the collet fingers against flexing wherein the collet fingers are prevented from flexing radially; (4) the connective means further including a closed chamber for applying fluid pressure against the piston means; (5) the collet fingers and the sleeve serially joining together the body and the carrier for supporting the carrier below the body to form the perforating gun assembly.

  10. Duodenal perforation with an unusual presentation: a case report.

    PubMed

    Sarmast, Arif Hussain; Parray, Fazl Q; Showkat, Hakim Irfan; Lone, Yasir A; Bhat, Naseer A

    2011-01-01

    A young female presented with classical complaints suggestive of peptic ulcer disease leading to signs of peritonitis. The said patient after being subjected to baseline workup was subjected to laparotomy which proved to be a surgical surprise. A live ascaris lumbricoides worm was seen pouting out of a duodenal perforation.

  11. Duodenal Perforation with an Unusual Presentation: A Case Report

    PubMed Central

    Sarmast, Arif Hussain; Parray, Fazl Q.; Showkat, Hakim Irfan; Lone, Yasir A.; Bhat, Naseer A.

    2011-01-01

    A young female presented with classical complaints suggestive of peptic ulcer disease leading to signs of peritonitis. The said patient after being subjected to baseline workup was subjected to laparotomy which proved to be a surgical surprise. A live ascaris lumbricoides worm was seen pouting out of a duodenal perforation. PMID:22567473

  12. Spontaneous Uterine Perforation of Pyometra Presenting as Acute Abdomen

    PubMed Central

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

    2014-01-01

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

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

    PubMed

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

    2014-01-01

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

  14. CHARACTERIZATION OF CLEAN AND FOULED PERFORATED MEMBRANE DIFFUSERS

    EPA Science Inventory

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

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

    PubMed

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

    2015-01-01

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

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

    NASA Astrophysics Data System (ADS)

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

    2013-12-01

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

  17. Esophageal perforation following cervical mediastinoscopy: a rare serious complication

    PubMed Central

    Salter, Benjamin; Evans, Adam; Reddy, Ramachandra

    2015-01-01

    We describe a rare case of esophageal perforation following cervical mediastinoscopy on a patient with mediastinal lymphadenopathy and right upper lobe (RUL) mass. The patient was successfully treated with esophageal stenting and bilateral pleural exploration and drainage with eventual discharge tolerating a regular diet. This report details an uncommon but noteworthy complication to keep in mind when performing this procedure. PMID:26793389

  18. Management of endoscopic retrograde cholangiopancreatography-related perforations

    PubMed Central

    Kim, Byung Seup; Kim, In-Gyu; Ryu, Byoung Yoon; Kim, Jong Hyeok; Yoo, Kyo Sang; Baik, Gwang Ho; Kim, Jin Bong

    2011-01-01

    Purpose The purpose of this study is to analyze the treatment strategies of patients with endoscopic retrograde cholangiopancreatography (ERCP)-related perforations. This is a retrospective study. Methods We experienced 13 perforations associated with ERCP. We reviewed the medical recordsand classified ERCP-related perforations according to mechanism of injury in terms of perforating device. Injury by endoscopic tip or insertion tube was classified as type I, injury by cannulation catheter or sphincterotomy knife as type II, and injury by guidewire as type III. Results Of four type I injuries, one case was managed by conservative management after primary closure with a hemoclip during ERCP. The other three patients underwent surgical treatments such as primary closure orpancreatico-duodenectomy. Of five type II injuries, two patients underwent conservative management and the other three cases were managed by surgical treatment such as duodenojejunostomy, duodenal diverticulization and pancreatico-duodenectomy. Of four type III injuries, three patients were managed conservatively and the remaining patient was managed by T-tube choledochostomy. Conclusion Type I injuries require immediate surgical management after EPCP or immediate endoscopic closure during ERCP whenever possible. Type II injuries require surgical or conservative treatment according to intra- and retro-peritoneal dirty fluid collection findings following radiologic evaluation. Type III injuries almost always improve after conservative treatment with endoscopic nasobilliary drainage. PMID:22066121

  19. 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

  20. Performance evaluation of perforated micro-cantilevers for MEMS applications

    NASA Astrophysics Data System (ADS)

    Swamy, Kenkere Balashanthamurthy Mruthyunjaya; Mukherjee, Banibrata; Ali Syed Mohammed, Zishan; Chakraborty, Suman; Sen, Siddhartha

    2014-04-01

    Miniaturized cantilevers are one of the elementary structures that are widely used in many micro-devices and systems. The dynamic performance of micro-cantilevers having process dictated through perforations is investigated. High-aspect ratio, long silicon cantilevers, intended for improved performance through lowered stiffness are designed with a series of through holes and simulated along with similar nonperforated/solid cantilevers for comparison. A few perforated structures are also fabricated using silicon-on-insulator-based multiproject MEMS processes from MEMSCAP Inc. (Durham, North Carolina) by reduced mask level and eliminating complex substrate trenching step. The dynamic behavior of these fabricated structures is experimentally studied for both in-plane and out-of-plane directions. It is shown that, due to the presence of perforations, stiffness in planar direction is lightly affected, whereas in out-of-plane direction it is significantly reduced by >35%. Similarly, the variation of damping in both perforated and nonperforated beams, too, is thoroughly analyzed for the first few modes of vibration. Nevertheless, their frequency response variation of <10% for modal frequencies in both planar and out-of-plane directions as compared to the nonperforated counterparts, points to potential applications in several micro-systems including those based on comb drives.

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

    PubMed Central

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

    2014-01-01

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

  2. Percutaneous peritoneal drainage in isolated neonatal gastric perforation.

    PubMed

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

    2015-12-07

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

  3. Percutaneous peritoneal drainage in isolated neonatal gastric perforation

    PubMed Central

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

    2015-01-01

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

  4. Insertion forces with intrauterine devices: implications for uterine perforation.

    PubMed

    Goldstuck, N D

    1987-08-01

    The force required to insert a Copper 7, Multiload Copper or Nova T IUD was measured in 197 successful and 25 unsuccessful insertion attempts. These forces were compared with the forces required to perforate freshly obtained uterine specimens with a metal uterine sound and Dalkon shield device, as well as with the clinically tested devices. The mean insertion forces for the Copper 7, Nova T and Multiload Copper devices were 1.502 N, 2.134 N and 4.041 N respectively, while the mean insertion pressures (N/mm2) were 0.203, 0.209 and 0.122 respectively. The mean in vitro fundal perforation forces with metal sounds was 20.7 N and with the Dalkon shield 31.6 N. The Copper 7, Multiload Copper and Nova T IUDs achieved mean in vitro forces of 5.75 N, 9.2 and 8.1 N respectively, without causing perforation. Primary uterine perforation at the time of insertion of these devices appears unlikely.

  5. CHARACTERIZATION OF CLEAN AND FOULED PERFORATED MEMBRANE DIFFUSERS

    EPA Science Inventory

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

  6. Techniques for application of tissue adhesive for corneal perforations.

    PubMed

    Erdey, R A; Lindahl, K J; Temnycky, G O; Aquavella, J V

    1991-06-01

    We describe a modified technique of using cyanoacrylate adhesive to seal corneal perforations. Easily performed at the slit lamp, its advantages over previously described methods include a smooth, contoured collagen surface overlying the adhesive, which is easily wet by the tear film. Even greater comfort and protection are provided by the addition of a hydrophilic bandage lens or collagen shield.

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

    PubMed

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

    2014-02-01

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

  8. Traumatic perforation of the sigmoid colon through schistosomal ulcerations.

    PubMed

    Culliford, A; Ibrahim, I; Worth, M H

    1975-06-01

    A case is presented in which the colon was perforated through a S. mansoni ulcer after blunt abdominal trauma. This is believed to be a unique situation. The colonic complications of schistosomiasis are discussed, and it is expected that they will be seen more frequently in the United States.

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

    PubMed

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

    2015-12-01

    Soft tissue coverage of distal medial ankle wounds is a challenging problem in orthopedic surgery because of the limited local tissues and prominent instrumentation. Traditionally, these wounds required free tissue transfer to achieve suitable coverage and subsequent bony union. To better respect the reconstructive ladder and to avoid the inherent difficulty of free flap coverage, rotational flaps have been used to cover these wounds. Both sural fasciocutaneous flaps and rotational fasciocutaneous perforator (propeller) flaps have been described for distal medial soft tissue coverage. The authors performed a retrospective chart review of patients who underwent distal medial leg coverage with the use of either sural flaps or rotational fasciocutaneous perforator flaps. The authors identified 14 patients by Current Procedural Terminology code who met the study criteria. The average age and degree of medical comorbidities were comparable in the 2 groups. The authors reviewed their medical records to evaluate fracture healing, flap size, complications, and return to normal shoe wear. All 7 sural flaps healed without incident, with underlying fracture healing. Of the 7 perforator flaps, 6 healed without incident, with underlying fracture healing. One perforator-based flap was complicated by superficial tip necrosis and went on to heal with local wound care. All patients returned to normal shoe wear. Both sural artery rotational flaps and posterior tibial artery-based rotational flaps are viable options for coverage of the distal medial leg. Coverage can be achieved reliably without microsurgery, anticoagulation, or monitoring in the intensive care unit. Copyright 2015, SLACK Incorporated.

  10. Local flaps, including pedicled perforator flaps: anatomy, technique, and applications.

    PubMed

    Maciel-Miranda, Alejandro; Morris, Steven F; Hallock, Geoffrey G

    2013-06-01

    After reading this article, the participant should be able to: 1. Discuss the types of local flaps. 2. Analyze the advantages, disadvantages, and applications for each kind of flap. 3. Perform appropriate design and dissection techniques of local flaps. 4. Describe appropriate design and dissection techniques of local perforator and propeller flaps. The purpose of this article is to comprehensively review the topic of local flaps. Local flaps are those that are elevated nearby and then transferred to an adjacent wound. Options include geometric local flaps, axial pattern local flaps and a new exciting group of flaps, local perforator flaps. The principles, advantages, disadvantages, and applications for each are carefully analyzed. Local perforator flaps can be harvested virtually anywhere in the body and represent a significant clinical advance, as these can solve a wide variety of clinical challenges. These flaps do require gentle microsurgical dissection technique with careful handling for inset of the flap and simultaneously provide the same advantages of other types of local flaps because they also use nearby tissues with a similar color match, thickness, and texture, with primary donor-site closure possible. Local perforator flaps are another very useful option that undoubtedly will become more popular as more surgeons become more familiar with their use and advantages.

  11. Gossypiboma: An Unusual Presentation as Perforation and Intraluminal Migration

    PubMed Central

    Mahey, Rajesh Kumar; Patil, Rajesh; Bakale, Nilesh; Suryawanshi, Sachin

    2016-01-01

    Gossypiboma is a mass formed around cotton material acting as foreign body in visceral cavity. In our study, we present a case of gossypiboma following open cholecystectomy. A surgical sponge left in the peritoneal cavity following cholecystectomy, caused inflammatory reaction, perforation and intraluminal migration. It is a relatively rare presentation. This patient underwent emergency laparotomy with Billroth II anastomosis and sponge removal. PMID:27790511

  12. 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.

  13. 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.

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

    PubMed

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

    2016-04-01

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

  15. Rumen perforation caused by horn injury in two cows.

    PubMed

    Braun, Ueli; Gerspach, Christian; Stettler, Manuela; Grob, Daniela; Sydler, Titus

    2016-01-20

    Post-operative complications of trocarisation and rumenotomy are the most common causes of peritonitis associated with a rumen disorder. Since horn injury leading to rumen perforation has not previously been reported in the literature, two cows with this condition are reported. Small superficial skin lesions were observed in one of the cows and the other had a perforating skin lesion in the left abdomen. Both cows had signs of hypovolaemic shock. Ultrasonography revealed hypoechoic fluid, echoic lesions and occasional fibrinous septa caudoventral to the reticulum. Caudally the fluid extended to the left flank fold and occupied about one third of the peritoneal cavity. The area of the skin perforation in the left abdomen was swollen and the muscle layers could not be differentiated using ultrasonography. Diffuse fibrino-purulent peritonitis was diagnosed in both cows, and because of a poor prognosis, they were euthanased and necropsied. Perforation of the abdominal wall and rumen with diffuse fibrino-purulent peritonitis was present. Ultrasonography is a suitable tool to characterise the inflammatory lesions between the rumen and left abdominal wall and objectify the interpretation of clinical findings. Horn injury should be included in the rule outs for cattle with left abdominal skin wounds and diffuse peritonitis.

  16. Esophageal perforation and pneumothorax after routine intraoperative orogastric tube placement.

    PubMed

    Turabi, Ali A; Urton, Ron J; Anton, Todd M; Herrmann, Robin; Kwiatkowski, David

    2014-05-15

    Orogastric and nasogastric tubes are routinely inserted in anesthetized patients to both reduce the volume of stomach contents and decrease the incidence of postoperative nausea. We present a case of esophageal perforation and subsequent pneumothorax after insertion of an orogastric tube in a patient undergoing routine shoulder arthroscopy.

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

    PubMed

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

    2016-03-01

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

  18. Metastatic Gas gangrene and Colonic Perforation: a case report

    PubMed Central

    Powell, Matthew J; Sasapu, Kishore K; Macklin, Christopher

    2008-01-01

    Clostridium septicum myonecrosis is associated with diabetes, colorectal and haematological malignancies. We present a case of metastatic myonecrosis in a diabetic patient with a perforated caecal tumour. The literature since 1989 is reviewed and 28 cases of Clostridium septicum myonecrosis are discussed. PMID:18373865

  19. Meckel's diverticulum perforated by a fishbone. An unusual presentation.

    PubMed

    Fonseca Sosa, Fernando Karel

    2017-02-27

    Finding a Meckel's diverticulum during a laparotomy is rare, operating on a patient for a complication of diverticulum is rare, but if this complication is the result of a perforation of the diverticulum by a foreign body, then we are in the presence of a medical curiosity.

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

    PubMed Central

    Lázár, György; Paszt, Attila; Mán, Eszter

    2016-01-01

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

  1. [Conservative management of esophageal perforation after pneumatic dilatation for achalasia].

    PubMed

    Scatton, Olivier; Gaudric, Marianne; Massault, Pierre-Philippe; Chaussade, Stanislas; Houssin, Didier; Dousset, Bertrand

    2002-10-01

    To assess the results and indications of conservative management of esophageal perforation following pneumatic dilatation for achalasia. Thirteen esophageal perforations complicating 524 dilatations in 412 patients (3%) were diagnosed by esophagogram. Medical treatment consisted of nasogastric succion, antibiotics and pleural drainage, if necessary. Conservative surgical treatment included left thoracophrenotomy, perforation closure, controlateral myotomy and anterior fundoplication. Surgical decision was based upon clinical and radiological parameters. Functional outcome was assessed by the means of the Eckardt's grading score. Six patients were successfully managed by medical treatment. Seven patients underwent conservative surgery, three of whom after failure of medical treatment. The presence of a pneumomediastinum at initial presentation led to immediate (n=2) or delayed (n=2) surgery in all instances. No patients died. In the surgical group, morbidity consisted of one wound infection, one pleural effusion and one venous thrombosis. One severe chest infection occurred in the medical group. Oral feeding was reintroduced after a median of 10 and 11 days in the surgical and medical groups, respectively. Functional results were satisfactory and similar in both groups. Conservative medical or surgical management of oesophageal perforation following pneumatic dilatation is safe, if the diagnosis is done early. Pneumomediastinum at initial presentation seems to predict failure of conservative medical treatment.

  2. Inelastic insights for molecular tunneling pathways: bypassing the terminal groups.

    PubMed

    Troisi, Alessandro; Ratner, Mark A

    2007-05-21

    As an example of the use of inelastic transport to deduce structure in molecular transport junctions, we compute the orientation dependence of the Inelastic Electron Tunneling (IET) spectrum of the 1-pentane monothiolate. We find that upon increasing the tilting angle of the molecule with respect to the normal to the electrode the spectrum changes as the intensity of some vibrations is enhanced. These differences occur because for higher tilting angles the tunneling path that bypasses the terminal group grows in importance. IETS can therefore be used to establish the molecular orientation in junctions terminating with alkyl chains and to investigate experimentally the relative importance of the available tunneling paths.

  3. Using dynamic infrared thermography to optimize color Doppler ultrasound mapping of cutaneous perforators.

    PubMed

    Muntean, Maximilian Vlad; Strilciuc, Stefan; Ardelean, Filip; Pestean, Cosmin; Lacatus, Radu; Badea, Alexandru Florin; Georgescu, Alexandru

    2015-12-01

    The high technical demands associated with perforator flaps demand a precise preoperative identification and evaluation of perforator vessels. Color Doppler Ultrasonography (CDU) and Dynamic Infrared Thermography (DIRT) are currently used for preoperative perforator mapping. Each individual technique has advantages and disadvantages. The purpose of this paper is to analyze the value of combining the two methods in order to optimize the process of preoperative perforator mapping. CDU and DIRT were used for preoperative perforator mapping in 10 pigs. The results were compared to intraoperative findings. Total number of perforators, localization, and identification of the dominant perforator was analyzed for each method. The examination time was recorded for each procedure. Both methods had a high sensitivity in determining the number and localization of perforators when compared to those identified during surgery. DIRT produced a higher number of false positive results. CDU accurately identified the emergence of the perforators in the fascia in all cases. Both methods correctly identified the dominant perforator. The sensitivity, positive predictive value, and accuracy of CDU were 93.56%, 97%, and 91.30% respectively and for DIRT 95.05%, 80.67%, and 77.41% respectively. The average examination was 39.76 minutes for CDU and 10.24 minutes for DIRT. The average time taken into account for the analysis of a single perforator in order to confirm DIRT findings was 1.83 minutes. Preoperative perforator mapping has become a compulsory step in nearly all reconstructive procedures. In our study, both CDU and DIRT correctly identified the dominant perforator in all cases. By combining the two examinations overall mapping time can be reduced significantly. A reduced examination time translates into increased patient compliance and a lower procedure cost. The combined mapping technique facilitates the selection of the ideal perforator in all cases. Correctly identifying the

  4. Factors Associated with Gastrointestinal Perforation in a Cohort of Patients with Rheumatoid Arthritis

    PubMed Central

    Curtis, Jeffrey R.; Lanas, Angel; John, Ani; Johnson, David A.; Schulman, Kathy L.

    2012-01-01

    Objective To estimate the incidence and risk factors for gastrointestinal (GI) perforation among patients with rheumatoid arthritis (RA). Methods Claims from employer health insurance plans were used to identify RA patients and those hospitalized for upper or lower GI perforation. GI perforation cases were identified using both a sensitive and specific definition. A Cox model using fixed and time-varying covariates was used to evaluate risk of GI perforation. Results Among 143,433 RA patients, and using a maximally sensitive GI perforation definition, 696 hospitalizations with perforation were identified. The rate of perforation was 1.70 per 1000 person years (PYs) [95% CI, 1.58–1.83] and most perforations (83%) occurred in the lower GI tract. The rate of perforation was lower when a more specific GI perforation definition was used (0.87, 95% CI, 0.78–0.96 per 1,000 PYs). Age and diverticulitis were among the strongest risk factors for perforation (diverticulitis hazard ratio=14.5 [95% CI, 11.8–17.7] for more sensitive definition, hazard ratio=3.9 [95% CI, 2.5–5.9] for more specific definition). Among various RA medication groups, and compared to methotrexate, the risk of GI perforation was highest among patients with exposure to concomitant non-biologic disease-modifying antirheumatic drugs and glucocorticoids. Biologics without glucocorticoid exposure was not a risk factor for perforation. Conclusion GI perforation is a rare but serious condition that affects patients with RA, most frequently in the lower GI tract. Clinicians should be aware of risk factors for GI perforation when managing RA patients, including age, history of diverticulitis, and use of glucocorticoids or NSAIDs. PMID:22730417

  5. Factors associated with gastrointestinal perforation in a cohort of patients with rheumatoid arthritis.

    PubMed

    Curtis, Jeffrey R; Lanas, Angel; John, Ani; Johnson, David A; Schulman, Kathy L

    2012-12-01

    To estimate the incidence and risk factors for gastrointestinal (GI) perforation among patients with rheumatoid arthritis (RA). Claims from employer health insurance plans were used to identify RA patients and those hospitalized for upper or lower GI perforation. GI perforation cases were identified using both a sensitive and a specific definition. A Cox model using fixed and time-varying covariates was used to evaluate the risk of GI perforation. Among 143,433 RA patients, and using a maximally sensitive GI perforation definition, 696 hospitalizations with perforation were identified. The rate of perforation was 1.70 per 1,000 person years (PYs; 95% confidence interval [95% CI] 1.58-1.83), and most perforations (83%) occurred in the lower GI tract. The rate of perforation was lower when a more specific GI perforation definition was used (0.87; 95% CI 0.78-0.96 per 1,000 PYs). Age and diverticulitis were among the strongest risk factors for perforation (diverticulitis hazard ratio [HR] 14.5 [95% CI 11.8-17.7] for the more sensitive definition, HR 3.9 [95% CI 2.5-5.9] for the more specific definition). Among various RA medication groups and compared to methotrexate, the risk of GI perforation was highest among patients with exposure to nonsteroidal antiinflammatory drugs (NSAIDs), concomitant nonbiologic disease-modifying antirheumatic drugs, and glucocorticoids. Biologic agents without glucocorticoid exposure were not a risk factor for perforation. GI perforation is a rare but serious condition that affects patients with RA, most frequently in the lower GI tract. Clinicians should be aware of risk factors for GI perforation when managing RA patients, including age, history of diverticulitis, and use of glucocorticoids or NSAIDs. Copyright © 2012 by the American College of Rheumatology.

  6. Successful treatment of gastric perforation with thyrotoxic crisis.

    PubMed

    Ogiso, Satoshi; Inamoto, Susumu; Hata, Hiroaki; Yamaguchi, Takashi; Otani, Tetsushi; Koizumi, Kinya

    2008-11-01

    Patients with thyrotoxic crisis presenting with another emergency are at a considerable risk. We report the successful treatment of a 55-year-old woman having gastric perforation with thyrotoxic crisis; the principle of treatment was delayed surgery after rapid preoperative restoration of thyroid function and cardiovascular status. The patient was admitted for severe abdominal pain and nausea with delirium, exophthalmos, diffuse goiter, tremulousness, diaphoresis, tabescence, pretibial edema, and atrial fibrillation. Computed tomography revealed free air over the liver surface. She had been diagnosed with uncontrolled hyperthyroidism 3 days before admission, with a free liothyronine (T(3)) of 23.2 pg/mL, a free levothyroxine sodium (T(4)) of greater than 7.78 ng/dL, and thyrotropin of less than 0.01 ng/mL. She was diagnosed with gastroduodenal perforation and thyrotoxic crisis, and we planned nonoperative management comprising nasogastric aspiration, cefmetazole sodium, omeprazole, thiamazole, and Lugol's solution. We also used landiolol, an ultrashort-acting beta(1)-adrenoceptor antagonist, and hydrocortisone. On the third day of admission, her thyroid function had improved with a free T(3) of 4.7 pg/mL and a free T(4) of 2.9 ng/dL; however, perforative peritonitis had worsened, and hence, omental patch repair was performed. She recovered uneventfully and was discharged after radioiodine administration. We discuss the management of a thyrotoxic patient with gastric perforation and focus on the importance of changing the management according to the patient's clinical course considering his thyroid function status and comparing the stress of surgery with that of perforative peritonitis in nonoperative management.

  7. Polypropylene mesh for nasal septal perforation repair: an experimental study.

    PubMed

    Yücebaş, Kadir; Taşkın, Ümit; Oktay, Mehmet Faruk; Tansuker, Hasan Deniz; Erdil, Mehmet; Altınay, Serdar; Kozanoğlu, Erol; Kuvat, Samet Vasfi

    2017-01-01

    The aim of this study is to determine the effectiveness and biocompatibility of polypropylene mesh for the repair of nasal septal perforations in an animal model on rabbits. A full-thickness nasal septal perforation with a diameter of nearly 10 × 10 mm was created on 12 rabbits, and then the perforation was reconstructed with two different methods. We used mucosal flaps and polypropylene mesh as an interpositional graft in group 1. Only mucosal flaps were used for reconstruction and are identified as group 2. After 4 weeks, we removed the nasal septum of the rabbits and performed histopathological examinations for acute rejection, infection, inflammatory response, fibrosis, and granuloma formation. We found perforation closure rates of 75 and 25 % in groups 1 and 2, respectively. Inflammatory response was seen in all specimens of group 1 (100 %). The inflammatory response was +1 in five of the specimens (62.5 %), +2 in one specimen (12.5 %), and +3 in two specimens (25 %). Mild fibrosis around the mesh was detected in four specimens (50 %), medium-level fibrosis was detected in one (12.5 %), and no fibrosis was detected in three (37.5 %). Severe fibrosis was not seen in any specimens. The foreign-body reaction was limited to a few giant cells, and granuloma formation was seen in two specimens (25 %). The propylene mesh showed excellent biocompatibility with the septal mucosa, and it can, therefore, be used for the repair of septal perforation as an interpositional graft safely.

  8. A 15.3 GHz satellite-to-ground diversity propagation experiment using a terminal separation of 4 kilometers

    NASA Technical Reports Server (NTRS)

    Grimm, K. R.; Hodge, D. B.

    1971-01-01

    The performance of a path diversity satellite-to-ground millimeter wave link with two ground terminals separated by 4 km is discussed. At this separation distance the duration of fades below 6 dB was decreased by at least a factor of 10 when using path diversity and the cumulative crosscorrelation between the attenuations observed at the two terminals during rain events was approximately 0.45. Narrow beam radiometers directed along the propagation paths were also utilized to relate the path radiometric temperature to the path attenuation. An analysis of downlink propagation data for generating diversity link performance statistics is included.

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

    PubMed

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

    2014-01-01

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

  10. Endoscopic findings and colonic perforation in microscopic colitis: A systematic review.

    PubMed

    Marlicz, Wojciech; Skonieczna-Żydecka, Karolina; Yung, Diana E; Loniewski, Igor; Koulaouzidis, Anastasios

    2017-10-01

    endoscopic findings were described in the left (descending, sigmoid, rectum - 10/21/11 studies), right (cecum, ascending - 7/7 studies), transverse colon (n=12), as well as duodenum (n=4), and terminal ileum (n=2). In 17 (1.1%) pts colonic perforation occurred. Endoscopic findings are recognized with increased frequency in pts with MC. This could improve MC diagnosis by prompting a more extensive biopsy protocol in such cases and an earlier initiation of treatment. Procedure-related perforation has been reported in this group; therefore, cautious air insufflation is advisable when endoscopic findings are recognised. Copyright © 2017 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.

  11. Nonadiabatic transition path sampling

    NASA Astrophysics Data System (ADS)

    Sherman, M. C.; Corcelli, S. A.

    2016-07-01

    Fewest-switches surface hopping (FSSH) is combined with transition path sampling (TPS) to produce a new method called nonadiabatic path sampling (NAPS). The NAPS method is validated on a model electron transfer system coupled to a Langevin bath. Numerically exact rate constants are computed using the reactive flux (RF) method over a broad range of solvent frictions that span from the energy diffusion (low friction) regime to the spatial diffusion (high friction) regime. The NAPS method is shown to quantitatively reproduce the RF benchmark rate constants over the full range of solvent friction. Integrating FSSH within the TPS framework expands the applicability of both approaches and creates a new method that will be helpful in determining detailed mechanisms for nonadiabatic reactions in the condensed-phase.

  12. Entanglement by Path Identity.

    PubMed

    Krenn, Mario; Hochrainer, Armin; Lahiri, Mayukh; Zeilinger, Anton

    2017-02-24

    Quantum entanglement is one of the most prominent features of quantum mechanics and forms the basis of quantum information technologies. Here we present a novel method for the creation of quantum entanglement in multipartite and high-dimensional systems. The two ingredients are (i) superposition of photon pairs with different origins and (ii) aligning photons such that their paths are identical. We explain the experimentally feasible creation of various classes of multiphoton entanglement encoded in polarization as well as in high-dimensional Hilbert spaces-starting only from nonentangled photon pairs. For two photons, arbitrary high-dimensional entanglement can be created. The idea of generating entanglement by path identity could also apply to quantum entities other than photons. We discovered the technique by analyzing the output of a computer algorithm. This shows that computer designed quantum experiments can be inspirations for new techniques.

  13. Entanglement by Path Identity

    NASA Astrophysics Data System (ADS)

    Krenn, Mario; Hochrainer, Armin; Lahiri, Mayukh; Zeilinger, Anton

    2017-02-01

    Quantum entanglement is one of the most prominent features of quantum mechanics and forms the basis of quantum information technologies. Here we present a novel method for the creation of quantum entanglement in multipartite and high-dimensional systems. The two ingredients are (i) superposition of photon pairs with different origins and (ii) aligning photons such that their paths are identical. We explain the experimentally feasible creation of various classes of multiphoton entanglement encoded in polarization as well as in high-dimensional Hilbert spaces—starting only from nonentangled photon pairs. For two photons, arbitrary high-dimensional entanglement can be created. The idea of generating entanglement by path identity could also apply to quantum entities other than photons. We discovered the technique by analyzing the output of a computer algorithm. This shows that computer designed quantum experiments can be inspirations for new techniques.

  14. Experimental investigation of the influence of perforating on gravel-pack impairment

    SciTech Connect

    Blok, R.H.J.; Welling, R.W.F.; Venkitaraman, A.

    1996-12-31

    Analysis of the performance of perforated, gravel-packed wells compared with openhole gravel-packed wells has indicated that the perforation could be responsible for the low productivity of internally gravel-packed wells. A series of laboratory experiments on weak rock (UCS = 1200 psi) was conducted to quantify this. Castlegate sandstone rock samples, 7 in. in diameter and 18 in. long, were perforated with shaped charges under downhole conditions. The perforations were gravel packed by circulating a gravel slurry past the tunnel entrance while applying a differential pressure. The preperforation, post-perforation and post-gravel-pack productivities of the core samples were monitored at different flow rates (5 to 20 b/d/perf). Sectional photographs of the core samples were taken at post-gravel-pack conditions for qualitative analysis. Performance evaluation of gravel-packed {open_quotes}realistic perforations{close_quotes} (debris and loose sand in the tunnel removed by drawdown-induced flow) versus {open_quotes}ideal perforations{close_quotes} (debris and loose sand removed by external means) showed the post-gravel-pack productivities of realistic perforations to be much lower than ideal perforations in oil-phase as well as water-phase experiments. Injection of fluid after gravel packing only temporarily unplugged the perforation tunnel. The study shows the importance of fines-and debris-free perforation tunnels in maintaining the productivities; of gravel-packed completions.

  15. Lack of utility of measuring serum bilirubin concentration in distinguishing perforation status of pediatric appendicitis.

    PubMed

    Bonadio, William; Bruno, Santina; Attaway, David; Dharmar, Logesh; Tam, Derek; Homel, Peter

    2017-06-01

    Pediatric appendicitis is a common, potentially serious condition. Determining perforation status is crucial to planning effective management. Determine the efficacy of serum total bilirubin concentration [STBC] in distinguishing perforation status in children with appendicitis. Retrospective review of 257 cases of appendicitis who received abdominal CT scan and measurement of STBC. There were 109 with perforation vs 148 without perforation. Although elevated STBC was significantly more common in those with [36%] vs without perforation [22%], the mean difference in elevated values between groups [0.1mg/dL] was clinically insignificant. Higher degrees of hyperbilirubinemia [>2mg/dL] were rarely encountered [5%]. Predictive values for elevated STBC in distinguishing perforation outcome were imprecise [sensitivity 38.5%, specificity 78.4%, PPV 56.8%, NPV 63.4%]. ROC curve analysis of multiple clinical and other laboratory factors for predicting perforation status was unenhanced by adding the STBC variable. Specific analysis of those with perforated appendicitis and percutaneously-drained intra-abdominal abscess which was culture-positive for Escherichia coli showed an identical rate of STBC elevation compared to all with perforation. The routine measurement of STBC does not accurately distinguish perforation status in children with appendicitis, nor discern infecting organism in those with perforation and intra-abdominal abscess. Copyright © 2017 Elsevier Inc. All rights reserved.

  16. PathMaster

    PubMed Central

    Mattie, Mark E.; Staib, Lawrence; Stratmann, Eric; Tagare, Hemant D.; Duncan, James; Miller, Perry L.

    2000-01-01

    Objective: Currently, when cytopathology images are archived, they are typically stored with a limited text-based description of their content. Such a description inherently fails to quantify the properties of an image and refers to an extremely small fraction of its information content. This paper describes a method for automatically indexing images of individual cells and their associated diagnoses by computationally derived cell descriptors. This methodology may serve to better index data contained in digital image databases, thereby enabling cytologists and pathologists to cross-reference cells of unknown etiology or nature. Design: The indexing method, implemented in a program called PathMaster, uses a series of computer-based feature extraction routines. Descriptors of individual cell characteristics generated by these routines are employed as indexes of cell morphology, texture, color, and spatial orientation. Measurements: The indexing fidelity of the program was tested after populating its database with images of 152 lymphocytes/lymphoma cells captured from lymph node touch preparations stained with hematoxylin and eosin. Images of “unknown” lymphoid cells, previously unprocessed, were then submitted for feature extraction and diagnostic cross-referencing analysis. Results: PathMaster listed the correct diagnosis as its first differential in 94 percent of recognition trials. In the remaining 6 percent of trials, PathMaster listed the correct diagnosis within the first three “differentials.” Conclusion: PathMaster is a pilot cell image indexing program/search engine that creates an indexed reference of images. Use of such a reference may provide assistance in the diagnostic/prognostic process by furnishing a prioritized list of possible identifications for a cell of uncertain etiology. PMID:10887168

  17. Four paths of competition

    SciTech Connect

    Studness, C.M.

    1995-05-01

    The financial community`s focus on utility competition has been riveted on the proceedings now in progress at state regulatory commissions. The fear that something immediately damaging will come out of these proceedings seems to have diminished in recent months, and the stock market has reacted favorably. However, regulatory developments are only one of four paths leading to competition; the others are the marketplace, the legislatures, and the courts. Each could play a critical role in the emergence of competition.

  18. PATHS groundwater hydrologic model

    SciTech Connect

    Nelson, R.W.; Schur, J.A.

    1980-04-01

    A preliminary evaluation capability for two-dimensional groundwater pollution problems was developed as part of the Transport Modeling Task for the Waste Isolation Safety Assessment Program (WISAP). Our approach was to use the data limitations as a guide in setting the level of modeling detail. PATHS Groundwater Hydrologic Model is the first level (simplest) idealized hybrid analytical/numerical model for two-dimensional, saturated groundwater flow and single component transport; homogeneous geology. This document consists of the description of the PATHS groundwater hydrologic model. The preliminary evaluation capability prepared for WISAP, including the enhancements that were made because of the authors' experience using the earlier capability is described. Appendixes A through D supplement the report as follows: complete derivations of the background equations are provided in Appendix A. Appendix B is a comprehensive set of instructions for users of PATHS. It is written for users who have little or no experience with computers. Appendix C is for the programmer. It contains information on how input parameters are passed between programs in the system. It also contains program listings and test case listing. Appendix D is a definition of terms.

  19. Ternary diffusion path in terms of eigenvalues and eigenvectors

    NASA Astrophysics Data System (ADS)

    Ram-Mohan, L. R.; Dayananda, Mysore A.

    2016-04-01

    Based on the transfer matrix methodology, a new analysis is presented for the description of slopes of the ternary diffusion path for a solid-solid diffusion couple. Concentration profiles and diffusion paths for isothermal, ternary diffusion couples are examined in the context of eigenvalues and eigenvectors obtained from the diagonalisation of the ? ternary interdiffusion coefficients employed for their representation. New relations are derived relating the decoupled interdiffusion fluxes to combinations of concentration gradients through the major and minor eigenvalues, and the diffusion path becomes parallel to the major eigenvector at each path end. General expressions for the slope of the ternary diffusion path at any section of the couple are also derived in terms of eigenvalue and eigenvector parameters. Expressions for the path slope at the Matano plane involve only concentrations, major and minor eigenvalues and eigenvector parameters. New constraints relating the eigenvalues and the concentration gradients of the individual components are also presented at selected sections, where the diffusion path is parallel to the straight line joining the terminal composition points on an isotherm. Applications of the various relations are illustrated with the aid of a hypothetical couple and an experimental Cu-Ni-Zn diffusion couple.

  20. Terminal automation system maintenance

    SciTech Connect

    Coffelt, D.; Hewitt, J.

    1997-01-01

    Nothing has improved petroleum product loading in recent years more than terminal automation systems. The presence of terminal automation systems (TAS) at loading racks has increased operational efficiency and safety and enhanced their accounting and management capabilities. However, like all finite systems, they occasionally malfunction or fail. Proper servicing and maintenance can minimize this. And in the unlikely event a TAS breakdown does occur, prompt and effective troubleshooting can reduce its impact on terminal productivity. To accommodate around-the-clock loading at racks, increasingly unattended by terminal personnel, TAS maintenance, servicing and troubleshooting has become increasingly demanding. It has also become increasingly important. After 15 years of trial and error at petroleum and petrochemical storage and transfer terminals, a number of successful troubleshooting programs have been developed. These include 24-hour {open_quotes}help hotlines,{close_quotes} internal (terminal company) and external (supplier) support staff, and {open_quotes}layered{close_quotes} support. These programs are described.

  1. Anomalous phenomena on HF radio paths during geomagnetic disturbances

    NASA Astrophysics Data System (ADS)

    Blagoveshchenskii, D. V.

    2016-07-01

    We analyze ionospheric oblique sounding data on three high-latitude and one high-latitude-midlatitude HF radio paths for February 15 and 16, 2014, when two substorms and one magnetic storm occurred. We investigate cases of anomalous propagation of signals: their reflection from sporadic layer Es, lateral reflections, type "M" or "N" modes, the presence of traveling ionospheric disturbances, and the diffusivity of signals and triplets. The most significant results are the following. In geomagnetically undisturbed times, sporadic Es-layers with reduced maximum observed frequencies (MOF Es) on three high-latitude paths were observed in both days. The values of MOF Es during disturbances are large, which leads to the screening of other oblique sounding signals reflected from the ionosphere. On all four paths, the most frequently traveling ionospheric disturbances due to the terminator were observed in quiet hours from 03:00 to 15:00 UT on the first day and from 06:00 to 13:00 UT on the second day of the experiment. In addition, both the sunset terminator and the magnetic storm on the high-latitude-mid-latitude path were found to generate traveling ionospheric disturbances jointly. No such phenomenon was found on high-latitude paths.

  2. [Colonic perforation, a rare complication of acute necrotizing pancreatitis].

    PubMed

    Calleja Subirán, M C; Urien Blázquez, L M

    2006-05-01

    The inflammatory disease of the pancreas can be classified like us acute or chronic pancreatitis. The pancreatitis incidence vary according to the countries and the causes which originate it; consumption of alcohol, gallotone, metabolic factors, drugs and others. The anatomopathological spectrum of the acute pancreatitis vary from pancreatitis edematosa, which usually is a light disorder with a limited evolution, to the pancreatitis necrosante, in which the grade of pancreas necrosis keeps relation with the importance of the attack and with its general declarations that in his evolution can give place to numerous complications, among which the colonic perforation is not frequent. We present a 75-year-old woman, with acute pancreatitis necrohaemorragic for colelitiasis multiple that evolves favorably at the beginning of the medical treatment, but she presented a later colonic perforation as a rare complication of the pancreatic process.

  3. Apparatus and method for sealing perforated well casing

    DOEpatents

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

    1997-01-01

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

  4. 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

  5. Colonic Perforation in a Young Tetraplegic Male Caused by Zucchini

    PubMed Central

    Pigac, Biserka; Masic, Silvija

    2016-01-01

    Introduction: Colonic perforation is a clinical condition which occurs due to variety of reasons, such as intrinsic disorders of the intestine, extrinsic causes, but also due to presence of foreign bodies. Foreign objects enter gastrointestinal tract by oral or transanal introduction. Case report: we present an uncommon case of a 26- year-old tetraplegic male, whose death was a consequence of a widespread purulent peritonitis provoked by colonic perforation inflicted by an unusual foreign body, transanally introduced 28 centimeters long zucchini (Cucurbita pepo L.). Conclusions: we share our experience in order to emphasize the importance of consideration and early recognition of foreign body presence in the alimentary tract as possible diagnosis. PMID:27994305

  6. Apparatus and method for sealing perforated well casing

    DOEpatents

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

    1997-03-25

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

  7. Effect of matrix placement on furcation perforation repair.

    PubMed

    Jantarat, J; Dashper, S G; Messer, H H

    1999-03-01

    Furcation perforations are a serious complication during endodontic treatment, and a matrix to aid placement of repair material has been recommended. This study tested the sealing ability of amalgam and Ketac silver placed with and without plaster of Paris as a matrix. A bacterial penetration technique was used to test the seal. Perforations created in the pulpal floor of extracted human mandibular molars were repaired as follows: group 1, amalgam; group 2, amalgam plus plaster as a matrix; group 3, Ketac silver; and group 4, Ketac silver plus plaster (17 teeth/group). Leakage was measured by placing bacteria (Streptococcus sobrinus) in the pulp chamber, and recording the time taken for bacterial growth in a medium bathing the root surface. A plaster of Paris matrix improved the seal with amalgam, but not with Ketac silver. Ketac silver provided the best seal, but all materials showed complete leakage within 22 days.

  8. [Radical operative treatment of perforative gastroduodenal ulcer disease].

    PubMed

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

    2009-01-01

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

  9. Study of a new railgun configuration with perforated sidewalls

    SciTech Connect

    Zhang, J.; Kim, K.; King, T.L. )

    1993-01-01

    A new railgun configuration with perforated sidewalls is investigated. The motivation for this new configuration is the desire to minimize the detrimental effects of inertial and viscous drag at high velocities caused by the debris from the projectile and the gun wall trapped in the plasma armature. The test has been done on a 1.2 m long railgun with a 3.2-mm-diameter bore. Results for hydrogen pellet acceleration show that at high currents the perforated railgun outperforms the unperforated one. Combined with a newly designed cryogenic pellet generator and the first stage gas gun, a solid hydrogen pellet velocity of 2.46 km/s has been achieved on the 1.2-m railgun.

  10. Magnetic resonance angiography in perforator flap breast reconstruction

    PubMed Central

    Levine, Joshua L.

    2016-01-01

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

  11. Endocardial left ventricular pacing after accidental aortic wall perforation.

    PubMed

    Şoşdean, Raluca; Enache, Bogdan; Macarie, Răzvan Ioan; Pescariu, Sorin

    2016-03-01

    Inadvertent endocardial placement of a pacing lead in the left ventricle through the aortic valve is a rare complication with an unknown incidence because of inadequate reporting. Reported cases are usually the result of lead insertion via the subclavian artery. A possible but very unusual situation is endocardial lead insertion in the left ventricle after aortic arch perforation. We report the case of a 72-year-old woman in whom a screw-in pacing lead accidentally perforated the aortic arch and continued its way through the ascending aorta, aortic valve and left ventricle, after insertion through the left subclavian vein. We describe how this complication was diagnosed, the predisposing factors, the risks it carries and the ways in which devastating consequences have so far been avoided, as the patient refused any surgical intervention including lead removal. Copyright © 2016. Published by Elsevier España.

  12. [Gonococcal conjunctivitis complicated by perforating corneal abscess in an adult].

    PubMed

    Gambrelle, J; Ponceau, B; Duquesne, N; Crepet, H; Fleury, J; Burillon, C; Grange, J D; Kodjikian, L

    2007-09-01

    We present a case of bilateral purulent conjunctivitis complicated by ocular perforation of the right eye secondary to fulminant corneal melt in a 29-year-old man. He developed urethritis after a sexual contact with a prostitute 3 weeks previously. Microbiological analyses of conjunctival and urinary cultures were positive for Neisseria gonorrhoeae resistant to penicillins, tetracyclines, and fluoroquinolones. Progression was favorable with a 15-day course of high doses of parenterally administered antibiotics associating imipenem and fosfomycin. Keratoplasty was done after 3 months. This observation is a good example of the problems raised by gonococcal conjunctivitis in adults. Extremely rare in developed countries, it remains widely unrecognized by ophthalmologists. It is a sexually transmitted disease usually resulting from autoinoculation from an infected genital site. The risk of marginal purulent corneal melt, which can lead to fulminant perforation, warrants prompt microbiological analysis and early parenteral antibiotic treatment.

  13. Ventricular perforation by pacemaker lead repaired with two hemostatic devices

    PubMed Central

    Prestipino, Filippo; Nenna, Antonio; Casacalenda, Adele; Chello, Massimo

    2014-01-01

    INTRODUCTION Cardiac perforation is a rare, but potentially serious, complication of pacemaker implantation that may develop days or weeks after implantation. PRESENTATION OF CASE In the current case, 92-year-old man underwent permanent pacemaker implantation, but he presented 3 weeks later with severe symptoms. Computed tomography showed protrusion of the tip of the ventricular electrode through the right ventricle and into the chest wall. During an urgent surgical intervention, the lead was disconnected and extracted. A sealing hemostatic device and an hemostatic patch were applied to repair the ventricle; the procedure was uneventfull. DISCUSSION This case demonstrates how the correct diagnosis of ventricular perforation is crucial, and should be followed immediately by surgical planning. CONCLUSION The hemostatic patch is a valuable alternative to sutures in patients with thin and fragile ventricular wall, unable to undergo stitching. PMID:25460433

  14. Spontaneous bowel perforation complicating ventriculoperitoneal shunt: a case report

    PubMed Central

    Birbilis, Theodosios; Liratzopoulos, Nikolaos; Oikonomou, Anastasia; Karanikas, Michael; Kontogianidis, Kosmas; Kouklakis, Georgios

    2009-01-01

    Ventriculoperitoneal shunt placement is an effective treatment of hydrocephalus diverting the cerebrospinal fluid into the peritoneal cavity. Unfortunately, the shunt devices have a high incidence of malfunction mainly due to catheter obstruction or infection and are associated with various complications, 25% of which are abdominal. Spontaneous bowel perforation is a rare potentially fatal complication of ventriculoperitoneal shunt occurring anytime, few weeks to several years, after the placement of the ventriculoperitoneal shunt device. A 54-year-old Greek man with spontaneous perforation of sigmoid colon as a complication of distal ventriculoperitoneal shunt migration was treated successfully by antibiotic prophylaxis and abdominal surgery. Clinicians managing patients with ventriculoperitoneal shunt must be familiar with its possible complications and be aware for early recognition of them. PMID:19918409

  15. Caecal perforation from TB and the Law of Laplace

    PubMed Central

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

    2015-01-01

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

  16. Impalement injury by glass shard with delayed colonic perforation

    PubMed Central

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

    2015-01-01

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

  17. Symptomatic duodenal perforation by inferior vena cava filter.

    PubMed

    Baptista Sincos, Anna Pw; Sincos, Igor R; Labropoulos, Nicos; Donegá, Bruno C; Klepacz, Andrea; Aun, Ricardo

    2017-01-01

    Objectives Duodenal perforation by an inferior vena cava filter is rare and life threatening. Our objective is to find out number of occurrences and compare diagnosis and treatments. Method The reference list of Malgor's review in 2012 was considered as well as all new articles with eligible features. Search was conducted on specific databases: MEDLINE, Web of Sciences, and Literatura Latino-Americana e do Caribe em Ciências da Saúde. Results Most of the patients presented with upper abdominal pain and the use of radiologic studies was crucial for diagnosis. The most common treatment was laparotomy with filter or strut removal plus duodenum repair. However, clinical conditions of patients must be considered and the endovascular technique with endograft deployment into inferior vena cava may be an alternative. Conclusion Duodenal perforation by an inferior vena cava filter is uncommon and in high-risk surgical patients endovascular repair must be considered.

  18. Managing bleeding, fluid absorption and uterine perforation at hysteroscopy.

    PubMed

    Istre, Olav

    2009-10-01

    Hysteroscopy is the current gold standard for evaluating intrauterine pathology, including submucous fibroids, polyps, hyperplasia and cancer. However, there are still problems and complications connected to hysteroscopy. Fluid overload of 1-2l occurs in approximately 5.2% and >2l in 1% of cases. This article discusses the physiology, implications and treatment of these cases. Uterine perforation is encountered in nearly 1% of cases. We describe the precautions to avoid this perforation and the methods to treat it. The article also discusses excessive bleeding, which occurs in 3% of operative hysteroscopies and describes strategies to avoid and to deal with this complication. Emergency hysterectomy and other surgical interventions are rarely indicated and are seen in 2% of cases. Finally, death due to septicaemia or fluid overload has been reported only very rarely (0.1%). These different complications are discussed in detail.

  19. Care of patients with deep inferior epigastric perforator reconstruction.

    PubMed

    Long, Laura; Israelian, Amy

    2013-01-01

    Recent trends reflect greater numbers of women opting for mastectomy for invasive breast cancer. Breast reconstruction, either at the time of mastectomy or later, is increasingly an option patients prefer. Although many women opt for implants, reconstruction using autologous tissue offers several advantages including tissue that feels more natural and will age naturally with the patient. The deep inferior epigastric perforator flap has emerged as an alternative to the transverse rectus abdominis myocutaneous flap and allows for preservation of the underlying abdominal muscle. As greater numbers of surgeons are able to offer this microvascular alternative, nurses will care for these postoperative patients in the intensive care unit and medical/surgical settings. This article reviews the evaluation of patients for deep inferior epigastric perforator reconstruction and the unique complexities of postoperative nursing care for these patients.

  20. The management of lens damage in perforating corneal lacerations.

    PubMed Central

    Muga, R.; Maul, E.

    1978-01-01

    Lens damage is present in 30% of perforating injuries of the anterior segment of the eye. There is no consensus on whether the cataractous lens should be removed at the initial repair of the corneal laceration or later, when the eye has recovered from injury. Twenty-seven consecutive cases with a perforating corneal injury and lens damage were alternatively treated either with simultaneous corneal suturing and cataract removal or with corneal suturing and delayed cataract removal several weeks later. The difference in the frequency of complications between the 2 groups was significant. The 1-step procedure was technically easier to perform, the period of postoperative irritation was shorter, complications due to the presence of an injured lens were prevented, and visual rehabilitation occurred earlier. PMID:568933

  1. Tracking hurricane paths

    NASA Technical Reports Server (NTRS)

    Prabhakaran, Nagarajan; Rishe, Naphtali; Athauda, Rukshan

    1997-01-01

    The South East coastal region experiences hurricane threat for almost six months in every year. To improve the accuracy of hurricane forecasts, meteorologists would need the storm paths of both the present and the past. A hurricane path can be established if we could identify the correct position of the storm at different times right from its birth to the end. We propose a method based on both spatial and temporal image correlations to locate the position of a storm from satellite images. During the hurricane season, the satellite images of the Atlantic ocean near the equator are examined for the hurricane presence. This is accomplished in two steps. In the first step, only segments with more than a particular value of cloud cover are selected for analysis. Next, we apply image processing algorithms to test the presence of a hurricane eye in the segment. If the eye is found, the coordinate of the eye is recorded along with the time stamp of the segment. If the eye is not found, we examine adjacent segments for the existence of hurricane eye. It is probable that more than one hurricane eye could be found from different segments of the same period. Hence, the above process is repeated till the entire potential area for hurricane birth is exhausted. The subsequent/previous position of each hurricane eye will be searched in the appropriate adjacent segments of the next/previous period to mark the hurricane path. The temporal coherence and spatial coherence of the images are taken into account by our scheme in determining the segments and the associated periods required for analysis.

  2. Tracking hurricane paths

    NASA Technical Reports Server (NTRS)

    Prabhakaran, Nagarajan; Rishe, Naphtali; Athauda, Rukshan

    1997-01-01

    The South East coastal region experiences hurricane threat for almost six months in every year. To improve the accuracy of hurricane forecasts, meteorologists would need the storm paths of both the present and the past. A hurricane path can be established if we could identify the correct position of the storm at different times right from its birth to the end. We propose a method based on both spatial and temporal image correlations to locate the position of a storm from satellite images. During the hurricane season, the satellite images of the Atlantic ocean near the equator are examined for the hurricane presence. This is accomplished in two steps. In the first step, only segments with more than a particular value of cloud cover are selected for analysis. Next, we apply image processing algorithms to test the presence of a hurricane eye in the segment. If the eye is found, the coordinate of the eye is recorded along with the time stamp of the segment. If the eye is not found, we examine adjacent segments for the existence of hurricane eye. It is probable that more than one hurricane eye could be found from different segments of the same period. Hence, the above process is repeated till the entire potential area for hurricane birth is exhausted. The subsequent/previous position of each hurricane eye will be searched in the appropriate adjacent segments of the next/previous period to mark the hurricane path. The temporal coherence and spatial coherence of the images are taken into account by our scheme in determining the segments and the associated periods required for analysis.

  3. Critical Path Web Site

    NASA Technical Reports Server (NTRS)

    Robinson, Judith L.; Charles, John B.; Rummel, John A. (Technical Monitor)

    2000-01-01

    Approximately three years ago, the Agency's lead center for the human elements of spaceflight (the Johnson Space Center), along with the National Biomedical Research Institute (NSBRI) (which has the lead role in developing countermeasures) initiated an activity to identify the most critical risks confronting extended human spaceflight. Two salient factors influenced this activity: first, what information is needed to enable a "go/no go" decision to embark on extended human spaceflight missions; and second, what knowledge and capabilities are needed to address known and potential health, safety and performance risks associated with such missions. A unique approach was used to first define and assess those risks, and then to prioritize them. This activity was called the Critical Path Roadmap (CPR) and it represents an opportunity to develop and implement a focused and evolving program of research and technology designed from a "risk reduction" perspective to prevent or minimize the risks to humans exposed to the space environment. The Critical Path Roadmap provides the foundation needed to ensure that human spaceflight, now and in the future, is as safe, productive and healthy as possible (within the constraints imposed on any particular mission) regardless of mission duration or destination. As a tool, the Critical Path Roadmap enables the decision maker to select from among the demonstrated or potential risks those that are to be mitigated, and the completeness of that mitigation. The primary audience for the CPR Web Site is the members of the scientific community who are interested in the research and technology efforts required for ensuring safe and productive human spaceflight. They may already be informed about the various space life sciences research programs or they may be newcomers. Providing the CPR content to potential investigators increases the probability of their delivering effective risk mitigations. Others who will use the CPR Web Site and its

  4. Critical Path Web Site

    NASA Technical Reports Server (NTRS)

    Robinson, Judith L.; Charles, John B.; Rummel, John A. (Technical Monitor)

    2000-01-01

    Approximately three years ago, the Agency's lead center for the human elements of spaceflight (the Johnson Space Center), along with the National Biomedical Research Institute (NSBRI) (which has the lead role in developing countermeasures) initiated an activity to identify the most critical risks confronting extended human spaceflight. Two salient factors influenced this activity: first, what information is needed to enable a "go/no go" decision to embark on extended human spaceflight missions; and second, what knowledge and capabilities are needed to address known and potential health, safety and performance risks associated with such missions. A unique approach was used to first define and assess those risks, and then to prioritize them. This activity was called the Critical Path Roadmap (CPR) and it represents an opportunity to develop and implement a focused and evolving program of research and technology designed from a "risk reduction" perspective to prevent or minimize the risks to humans exposed to the space environment. The Critical Path Roadmap provides the foundation needed to ensure that human spaceflight, now and in the future, is as safe, productive and healthy as possible (within the constraints imposed on any particular mission) regardless of mission duration or destination. As a tool, the Critical Path Roadmap enables the decisionmaker to select from among the demonstrated or potential risks those that are to be mitigated, and the completeness of that mitigation. The primary audience for the CPR Web Site is the members of the scientific community who are interested in the research and technology efforts required for ensuring safe and productive human spaceflight. They may already be informed about the various space life sciences research programs or they may be newcomers. Providing the CPR content to potential investigators increases the probability of their delivering effective risk mitigations. Others who will use the CPR Web Site and its content

  5. Critical Path Web Site

    NASA Technical Reports Server (NTRS)

    Robinson, Judith L.; Charles, John B.; Rummel, John A. (Technical Monitor)

    2000-01-01

    Approximately three years ago, the Agency's lead center for the human elements of spaceflight (the Johnson Space Center), along with the National Biomedical Research Institute (NSBRI) (which has the lead role in developing countermeasures) initiated an activity to identify the most critical risks confronting extended human spaceflight. Two salient factors influenced this activity: first, what information is needed to enable a "go/no go" decision to embark on extended human spaceflight missions; and second, what knowledge and capabilities are needed to address known and potential health, safety and performance risks associated with such missions. A unique approach was used to first define and assess those risks, and then to prioritize them. This activity was called the Critical Path Roadmap (CPR) and it represents an opportunity to develop and implement a focused and evolving program of research and technology designed from a "risk reduction" perspective to prevent or minimize the risks to humans exposed to the space environment. The Critical Path Roadmap provides the foundation needed to ensure that human spaceflight, now and in the future, is as safe, productive and healthy as possible (within the constraints imposed on any particular mission) regardless of mission duration or destination. As a tool, the Critical Path Roadmap enables the decisionmaker to select from among the demonstrated or potential risks those that are to be mitigated, and the completeness of that mitigation. The primary audience for the CPR Web Site is the members of the scientific community who are interested in the research and technology efforts required for ensuring safe and productive human spaceflight. They may already be informed about the various space life sciences research programs or they may be newcomers. Providing the CPR content to potential investigators increases the probability of their delivering effective risk mitigations. Others who will use the CPR Web Site and its content

  6. Critical Path Web Site

    NASA Technical Reports Server (NTRS)

    Robinson, Judith L.; Charles, John B.; Rummel, John A. (Technical Monitor)

    2000-01-01

    Approximately three years ago, the Agency's lead center for the human elements of spaceflight (the Johnson Space Center), along with the National Biomedical Research Institute (NSBRI) (which has the lead role in developing countermeasures) initiated an activity to identify the most critical risks confronting extended human spaceflight. Two salient factors influenced this activity: first, what information is needed to enable a "go/no go" decision to embark on extended human spaceflight missions; and second, what knowledge and capabilities are needed to address known and potential health, safety and performance risks associated with such missions. A unique approach was used to first define and assess those risks, and then to prioritize them. This activity was called the Critical Path Roadmap (CPR) and it represents an opportunity to develop and implement a focused and evolving program of research and technology designed from a "risk reduction" perspective to prevent or minimize the risks to humans exposed to the space environment. The Critical Path Roadmap provides the foundation needed to ensure that human spaceflight, now and in the future, is as safe, productive and healthy as possible (within the constraints imposed on any particular mission) regardless of mission duration or destination. As a tool, the Critical Path Roadmap enables the decision maker to select from among the demonstrated or potential risks those that are to be mitigated, and the completeness of that mitigation. The primary audience for the CPR Web Site is the members of the scientific community who are interested in the research and technology efforts required for ensuring safe and productive human spaceflight. They may already be informed about the various space life sciences research programs or they may be newcomers. Providing the CPR content to potential investigators increases the probability of their delivering effective risk mitigations. Others who will use the CPR Web Site and its

  7. Portage and Path Dependence*

    PubMed Central

    Bleakley, Hoyt; Lin, Jeffrey

    2012-01-01

    We examine portage sites in the U.S. South, Mid-Atlantic, and Midwest, including those on the fall line, a geomorphological feature in the southeastern U.S. marking the final rapids on rivers before the ocean. Historically, waterborne transport of goods required portage around the falls at these points, while some falls provided water power during early industrialization. These factors attracted commerce and manufacturing. Although these original advantages have long since been made obsolete, we document the continuing importance of these portage sites over time. We interpret these results as path dependence and contrast explanations based on sunk costs interacting with decreasing versus increasing returns to scale. PMID:23935217

  8. JAVA PathFinder

    NASA Technical Reports Server (NTRS)

    Mehhtz, Peter

    2005-01-01

    JPF is an explicit state software model checker for Java bytecode. Today, JPF is a swiss army knife for all sort of runtime based verification purposes. This basically means JPF is a Java virtual machine that executes your program not just once (like a normal VM), but theoretically in all possible ways, checking for property violations like deadlocks or unhandled exceptions along all potential execution paths. If it finds an error, JPF reports the whole execution that leads to it. Unlike a normal debugger, JPF keeps track of every step how it got to the defect.

  9. Path Integrals and Supersolids

    NASA Astrophysics Data System (ADS)

    Ceperley, D. M.

    2008-11-01

    Recent experiments by Kim and Chan on solid 4He have been interpreted as discovery of a supersolid phase of matter. Arguments based on wavefunctions have shown that such a phase exists, but do not necessarily apply to solid 4He. Imaginary time path integrals, implemented using Monte Carlo methods, provide a definitive answer; a clean system of solid 4He should be a normal quantum solid, not one with superfluid properties. The Kim-Chan phenomena must be due to defects introduced when the solid is formed.

  10. JAVA PathFinder

    NASA Technical Reports Server (NTRS)

    Mehhtz, Peter

    2005-01-01

    JPF is an explicit state software model checker for Java bytecode. Today, JPF is a swiss army knife for all sort of runtime based verification purposes. This basically means JPF is a Java virtual machine that executes your program not just once (like a normal VM), but theoretically in all possible ways, checking for property violations like deadlocks or unhandled exceptions along all potential execution paths. If it finds an error, JPF reports the whole execution that leads to it. Unlike a normal debugger, JPF keeps track of every step how it got to the defect.

  11. Long path CO{sub 2} lidar measurements

    SciTech Connect

    Senft, D.C.; Fox, M.J.; Gonglewski, J.D.

    1996-11-01

    The Air Force Phillips Laboratory conducted a series of measurements in February, May and August 1995 at the Air Force Maui Optical Station (AMOS) facility on Maui, Hawaii, to determine system requirements for an airborne long path CO{sub 2} DIAL system. The lidar incorporates a cavity-matched mode-locked 3-J laser with the 60 cm diameter AMOS Beam Director Telescope. The one-way beam propagation path length was 21.3 km, originating at the AMOS facility on Haleakala at an altitude of 3.050 km ASL, and terminating at a target site enar sea level. 5 refs., 8 figs., 1 tab.

  12. Global Optimum Path Planning for a Redundant Space Robot.

    DTIC Science & Technology

    1991-12-01

    space mission . This paper presents a global optimum path planning scheme for redundant space robotic manipulators to be used in such missions. In this formulation, a variational approach is used to minimize the objective functional. Two optimum path planning problems are considered: first, given the end-effector trajectory, find the optimum trajectories of the joints, and second, given the terminal conditions of the end-effector, find the optimum trajectories for the end-effector and the joints. It is explicitly assumed that the gravity is zero in, and the robotic

  13. Small bowel perforation: a rare complication of ventriculoperitoneal shunt placement.

    PubMed

    Bourm, Kelsey; Pfeifer, Cory; Zarchan, Adam

    2016-06-01

    Small bowel perforation is a rare complication of ventriculoperitoneal (VP) shunt placement. When seen, it most commonly affects the stomach or colon. We describe a case and image findings of an 8-year-old female who presented with sepsis and erosion of the VP shunt into the small bowel. The imaging findings were confirmed surgically. We also provide an overview of the current literature discussing previously reported cases, clinical features, and treatment.

  14. Perforated monolayers. Progress report, July 1, 1991--Mar 31, 1992

    SciTech Connect

    Regen, S.L.

    1992-05-01

    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.

  15. Temperature driven annealing of perforations in bicellar model membranes.

    PubMed

    Nieh, Mu-Ping; Raghunathan, V A; Pabst, Georg; Harroun, Thad; Nagashima, Kazuomi; Morales, Hannah; Katsaras, John; Macdonald, Peter

    2011-04-19

    Bicellar model membranes composed of 1,2-dimyristoylphosphatidylcholine (DMPC) and 1,2-dihexanoylphosphatidylcholine (DHPC), with a DMPC/DHPC molar ratio of 5, and doped with the negatively charged lipid 1,2-dimyristoylphosphatidylglycerol (DMPG), at DMPG/DMPC molar ratios of 0.02 or 0.1, were examined using small angle neutron scattering (SANS), (31)P NMR, and (1)H pulsed field gradient (PFG) diffusion NMR with the goal of understanding temperature effects on the DHPC-dependent perforations in these self-assembled membrane mimetics. Over the temperature range studied via SANS (300-330 K), these bicellar lipid mixtures exhibited a well-ordered lamellar phase. The interlamellar spacing d increased with increasing temperature, in direct contrast to the decrease in d observed upon increasing temperature with otherwise identical lipid mixtures lacking DHPC. (31)P NMR measurements on magnetically aligned bicellar mixtures of identical composition indicated a progressive migration of DHPC from regions of high curvature into planar regions with increasing temperature, and in accord with the "mixed bicelle model" (Triba, M. N.; Warschawski, D. E.; Devaux, P. E. Biophys. J.2005, 88, 1887-1901). Parallel PFG diffusion NMR measurements of transbilayer water diffusion, where the observed diffusion is dependent on the fractional surface area of lamellar perforations, showed that transbilayer water diffusion decreased with increasing temperature. A model is proposed consistent with the SANS, (31)P NMR, and PFG diffusion NMR data, wherein increasing temperature drives the progressive migration of DHPC out of high-curvature regions, consequently decreasing the fractional volume of lamellar perforations, so that water occupying these perforations redistributes into the interlamellar volume, thereby increasing the interlamellar spacing. © 2011 American Chemical Society

  16. Cerebral Aneurysm Perforations during Treatment with Detachable Coils

    PubMed Central

    Layton, K.F.; Cloft, H.J.; Kallmes, D.F.

    2006-01-01

    Summary Perforation of intracranial aneurysms during endovascular treatment with platinum microcoils is a well-known and serious complication reported to occur in 2-4% of patients. Inflation of a remodelling balloon across the aneurysm neck or within the proximal parent vessel is an additional technique that theoretically might be useful to reduce flow within the aneurysm and achieve hemostasis. In the case reports that follow, we present our experience using this technique for managing intraprocedural aneurysm rupture. PMID:20569548

  17. Small bowel perforation: a rare complication of ventriculoperitoneal shunt placement

    PubMed Central

    Bourm, Kelsey; Pfeifer, Cory; Zarchan, Adam

    2016-01-01

    Small bowel perforation is a rare complication of ventriculoperitoneal (VP) shunt placement. When seen, it most commonly affects the stomach or colon. We describe a case and image findings of an 8-year-old female who presented with sepsis and erosion of the VP shunt into the small bowel. The imaging findings were confirmed surgically. We also provide an overview of the current literature discussing previously reported cases, clinical features, and treatment. PMID:27761183

  18. Effect of narcotic premedication of scintigraphic evaluation of gallbladder perforation

    SciTech Connect

    Sefczek, D.M.; Sharma, P.; Isaacs, G.H.; Brodmerkel, G.J. Jr.; Adatepe, M.H.; Powell, O.M.; Nichols, K.

    1985-01-01

    A case of gallbladder perforation is presented in which a small bile leak was demonstrated by cholescintigraphy while the patient was receiving meperidine, but not after meperidine was discontinued. The scintigrams obtained during meperidine therapy also showed a pattern of bile-duct obstruction. It is suggested that increased biliary pressure secondary to meperidine admininstration permitted visualization of the leak. Use of narcotic drugs may be a useful pharmocologic intervention in cases of peritonitis due to small obscure bile leaks.

  19. Temperature Driven Annealing of Perforations in Bicellar Model Membranes

    SciTech Connect

    Nieh, Mu-Ping; Raghunathan, V.A.; Pabst, Georg; Harroun, Thad; Nagashima, K; Morales, H; Katsaras, John; Macdonald, P

    2011-01-01

    Bicellar model membranes composed of 1,2-dimyristoylphosphatidylcholine (DMPC) and 1,2-dihexanoylphosphatidylcholine (DHPC), with a DMPC/DHPC molar ratio of 5, and doped with the negatively charged lipid 1,2-dimyristoylphosphatidylglycerol (DMPG), at DMPG/DMPC molar ratios of 0.02 or 0.1, were examined using small angle neutron scattering (SANS), {sup 31}P NMR, and {sup 1}H pulsed field gradient (PFG) diffusion NMR with the goal of understanding temperature effects on the DHPC-dependent perforations in these self-assembled membrane mimetics. Over the temperature range studied via SANS (300-330 K), these bicellar lipid mixtures exhibited a well-ordered lamellar phase. The interlamellar spacing d increased with increasing temperature, in direct contrast to the decrease in d observed upon increasing temperature with otherwise identical lipid mixtures lacking DHPC. {sup 31}P NMR measurements on magnetically aligned bicellar mixtures of identical composition indicated a progressive migration of DHPC from regions of high curvature into planar regions with increasing temperature, and in accord with the 'mixed bicelle model' (Triba, M. N.; Warschawski, D. E.; Devaux, P. E. Biophys. J.2005, 88, 1887-1901). Parallel PFG diffusion NMR measurements of transbilayer water diffusion, where the observed diffusion is dependent on the fractional surface area of lamellar perforations, showed that transbilayer water diffusion decreased with increasing temperature. A model is proposed consistent with the SANS, {sup 31}P NMR, and PFG diffusion NMR data, wherein increasing temperature drives the progressive migration of DHPC out of high-curvature regions, consequently decreasing the fractional volume of lamellar perforations, so that water occupying these perforations redistributes into the interlamellar volume, thereby increasing the interlamellar spacing.

  20. 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.